Open Access. Powered by Scholars. Published by Universities.®

Demography, Population, and Ecology Commons

Open Access. Powered by Scholars. Published by Universities.®

Gender and Sexuality

2008

English

Articles 1 - 30 of 49

Full-Text Articles in Demography, Population, and Ecology

Introduction Of Quality Of Care And A Gender Perspective In Reproductive Health Service Organizations In Latin America And The Caribbean, Patricia Riveros, Antonieta Martin, Ricardo Vernon Jan 2008

Introduction Of Quality Of Care And A Gender Perspective In Reproductive Health Service Organizations In Latin America And The Caribbean, Patricia Riveros, Antonieta Martin, Ricardo Vernon

Reproductive Health

In 2005 and with the technical assistance of the Frontiers in Reproductive Health (FRONTIERS) Program, the Integrated Health Coordination Program (PROCOSI), a Bolivian network of 33 nongovernmental organizations, designed and tested a set of four guidelines to help organizations deliver high-quality reproductive health services with a gender perspective. The guidelines were: 1) to present a strategy to certify organizations as “gender sensitive” healthcare providers; 2) to present the knowledge staff members should know to be certified; 3) to describe procedures to collect and analyze the data to evaluate implementation of the strategy; and 4) to describe how to assess strategy …


Evaluation Of The Long-Term Impact Of The Tostan Programme On The Abandonment Of Fgm/C And Early Marriage: Results From A Qualitative Study In Senegal, Nafissatou J. Diop, Amadou Moreau, Helene Benga Jan 2008

Evaluation Of The Long-Term Impact Of The Tostan Programme On The Abandonment Of Fgm/C And Early Marriage: Results From A Qualitative Study In Senegal, Nafissatou J. Diop, Amadou Moreau, Helene Benga

Reproductive Health

In 1998–99, a village empowerment program was implemented in the Thiès/Fatick and Kolda regions of Senegal by the nongovernmental organization Tostan, to mobilize communities to hold public declarations in support of abandoning harmful traditional practices, including female genital mutilation/cutting (FGM/C) and child marriage. The information presented in this report indicates that many did end the practices following a public declaration, however, the lack of follow-up in the field and the absence of support mechanisms pose a large obstacle. Nevertheless, the program achieved significant results: knowledge of life skills resulting in positive changes and a shift in the perception of FGM/C …


Senegal: Education And Public Declarations Contribute To Tostan's Success, Population Council Jan 2008

Senegal: Education And Public Declarations Contribute To Tostan's Success, Population Council

Reproductive Health

In 1998, the nongovernmental organization Tostan implemented a village empowerment program in southern and western Senegal to help communities, especially women, improve living and health conditions in their villages, and to mobilize villages to hold public declarations supporting abandonment of harmful practices, particularly female genital mutilation/cutting (FGM/C) and child marriage. The program included modules on hygiene, literacy and numeracy, human rights, and children’s and women’s health. The Tostan approach has since been implemented more broadly in Senegal and in Burkina Faso, Guinea, and Sudan. In 2005–06, FRONTIERS evaluated the long-term impact of the program, focusing on the abandonment of FGM/C …


Kenya: Training Can Enhance Providers' Management Of Fgm/C And Willingness To Advocate Against The Practice, Population Council Jan 2008

Kenya: Training Can Enhance Providers' Management Of Fgm/C And Willingness To Advocate Against The Practice, Population Council

Reproductive Health

In 2004, FRONTIERS collaborated with UNICEF on a study of female genital mutilation/cutting (FGM/C) in Kenya’s Somali community and on ways of managing maternal care for cut women. The study showed that the health-care system in North Eastern Province, where many Somalis live, is ill prepared to deal with women who have been cut, particularly infibulated women who are pregnant or delivering. The study recommended improving providers’ ability to counsel and treat pregnant cut women as part of an overall improvement of maternal care, and strengthening providers’ role as behavior change agents within communities. In 2005, FRONTIERS launched an intervention …


Dominican Republic, Haiti, Nicaragua: Promoting Family Planning During The Postpartum Period Can Increase Contraceptive Acceptance, Population Council Jan 2008

Dominican Republic, Haiti, Nicaragua: Promoting Family Planning During The Postpartum Period Can Increase Contraceptive Acceptance, Population Council

