Health Services Research Commons^™

Capacity Building: Creating A Culture Of Evidence-Based Decisionmaking, Frontiers In Reproductive Health

Reproductive Health

For research to have significant impact, it is important to have not only trained individuals and institutions capable of conducting research, but also program managers and donors who believe in making decisions based on evidence. The focus on fostering research utilization through capacity building has been a major contribution of the FRONTIERS legacy. The FRONTIERS capacity-building initiative began in 1999 in response to the need for developing-country partners and institutions to conduct research, understand study findings, and develop policies and programs based on evidence. This is one of eight Legacy Papers synthesizing major lessons learned in research conducted under the …

Informed Consent In Hiv Prevention Trials: Highlights From An International Workshop, Population Council

HIV and AIDS

Brief adapted from the report of a workshop co-hosted by the Population Council and Family Health International in May 2005. The brief focuses specifically on tools and strategies presented at the workshop that are being used in HIV-prevention trials to facilitate informed consent, explain difficult concepts, and assess comprehension among trial participants. Illustrative examples from completed and ongoing trials are highlighted. This brief will be useful for an audience of local researchers, advocates, and clinical trial staff.

Consentement Éclairé Dans Les Essais De Prévention Du Vih: Points Saillants D'Un Atelier International, Population Council

HIV and AIDS

Résumé adapté du rapport de l'atelier co-organisé par le Population Council et Family Health International en mai 2005. Le résumé se concentre spécifiquement sur les outils et stratégies présentés lors de l'atelier qui sont utilisés dans les essais de prévention du VIH pour faciliter le consentement éclairé, expliquer concepts difficiles et évaluer la compréhension parmi les participants à l'essai. Des exemples illustratifs d'essais achevés et en cours sont mis en évidence. Ce résumé sera utile à un public de chercheurs locaux, d'avocats et de membres du personnel des essais cliniques.

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Brief adapted from the report of a workshop co-hosted …

Consentimiento Informado En Ensayos De Prevención Del Vih: Aspectos Destacados De Un Taller Internacional, Population Council

HIV and AIDS

Resumen adaptado del informe del taller organizado conjuntamente por el Population Council y Family Health International en mayo de 2005. El resumen se centra específicamente en las herramientas y estrategias presentadas en el taller que se están usando en ensayos de prevención del VIH para facilitar el consentimiento informado, explicar conceptos difíciles, y evaluar la comprensión entre los participantes del ensayo. Se destacan ejemplos ilustrativos de ensayos concluidos y en curso. Este resumen será útil para una audiencia de investigadores locales, defensores y personal de ensayos clínicos.

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Brief adapted from the report of a workshop co-hosted by the Population …

Consentimento Informado Nos Ensaios De Prevenção Do Hiv: Pontos Altos Dum Workshop Internacional, Population Council

HIV and AIDS

Resumo adaptado do relatório do workshop organizado pelo Population Council e Family Health International em maio de 2005. O resumo se concentra especificamente nas ferramentas e estratégias apresentadas no workshop que estão sendo usadas em testes de prevenção do HIV para facilitar o consentimento informado, explicar conceitos difíceis e avaliar a compreensão entre os participantes do estudo. Exemplos ilustrativos de ensaios concluídos e em andamento são destacados. Este resumo será útil para um público de investigadores locais, advogados e equipe de ensaios clínicos.

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Brief adapted from the report of a workshop co-hosted by the Population Council and Family Health …

Sharing Experiences With Comprehensive Responses To Adolescent Reproductive Health Needs In Africa, Nafissatou J. Diop, Anta Fall Diagne

Reproductive Health

In 1999, the Population Council’s USAID-funded Frontiers in Reproductive Health (FRONTIERS) project, began a three-year collaboration in Senegal on an adolescent reproductive health (ARH) pilot project that showed that a multisectoral, multidisciplinary approach can increase knowledge, enhance attitudes, and foster positive behaviors for reproductive health. Following requests from several neighboring countries, and given the long collaboration with WHO, FRONTIERS initiated efforts in 2007 to enable utilization of these findings in other African countries. The purpose of this report is to promote the utilization of multisectoral approaches for improving ARH programming by governments, donors, and national and international agencies in francophone …

