International Public Health Commons^™

Incentivizing Providers To Improve Maternal, Newborn And Child Health Services In Bangladesh: Pay-For-Performance Model Refinement And Advocacy (P4p Mra) Final Report, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, A.K.M. Zafar Ullah Khan, Riad Mahmud, Azizul Alim, Ismat Ara Hena, Farhana Akter, Anup Kumar Dey

Reproductive Health

An operations research project by the Directorate General of Health Services (DGHS) of the Ministry of Health and Family Welfare, Government of Bangladesh tested the feasibility of a pay-for-performance (P4P) approach, which offered financial incentives to reward service providers for meeting and exceeding specified performance targets for maternal, newborn, and child health services. In response to the encouraging findings, the DGHS implemented a follow-up project, with technical assistance from Population Council and UNICEF, to utilize the experiences and findings of the P4P OR project. Despite it short duration, implementation of the revised P4P scheme induced improvements in service volume and …

Introduction Of Emergency Contraceptive Pills (Ecps) Through Lady Health Workers (Lhws) Program In Pakistan: Findings Of An Evaluation Study, Arshad Mahmood, Yasir Bin Nisar

Reproductive Health

This report documents the findings from a five-day study tour of Pakistani officials to Bangladesh, organized by the Population Council, to afford an opportunity for representatives of both the Ministry of Health and Population Welfare to learn from the experience of Bangladesh in introducing emergency contraceptive pills (ECPs) through their National Public Health System. One of the recommendations was to enhance the availability of emergency contraception in Pakistan by making it available through outlets of the health system, especially through the network of the community-based Lady Health Workers (LHWs). There is a high unmet need for ECP in LHW areas, …

Key Opinion Leaders' Views Regarding Emergency Contraception In India, M.E. Khan, Isha Bhatnagar, Deepthi S. Varma, Anvita Dixit

Reproductive Health

This policy brief explores the views of key opinion leaders (KOLs) in the field of reproductive health and family welfare on provision of emergency contraception (ECPs). The study’s objective was to gain a better understanding of how the attitudes and beliefs of KOLs might influence policy and program implementation, either encouraging or opposing ECP promotion and service delivery. Results suggest strong support by the majority of KOLs to continue the sale of ECP as an over-the-counter drug. KOLs also emphasized the importance of comprehending and addressing the main barriers to ECP provision and use: poor knowledge, lack of training, moral …

Providers' Attitudes And Practices Regarding Emergency Contraception In India: Key Findings, M.E. Khan, Isha Bhatnagar, Deepthi S. Varma, Anvita Dixit

Reproductive Health

This policy brief reports key findings of a study in India that explored providers’ knowledge of how emergency contraception (ECP) works and its safety and effectiveness, their perceptions of the frequency of repeat use, their provision of ECP, and their attitudes toward women who seek it. Many of the findings of this study are encouraging. Most providers believed that ECP is an effective and safe method to prevent pregnancy and that it cannot induce abortion, and half supported the over-the-counter provision of ECP. Nevertheless, the study revealed many biases and gaps in knowledge. Recommendations include a number of ways to …

Increasing Access To Family Planning And Reproductive Health Services Through Community Work: A Case Study Of A Dual Cadre Model In India, Jaleel Ahmad, Isha Bhatnagar, M.E. Khan

Reproductive Health

Before the introduction of Accredited Social Health Activists (ASHAs) in India, mid-level auxiliary nurse midwives (ANMs) were responsible for community health education and services such as antenatal care, delivery, IUCD insertion, and sterilization referrals. The Population Council studied how community extension work and some primary care responsibilities have been shifted to ASHAs, who are tasked with identifying pregnant women; facilitating ANC check-ups; motivating women for institutional deliveries during ANC checkups; and organizing child immunization. Establishing dual worker cadres in India by shifting community extension tasks from ANMs to local ASHAs has been well conceived. Task shifting has allowed ANMs, as …

Situation Analysis Of Behavior Change Communication Activities In Bihar: A Step Towards Developing A Comprehensive Bcc Strategy, M.E. Khan, Isha Bhatnagar, Avishek Hazra, Mukesh Kumar