Reproductive Health

The World Health Organization recommends that women receive information on family planning (FP) during antenatal care (ANC), immediately after birth, and during postpartum and well-baby care. However, few studies have assessed the effect of information during each of these stages on women’s use of contraceptive methods. Data collected by FRONTIERS in the Dominican Republic, Haiti, and Nicaragua have been analyzed to answer this question. Use of maternal care services, exposure to FP information, and use of postpartum contraception varies among countries. All women interviewed in the Dominican Republic attended ANC services and delivered in a facility; ANC use and institutional …


Africa Regional Sexual And Gender-Based Violence Network Consultation: Technical Exchange And Planning Meeting, Population Council Jan 2008

Africa Regional Sexual And Gender-Based Violence Network Consultation: Technical Exchange And Planning Meeting, Population Council

Reproductive Health

In March 2008, the Population Council brought together members of the Africa Regional Sexual and Gender Based Violence (SGBV) Network for a South-South technical exchange meeting. The objectives were to identify best practices from existing programs, provide an evidence base for new programming, and develop mechanisms for South-South technical assistance. As detailed in this report, discussions covered the medical, legal, and psychosocial issues associated with SGBV prevention and response activities. Participants identified the following: Protocols and guidance documents are essential for ensuring comprehensive, quality response at all levels. Enabling access and utilization of the full range of medical services remains …


Assessing Routine Health Information System In Selected Paiman Districts By Using Lot Quality Assurance Sampling (Lqas) Technique, Pakistan Initiative For Mothers And Newborns (Paiman) Jan 2008

Assessing Routine Health Information System In Selected Paiman Districts By Using Lot Quality Assurance Sampling (Lqas) Technique, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by USAID. Its goal is to reduce maternal and newborn mortality in Pakistan through viable initiatives and capacity building of existing programs and structures within health systems and communities to ensure improvements and supportive linkages in the continuum of health care for women from the home to the hospital. PAIMAN is compiling data from three data sources and making efforts to improve the functioning of these Health Information Systems (HISs) for efficient management of health services at the district level through generation of quality data and their …


Meeting The Family Planning Needs Of Postpartum Women, Ricardo Vernon Jan 2008

Meeting The Family Planning Needs Of Postpartum Women, Ricardo Vernon

Reproductive Health

The first days, weeks, and months after a delivery represent a period of substantial information and service needs for both mother and child, including treatment of hemorrhage and infections, breastfeeding information and support, nutritional complements and micronutrients, immunizations for children and mothers, counseling for managing intimate partner violence and depression, and, most importantly, contraception. In areas of high HIV prevalence, contraceptives and antiretroviral therapy are especially critical elements of postpartum care. Yet despite its strategic importance, few organizations have made it a priority to address women's reproductive health and fertility needs during the year following delivery. The situation is compounded …


Dominican Republic, Haiti, Nicaragua: Women Living With Hiv Have Unmet Family Planning Needs, Population Council Jan 2008

Dominican Republic, Haiti, Nicaragua: Women Living With Hiv Have Unmet Family Planning Needs, Population Council

Reproductive Health

Women living with HIV in the Dominican Republic, Haiti, and Nicaragua are marginalized in many ways, including their access to family planning (FP) services. Making FP services accessible to persons living with HIV (PLWH) is one of four key strategies that WHO promotes in its comprehensive approach to prevent HIV infections in infants and young children. This strategy also increases the coverage and quality of FP services among a population commonly underserved and at high risk of unplanned pregnancy. Expanded access to antiretroviral therapy in many developing countries has improved the life expectancies and health of many PLWH who are …


Profile Of Abortion Seekers In Ghana And Their Decision-Making Processes, Philomena Nyarko, Cletus Adohinzin, Saumya Ramarao, Placide Tapsoba, Ayorinde Ajayi Jan 2008

Profile Of Abortion Seekers In Ghana And Their Decision-Making Processes, Philomena Nyarko, Cletus Adohinzin, Saumya Ramarao, Placide Tapsoba, Ayorinde Ajayi

Reproductive Health

In 2006, a consortium of agencies, including the Population Council, came together to provide technical and financial support to the Government of Ghana in the rollout of comprehensive abortion care (CAC) services. The consortium collaborated with the government in expanding women’s access to modern family planning and CAC. The consortium’s program, Reducing Maternal Mortality and Morbidity (R3M), aims to reduce unwanted pregnancy and severe complications and deaths caused by unsafe abortion. The formative research in this report was undertaken to provide a profile of beneficiaries, their needs for information and services, their decision-making process in seeking care, and the quality …


