Public Health Commons^™

Manual On Financial Mechanism For The Health Facilities: Introducing Pay-For-Performance Approach To Increase Utilization Of Maternal, Newborn, And Child Health Services In Bangladesh, Laila Rahman, Dipak Kumar Shil, Md. Mamun-Or Rashid, Ismat Ara Hena, Md. Noorunnabi Talukder, Farhana Akter, Anup Kumar Dey, Ripa Ali, Joynal Abedin, Mursheda Rahman, Md. Ataur Rahman, Md. Julkarnayeen, Arifur Rahman, Md. Abdur Rab Sardar

Reproductive Health

The Population Council initiated an operations research study to test two Pay-for-Performance (P4P) strategies to improve maternal, newborn, and child health (MNCH) services in Bangladesh in 2010. The P4P study is being implemented as part of the two ongoing MNCH and maternal and newborn health (MNH) projects of the United Nations Children’s Fund (UNICEF) implemented by the Directorate General of Health Services, Government of Bangladesh. The study has been testing two strategies. The first introduces incentives tied with performance for motivating service providers to improve the quantity as well as quality of services, and enable poor pregnant women, and mothers …

Executive Summary: A Step-By-Step Guide To Strengthening Sexual Violence Services In Public Health Facilities, Jill Keesbury, Jill Thompson

Reproductive Health

This document contains an executive summary of “A step-by-step guide to strengthening sexual violence services in public health facilities: Lessons and tools from sexual violence services in Africa.” Sexual violence (SV) is a serious health and human rights problem across Africa that disproportionately affects women and girls. Survivors require comprehensive and sensitive care to mitigate the negative health consequences of SV, minimize psychological trauma, and promote long-term reintegration and recovery. Despite high levels of sexual violence and a growing recognition of the need to improve the management of rape and sexual assault, many public health facilities in Africa do not …

Facility Assessment Report: Introducing Pay-For-Performance (P4p) Approach To Increase Utilization Of Maternal, Newborn, And Child Health Services In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, Ismat Ara Hena, Farhana Akter, Mohammad Ataur Rahman, Md. Julkarnayeen, Md. Akteruzzaman, Md. Sohel Rana, Ripa Ali

Reproductive Health

Under the leadership of the Directorate General of Health Services, the Population Council in collaboration with James P. Grant School of Public Health, BRAC University and with support from UNICEF is testing an innovative service delivery model to provide financial incentives to institutions to enhance their performance on maternal, newborn, and child health (MNCH) services in three districts of Bangladesh as part of GOB-UNICEF’s ongoing MNCH/MNH projects. A comparative analysis on the availability and condition of physical and human assets across 16 health facilities will inform what is needed in a facility in terms of inputs and processes. This report …

Future Of Family Planning Program In Bangladesh: Issues And Challenges, Ubaidur Rob, Md. Noorunnabi Talukder, A.K.M. Zafar Ullah Khan

Reproductive Health

Bangladesh experienced large population growth in the past, but due to a successful family planning program, the total fertility rate (TFR) declined rapidly until the mid-nineties. Over the last decade, the country experienced a slow pace in fertility decline with a small increase in the contraceptive prevalence rate (CPR). This slow pace in fertility decline is causing serious concern for reaching replacement level fertility by 2015. CPR increased seven-fold from 1975 to 2000, but there was no significant increase from 2000-09, demonstrating the weakness of present program efforts. This raises concern among researchers, policymakers, and program managers about the prospect …

Urban Family Planning Program Of Bangladesh: Issues And Challenges, Ubaidur Rob, Md. Noorunnabi Talukder, A.K.M. Zafar Ullah Khan

Reproductive Health

Extremely inadequate government primary health care (PHC) structure exists in cities in Bangladesh. Nongovernmental organizations (NGOs) play an important role in providing basic health and family planning services to a limited proportion of the urban population. However, NGO programs are time-bound and subject to the availability of development assistance. Bangladesh has one of the highest rates of growth of urban populations among developing countries. For this teeming urban population, there is no structured family planning service. To ensure continuous family planning services in urban areas it is critical to develop a sustainable primary health care structure with the thrust on …

