Public Health Commons^™

Effect Of Nutrition Intervention On The Outcomes Of Pregnancy: A Rural Urban Comparison, Ranjita Misra

Health Services Research Dissertations

The present study examines the effect of nutritional intervention on two outcomes of pregnancy: birth weight of the baby and gestational age. The study further examines the difference in nutritional intervention in rural and urban areas. The research method used is ex-post facto design. Data for the study is extracted from the health records and tracking sheets of women participating in the Nutrition Intervention Project in Virginia Department of Health. Path analysis and effects analysis are used to analyze the causal and direct effect of the independent variables and each of the outcome variables. A model has been developed grounded …

An Overview Of The Effectiveness And Efficiency Of Hiv Prevention Programs, D. R. Holtgrave, Noreen L. Qualls, J. W. Curran, Ronald O. Valdiserri, Mary Guinan, William C. Parra

School of Public Health Faculty Research

Because of the enormity of the HIV-AIDS epidemic and the urgency for preventing transmission, HIV prevention programs are a high priority for careful and timely evaluations. Information on program effectiveness and efficiency is needed for decision-making about future HIV prevention priorities. General characteristics of successful HIV prevention programs, programs empirically evaluated and found to change (or not change) high-risk behaviors or in need of further empirical study, and economic evaluations of certain programs are described and summarized with attention limited to programs that have a behavioral basis. HIV prevention programs have an impact on averting or reducing risk behaviors, particularly …

A Model Of Costs Of A Cbd Programme, Saumya Ramarao, John Townsend, M.E. Khan

Reproductive Health

This study is a collaborative effort of the Population Council, New Delhi, and the Centre for Development and Population Activities, New Delhi. Cost analysis is an analytical tool that provides program managers and planners with information about existing and potential programs. Existing programs can be evaluated for efficiency and effectiveness, while the resource requirements of future programs can be estimated. In the context of family planning (FP) programs, cost analysis provides policymakers and program managers with sufficient data on efficient ways to meet the demand for FP services with available resources. As FP programs mature and requirements for the resources …

Organizational Slack, Efficiency, And Quality Of Care In Acute Care Hospitals, Kyung Ii Youn

Theses and Dissertations

The relationship between technical efficiency and quality of care in hospitals is studied in the context of resource availability in hospital organizations. The resource availability of hospitals is conceptualized by organizational slack.

An integrated model is developed encompassing the source of organizational slack, its impact on technical efficiency and on quality of care, and its impact on the relationship between efficiency and quality. Organizational threat as an environmental factor affecting the level of slack is measured by the level of competition and regulation. Organizational slack is measured using financial and operational indicators of the hospitals. Technical efficiency is estimated by …

Development Of Approaches To Community Based Family Planning Outreach In Egypt: Assessment Of Raidats Rifiats Program, Population Council

Reproductive Health

Egypt’s family planning program officially began in 1965. Impressive gains in contraceptive use have been made since 1980, and the contraceptive prevalence rate increased from 24 percent in 1980 to 47 percent in 1992. Egypt’s National Population Policy addresses the nation’s population growth through multiple interventions designed to reduce fertility, including family planning (FP) services. FP accessibility is promoted through a network of public and NG0 FP clinics. A number of years ago, the Egyptian Family Planning Program began using the Raidats Rifiats program to extend services into rural communities. There is concern regarding the program’s ability to recruit women …

Experience With The Dmpa Injectable Contraceptive: Findings From A Survey Of Dmpa Acceptors, Maria Carmela Patron, Marilou P. Costello

Reproductive Health

This report presents the results of a survey of 899 DMPA acceptors who availed of injectable contraceptive services from public health facilities under the Philippine Department of Health's (DOH) DMPA Reintroduction Program. The survey is part of the DMPA Monitoring and Follow-up Studies sponsored by the Population Council’s Manila office in response to a request by the DOH to provide operations research support to the program. Depot-medroxyprogesterone acetate (DMPA), commonly known as Depo-Provera, is a three-month injectable contraceptive. It was recently officially endorsed as a family planning (FP) program method by the DOH, following its approval by the Philippine Bureau …

Report On Norplant® Implants In Indonesia, Andrew A. Fisher, Soledad Diaz, Alejandro N. Herrin, Joedo Prihartono

Reproductive Health

At the request of the Indonesian National Family Planning Coordinating Board, the Population Council’s consultant team reviewed issues related to Norplant® implant service delivery in Indonesia and recommended specific areas for new initiatives, improvements, and further research. The team reviewed secondary sources on the subject and visited Indonesia from April 17–28, 1995. They talked with family planning (FP) officials and observers and made field visits to West Java and Yogyakarta. This report reviews important issues facing the national FP program, particularly regarding Norplant insertions and removals. Program approaches are included, as are an outline for a national assessment study that …