A Situation Analysis Of Care And Support For Rape Survivors At First Point Of Contact In India And Bangladesh, M.E. Khan, Aruna Bhattacharya, Ismat Bhuiya, Aditi Aeron

Reproductive Health

A situation analysis of post-rape care services available at the first point of contact was conducted in three cities in India and four cities in Bangladesh. The aim of this investigation was to gather information that could be used in the development of a comprehensive care and support system for the rape survivor. Secondarily, the study field-tested sensitive and practical tools that could be used in the future for large-scale situation analyses of the rape survivor services. The results demonstrated that there is no uniform service provision protocol to follow for managing rape survivors at health facilities in India or …

Sexual Behavior And Sti/Hiv Status Among Adolescents In Rural Malawi: An Evaluation Of The Effect Of Interview Mode On Reporting, Barbara Mensch, Paul C. Hewett, Richard Gregory, Stephane Helleringer

Poverty, Gender, and Youth

This paper presents the results from an interview-mode experiment conducted by the Population Council with unmarried young women in rural southern Malawi. To collect data on sexual behavior and the dynamics of HIV transmission, respondents were randomly assigned to either an audio computer-assisted self-interview (ACASI) or a conventional face-to-face (FTF) interview. Clear evidence indicates that the mode of interviewing and probing concerning various sexual partnerships affects respondents’ reporting of their sexual activity, yet the results are not always in accordance with expectations. Reporting for “ever had sex” and “sex with a boyfriend” is higher in the FTF mode, whereas, when …

Managing And Preventing Female Genital Cutting (Fgm/C) Among The Somali Community In Kenya, Maryam Sheikh Abdi, Guyo W. Jaldesa, Ian Askew

Reproductive Health

This report details the Council’s innovative work with religious leaders to reduce the practice of FGM/C in the Somali community in Northern Kenya. In the mid to late 2000s, through the USAID Frontiers project, the Council successfully engaged religious leaders and scholars as community educators to correct the customary misconception that FGM/C is a requirement of Islam. Through sermons and training sessions, these leaders were able to dis-associate FGM/C from Islam, raise public awareness about the harms associated with the practice, and encourage its abandonment.

Technical Assistance To The Interagency Coordination Group Seeking To Reduce Female Genital Mutilation/Cutting, Nafissatou J. Diop

Reproductive Health

This report documents technical assistance provided by FRONTIERS to the Interagency Coordination Group seeking to reduce female genital mutilation/cutting (FGM/C) in sub-Saharan Africa. In particular, staff assisted the group in networking, learning to talk to each other, setting up an operational way of functioning, and influencing key international policy and programmatic documents. Lessons learned through operations research on FGM/C were disseminated widely through the group’s activities and FRONTIERS technical assistance influenced several plans of action and implementation programs. The report notes that in addition to better networking for presenting a common regional vision during the development of policy and programmatic …

Creating The Conditions For Scaling Up The Integration Of Reproductive Health Services For Men In Health And Family Welfare Centers In Bangladesh, M.A. Mannan, Jafar Ahmad Hakim, Syeda Tazneen Waris, Ashraf Ali, Akm Nurul Hakim, Abdul Hannan, Sameena Chowdhury, Saria Tasnim, Saiful Islam, Aqm Rezaul Karim, Sharif M.I. Hossain, Ubaidur Rob, M.E. Khan

Reproductive Health

An operations research study, supported by the Population Council’s Frontiers in Reproductive Health (FRONTIERS) program, showed that reproductive health services for men could be feasibly and acceptably integrated within the Health and Family Welfare Centres in Bangladesh, which have been primarily women-centered health facilities. Given these findings, a follow-up study was implemented to create the conditions for scaling up the model through identifying and piloting the operational details to consider when taking the intervention to scale. The findings presented in this report suggest that this model of service delivery and training can be scaled up countrywide, preferably in stages. To …

Strengthening The Financial Sustainability Of Two Population Services And Training Center (Pstc) Clinics (Bangladesh), Population Services And Training Center (Pstc), Frontiers In Reproductive Health

Reproductive Health

The Population Services and Training Center of Bangladesh (PSTC) operates 15 clinics and 150 satellite posts that provide an Essential Services Package (ESP) to the poor, consisting of child health, family planning, maternal health, communicable disease treatment, and limited curative care. The objective of this study was to conduct an operations research study to determine the feasibility of improving cost recovery in two clinics by raising prices. It appears that the study design was too ambitious for PSTC, a service delivery organization with no prior research experience. Lack of experience was compounded by the resignation of all three PSTC research …