Workshop Report: Introducing Pay-For-Performance (P4p) Approach And Increase Utilization Of Maternal, Newborn, And Child Health Services In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Ismat Ara Hena, Farhana Akter, Mohammad Ataur Rahman, Md. Julkarnayeen

Reproductive Health

In Bangladesh, improving skilled birth attendance at delivery and access to facility-based obstetric and newborn care are vital to improving maternal and neonatal health. The health system in Bangladesh faces a critical challenge on the supply side: unavailability of quality services at public health facilities, due to inadequately motivated providers, vacant positions, and provider absenteeism. As well, salaries of public-sector providers do not depend on quality of work or quantity of services provided. Paying an incentive to facilities based on a performance benchmark has the potential of increasing the quantity and quality of maternal, neonatal, and child health (MNCH) care. …

Brief Report: Activities And Achievements Of The P4p Project—Introducing Pay-For-Performance (P4p) Approach To Increase Utilization Of Maternal, Newborn, And Child Health Services In Bangladesh, Population Council

Reproductive Health

A pilot study was initiated in Bangladesh for testing Pay-for-Performance for providers and clients in improving maternal, newborn, and child health (MNCH) services by addressing supply and demand-side barriers. With funding from UNICEF, the Population Council provided technical assistance for the operations research study implemented by the Directorate General of Health Services, Ministry of Health and Family Welfare of the Government of Bangladesh. Necessary and key human resource placement and training on integrated management of childhood illness, emergency operations centers, newborn care, infection prevention, and waste management are important for better performance in all facilities. In spite of existing barriers, …

Guidelines For Pilot Study On Introducing Pay-For-Performance (P4p) Approach To Increase Utilization Of Maternal, Newborn And Child Health Services In Bangladesh, Directorate General Of Health Services (Dghs), Population Council, Unicef

Reproductive Health

The Population Council launched a pilot study to test two Pay-for-Performance (P4P) strategies to improve MNCH services in Bangladesh. This document presents guidelines for offering incentives to providers, distributing coupons, and forming P4P and/or Coupon Committees and Quality Assurance Groups. The guidelines were developed over the course of five policy-level and consensus-building workshops with national and local-level program managers and service providers, organized under the leadership of the DGHS, in consideration of the local context and sustainability in case of nationwide replication in the country. These guidelines will come into effect upon receiving approval from the DGHS, Ministry of Health …

Public Expenditure On Health Care In Orissa: Focus On Reproductive And Child Health Services, Sarit Kumar Rout

Reproductive Health

In view of the importance of public financing in influencing health outcomes and the paucity of studies that have explored patterns of resource allocation on reproductive and child health services, a study was undertaken in Orissa, India to examine the pattern of and trends in public expenditure on health care with a special focus on expenditure on reproductive and child health services. The study was part of the Population Council, India’s Health and Population Innovation Fellowship program. Findings indicate that major policy issues such as the transfer of power to panchayati raj institutions and those involving health administration and management, …

Increasing Appropriate Complementary Feeding In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative study in rural Uttar Pradesh, India to determine current complementary feeding practices among children aged 6–23 months; understand the facilitating factors and barriers in adopting appropriate complementary feeding practices; and identify programmatic and behavior change communication (BCC) initiatives that could promote the adoption of appropriate complementary feeding practices. The qualitative study shows that women and family members did not feed a measured quantity of food to their children. A lack of knowledge and lack of communication created barriers to initiating complementary feeding. The policy brief recognized education and antenatal care as facilitating factors and …

Increasing Early And Exclusive Breastfeeding In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative study in rural Uttar Pradesh, India to determine the current status of early and exclusive breastfeeding, understand the facilitating factors and barriers in adopting the desired breastfeeding practices, and identify programmatic and behavior change communication (BCC) initiatives to promote the practice. Findings indicate that efforts by Primary Health Centre staff to counsel and encourage women to breastfeed early could significantly increase adoption of this practice. The policy brief identifies barriers that reflect a lack of knowledge and misperceptions about breastfeeding, but finds that education, supportive family members, and knowledgeable health workers can facilitate breastfeeding. …

Reach Of Media And Interpersonal Communication In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

