Health Services Research Commons^™

Peru: Providers' Compliance With Quality Of Care Norms, Federico R. Leon

Reproductive Health

Peru's Ministry of Health (MOH) introduced changes in its family planning service delivery strategy and set quality-of-care goals purported to ensure informed choice of methods and respect for the users’ reproductive intentions and rights. This study was designed to assess the extent to which providers comply with the guidelines in their daily routine. The study found that among the strongest elements of care are interpersonal relationships and free choice of methods. However, shortcomings were observed in screening for contraindications and information given to the client. The report includes a number of recommendations, including offering providers IEC materials, training, and supervision …

Comparing Alternative Products In The Provision Of Emergency Contraception, John P. Skibiak, Yusuf Ahmed, M. Ketata

Reproductive Health

This report is the third in a series of summaries produced in connection with the operations research project “Enhancing Access to Family Planning Services through the Introduction of Emergency Contraception.” Launched in September 1997, the project explores the many issues surrounding the introduction and delivery of emergency contraception services in a developing country context. The study compares the introduction of two different emergency contraception pills—the combined oral contraceptive PC-4, introduced in Zambia in 1997, and the progestin-only contraceptive Postinor-2, introduced by this study in the following year. Client histories showed only minor differences in the attitudes of emergency contraception users …

Nursing Home Ownership And Public Policy: An Historical Analysis, K. R. Kaffenberger

Graduate Doctoral Dissertations

In the early days of the United States, care of the disabled elderly outside the home meant the public almshouse. By the 1920s, private, nonprofit homes for the aged were prevalent. More recently, private, for-profit facilities have grown to dominate the field.

For-profit ownership has been controversial. Underlying the controversy is the concern that quality might be lowered in order to enhance profit.

This study asks why most nursing homes are privately owned and why most privately owned nursing homes are operated for profit. It does so with reference to The Nonprofit Economy, in which Burton Weisbrod describes a …

Manuel De Recherche Opérationnelle En Matière De Planification Familiale, Andrew A. Fisher, John E. Laing, John E. Stoeckel, John Townsend

Reproductive Health

Le Manuel de recherche opérationnelle en matière de planification familiale, publié pour la première fois en anglais par le Population Council en 1984, se basait sur des projets de recherche en Asie. Cette seconde édition contient des sections révisées et développées. Le cas échéant, des exemples d'Amérique latine et d'Afrique ont été ajoutés. Le chapitre d'introduction comprend une exposé actualisé sur le processus de la recherche opérationnelle (RO) en matière de santé et planification familiale. De nouveaux chapitres concernent le choix du type d’intervention à tester dans une étude RO ainsi que les principaux éléments constituant un programme d'intervention. Le …

Reproductive Health Operations Research, 1995–1998, James R. Foreit, Federico R. Leon, Ricardo Vernon, Timothy D.N. King, Deborah L. Billings, A.B Friedman, Janie Benson

Reproductive Health

This book presents in-depth reports on promising new interventions that have been developed and important programmatic changes that have been achieved by operations research in Latin America between 1995 and 1998. The INOPAL III project has made advances in five areas including access and quality of services, integration of family planning and other reproductive health services, financial sustainability, post-abortion care, and emergency contraception. Each of these topics are represented by at least three studies conducted in two or more countries. The operations research projects discussed under each topic are not replications of a single study. They use different research designs …

Youth Centres In Ghana: Assessment Of The Planned Parenthood Association Of Ghana Programme, Evam Kofi Glover, Annabel Erulkar, Joana Nerquaye-Tetteh

Reproductive Health

The sexual and reproductive health of adolescents has become a major public concern, particularly with the advent of HIV/AIDS. Many organizations have tried to find strategies to reach youth with reproductive health (RH) information and services through various service delivery models. One such model has been the multipurpose youth center approach. Multipurpose youth centers typically include recreational or vocational services as entry points for RH and family planning (FP) information and services. There is some evidence in a variety of African settings (notably Kenya and Zimbabwe) suggesting that these centers are underutilized and not cost-effective. As a result, the Planned …