Situation Analysis Of The Integration Of Family Planning Services In Postpartum, Postabortion And Prevention Of Mother To Child Transmission Programs In The Dominican Republic, Gisela Quiterio, Maritza Molina, Marija Miric, Ricardo Vernon, M. Estela Rivero-Fuentes

Reproductive Health

A diagnostic study of the provision and use of contraception in postpartum, postabortion, and prevention of mother-to-child transmission (PMTCT) programs in the Dominican Republic was conducted with funding from USAID. The objectives of the study were to assess the contraceptive knowledge, attitudes, and behaviors of providers and clients; the degree to which information, counseling, and delivery are implemented in postpartum, postabortion, and PMTCT services; the quality of these services; and the readiness of postpartum, postabortion, and PMTCT services to offer contraceptive services. The report finds that family planning services are linked to antenatal, delivery, and postpartum care in most of …

Helping Egyptian Women Achieve Optimal Birth Spacing Intervals Through Fostering Linkages Between Family Planning And Maternal/Child Health Services, Nahla G. Abdel-Tawab, Sarah Loza, Amal Zaki

Reproductive Health

The Population Council’s USAID-funded Frontiers in Reproductive Health (FRONTIERS) program, in collaboration with the Egyptian Ministry of Health and Population and the NGO Social Planning, Analysis and Administration Consultants, conducted an operations research study to measure the acceptability and effectiveness of two birth spacing message models in Upper Egypt. Overall, the study found that providing birth spacing messages to low-parity women during antenatal and postpartum care and also to husbands through community awareness activities was feasible and acceptable. As a result, birth spacing messages have been integrated into service delivery guidelines for antenatal and postpartum care, and IEC materials on …

Enhancing Utilization Of The Findings From The Youth Reproductive Health Project In Senegal, Nafissatou J. Diop, Anta Fall Diagne

Reproductive Health

This operations research (OR) study focused on providing information appropriate to the cultural context of Senegalese adolescents on a variety of reproductive health issues including: knowledge of the human body; puberty; sexuality; gender roles; different cultural, familial, and peer values regarding sexual and reproductive behavior; contraception; responsible parenthood; STIs and AIDS; and sources of help and services. The study was undertaken in three urban communities in northern Senegal and had an overall positive result on young people's reproductive health knowledge, enhanced community understanding of youth reproductive health needs, and showed that a multisectoral approach is vital to supporting young people’s …

Strengthening Health And Family Planning Services In Low Performing And Hard-To-Reach Areas Of Bangladesh: Workshop Report, Ubaidur Rob, Md. Noorunnabi Talukder

Reproductive Health

Although Bangladesh has established a comprehensive physical infrastructure to deliver health and family planning services with a network of primary health care facilities in rural areas, the impact of this health service network has been much less than expected because services do not reach all regions effectively. Two divisions, Sylhet and Chittagong, remain the most disadvantaged in terms of health and population outcomes and access to services, compounded by poor utilization of facilities in these areas. Moreover, the current health and population sector programs are beset with human resources and infrastructural problems. The Population Council organized a workshop to find …

Operations Research For Managers Of Reproductive Health Programs, James R. Foreit, M.E. Khan

Reproductive Health

The course presented in this publication defines operations research (OR) as the study of factors under the control of health program managers and other decision-makers. The purpose of OR is to improve programs and provide information for management decision-making. Successful OR is characterized by a close collaboration between program managers and researchers throughout the study. The course focuses on OR as a branch of the behavioral sciences and deals with formative research and field experiments. It concentrates on improving the research knowledge of managers who have had little or no training in research. The focus of this interactive course is …

India: Quality Assurance Procedure Monitors And Improves Quality Of Services, Population Council

Reproductive Health

A quality assurance (QA) procedure was pilot-tested and subsequently scaled up throughout the state of Gujarat, India, after demonstrating that a 65-item checklist is an efficient tool for identifying and remedying gaps in service delivery. From 2004–06, FRONTIERS developed and tested a standardized QA procedure. The State Ministry of Health and Family Welfare (MOHFW) used the procedure to assess health-care services in rural clinics in two pilot districts each in the states of Gujarat and Maharashtra. Based on positive results, the State MOHFW expanded the QA procedure in a phased manner throughout all 25 districts of Gujarat. The model is …