RK Swamy BBDO and the Population Council carried out an analysis to assess the reach of the media and interpersonal communication (IPC). The advertising agency and partner in a Population Council–led consortium analyzed data to explore the reach of various mass media and viewership patterns. The Population Council analyzed the reach of other sources of information, including mobile phones, mid-media, IPC, and mass media (print media, radio, and TV). This policy brief discusses describes the current status and trends in mass media exposure and media reach by audience segmentation. It also explores the reach of mid-media and IPC between frontline …

Media Perspectives On Partnerships To Address Family Health In Northern India: Implications For Behavior Change Communication, Population Council

Reproductive Health

Ideosync Media Combine, a partner in the Population Council-led consortium, conducted a qualitative study of media agencies to explore the perspectives of senior media managers in northern India on the following issues: (a) the decisionmaking process related to content; (b) the approaches adopted for audience targeting and feedback; (c) the extent of health-related coverage in the media and the process of prioritization of other development issues; and (d) partnership priorities and possibilities for collaboration. The policy brief discusses findings related to these issues and presents implications for the behavior change communication strategy.

Role Of The Corporate Sector In Promoting Family Health In Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Confederation of Indian Industry, a partner in the Population Council–led Consortium, took the lead to explore a) the role of the corporate sector in family health in Uttar Pradesh, India; b) the possibility of partnering with this sector to design, leverage, and implement a behavior change communication (BCC) strategy; and c) the support and assistance the sector would require to ensure better planning and implementation of their corporate social responsibility (CSR) activities. Based on the findings, this policy brief identified the following, with implications for BCC strategy: corporate partnerships have the potential to scale up initiatives; companies can leverage …

Role Of Advertising Agencies In Behavior Change Communication, Population Council

Reproductive Health

A partner in the Population Council–led Consortium, RK Swamy BBDO, conducted a qualitative study of advertising agencies to document their experiences with regard to planning and implementing behavior change communication (BCC) campaigns on social and health issues for rural populations; explore media planners' perspectives regarding the challenges faced in implementing these campaigns and possible strategies to make them more effective; and understand the role of the Directorate of Advertising and Visual Publicity, the nodal multi-media unit of the Ministry of Information and Broadcasting, Government of India in reaching rural populations with information on government policies and programs. The findings outlined …

Increasing Postpartum Contraception In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative study in rural Uttar Pradesh, India to assess the level of adoption of postpartum contraception for spacing among low parity women, identify the facilitating factors and barriers to the adoption of this target behavior, and identify programmatic and behavior change communications (BCC) initiatives that could accelerate the adoption of postpartum contraception for spacing and improve the service delivery system, if required, to facilitate the process. Barriers included low awareness of consequences of closely spaced births, misconceptions about contraceptive methods, lack of counseling by health workers, reluctance to include husbands, and programmatic emphasis on limiting …

Improving The Health Care Response To Gender-Based Violence: Project Evaluation Report, Meiwita P. Budiharsana, Mai Quoc Tung

Reproductive Health

Consistent with previous studies, this study provides evidence that gender-based violence (GBV) remains a problem in Viet Nam with indications that it may be on the increase. In 2009 the Population Council Viet Nam in collaboration with the Hanoi Health Department, carried out an evaluation among the staff of Duc Giang Hospital to assess the extent to which awareness and perceptions of GBV had changed since a pilot intervention project commenced in 2005. Overall the project has been very effective in raising awareness and willingness to integrate GBV screening in the health services. This report documents the results and lists …

Private Sector's Role In Health Service Provision In Senegal, Population Council

Reproductive Health

In Senegal, private providers are a major source of health services, including contraceptive services, and private sector partnerships are a key component of the Ministry of Health strategy toward achieving national health objectives. This brief reports on SMNI/PF/PALU—a five-year USAID-bilateral project aiming to foster high-quality service delivery, and build strong links between all levels of the health system and communities, including between private and public health sectors. In Senegal, private businesses have hosted innovative advocacy activities, committed to health supplies and information management, and demonstrated a general interest in supporting a collaborative movement toward national health objectives. With private sector’s …

Rôle Du Secteur Privé Dans L'Offre De Services De Santé Au Sénégal, Population Council