Peru Logistics Chain Analysis, Jeanne Noble, James R. Foreit

Reproductive Health

The inventory module of situation analysis, developed by the Population Council, has been adapted to help generate indicators of logistics system functioning suggested by the Evaluation Project and to provide an analytical framework that permits more accurate estimations of the frequency, location, and patterns of logistics problems. In 1996, the module was implemented in southern Peru. In 1997, the same module was implemented in the province of Santa and two provinces of Huancavelica. Comparable information was obtained from 149 service delivery points (SDPs) in four departments. Data include inventories of contraceptive supplies and materials required for safe delivery of contraception; …

Assessing The Quality Of Reproductive Health Services, Raeda Al Qutob, Salah Mawajdeh, Laila Nawar, Salama Saidi, Firas Raad

Reproductive Health

This paper offers a broad definition of quality of care and presents a comprehensive conceptual framework for the assessment of quality of reproductive health services and methodological approaches for its measurement. It presents three studies that were conducted between 1990 and 1991 by members of the regional Reproductive Health Working Group from Egypt, Jordan, and Tunisia. The studies provide examples of applications of the framework and its measurement using multiple data sources. Selected findings are presented to illustrate comparative results between countries. Based on the lessons learned from the studies, examples of reproductive health interventions that may improve the quality …

Advances And Challenges In Postabortion Care Operations Research: Summary Report Of A Global Meeting, Dale Huntington

Reproductive Health

The Global Meeting on Postabortion Care: Advances and Challenges in Operations Research was held at the Population Council’s New York office on January 19–21, 1998, to review progress made by three regional operations research (OR) projects in improving delivery of postabortion care. The resources of the three OR contracts were pooled, and, in collaboration with Ipas and the Ebert Program, approximately 65 researchers, senior program managers, and government officials from Africa, Latin America, the Middle East, and Southeast Asia were convened. Three objectives guided the planning of the meeting: review progress in the development of OR methodologies pertaining to postabortion …

Strengthening The Research Capacity Of Planned Parenthood Association Of Ghana, Robert A. Miller

Reproductive Health

The Planned Parenthood Association of Ghana (PPAG) is one of the most active nongovernmental organizations delivering reproductive health (RH) services in Ghana, focusing particularly on youth issues and services. USAID suggested to the Population Council’s Africa OR/TA Project II staff that PPAG might benefit from technical assistance. A large and well-funded IPPF program to promote sexual health among youth of the Volta Region offered a good opportunity to begin OR work. Earlier, the program was envisioned as a demonstration educational program of five years duration. Further discussions suggested that this program was unlikely to be duplicated anywhere, because of its …

Strengthening Rti/Std Services: Lessons Learned From A Pilot Project, Ismat Bhuiya, Ubaidur Rob

Reproductive Health

The national family planning and maternal child health (FP-MCH) program in Bangladesh has raised FP acceptance among couples of reproductive age significantly. A major challenge still facing the program, however, is strengthening its reproductive health (RH) component. The Population Council launched a pilot project to examine the feasibility of strengthening comprehensive reproductive tract infection (RTI) and sexually transmitted disease (STD) services at the Health and Family Welfare Center level. The project had three phases. First, a needs assessment was conducted. Then the components of the intervention were identified, designed, and implemented. And at the third phase, an evaluation was carried …

Strengthening The Utilization Of Family Planning Operations Research: Findings From Case Studies In Africa, Julie Solo, Annamaria Cerulli, Robert A. Miller, Ian Askew, Elizabeth Pearlman

Reproductive Health

The goal of undertaking operations research (OR) on family planning (FP) and reproductive health (RH) services is to strengthen the ability of programs and policies to maximize access to and quality of these services. This report addresses the need for a greater understanding of how information from OR studies is utilized. The Africa OR/TA Project II undertook a study to assess the extent to which information from OR studies conducted under the Africa OR/TA Project I (1988–1993) was utilized. The study also examined the factors influencing how study results were utilized. Case studies of several OR projects were undertaken to …

Seminar On Male Involvement In Reproductive Health In Egypt: Summary Of Research Findings And Future Directions, Nahla G. Abdel-Tawab