Reproductive Health

A situation analysis undertaken by the Population Council in Bihar, India assessed a number of contributing factors to a behavior change communication (BCC) strategy. Social norms and practices can be changed if appropriate messages are delivered through a combination of communication channels including mass, mid-, and other media, coupled with improved interactions between frontline healthcare workers and target populations at family and community levels. The analysis notes that effective BCC strategy should be measured in terms of actual behavior change. Impact of BCC activities can be measured by immediate outputs and intermediate and final outcomes depending on implementation duration. The …

Repositioning Community-Based Family Planning In Ghana: A Case Study Of Community-Based Health Planning And Services (Chps), Stephen Ntsua, Placide Tapsoba, Gloria Quansah Asare, Frank K. Nyonator

Reproductive Health

The Population Council conducted a diagnostic appraisal of delivering family planning services using the community-based health planning and services (CHPS model) in Ghana. This study’s results indicate that the CHPS program is well appreciated by rural communities where it is operational. However, the study identified several developments with implications for service delivery: increased community health officer (CHO) workloads and concomitant reductions in outreach services and home visits by community health visitors (CHVs) have weakened the CHO-CHV working relationship, leaving both cadres working in isolation. CHPS has significantly improved health indices but its contribution to increasing family planning is limited and …

Providers' And Key Opinion Leaders' Attitudes And Practices Regarding Emergency Contraception In Senegal: Key Findings, Babacar Mane, Martha Brady, Saumya Ramarao, Fatou Bintou Mbow

Reproductive Health

This study examines providers’ and key opinion leaders’ knowledge, attitudes, and practices regarding the emergency contraceptive pill (ECP) in Senegal, and synthesizes the findings to suggest program and policy recommendations. Analysis of providers’ opinions and beliefs reveals that although many providers believe ECP is a safe product, persistent negative views remain. KOLs and providers recognize the importance of ECP for preventing unintended pregnancy and are supportive of the integration of ECP into national guidelines. They note, however, the need to improve accessibility and quality of provision. Given the magnitude of sexual violence and abuse, considerable interest exists in devising strategies …

Attitudes, Croyances Et Pratiques Des Leaders D'Opinion Clés (Loc) Et Des Prestataires Sur La Contraception D'Urgence (Cu) Au Sénégal, Babacar Mane, Saumya Ramarao, Martha Brady, Fatou Bintou Mbow, Ababacar Thiam

Reproductive Health

In Senegal, initiatives for mainstreaming the emergency contraceptive pill (ECP) in the family planning program are fairly recent. Service statistics indicate, however, that ECP distribution through the public sector is very low. While most users access ECPs through the private sector, the volume of sales is not clear, due to the absence of an operational information system of EC distribution through pharmacies. In an effort to strengthen EC provision in Senegal and reposition EC within the FP program, the Population Council conducted a study in collaboration with the Reproductive Health Division of the Ministry of Health, Senegal to document the …

Providers' And Key Opinion Leaders' Attitudes, Beliefs, And Practices Regarding Emergency Contraception In Nigeria: Key Findings, Babatunde A.O. Ahonsi, Salisu Mohammed Ishaku, Araoyinbo Idowu, Ayodeji Oginni

Reproductive Health

This brief reports on a study in Nigeria to document provider attitudes, beliefs, and practices regarding emergency contraception (ECP), and to identify key opinion leaders’ opinions and insights pertaining to policy and programmatic issues in that country. Findings reveal that ECP is well known in urban Nigeria. Its provision is controlled mainly by the largely unregulated and unmonitored private sector. Government plays a distant role, thereby leaving family planning and ECP supply almost entirely in the hands of donor agencies. For wider availability and affordability of ECP products in both the private and public sectors, official policy action is required, …

The Africa Regional Sexual And Gender-Based Violence Network Annual Partners Meeting: June 26-27 2012, Mombasa, Kenya—Meeting Report, Population Council