Reproductive Health

In Senegal, private providers are a major source of health services, including contraceptive services, and private sector partnerships are a key component of the Ministry of Health strategy toward achieving national health objectives. This brief reports on SMNI/PF/PALU—a five-year USAID-bilateral project aiming to foster high-quality service delivery, and build strong links between all levels of the health system and communities, including between private and public health sectors. In Senegal, private businesses have hosted innovative advocacy activities, committed to health supplies and information management, and demonstrated a general interest in supporting a collaborative movement toward national health objectives. With private sector’s …

Proceedings And Presentations From The Free State Child Abuse Indaba, Population Council

Reproductive Health

The Free State Department of Health and its partners held a “first-of-its kind” Child Sexual Assault Indaba (conference) in South Africa to streamline relationships between services for effective prevention and management of child abuse. This report details the presentations delivered at the conference, which was a resounding success, with participation from a wide range of stakeholders. The recurring theme of all the presentations was the urgent need to unite and fight against child sexual assault. The most appropriate strategy was unanimous—information—and clarity in terms of the role of each stakeholder. The Free State Department of Health will coordinate the development …

Comprehensive Responses To Gender-Based Violence In Low-Resource Settings: Lessons Learned From Implementation, Jill Keesbury, Ian Askew

Reproductive Health

The Population Council undertook a program of technical assistance and research to strengthen the evidence base on sexual and gender-based violence (SGBV) programming in sub-Saharan Africa. This project created an active network of implementers and researchers across sub-Saharan Africa, all of whom were charged with developing, implementing, and evaluating core elements of a comprehensive, multisectoral model for strengthening responses for survivors of SGBV, especially survivors of sexual violence. Based on the experiences of these partners, this document reviews the findings, lessons learned, and promising practices in the provision of comprehensive SGBV services in sub-Saharan Africa. The findings are intended to …

Training Institutions For Community Midwives In Pakistan: An Initial Assessment, Zakir Hussain Shah, Momina Salim, Mumraiz Khan

Reproductive Health

This study focuses on the training of community midwives (CMWs) in Pakistan, to specifically look at the institutions providing CMW training to see what resources (both physical and human resources) they had available and how these resources were being utilized. This study served as an early evaluation of the trainings and upgrades by the PAIMAN project, to assess how their interventions fared, and provides documentation for future decisions regarding the management, training, and practice of CMWs in Pakistan. As Pakistan transitions from a country with a high level of home births to a country where most births take place in …

Assessing The Feasibility Of Home Administration Of Misoprostol In The Prevention Of Postpartum Hemorrhage In Rural Pakistan, Ali M. Mir, Abdul Wajid, Sadaf Gull

Reproductive Health

This report details an operations research project carried out by the Population Council as part of the Pakistan Initiative for Mothers and Newborns. The overall goal of the project was to test the feasibility of administering misoprostol for the prevention of postpartum hemorrhage (PPH) in a home setting through community‐based healthcare providers, including traditional birth attendants (TBAs), or family members, in two districts of Pakistan. Furthermore, it aimed to identify common side effects of misoprostol and determine the reduction in demand for referral due to PPH after oral ingestion of misoprostol. The results provide a useful addition to the literature …

Assessing The Potential Acceptability Of A New Cadre Of Community Midwives For Pregnancy And Delivery Related Care In Rural Pakistan: Findings From A Qualitative Study, Abdul Wajid, Ali M. Mir, Zubaida Rashid, Abida Aziz

Reproductive Health

The Population Council designed an operations research study to assess the potential acceptability of a new cadre of community midwives (CMWs) for pregnancy and delivery-related care in rural Pakistan. Specific objectives of the study were to determine the need for skilled birth attendants, identify any misconceptions in the community about CMWs, determine levels of acceptance in the community, and explore barriers to the placement of CMWs in the community. The report recommends sensitizing family members so they are more willing to grant permission for pregnant women to consult CMWs, developing flexible fee structures, giving clients greater accessibility, building a network …

Process Evaluation Of Community Mobilization Activities, Zakir Hussain Shah

Reproductive Health

This report presents the findings of a process evaluation by the Population Council of community mobilization (CM) activities implemented under the PAIMAN project in Pakistan. PAIMAN developed a comprehensive communication, advocacy, and mobilization (CAM) strategy to increase knowledge and awareness of harmful practices among women and their family and to improve their health-seeking behaviors. The CAM roadmap acknowledges the importance of engaging communities in order to achieve behavior change and links clients with providers and services. The main objective of this evaluation was to assess the process of CM implementation and to identify its gaps in order to develop corrective …