Dmpa Monitoring Study: Findings On Use And Continuation Rates, Population Council

Reproductive Health

This report presents the results of the DMPA Monitoring Study undertaken by Population Council, Manila, as a technical assistance project for the DMPA Reintroduction Program of the Department of Health. The primary objective of the study is to provide data on DMPA (injectable contraceptive) utilization and continuation rates that may be used to project the logistical needs of the program for the next four years (1995–1998). Availability of DMPA supplies, and information, education, and communication (IEC) materials on DMPA in the facilities were also monitored to provide some measure of the effectiveness of the distribution system. The study covers a …

Improving The Counseling And Medical Care Of Postabortion Patients In Egypt, Population Council, Egyptian Fertility Care Society

Reproductive Health

This pilot study conducted in Cairo and Minya examined the effects of improving the medical care and counseling of post-abortion patients in Egypt. A pre-test/post-test, no control group study design was used to measure the effects of an intervention that upgraded physicians' clinical and interpersonal communication skills for the care of post-abortion patients, including counseling and family planning (FP). The study's surveys utilized direct interviews with staff working in the OB/GYN wards, structured observations of treatment procedures and counseling of post-abortion patients, and interviews with patients prior to discharge. Changes in the clinical management of post-abortion patients were introduced through …

An Exploratory Study Of The Psycho-Social Stress Associated With Abortions In Egypt, Dale Huntington, Laila Nawar, Dalia Abdel Hady

Reproductive Health

An operations research study was conducted to investigate the concerns of postabortion patients in Egypt to improve counseling that women receive. A corollary use of the study results is the development of sensitive survey research questions for measuring incidence of induced abortion. This study utilized qualitative research methods by conducting in-depth interviews with postabortion patients in El Galaa and El Menia University Hospitals and focus group discussions with family planning clients and noncontracepting women. For all types of postabortion patients the most salient issue was physical survival of an extremely painful experience. All postabortion patients were acutely concerned about their …

Improving Community Based Family Planning Services And The Potential For Increasing Contraceptive Prevalence In Bangladesh, Amy Gale Dunston, Peter C. Miller

Reproductive Health

This report contains descriptions of 13 family planning (FP) projects recently implemented in Bangladesh. The results in terms of the contraceptive prevalence rate (CPR) are analyzed to investigate the degree to which improved FP service delivery in Bangladesh can increase contraceptive use in the present status of demand, investigate the programmatic factors most associated with increased prevalence, and make these projects more widely known. Criteria for inclusion included coverage of a geographic area where household distribution of contraceptive supplies was available, and where at least one measurement of CPR has been made through credible survey efforts since July 1988. The …

Support For Research, Dissemination, Utilization, And Policy In Bangladesh, Ubaidur Rob, Donna Nager

Reproductive Health

Through the initiative of the Family Planning Fortnight: Meeting the Future Challenges, held in December 1993, the Government of Bangladesh made a policy statement about the critical importance of dealing with the nation's population problem. The Fortnight provided the strategic framework for developing actions to strengthen the National Family Planning Program that would meet the country's population challenges. To initiate rapid action, the Family Planning Fortnight Steering Committee, under the chairmanship of the Secretary, Ministry of Health and Family Welfare, formed a working group to prepare a report that would capitalize on all earlier efforts and lay out a plan …

Knowledge, Attitudes And Practice Of The Dmpa Injectable Contraceptive: Data From Focus Group Discussions, Maria Carmela Patron, Marilou P. Costello

Reproductive Health

This report is based on data from 12 focus group discussions conducted throughout the Philippines as part of the DMPA Monitoring and Follow-up Studies. The DMPA Monitoring and Follow-up Studies are part of a technical assistance project undertaken by the Population Council in support of the Department of Health’s DMPA Reintroduction Program. The project provides data on DMPA (depot-medroxyprogesterone acetate) acceptance and continuation rates as well profiles of DMPA users and dropouts to serve as bases for decisions and policies that will ensure quality services. The project draws information from several sources including a 15-month monitoring of DMPA acceptors; surveys …

Operations Research For Program Planning And Management, Alejandro N. Herrin

Reproductive Health

The Family Planning Operations Research and Training Program of the Philippines was established in 1992 to strengthen the nation's capacity to carry out and utilize operations research (OR) for program planning and management. It has sponsored training workshops and funded OR studies on issues of priority to both national and local program managers. The program’s recent activities, culminated in the National Research Utilization Conference held in September 1994, were designed to assist in the institutionalization processes. However, more needs to be done to determine how these processes will actually work in specific national and local government agencies and academic and …

Current Experiences With Community-Based Distribution Of Family Planning In Kenya: A Review Prepared For Usaid/Kenya, Population Council