Reproductive Health

As more work in the area of male involvement in reproductive health (RH) is expected in Egypt, it is important that researchers and donor agencies become aware of existing studies, topics covered, and main research findings so duplication can be avoided. It is also important that policymakers and program managers learn about the results of existing studies so they can use those results in designing more effective policies to increase male involvement in Egypt. To address this need, the Population Council’s ANE OR/TA Project organized a seminar on “Disseminating Results of Research on Male Involvement in Reproductive Health in Egypt” …

Analysis Of Price Change On The Perceptions And Use Of Dmpa Among Clients Using Reproductive Health Services In Uttar Pradesh, India, Leila Caleb-Varkey, John Townsend, Sneh Vishwanath, Sudha Tiwari

Reproductive Health

Depo-medroxy Progesterone Acetate (DMPA) is a progesterone-only injectable contraceptive that has been approved by the Government of India for provision in the commercial sector, where it is marketed under the brand name Depo-Provera. In 1996, it was available at rates between Rs. 140 to Rs. 180 per injection. At this price it is often beyond the reach of many women wanting a safe and effective contraceptive. In January 1996, DMPA was provided to women in three cities of Uttar Pradesh through Parivar Seva Sanstha’s (PSS) clinics at Rs. 150. In July 1996, as part of operations research (OR), the price …

Increasing Demand For Reproductive Health Services In A Peruvian Clinic, Federico R. Leon, Anibal Velasquez, Lissette Jimenez, Alicia Calderon

Reproductive Health

Over the past few years, well-established family planning (FP) organizations in developing countries, such as INPPARES, the IPPF affiliate in Peru, have strived to implement the Cairo Agenda. In the process of including reproductive health (RH) in FP care, they have dedicated human resources and infrastructure to provide RH services seldom offered in the past. The problem these organizations now face is to increase use of the newly available RH care. Currently, clients seeking FP services may leave clinics unaware of the other RH care provided. At a time when international donors are phasing out financial assistance, the partially idle …

Workshop Report: Launching Of The Revised Reproductive Health Policy Guidelines And Standards, Division Of Primary Health Care, Kenya Ministry Of Health

Reproductive Health

The Government of Kenya recently revised its Policy Guidelines and Standards for family planning (FP) and other reproductive health (RH) services to encourage service providers to undertake a more comprehensive approach to service delivery. Some of the recommendations, especially those relating to the integration of STI/HIV/AIDS services into MCH/FP services, and to safe motherhood, include new practices and procedures. A number of research studies have been conducted in Kenya and elsewhere that provide data pertinent to many of these recommendations, and the Division of Primary Health Care (DPHC) used the results to provide a framework within which the guidelines were …

Creating Linkages Between Incomplete Abortion Treatment And Family Planning Services In Kenya: What Works Best?, Julie Solo, Achola Ominde, Margaret Makumi, Deborah L. Billings, Colette Aloo-Obunga

Reproductive Health

Unsafe abortion constitutes a major public health problem throughout the world, leading to high levels of maternal morbidity and mortality. Abortion accounts for roughly one-third of maternal mortality in the world. Millions of other women experience short- and long-term morbidity, such as infertility and pain. The concept of postabortion care (PAC) has gained wide acceptance as a means to improve services provided to women with complications from spontaneous or unsafely induced abortions. One way to improve emergency treatment is through introducing manual vacuum aspiration (MVA), which has been shown to be safer and less costly than dilation and curettage (D&C). …

Factors Affecting The Outputs And Costs Of Community-Based Distribution Of Family Planning Services In Tanzania, Jane Chege, Naomi Rutenberg, Barbara Janowitz, Andrew Thompson

Reproductive Health

This study assesses the cost-effectiveness of reimbursement schemes for community-based distribution (CBD) programs in Tanzania, and answers whether agents who receive monetary incentives perform better and are more cost-effective than those that receive nonmonetary incentives. Fieldwork was undertaken in April and May 1997, and data forming the basis of the analysis was collected from four CBD programs. These programs vary in their remuneration schemes and status of their CBD agents, size, and geographical coverage; the range of activities undertaken by the agents; and supervision and management structures. As noted in this report, CBD agents who receive monetary remuneration see more …