Bolivia: A Gender Focus In Service Delivery Improves Quality Of Care, Population Council Jan 2008

Bolivia: A Gender Focus In Service Delivery Improves Quality Of Care, Population Council

Reproductive Health

A program to operationalize and institutionalize a gender perspective in reproductive health services in Bolivia resulted in a significant reduc­tion in unmet need for contraception, increased client satisfaction, and improved communication between partners. Bolivia’s Integral Health Coordination Program (PROCOSI) encourages member NGOs to address gender-based differences in roles, relationships, access to services, and service needs in their RH programs. In 2005, FRONTIERS collaborated with PRO­COSI to test the feasibility and costs of a sys­tem for certifying that its member organizations provided gender-sensitive RH services. The two-year project followed a 2000 intervention to incorporate gender perspectives in PROCOSI clinics that led …


Family Planning And Comprehensive Abortion Care Handbook For Medical Students And House Officers, Population Council Jan 2008

Family Planning And Comprehensive Abortion Care Handbook For Medical Students And House Officers, Population Council

Reproductive Health

The persistently high maternal mortality and morbidity in Ghana is partly due to high rates of unwanted fertility, unsafe abortion, and relatively low use of modern contraception. In 2006, a consortium of agencies, including the Population Council, initiated the Reducing Maternal Mortality and Morbidity program. The program provides financial and technical resources that will enable the government to significantly expand women's access to modern family planning, contraception, and comprehensive abortion care (CAC) to reduce maternal mortality in Ghana. This handbook on FP and CAC was developed as part of the program. It updates a previous document produced more than ten …


Involving Young People In The Care And Support Of People Living With Hiv In Zambia: An Evaluation Of Program Sustainability, Eka Esu-Williams, Catherine Searle, Anderson Zulu Jan 2008

Involving Young People In The Care And Support Of People Living With Hiv In Zambia: An Evaluation Of Program Sustainability, Eka Esu-Williams, Catherine Searle, Anderson Zulu

HIV and AIDS

In 2005, approximately 17 percent of the population of reproductive age in Zambia was infected with HIV and nearly 710,000 under the age of 18 were orphans. As the needs of people living with HIV (PLHIV) and orphans and vulnerable children (OVC) escalate, communities are seeking new ways of helping those affected by the disease. A Horizons intervention study conducted in northern Zambia from 2000–02 found that youth could be trained to help meet the care and support needs of PLHIV and their families, including OVC. Study participants belonged to anti-AIDS clubs that taught about HIV and how to prevent …


South Africa: Integrating Services For Fp And Hiv Improves Quality And Hiv Testing, Population Council Jan 2008

South Africa: Integrating Services For Fp And Hiv Improves Quality And Hiv Testing, Population Council

Reproductive Health

The South African government wishes to expand availability and use of counseling and testing (C&T) for HIV. One option is to integrate C&T into well-attended services, such as family planning (FP). In 2004, the Population Council began a three-year study with the Department of Health in North West Province. The study tested the feasibility, acceptability, and cost of two models for integrating HIV prevention services within established FP programs, and evaluated their quality against standard practice. In the testing-model clinics, providers provided C&T services at the same consultation; in the referral-model clinics, providers offered HIV counseling and referred clients to …


Manual For Building Capacity Of Trainers And Program Managers In Emergency Contraception, Sharif M.I. Hossain, M.E. Khan, Mary Philip Sebastian, Sohini Roychowdhury Jan 2008

Manual For Building Capacity Of Trainers And Program Managers In Emergency Contraception, Sharif M.I. Hossain, M.E. Khan, Mary Philip Sebastian, Sohini Roychowdhury

Reproductive Health

This manual equips trainers with appropriate knowledge on emergency contraceptive pills (ECPs). Emergency contraception (EC) refers to any method of contraception that can be used by a woman to prevent an unwanted pregnancy within three days of unprotected intercourse or a contraceptive accident such as condom leakage. This manual discusses ECPs and the provision of related services. After a day’s training, trainers have the knowledge and skills necessary to train service providers and workers on ECPs. The manual is divided into four sessions. The first provides an overview of the demographic and reproductive health (RH) situation in South and South …