A Cohort Study Of Reproductive And Hormonal Factors And Renal Cell Cancer Risk In Women, Gc Kabat, Stephanie A. Navarro Silvera, Ab Miller, Te Rohan

Department of Public Health Scholarship and Creative Works

We examined the association of reproductive and hormonal factors with renal cell cancer risk in a cohort study of 89 835 Canadian women. Compared with nulliparous women, parous women were at increased risk (hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.02–3.09), and there was a significant gradient of risk with increasing levels of parity: relative to nulliparous women, women who had X5 pregnancies lasting 4 months or more had a 2.4-fold risk (HR 1⁄4 2.41, 95% CI 1⁄4 1.27–4.59, P for trend 0.01). Ever use of oral contraceptives was associated with a modest reduction in risk. No associations were …

Day Of Dialogue—Insights And Evidence From Product Introduction: Lessons For Microbicides, Martha Brady, C. Elizabeth Mcgrory

HIV and AIDS

This report summarizes key issues and themes emerging from a Population Council Day of Dialogue held in March 2007. The Council convened this meeting of experts in the fields of product development, introduction, and social marketing; clinical trials; and reproductive health and HIV/AIDS in order to identify key features that can be used to guide efforts to introduce microbicides.

Developing Regional Operations Research Training Capacity In South Asia, M.E. Khan, James R. Foreit, Sohini Roychowdhury, F. Ram, Chander Shekhar

Reproductive Health

This project’s overall objective was to create a self-sustaining regional operations research (OR) training and research center for South Asia at the International Institute of Population Sciences (IIPS), in Mumbai, India. The goal was to institutionalize operations research (OR) in IIPS by building the teaching and research capabilities of the faculty and research team. Capacity building was accomplished through a training of trainers that included an OR workshop in Nepal, two four-day OR workshops for program managers, one ten-day OR workshop for researchers, and a four-day scientific-writing course for researchers and program managers to provide guidelines for preparing research articles …

Bolivia: Marketing And Economic Analyses Help Ngos Develop Strategies For Sustainability, Frontiers In Reproductive Health

Reproductive Health

Many nongovernmental organizations (NGOs) face reduced funding for reproductive health services and are seeking ways to assess and enhance their ability to generate income to cover their service costs. In 2004, following a workshop on financial sustainability presented by the Population Council’s FRONTIERS Program, three Bolivian NGOs—Prosalud; the Center for Research, Education, and Services (CIES); and the Association of Rural Health Programs (APSAR)—developed operations research studies to improve their financial sustainability. The Prosalud and CIES studies included a cost-recovery study, a study measuring clients’ willingness to pay for services, and a market segmentation study to compare the NGOs’ services with …

Mainstreaming And Scaling Up The Kenya Adolescent Reproductive Health Project, Ian Askew, Humphres Evelia

Reproductive Health

From 1999–2003, FRONTIERS implemented a Global Agenda program of operations research (OR) projects to address the reproductive health (RH) needs of adolescents in four countries—Bangladesh, Kenya, Mexico, and Senegal. The project was implemented in two districts of Western Province in Kenya and was known as the Kenya Adolescent Reproductive Health Project (KARHP). The project supported a public sector, multisectoral intervention to enhance young people’s knowledge and behavior regarding HIV prevention and RH. Implemented jointly with PATH, this OR project demonstrated that such an intervention could be implemented by the public sector, that it was acceptable to communities, that its influence …

Mainstreaming Adolescent Reproductive Health In Senegal: Enhancing Utilization Of The Findings From The Youth Reproductive Health Project, Nafissatou J. Diop, Anta Fall Diagne

Reproductive Health

From 1999–2003, FRONTIERS implemented a Global Agenda program of operations research projects to address the reproductive health (RH) needs of adolescents in four countries—Bangladesh, Kenya, Mexico, and Senegal. The project was implemented in urban areas of Saint-Louis and Louga, in northwestern Senegal, and was known as Improving the Reproductive Health of Youth in Senegal. The project supported a public-sector, multisectoral intervention to enhance young people’s knowledge and behavior regarding HIV prevention and RH, and systematically tested its feasibility, acceptability, effectiveness, and cost. The intervention had a significant positive impact on young people’s awareness and understanding of RH issues. The pilot …