Getting Men Involved In Family Planning: Experiences From An Innovative Program, Directorate Of Family Planning, National Institute Of Population Research And Training, Population Council

Reproductive Health

This study was designed to determine the effect of interventions on accelerated proactive male involvement in family planning (FP) and factors influencing acceptance of male contraceptive methods. It was observed that a program can be successful if management cadres can be motivated and involved in the process. Other findings suggest the importance of education and communication materials, supply of information, orientation of fieldworkers, and mobilization of resources including hands-on refresher training. Misconceptions about male contraception (particularly vasectomy) are rampant in traditional Bangladeshi society, thus ideas should be positively expressed through visual aids. Among the various communications materials, at least one …

Family Planning Operations Research: A Book Of Readings, James R. Foreit, Tomas Frejka

Reproductive Health

For as long as there have been family planning programs, there has been family planning research. At the theoretical level, researchers examine the effect of fertility on health and socioeconomic development and study the determinants of fertility for individuals and populations. At the policy level, studies explore the role of family planning programs in modifying fertility and health. The development of new contraceptives is accompanied by clinical and pre-introductory trials in program settings. Surveys measure changes in contraceptive use and fertility, and the results are used to make decisions affecting programs. Finally, programs themselves carry out operations research (OR) to …

Technical Assistance To Enhance The Institutionalization Of Operations Research Within The Philippines Family Planning Program, Population Council

Reproductive Health

This technical assistance project supports the goal of the Asia Near East Operations Research and Technical Assistance (ANE OR/TA) project of helping strengthen family planning (FP)/reproductive health (RH) operations research (OR) capabilities in the Philippines. During the extension period of the ANE OR/TA project, four OR studies were implemented in the Philippines dealing with cross-cutting issues, including a study to assess the feasibility of integrating RTI management within FP/MCH programs; an intervention study dealing with improving quality of care via expanded FP counseling; an intervention to address high unmet need in Pangasinan Province; and an intervention study to increase male …

Male Involvement Through Reproductive Health Awareness In Bukidnon Province, The Philippines: An Intervention Study, Lita Palma-Sealza, Marilou P. Costello, Chona R. Echavez

Reproductive Health

Recent years have been characterized by an increasing consensus that, in order to support women's goals and aspirations, health programs directed to the improvement of women's and children's health must consider men's perspectives. Although family planning (FP) is often viewed as the woman's responsibility, men have an important role in decisions of whether FP will be practiced and which method will be used. Even though gender relations in the Philippines are often characterized as being relatively egalitarian, there are several reasons for believing that male involvement in FP is highly relevant for this country. Studies indicate that not only are …

Condom Availability In New York City Public High Schools: Relationships To Condom Use And Sexual Behavior, Sally Guttmacher, Lisa D. Lieberman, David Ward, Nick Freudenberg, Alice Radosh, Don Des Jarlais

Department of Public Health Scholarship and Creative Works

OBJECTIVES: This study examines the impact of the condom availability program in New York City public high schools by comparing rates of sexual activity and condom use for New York students and similar students in Chicago. METHODS: A total of 7119 students from 12 randomly selected New York schools and 5738 students from 10 Chicago schools participated in a cross-sectional survey. RESULTS: New York students, compared with Chicago students, reported equal rates of sexual activity but higher rates of condom use at last intercourse (odds ratio [OR] = 1.36). For higher-risk students (those with three or more sexual partners in …

Devolpment Of A Scale To Assess Home Health Care Aides' Ability To Recognize Depression In Older Adults, Tina M. Nerney

Community & Environmental Health Theses & Dissertations

Depression afflicts 20% to 40% of people 65 and older. Depression in older adults is frequent and chronic. The challenge of a hospital stay and the knowledge of having a long term disability may increase the risk for a depressive episode. In today's health care environment older adults are being released from hospitals after a short length of stay and are frequently dependent on home health services for assistance with activities of daily living. Home health care aides are given the responsibility of providing these services to the older adult in the home environment and need to be aware of …