Parents Matter: How Supportive Parenting Influences The Behaviours Of Youth, Maharashtra, International Institute For Population Sciences (Iips) Jan 2008

Parents Matter: How Supportive Parenting Influences The Behaviours Of Youth, Maharashtra, International Institute For Population Sciences (Iips)

Poverty, Gender, and Youth

In India, policies and programs have increasingly recognized the need to actively engage parents in enabling adolescents to make safe and healthy transitions to adulthood. The design of appropriate strategies to engage parents is, however, hampered by the paucity of evidence available. Little is known about the socialization of daughters and sons, the extent to which socialization practices differ for daughters and sons, and the extent to and ways in which parents communicate sensitive matters to their adolescent children. Similarly, research is limited that sheds light on the role of socialization patterns and parental interaction in influencing young people’s schooling …


Young People's Participation In Civil Society And Political Life In Maharashtra, International Institute For Population Sciences (Iips) Jan 2008

Young People's Participation In Civil Society And Political Life In Maharashtra, International Institute For Population Sciences (Iips)

Poverty, Gender, and Youth

Youth participation in civil society and political life is increasingly recognized as an important development objective. The opportunities for participation that young people experience in their communities may influence their development and the types of transitions they make to adulthood. Moreover, behaviors and attitudes relating to community participation that individuals adopt as young people predict lifelong civic affiliations and perspectives. In India, the National Youth Policy 2003 has underscored the role of India’s youth in political decision-making, and has argued for greater representation of youth in appropriate bodies as well as more extensive youth participation in program design and implementation. …


Romance And Sex Before Marriage Among Young Women And Men In Maharashtra, International Institute For Population Sciences (Iips) Jan 2008

Romance And Sex Before Marriage Among Young Women And Men In Maharashtra, International Institute For Population Sciences (Iips)

Poverty, Gender, and Youth

Premarital partnerships among youth are widely discouraged in India. Indeed, there is a widespread perception that youth do not find opportunities to mix and form romantic relationships, and that premarital sex is negligible. These kinds of perceptions are often cited to argue against the provision of sexuality or family life education and sexual and reproductive health services to unmarried young people. While several small studies have noted that sizable proportions of young people, particularly young men, are sexually active before marriage, the lack of rigorous evidence on the levels and patterns of intimate partnerships among youth continues to hamper the …


Education And Transition To Work Among Youth In Maharashtra, International Institute For Population Sciences (Iips) Jan 2008

Education And Transition To Work Among Youth In Maharashtra, International Institute For Population Sciences (Iips)

Poverty, Gender, and Youth

The extent to which India will be able to successfully harness its demographic dividend depends significantly on the situation of its youth, notably on the levels of education and market-oriented skills they attain. In many states, youth have made progress on these fronts. Youth in Maharashtra have made considerable strides in terms of educational attainment, yet it is not clear that they are prepared for the challenges they will face in a globalized world. Looking at the current educational and employment situation of youth in Maharashtra, this policy brief argues that significant investments in terms of appropriate policies and programs …


Identifying Sources Of Adolescent Exclusion Due To Violence: Participatory Mapping In South Africa, Nora Kenworthy, Kelly Hallman, Judith A. Diers Jan 2008

Identifying Sources Of Adolescent Exclusion Due To Violence: Participatory Mapping In South Africa, Nora Kenworthy, Kelly Hallman, Judith A. Diers

Poverty, Gender, and Youth

Adolescents in post-apartheid South Africa lead lives that are filled with new opportunities yet overshadowed by rampant violence and crime. The presence of multiple and simultaneous forms of violence and the systemic lack of safety are experienced most acutely by adolescents—in particular, adolescent girls. High levels of violence and crime within the community are coupled with violence within the home and schools. The Population Council’s Transitions to Adulthood Program examines the particular factors that shape adolescents’ life chances and choices. In South Africa, Council researchers have studied how economic literacy and life skills education affect young men and women who …