Improving Quality Of Health Care For Gender-Based Violence Victims At Health Facilities In Viet Nam, Mai Quoc Tung, Meiwita P. Budiharsana, Nguyen Thi Phuong Lan, Jane H. Patten

Reproductive Health

This report presents the results of the May 2009 baseline (pre-intervention) assessment among health care providers (HCPs), and the July 2010 pre- and post-Training of Trainers assessments among HCPs, in Ho Chi Minh City (HCMC) and Da Nang, regarding the issue of quality of care for victims of gender-based violence (GBV) at health facilities in Vietnam. The views of HCPs detailed in this report represent an important foundation for project development and implementation in the study locations. The pre- and post-Training of Trainers questionnaire aimed to assess the HCPs on the topics covered in the training course. The results showed …

The Role Of Traditional Leaders In Preventing And Addressing Sexual And Gender-Based Violence: Findings From Kwazulu-Natal, Northwest And Limpopo Provinces In South Africa, Mantshi Teffo-Menziwa, Saiqa Mullick, Prince Cedza Dlamini

Reproductive Health

The Population Council, in partnership with the Ubuntu Institute, embarked on a program to engage traditional Leaders in three South African provinces (North West, KwaZulu-Natal and Limpopo) to address sexual and gender-based violence (SGBV) in rural communities. The overarching goals of the program were to strengthen linkages between the Population Council and traditional communities, generate and share strategic information on SGBV, strengthen prevention and response to child sexual assault, engage new partners to address prevention of and access to SGBV services, and expand access to comprehensive post-rape services by working with traditional leadership structures. Some of the key findings reflect …

Introducing And Pilot-Testing The National Guidelines On Integrating The Management Of Stis/Rtis Into Reproductive Health Settings In Kenya, Wilson Liambila, Saiqa Mullick, Ian Askew, Nathalie Broutet, Bartilol Kigen, Cosmas Mutunga, Daniel Sande, Nimrod Garama, Benjamin Tsofa, Christine Awuor, Ibrahim Mohammed

Reproductive Health

This report evaluated a project in ten Kenyan health facilities. It examined the feasibility, acceptability and effect of introducing reproductive tract infection and sexually transmitted infection (RTI/STI) guidelines on the quality of care provided, and the incremental costs of integrating these services into existing reproductive health (RH) services; it also disseminated the results and lessons learnt within Kenya. Overall, the results showed that integration of activities to screen for and manage STIs/RTIs into RH services is feasible, acceptable to clients and providers, and effective in improving the range and quality of services offered to clients.

Emergency Contraception: Idea To Program, Saumya Ramarao, John Townsend, Sarah Raifman

Reproductive Health

This report summarizes the role of the Population Council in generating evidence, providing technical leadership, and demonstrating at scale that emergency contraception (EC) can be easily integrated into national family planning programs and other reproductive health services. Since the 1990s, the Population Council, along with other partners, has contributed to the changes seen in the provision and availability of EC, now available in over 140 countries around the world. While much progress has been made in the campaign for access to EC, the Council is committed to improving existing methods of service delivery and to leading advocacy efforts and research …

Family Members' Influence On Family Meal Vegetable Choices, Tionni R. Wenrich, J. Lynne Brown, Michelle Miller-Day, Kevin J. Kelley, Eugene J. Lengerich

Communication Faculty Articles and Research

Objective—Characterize the process of family vegetable selection (especially cruciferous, deep orange, and dark green leafy vegetables); demonstrate the usefulness of Exchange Theory (how family norms and past experiences interact with rewards and costs) for interpreting the data.

Design—Eight focus groups, two with each segment (men/women vegetable-likers/dislikers based on a screening form). Participants completed a vegetable intake form.

Setting—Rural Appalachian Pennsylvania.

Participants—61 low-income, married/cohabiting men (n=28) and women (n=33).

Analysis—Thematic analysis within Exchange Theory framework for qualitative data. Descriptive analysis, t-tests and chi-square tests for quantitative data.

Results—Exchange Theory proved useful for understanding that regardless …