Reproductive Health

Kenya has been one of the leading countries worldwide in developing and implementing community-based distribution (CBD) programs as part of the national family planning (FP) program. CBD activities in Kenya are coordinated by the National Council for Population and Development, with support from USAID and other donor agencies. Kenya’s CBD program has been widely publicized because of its success in improving access to FP information and services, and its diversity of organizational structures. USAID would like to review the current situation and possible future directions before designing its CBD strategy for the next five-year bilateral project. The Africa OR/TA II …

Quality Of Care In Family Planning Service Delivery In Kenya: Clients' And Providers' Perspectives, Lewis Ndhlovu

Reproductive Health

In recent years, the increasing number of organizations that have studied quality of care in international family planning (FP) programs demonstrates the importance the topic has acquired. To define quality of care in FP, the Bruce–Jain framework of six elements of care (choice of methods, information given to clients, technical competence, interpersonal relations, continuity and follow up, and appropriate constellation of services) have been used as the standard. However, what has been overlooked in this approach is the clients' perspectives of service quality. This study sought to narrow the gap in knowledge about the comparability and consistency in views between …

Women’S-Perceived Quality In Postpartum Care, Maryland A. Hunter

Theses and Dissertations (ETD)

Increased competition among healthcare organizations for the obstetric consumer market has led to increased interest in women’s perceptions of their obstetric experience. This study explored women’s perceptions of quality and women’s perceptions of benefits for women who received family-centered postpartum care (FCPPC) and women who received traditional postpartum care (TPPC). The study also assessed the relationship between women’s-perceived quality (WPQ) and women’s-perceived benefit (WPB) for those receiving FCPPC and those receiving TPPC. Quality and beneficence are the two concepts of Larrabee’s (1992) model of quality operationalized in this study. The sample consisted of 60 postpartum women, 30 receiving care on …

Small Group Market Health Insurance Purchasing Cooperatives Revisited, Karl Polzer

National Health Policy Forum

As Congress was in the final stages of considering the Clinton administration's proposal for comprehensive health reform and various derivatives of it, this Forum session examined the progress of several purchasing cooperatives in helping employees of small firms find affordable insurance coverage. The first half of the meeting focused on California's purchasing alliance, especially its impact on prices in the small-group insurance market. Varying models of cooperatives (or alliances) being set up in Florida, Iowa, and Kentucky also were discussed, with special attention being paid to their potential for addressing fundamental problems such as rising costs and access to insurance.

Patient Perceptions Of Quality: The Influence Of Value And Beneficence, Rebecca H. Waldon

Theses and Dissertations (ETD)

The influence of patient values and patient perception of benefits on patient perceptions of quality have not been extensively investigated, even though patient and provider perceptions of quality have been widely studied. Refocusing quality assessment and improvement to include factors that influence patient perceptions of quality is necessary for humanitarian and economic reasons. The health care patient has certain expectations of health care. These expectations are based on the value the patient places on the services. Value is a predictor of patient-perception of quality. The relative worth of patient goals may also be related to patient perceptions of quality. If …

Federal Support For Medical Education: Framing The Issues For The Systems Reform Debate, Karen Matherlee

National Health Policy Forum

Designed primarily for federal legislative and regulatory health staff involved in systems reform efforts, the session provided a primer on current medical education policies (with emphasis on federal strategies) and a prospectus on policies to change them.

Quantitative Economic Evaluations Of Hiv-Related Prevention And Treatment Services: A Review, David R. Holtgrave, Ronald O. Valdiserri, Gary A. West

RISK: Health, Safety & Environment (1990-2002)

Dr. Holtgrave and colleagues at the CDC set forth an extensive taxonomy of HIV prevention and treatment services and review reports of efforts to subject some of those services to formal economic evaluation. They find few services thus far to have been so evaluated, no evaluation to have focused solely upon behavioral outcomes and most economic evaluations to lack formal quantitative analyses.

Family Planning And Reproductive Health: Briefing Sheets For A Gender Analysis, Kirsten Moore, Debbie Rogow

Reproductive Health

This series of briefing sheets, developed by the Population Council, represents a starting point for the application of gender to the family planning (FP) and reproductive health (RH) arena. The information covers five key areas of RH: gender-based abuse, FP and gender issues among adolescents, sexuality and FP, men’s and women’s social and economic responsibilities for childrearing, and the complicated nexus between gender and FP/RH. In so doing, it provides a strong foundation for gender training. This concept was first developed to fulfill a need for gender training within the regional Operations Research/Technical Assistance Projects. To date, two such workshops …

Profile Of Clients Of Different Providers Of Family Planning Services In Egypt, Social Planning, Analysis & Administration Consultants (Spaac)