Reforming Marriage Practices In Bangladesh, Sajeda Amin Jan 2008

Reforming Marriage Practices In Bangladesh, Sajeda Amin

Poverty, Gender, and Youth

Marriage customs in Bangladesh vary by region complicating national-level efforts to eliminate some of the more harmful practices, such as early marriage and dowry demands, that undermine the status of women. Efforts to reform marriage must consider economic concerns, social traditions, and social activism. Early marriage—often involving girls as young as 10—has been widely recognized in Bangladesh and elsewhere as a human rights offense. The current legal age at marriage is 18 for women and 21 for men, yet age restrictions are difficult to enforce because Bangladesh lacks an official birth registration system that can verify age. By studying the …


Training Youth Caregivers To Provide Hiv Education And Support To Orphans And Vulnerable Children In South Africa, Tobey C. Nelson, Eka Esu-Williams, Lungile Mchunu, Pinkie Nyamakazi, S'Fiso Mnguni, Katie D. Schenk, Catherine Searle, Jennifer Redner Jan 2008

Training Youth Caregivers To Provide Hiv Education And Support To Orphans And Vulnerable Children In South Africa, Tobey C. Nelson, Eka Esu-Williams, Lungile Mchunu, Pinkie Nyamakazi, S'Fiso Mnguni, Katie D. Schenk, Catherine Searle, Jennifer Redner

HIV and AIDS

In KwaZulu Natal, South Africa, in Durban’s peri-urban community of Valley of 1000 Hills, Horizons partnered with Valley Trust to implement and evaluate a program to provide education and support to orphans and vulnerable children. The study utilized a pre-post test design to assess the feasibility and impact of building the capacity of youth aged 18–24 years to provide HIV education and support to in-school orphans and vulnerable children in their communities. The Valley Trust Youth Caregiver Program trained older youth to provide HIV education, homework assistance, and psychosocial support to orphans and vulnerable children aged 11–15 years. The program …


Malaria In Pregnancy Pilot Projects Nationally Adopted In Kenya And Malawi, Population Council Jan 2008

Malaria In Pregnancy Pilot Projects Nationally Adopted In Kenya And Malawi, Population Council

Reproductive Health

Kenya and Malawi have developed national policies to prevent malaria in pregnancy. Measures to prevent malaria among antenatal clients were shown to be sustainable several years after pilot interventions ended. In Malawi, the approach has been expanded nationwide. In most malaria-endemic areas of Africa, women in their first and second pregnancies have the highest risk of acquiring malaria and, consequently, of malaria-associated anemia and low birth-weight. Two USAID-funded interventions aimed at strengthening the prevention and management of malaria in pregnancy were pilot-tested at the district level in Kenya (1998–2002) and Malawi (1998–2004). As noted in this brief, the goal was …


Adapting Focused Antenatal Care: Lessons From Three African Countries, Harriet Birungi Jan 2008

Adapting Focused Antenatal Care: Lessons From Three African Countries, Harriet Birungi

Reproductive Health

In 2001, the World Health Organization issued guidance on a new model of antenatal care (ANC) called goal-oriented or focused antenatal care (FANC), for implementation in developing countries. The new model reduces the number of required antenatal visits to four, and provides focused services shown to improve maternal outcomes. FANC emphasizes helping women maintain normal pregnancies by identifying existing health conditions, detecting emerging complications, promoting health, preparing for a healthy birth, and educating clients on postpartum care including nutrition, breastfeeding, and family planning. Trials conducted in Argentina, Cuba, Saudi Arabia, and Thailand proved that FANC was safe and was a …


Assessment Of Risk Factors For Hiv Infection Among Men Who Have Sex With Men In The Metropolitan Area Of Campinas City, Brazil, Using Respondent-Driven Sampling, Maeve De Mello, Adriana De Araujo Pinho, Magda Chinaglia, Waimar Tun, Aristides Barbosa Junior, Maria Cristina, F.J. Ilario, Paulo Reis, Regina C.S. Salles, Suzanne Westman, Juan Diaz Jan 2008

Assessment Of Risk Factors For Hiv Infection Among Men Who Have Sex With Men In The Metropolitan Area Of Campinas City, Brazil, Using Respondent-Driven Sampling, Maeve De Mello, Adriana De Araujo Pinho, Magda Chinaglia, Waimar Tun, Aristides Barbosa Junior, Maria Cristina, F.J. Ilario, Paulo Reis, Regina C.S. Salles, Suzanne Westman, Juan Diaz