Reproductive Health

The Population Council convened an annual partners meeting of its Africa Regional Sexual and Gender-Based Violence (SGBV) Network. Over 30 participants attended the meeting whose objectives were: 1) to facilitate South-South technical exchange and information-sharing on the changing landscape of violence among partners, donors, and other experts; and 2) to reflect on the ways in which research is translating into policy and practice. This report highlights the myriad ways in which activities conducted under this Network have influenced policy, practice, and funding considerations in the region, while detailing the progress of Network partners on their projects, built around several key …

Community Midwifery Services In Kenya: Implementation Guidelines, Kenya Ministry Of Health

Reproductive Health

Community midwifery guidelines by the Kenya Minister for Health have been revised in order to standardize the implementation of community midwifery services as a strategy for improving skilled attendance in the provision of maternal and newborn health care at the community level. The revised guidelines address key policies that are outlined in the Kenya Health Policy regarding the provision of essential packages for health in line with the new constitution, Vision 2030, and the Community Health Strategy. The policy emphasizes a shift of focus to preventive and promotive health care; major strategies include improving access, realizing equity goals, and providing …

Critical Issues For Integrating Srh And Hiv/Aids Services To Provide Dual Protection Against Unintended Pregnancy And Hiv/Sti Acquisition, Population Council

Reproductive Health

This document reports on a one-day symposium that was held by the STEP UP (Strengthening Evidence for Programming on Unintended Pregnancy) Research Program Consortium, coordinated by the Population Council. STEP UP generates policy-relevant research to promote an evidence-based approach for improving access to family planning and safe abortion in Bangladesh, Ghana, India, Kenya, and Senegal. The symposium’s objectives were to review and discuss critical and emerging issues around integrating SRH and HIV and AIDS services to enable dual protection, including new directions in dual protection technology and behaviour change interventions. The meeting also provided an opportunity to discuss the programmatic …

Providers' And Key Opinion Leaders' Attitudes, Beliefs, And Practices Concerning Emergency Contraception: A Multicountry Study In India, Nigeria, And Senegal, Martha Brady, M.E. Khan, Babatunde A.O. Ahonsi, Babacar Mane, Ian Askew, Saumya Ramarao

Reproductive Health

The Population Council conducted a cross-sectional, descriptive, multicountry study in India, Nigeria, and Senegal aimed at understanding the attitudes, beliefs, and practices of providers and key opinion leaders (KOLs) regarding the provision and use of emergency contraception (ECP). The overarching goal of this study was to investigate and document providers’ attitudes, beliefs, and practices regarding ECP, and to capture the opinions and insights of providers and KOLs on a range of policy and program issues. Findings indicate that many provider-related barriers can be overcome through implementation of targeted interventions such as training and values clarification, whereas other barriers will require …

Replication Of The Community Mobilization For Postabortion Care (Commpac) Model In Naivasha District, Rift Valley Province, Kenya: An Evaluation Report, Chi-Chi Undie, Francis Obare, Saumya Ramarao

Reproductive Health

The Population Council’s RESPOND project worked with districts and communities in Kenya to: strengthen service delivery points to provide postabortion care (PAC) services; conduct community mobilization to improve involvement in and knowledge of the prevention and treatment of postabortion complications; build community capacity to address needs related to PAC; and encourage involvement in community action of those most marginalized and most affected by postabortion complications. The program succeeded at increasing knowledge of critical danger signs; enabling providers to effectively offer PAC services; and raising awareness of PAC, among other goals. The intervention was less successful in increasing FP knowledge, current …

Birth Spacing And Family Planning Uptake In Pakistan: Evidence From Falah, Arshad Mahmood

Reproductive Health

The Population Council was the lead implementing agency for the Family Advancement for Life and Health (FALAH) project in Pakistan. The project’s main objectives were to achieve a 10 percent increase in the use of moden contraceptives, to equip 80 service delivery points to provide family planning services, and to ensure birth-spacing understanding and ways to achieve it by three-quarters of the target population. The main conclusion of this research is that a sharp uptake of family planning is possible in a relatively short time, if certain investments are made to ensure better communication and greater access to quality family …

Reproductive Health Education In The Kibera Slum: Developing A Slum-Specific Curriculum, Susanna Schneider Banks