Reproductive Health

The Government of Egypt launched its national family planning (FP) program in 1966. The early phase was mainly supply oriented and aimed at ensuring wide distribution of contraceptives primarily through pharmacies to meet rising demand. Between 1988 and 1992 a number of additional sources of FP services appeared, with an increase in clinic-based services through both the private and public sectors. In 1992 about one-fourth of users relied on pharmacies to get their FP supplies compared to about one-half in 1988. This change evolved through the influence of two forces: the initiation of a number of FP projects, and expanded …

Factors That Contribute To The Varying Performance Of Bspos And Bhws In The Delivery Of Family Planning Services In Iloilo City, Fely David, Fely Chin

Reproductive Health

In 1992, the Population Council established the Family Planning Operations Research and Training (FPORT) Program in the Philippines. It brought together program managers and regional researchers to identify problem areas that might benefit from operations research. From Western Visayas (Region VI), the City Population Office (CPO) of Iloilo City in collaboration with the Social Science Research Institute of the Central Philippine University, identified a problem concerning the poor performance of volunteer family planning (FP) workers and undertook to study it. The study focused on the Barangay Service Point Officers (BSPOs) who assist in the delivery of FP services under the …

Planning Services In Iloilo City: A Diagnostic Study Of The Implementation Of The Department Of Health Training Courses For Family Planning Providers In Region Ii And Cordillera Administrative Region, Steven Rood, Marcelo Raquepo, Mary Ann Ladia

Reproductive Health

This research project is one of several being undertaken in the Philippines under the Family Planning Operations Research and Training (FPORT) Program of the Department of Health (DOH) and the Population Council. The general aim of FPORT is to train researchers to provide information to family planning (FP) practitioners that will be of value in the operation of FP programs. It was decided that researchers in northern Luzon would focus on FP trainings undertaken by the Department of Health. Several meetings among researchers and health personnel were held to shape research questions that would be of use to the DOH …

Factors Affecting The Family Planning Program Drop-Out Rate In Bukidnon, Philippines, Lita Sealza

Reproductive Health

This study has involved interviews with a randomly selected sample of 389 family planning (FP) acceptors from 20 barangays in Bukidnon province, Philippines. Respondents were currently married women who had either continued to use family planning (FP) since their initial acceptance (current users) or who had stopped using FP altogether (dropouts). Findings from the present study are expected to shed light on several aspects of the dropout problem, namely: How extensive is this problem and how accurate are the DOH records in this regard? How do FP acceptors view their local FP clinic and the services offered? What reasons are …

Family Planning Studies In The Philippines: A Review And Synthesis, Virginia Miralao

Reproductive Health

This report, which summarizes the major study findings on population and family planning (FP) trends in the Philippines, was prepared for the Research Unit of the Family Planning Services (FPS) of the Department of Health (DOH). It was used by the FPS in its National Consultative Planning Workshop in early 1994 to formulate plans for the Philippine Family Planning Program for 1994–1995. Workshop participants included DOH Regional Family Planning Coordinators, representatives of local government offices engaged in population and health activities, and local NGOs and women's groups. The report alerted participants to population and FP issues and trends that could …

A Diagnostic Study Of The Implementation Of Department Of Health Volunteer Workers Program, Marlina Lacuesta, Segundina Sarangani, Napoleon Amoyen

Reproductive Health

This report presents findings from a 1993 survey of 200 Barangay Health Workers (BHWs) from two Davao provinces and two Lanao Provinces in the Philippines. Premised on the belief that the BHWs are important in improving the delivery of health and family planning (FP) services in the countryside, the study examined the factors that affect the performance of these health workers. The study is basically descriptive in nature, with the view to diagnosing problems in the implementation and functioning of the program and suggesting appropriate solutions. The survey method was utilized as a main data collection tool. Beside the survey …

National Research Utilization Conference, September 1994, Family Planning Operations Reserach And Training (Fport) Program

Reproductive Health

The National Research Utilization Conference, held in Manila September 20, 1994, was the third conference convened by the Population Council's Family Planning Operations Research and Training (FPORT) Program in collaboration with the Department of Health. The FPORT program is being conducted under the Population Council's Asia and Near East Operations Research and Technical Assistance Project. This conference is the culmination of activities that started in October 1992 with a workshop on Introduction to Operations Research in Family Planning. The conference disseminated the results of five OR studies, discussed and evaluated policy and program implications, contributed to the legitimation of OR …

Provider Training And Long-Term Client Outcomes: The Csi Experience, Social Planning, Analysis & Administration Consultants (Spaac)

Reproductive Health

The present study examined the impact of the Clinical Services Improvement (CSI) Project's provider training program on clients' long-term satisfaction and method use. A sample of 154 clients who received a family planning (FP) method in one of 30 CSI clinics were followed up over a period of 19 months through a series of home interviews. The interviews monitored clients' use of the FP method received at the clinic as well as their satisfaction with that method and the services at CSI. Results of the present study show that provider training on counseling and interpersonal communication has a positive impact …