HIV and AIDS

The Population Council, in collaboration with the Brazil Ministry of Health, the Municipal Program of STD/AIDS of Campinas, and the US Centers for Disease Control and Prevention/Global AIDS Program/Brazil, conducted a study to characterize the sociodemographic, behavioral, and environmental factors associated with subgroups of MSM who are most at risk for HIV infection. This research is the first Brazilian study to provide population-based estimates for HIV, syphilis, and HIV-related risk behaviors using an innovative sampling technique to reach members of the target population. Our data suggest the importance for HIV prevention programs to address not only sexual risk reduction, but …


How Early Marriage Compromises Girls' Lives, Maharashtra, International Institute For Population Sciences (Iips) Jan 2008

How Early Marriage Compromises Girls' Lives, Maharashtra, International Institute For Population Sciences (Iips)

Poverty, Gender, and Youth

The policy and program discourse around early marriage has increased significantly over the last decade in India. For example, several national-level policies formulated since 2000, including the Prohibition of Child Marriage Act 2006, have advocated special program attention to delay age at marriage and to enforce existing laws against child marriage. Also, programmatically several initiatives have been launched to prevent early marriage. Despite these commitments, substantial proportions of girls continue to marry in adolescence. As recently as 2005–06, 47 percent of women aged 20–24 were married by 18 years nationally. While the situation of married young women in India has …


Sexuality Education For Youth In Maharashtra: Yes Or No?, International Institute For Population Sciences (Iips) Jan 2008

Sexuality Education For Youth In Maharashtra: Yes Or No?, International Institute For Population Sciences (Iips)

Poverty, Gender, and Youth

Serious reservations have been expressed in Maharashtra about the sexuality component of programs intended to build awareness of safe and healthy behaviors for school-going youth. This policy brief answers: Is there a need for sexuality education in school and out-of-school in Maharashtra? Are the concerns expressed supported by evidence? Evidence was obtained from the Youth in India: Situation and Needs study conducted in Maharashtra, which explored young people’s awareness of sexual and reproductive matters, sexual experiences of youth, parent–child communication on sexual and reproductive matters, and experience and acceptability of sexuality education programs. Parents were asked whether they had discussed …


Kenya: Islamic Scholars Find No Religious Justification For Fgm/C, Population Council Jan 2008

Kenya: Islamic Scholars Find No Religious Justification For Fgm/C, Population Council

Reproductive Health

In 2004, FRONTIERS undertook a study on the cultural basis of female genital mu­tilation and cutting (FGM/C) in Kenya’s Somali community. The study showed universal support for FGM/C, and indicated that one of the major justifications is the perception that Islam requires female as well as male genital cutting. Interviews with informants showed that belief in the religious justification overrides arguments about the health and human rights aspects and the knowledge that it is illegal in Kenya. In 2005, FRONTIERS launched an intervention to engage the community in discussions about FGM/C to clarify the religious position. FRONTIERS arranged symposia involving …


Kenya: Integrating Services For Fp And Hiv Improves Quality And Hiv Testing, Population Council Jan 2008

Kenya: Integrating Services For Fp And Hiv Improves Quality And Hiv Testing, Population Council

Reproductive Health

The Kenyan government’s reproductive health policy highlights service integration and quality of care. While integrating counseling and testing (C&T) for HIV into family planning (FP) can potentially increase the range of services to clients at risk from sexually transmitted infections (STIs) including HIV, few studies have documented the feasibility, effects, or costs of such integration. From 2005–07, the Population Council worked with the Kenyan Ministry of Health to test the feasibility of two models for integrating C&T into existing FP services. Both models featured client education on HIV prevention during FP visits. Providers were trained to routinely use the Balanced …


Financial Capacity Building For Ngo Sustainability, John H. Bratt, Rick Homan, Barbara Janowitz, James R. Foreit Jan 2008

Financial Capacity Building For Ngo Sustainability, John H. Bratt, Rick Homan, Barbara Janowitz, James R. Foreit

Reproductive Health

While demand for family planning and reproductive health services is increasing worldwide, a number of recent trends threaten the financial sustainability of donor-supported NGOs that provide these services. First, the U.S. Agency for International Development has seen its funding for population assistance decline since 1995. A second reason is the growth of government-funded programs that provide these services for low-income clients, which reduced the need for NGOs to focus programs entirely on the poor. Health-sector reform has created opportunities for NGOs via public–private partnerships in some countries, but sustained public-sector support is unlikely given limited economic growth in domestic economies …