Independent Study Project (ISP) Collection

The principal objective of this Independent Study Project is to make recommendations for a slum-specific reproductive health curriculum to be used in primary schools that serve the Kibera Slum in Nairobi, Kenya. In order to obtain data and form a credible basis for the recommendations, interviews were conducted with teachers, focus groups were facilitated with students, and questionnaires were distributed to parents. Additionally, observations were made about the current state of reproductive health education at each school. Data was collected at Kibera School for Girls, a private school in Kibera, and Olympic Primary School, a public school at the edge …

Understanding Social Marketing In A Not-For-Profit Ngo Setting: An Internship With Pace In Eastern Uganda, Veronica L. Tuerffs

Independent Study Project (ISP) Collection

The organization PACE (Programme for Accessible health, Communication and Education) focuses on generating a positive health impact throughout Uganda by the means of social marketing and other proven, evidence based techniques. An internship with the organization took place over the course of six weeks and was conducted under the A2L (Access to Life) program which is located in four of the country’s eastern districts. The focus of the health and sales communication internship was the implementation of PACE’s marketing scheme on their life-saving products and how the products and organization are perceived.

Any of the information gathered during this time …

Western Influence, Latent Racism, And Their Impact On Access To Health Care In Madagascar, Jessica Joy

Independent Study Project (ISP) Collection

While the Malagasy commemorate their Independence Day on June 26 as the day they were freed from colonization and allowed to function as their own country with their own cultures and practices, colonization and Western influence has left an indelible mark on Madagascar that continues to exert its power to this day, shaping Malagasy social behaviors, values, and lives. The introduction of the slave trade to Madagascar in the mid-1800s, as well as French colonization, has left behind a thriving latent and structural racism in the country; a Western ideal of beauty, made complete by its valorization of fair skin, …

The Benefits Of Having An Integrated Health Care System In Madagascar, Elizabeth Miller

Independent Study Project (ISP) Collection

For my individual research, I wanted to look into all the benefits that could be offered by collaborating allopathic and traditional healthcare systems and how such a system is accomplished in Madagascar, in order to weigh and to discover the feasibility of using integrated healthcare systems as sustainable development in other parts of the world. Furthermore, as Madagascar sets the example in my research this summer, the use of traditional and modern medicine as an integrated health care system best serves the majority of the Malagasy population for several important reasons.

“Mind The Gap” Addressing The Gap Between Health Care Policy & Health Care Reality In Madagascar & The Way Forward Integrating Traditional Medicine & Ethical Reform Within Health Care, Laura Dillon

Independent Study Project (ISP) Collection

At first glance the health care system in Madagascar looks pretty good. No health care system is perfect, in fact most are far from perfect, but some certainly work better than others. On paper it seems that the current system in Madagascar would be among those that “work better”. Sadly, there is oftentimes a disconnect between what a government writes on paper and what happens in reality; looking around the streets of Antananarivo it quickly became apparent that Madagascar is an example of this disconnect. You do not have to be a health care professional to see the lack of …

Situation Assessment Of The Hiv Response Among Young People In Zambia, Sam Kalibala, Drosin Mulenga

HIV and AIDS

The main objective of this situational assessment is to compile and synthesize existing recent information on HIV and young people together with the current AIDS response for young people in Zambia—including programs, policies, and key partners—and to document gaps and challenges in the response. The assessment aims to further strengthen this response by all stakeholders including the Government of the Republic of Zambia, the UN, faith-based organizations, civil society organizations, donors, young people, and youth-led organizations. Recommendations include: amending and strengthening laws related to HIV programming for young people and involving them in design and implementation; offering health services, life …

Migration And Hiv In India: Study Of Select Districts, Niranjan Saggurti, Bidhubhusan Mahapatra, Suvakanta N. Swain, Madhusudana Battala, Alka Narang, Umesh Chawla

HIV and AIDS

Report of a study assessing the important role of migration in the spread of HIV in districts with high out-migration in India. The study suggests a considerable spread of HIV linked to migrants’ extramarital sexual behaviors, and subsequent delay in treatment for infected spouses. In order to control the spread of HIV, the study provides programmatic recommendations made by the study participants and the counselors from ICTCs and ART centers. These suggestions include village-level mapping of at-risk persons, mainstreaming HIV prevention interventions within current health resources, improving various village level HIV prevention programs, and involving women left behind by migrant …