Assessment: Frontiers Small Grants Program, Koli Banik

Reproductive Health

This report reviews the Small Grants Program (SGP) implemented by FRONTIERS. It assesses the SGP’s areas of achievements and challenges, and explores the feasibility of using this approach to build capacity in operations research. The report provides ideas for implementing a successful SGP that can deliver high-quality, relevant, and timely information for program design. Although capacity building was not an objective in the FRONTIERS SGP, it did produce some increased capacity after two years. As was found with other small grants programs, the FRONTIERS experience suggests that considerable resources are required to produce good quality research and final products. Program …

From Pilots To Regional Programs: Expanding Contraceptive Choice And Improving Quality Of Care In Zambia's Copperbelt, Jill Keesbury

Reproductive Health

Between 2002 and 2005, the Pilots to Regional Programs (PRP) initiative was implemented in eight rural and periurban districts of Zambia’s Copperbelt region. Implemented by the Zambian Ministry of Health/Central Board of Health in collaboration with the Copperbelt Provincial Health Office and with technical assistance from the Population Council, the PRP initiative had two objectives: to expand contraceptive choice and increase the availability of high-quality reproductive health services, and to field-test a model for scaling up reproductive health interventions. The resulting project was structured around three activities: (1) expanding the method mix, (2) training healthcare workers, and (3) linking the …

Increasing Dual Protection Among Rickshaw Pullers In Bangladesh, Ismat Bhuiya, Mizanur Rahman, Ubaidur Rob, M.E. Khan, K.M. Zahiduzzaman

Reproductive Health

The main objective of this study, conducted in six urban clinics of Dhaka, Bangladesh was to increase contraceptive use among rickshaw pullers, with special emphasis on condom use. The study tested two strategies to increase access to family planning and reproductive health (RH) information and services: a) an educational campaign together with improved availability of condoms; and b) an educational campaign alone. Findings show that rickshaw pullers’ knowledge on contraceptive methods increased significantly in both the experimental sites compared to the control site. Use of any contraceptive method increased significantly in the experimental sites, and condom use increased significantly in …

Consolidating A Gender Perspective In The Procosi Network, Erica Palenque De La Quintana, Patricia Riveros Hamel, Ricardo Vernon

Reproductive Health

The Integral Health Coordination Program (Programa de Coordinación en Salud Integral, or PROCOSI) in Bolivia developed a program to certify service delivery and management support NGOs as gender-sensitive. The certification system is based on an initial self-assessment by teams consisting of staff from service delivery (clinical) or management support (administrative) NGOs, followed by the development and implementation of activities to improve the gaps found until a minimum of 80 percent of the designated quality and gender standards are met. At the project’s end, 14 of the 15 participating NGOs had reached compliance with at least 80 percent of the proposed …

Technical Assistance To The Institute Of Reproductive Health, Georgetown University In Researching Introduction Strategies For The Standard Days Contraceptive Method (Sdm), Saumya Ramarao, James R. Foreit

Reproductive Health

The Institute of Reproductive Health (IRH), Georgetown University tested the impact of introducing the standard days contraceptive method (SDM) with the technical assistance (TA) of Population Council staff. FRONTIERS technical assistance had the immediate effect of allowing IRH to carry out evaluations of the SDM in Asia and Latin America. The IRH studies also produced important lessons learned on strategies for the introduction of natural methods. IRH staff responsible for the India and Ecuador projects learned specific skills in cost-analysis and research instrument design.

Health Systems And Maternal Mortality, Neonatal Mortality And Child Health: Review Of Selected Service Delivery Models, Md. Noorunnabi Talukder, Ubaidur Rob

Reproductive Health

Effective maternal and child health services at the community level in developing countries are rarely available. In many developing countries the health systems cannot provide quality maternal and child health care services due to lack of adequate human resources; shortages of equipment, drugs, and supplies; and absence of proper referral mechanisms. Strengthening health systems is central to improving maternal and child health. A variety of targeted interventions have been implemented in the health systems of developing countries. This study was conducted to identify the health service delivery models that have contributed to the reduction of maternal, infant, and child mortality …