Situation Analysis Of Lgu Health Centers For Integrating Rti Management Within The Philippines Fp/Mch Program, Jesus Encena, Carmeli Marie Chaves, Marilou P. Costello, Chona R. Echavez

Reproductive Health

A Situation Analysis (SA) was conducted in seven local government health centers as part of a larger project studying the feasibility of integrating RTI services within the existing Family Planning/Reproductive Health Program of the Department of Health (DOH). The SA was part of a series of baseline activities conducted by the Family Planning Operations Research and Training Project as part of its study on Integrating RTI Management in Local Government Unit Health Centers. It was conducted by Population Council, Manila, for the DOH. Participating health centers were located in a large and highly urbanized community, a medium-sized city, and two …

Postabortion Care Services In Kenya: Baseline Findings Of An Operations Research Study, Julie Solo, Deborah L. Billings

Reproductive Health

In Kenya, as throughout the world, the health consequences of unsafe abortion for women of reproductive age are significant. Hospital-based studies in Nairobi have shown that unsafely induced abortion accounts for as much as 35 percent of pregnancy-related mortality and at least 50 percent of hospitals’ gynecological admissions. The concept of postabortion care (emergency treatment, postabortion family planning counseling and services, links between emergency abortion treatment services and comprehensive reproductive health care) has gained wide acceptance as one model of providing comprehensive care to women suffering from abortion complications. Integration of these three components is rarely found in public health …

Iron Supplementation: Knowledge, Perceptions, And Usage Among Pregnant Women In Rural India, Jayanti Tuladhar, John Townsend, Nazir Haider, Leila Caleb-Varkey

Reproductive Health

In India, severe anemia has been one of the causes of high maternal mortality and death of newborns and infants due to low birthweight. The prevalence of anemia among women ages 15–44 is extremely high. The Government of India has provided iron and folic acid tablets (IFA) as a prophylaxis against nutritional anemia among pregnant women as part of the Child Survival and Safe Motherhood program and will continue to do so in the Reproductive and Child Health package. This paper presents findings of both qualitative and quantitative research conducted among pregnant women to investigate the extent of distribution and …

Reproductive Behavior Among Muslims In Uttar Pradesh, M.E. Khan, Bella C. Patel

Reproductive Health

Muslims form the largest minority group in India, according to the 1991 census, constituting about 12 percent of the country's population. India has the second largest Muslim population in the world. The growth rate of the Muslim population in India during the last three decades is somewhat higher than the non-Muslim population. The present paper, based on a large sample survey carried out in Uttar Pradesh, India, compares the reproductive behavior of Hindus and Muslims. An attempt has been made to examine the determinants of their differential fertility and family planning behavior.

Reintroducing Dmpa To The Philippine Family Planning Program: A Longitudinal Study Of Continuing Users And Drop-Outs, Population Council

Reproductive Health

In 1994, the Population Council, Manila, conducted an operations research (OR) project entitled “DMPA Monitoring and Follow-up Studies.” The activity was undertaken to provide accurate and timely support to the DMPA Reintroduction Program of the Department of Health. Commonly known as Depo-Provera, DMPA stands for Depo-Medroxy Progesterone Acetate, an extremely effective injectable contraceptive given every three months. This report focuses on the survey component of these studies which aims to comprehensively examine the influence on DMPA use of factors classified into the following eight major areas: socioeconomic and demographic characteristics; reproductive history; contraceptive history; adoption of DMPA; quality of care …

Proceedings Of The Operations Research Training Workshop For Program Managers And Researchers, January 15-21, 1996, Family Planning Service, The Family Planning Operations Research And Training (Fport) Program, Population Council

Reproductive Health

This document contains the proceedings of the training workshop on operations research (OR) for program managers and researchers held January 15-21, 1996, in Mindoro, Philippines. The workshop was co-sponsored by the Family Planning Service of the Department of Health and the Family Planning Operations Research and Training Program of the Population Council, Manila. Representatives from the health and population offices of ten local government units (LGUs) worked with a select group of researchers to evolve a list of relevant topics for operations research (OR) and develop a concept paper on a chosen OR topic. The LGUs represented in the workshop …