Hiv Transmission Among Married Men And Women In Districts With High Out-Migration In India: Study Brief, Niranjan Saggurti, Bidhubhusan Mahapatra, Suvakanta N. Swain, Madhusudana Battala, Umesh Chawla, Alka Narang

HIV and AIDS

This brief describes a study examining the links between male out-migration and HIV transmission among married men and women and other mechanisms by which HIV is transmitted within marital relationships in districts with high out-migration.

Evaluation Of The Informed Consent Process For Male Circumcision Scale-Up In Swaziland, Barbara Friedland, Louis Apicella, Katie D. Schenk, Meredith Sheehy, Paul C. Hewett

HIV and AIDS

This report evaluates the informed consent process for male circumcision conducted through the Male Circumcision Partnership for Swaziland, led by Population Services International, in partnership with Jhpiego, Marie Stopes International, and the Population Council. The study assesses participants' comprehension of the circumcision process, the informed consent process, as well as the affect of male circumcision counseling on their experience.

Hiv Integrated Biological And Behavioural Surveillance Survey (Ibbss) 2010, Federal Ministry Of Health

HIV and AIDS

This report by the Nigerian Federal Ministry of Health highlights the findings of an integrated biological and behavioral surveillance survey (IBBSS) in Nigeria among groups whose behaviors or occupations often place them at higher risk of contracting sexually transmitted infections, including HIV. The main objectives of the study were to assess the knowledge and beliefs of high-risk groups about STI and HIV, determine the prevalence of HIV infection among these groups, and obtain data that will permit identification of trends over time. Since the 2007 IBBSS survey report, a considerable number of interventions have commenced among the study groups.

Social Mobilization Strategy, Family Advancement For Life And Health (Falah)

Reproductive Health

This document outlines social mobilization strategies at the national and community levels of the Family Advancement for Life and Health (FALAH) project in Pakistan. The project aims to improve the health and well-being of women, men, and their children through tackling the major obstacles in adoption of birth spacing to improve maternal and child health outcomes and family well-being, by increasing knowledge of the benefits of birth spacing as well as knowledge, increased demand for, and effective use of contraceptive methods. The strategy aims to achieve a significant increase in couples’ knowledge and understanding of the need for and benefits …

Strengthening The Delivery Of Comprehensive Reproductive Health Services At The Community Level In Kenya, Population Council

Reproductive Health

The Population Council APHIA II Operations Research Project collaborated with the Ministry of Public Health and Sanitation to improve the quality of services offered by community-based midwives in two districts in Western Kenya, to prepare them to offer more comprehensive maternal services through antenatal, obstetric, postpartum, and newborn care. The study found that community midwives can tremendously increase clients’ access to essential maternal health services and other reproductive health services. Therefore Ministry of Health and its partners should scale up community midwives’ activities to enable more women access these services. Furthermore, information campaigns are needed to promote the range of …

"Knowing Myself First": Feasibility Of Self-Testing Among Health Workers In Kenya, Sam Kalibala, Waimar Tun, William Muraah, Peter Cherutich, Erick Oweya, Patricia Oluoch

HIV and AIDS

Report of a study exploring the feasibility and acceptability of free HIV home self-testing among health workers in Kenya, within the range of other HIV testing options available.

Evaluation Of The Informed Consent Process For Male Circumcision Scale-Up In Zambia, Barbara Friedland, Louis Apicella, Katie D. Schenk, Meredith Sheehy, Paul C. Hewett

HIV and AIDS

This report evaluates the informed consent process for male circumcision conducted through the Male Circumcision Partnership for Zambia, led by Population Services International (Society for Family Health, Zambia), in partnership with Jhpiego, Marie Stopes International, and the Population Council. The objectives of the study were to assess male circumcision clients' comprehension of the informed consent process, examine social norms and practices regarding informed consent for adolescents, compare clients' expectations and experiences, and make additional recommendations for improving the informed consent process.