Photo: Family planning is a cross-sectoral intervention that can hasten progress across the 5 SDG themes of People, Planet, Prosperity, Peace, and Partnership. ©2016 USAID
Table of Contents — June 20, 2016, 4 (2)
Global Health: Science and Practice (GHSP), a no-fee, peer-reviewed, open-access journal, is targeted to global health professionals, particularly program implementers, to validate their experiences and program results by peer reviewers and to share them with the greater global health community.
June 2016 | Volume 4 | Number 2
- How can LARCs lead the way toward expanding effective family planning services in Nigeria?
- What's keeping us from making potentially inexpensive drugs for hepatitis B widely available?
- How does family planning advance all the Sustainable Development Goals?
- Can WhatsApp mobile messaging service help with supervision of CHWs in Kenya?
- Time for a new practical handwashing system?
Read the June 2016 issue of GHSP to find answers to these questions and more. View a list of all articles by article type below or online.
Visit the GHSP website to read and comment on the articles, and subscribe to receive alerts when new articles and issues are published.
TABLE OF CONTENTS
Leading With LARCs in Nigeria: The Stars Are Aligned to Expand Effective Family Planning Services Decisively
Despite years of family planning effort in Nigeria, the modern contraceptive prevalence (mCPR) has reached only 10%. Yet a few recent seminal, well-executed programs have been outstandingly successful providing long-acting reversible contraceptives (LARCs)—both in the public and private sector, and in the North and South. Remarkably, the LARCs they provided were equivalent to 2% mCPR in 2015 alone.
Accordingly, we advocate markedly increased support for: (1) private-sector approaches such as social franchising, particularly in the South, (2) mobile outreach, and (3) support to public clinical facilities, including expanding access through community health extension workers (CHEWs), particularly in the North. Success will require system support, quality, and concerted engagement from a variety of partners including the Government of Nigeria.
Without significant progress in Nigeria, the global FP2020 goal appears unattainable. Fortunately, leading with LARCs along with wide choice of other methods provides a clear avenue for success.
James D Shelton, Clea Finkle
Drugs that are inexpensive to manufacture and simple to administer greatly expand the potential to help tens of millions of people who need treatment for chronic hepatitis B virus (HBV) infection. Key program implementation challenges include identifying who would benefit from antiviral medication and ensuring long-term and consistent treatment to people who feel well. The best opportunities are where health systems are advanced enough to effectively address these challenges and in settings where HIV service platforms can be leveraged. Research, innovation, and collaboration are critical to implement services most efficiently and to realize economies of scale to drive down costs of health care services, drugs, and diagnostics.
Voluntary family planning brings transformational benefits to women, families, communities, and countries. Investing in family planning is a development "best buy" that can accelerate achievement across the 5 Sustainable Development Goal themes of People, Planet, Prosperity, Peace, and Partnership.
Ellen Starbird, Maureen Norton, Rachel Marcus
mHealth for Tuberculosis Treatment Adherence: A Framework to Guide Ethical Planning, Implementation, and Evaluation
Promising mHealth approaches for TB treatment adherence include: (1) video observation, (2) patient- or device-facilitated indirect monitoring, and (3) direct monitoring through embedded sensors or metabolite testing. To mitigate ethical concerns, our framework considers accuracy of monitoring technologies, stigmatization and intrusiveness of the technologies, use of incentives, and the balance of individual and public good.
Michael J DiStefano, Harald Schmidt
Feasibility and Effectiveness of mHealth for Mobilizing Households for Indoor Residual Spraying to Prevent Malaria: A Case Study in Mali
Sending voice and/or text messages to mobilize households for spraying was more costly per structure and less effective at preparing structures than traditional door-to-door mobilization approaches supplemented with radio and town hall announcements. Challenges included: (1) lack of familiarity with mobile phones and with public health mobile messaging, (2) lack of face-to-face communication with mobilizers, making it easier to ignore mobilization messages and preventing trust-building, (3) low literacy levels and, (4) gender differentials in access to mobile phones.
Keith Mangam, Elana Fiekowsky, Moussa Bagayoko, Laura Norris, Allison Belemvire, Rebecca Longhany, Christen Fornadel, Kristen George
Factors Associated With Community Health Worker Performance Differ by Task in a Multi-Tasked Setting in Rural Zimbabwe
Programs should consider specific tasks and how they relate to health worker factors, community support, and the work context. In a setting where community health workers were responsible for multiple tasks, those who referred more pregnant women were female, unmarried, under 40 years old, and from larger households, and they felt they had adequate work resources and positive feedback from supervisors and the community. In contrast, workers with high scores on delivering household behavior change lessons were from smaller households and received more supportive supervision.
Rukundo A Kambarami, Mduduzi NN Mbuya, David Pelletier, Dadirai Fundira, Naume V Tavengwa, Rebecca J Stoltzfus
School Distribution as Keep-Up Strategy to Maintain Universal Coverage of Long-Lasting Insecticidal Nets: Implementation and Results of a Program in Southern Tanzania
A school-based net distribution program, piloted in the Southern Zone of Tanzania to sustain ≥80% universal net coverage previously attained through mass campaigns, successfully issued nets to nearly all eligible students and teachers. Keys to success included: (1) effective collaboration between the Ministry of Health, local government, and implementing partners, (2) social mobilization to sensitize the community about the importance of net use, and (3) development of a mobile application to facilitate data collection and analysis.
Shabbir Lalji, Jeremiah M Ngondi, Narjis G Thawer, Autman Tembo, Renata Mandike, Ally Mohamed, Frank Chacky, Charles D Mwalimu, George Greer, Naomi Kaspar, Karen Kramer, Bertha Mlay, Kheri Issa, Jane Lweikiza, Anold Mutafungwa, Mary Nzowa, Ritha A Willilo, Waziri Nyoni, David Dadi, Mahdi M Ramsan, Richard Reithinger, Stephen M Magesa
Improved Childhood Diarrhea Treatment Practices in Ghana: A Pre-Post Evaluation of a Comprehensive Private-Sector Program
From 2011 to 2015, a diarrhea management program in Ghana targeting pharmaceutical suppliers, private-sector providers, and caregivers successfully increased caregiver use of oral rehydration salts (ORS) with zinc to treat diarrhea in children under 5, from 0.8% to 29.2%, and reduced antibiotic use (which is generally inappropriate for treatment of non-bloody diarrhea) from 66.2% to 38.2%.
Marianne El-Khoury, Kathryn Banke, Phoebe Sloane
Success Providing Postpartum Intrauterine Devices in Private-Sector Health Care Facilities in Nigeria: Factors Associated With Uptake
41% of women delivering in the social franchise private facilities chose the postpartum IUD. Factors associated with acceptance included lower education, higher parity, and being single. Scale-up of postpartum IUD services in both public and private facilities has the potential to significantly increase use of long-acting reversible contraception in Nigeria.
George IE Eluwa, Ronke Atamewalen, Kingsley Odogwu, Babatunde Ahonsi
Partnerships for Policy Development: A Case Study From Uganda's Costed Implementation Plan for Family Planning
The development and launch of the costed implementation plan (CIP) in Uganda was successful in many ways. However, it would have benefitted from more focus on long-term partnership development critical for executing the CIP and by including district health officers—key players in executing the plan—more substantially in the process. Using a partnership approach sets the stage for ensuring that the right people are contributing to both development and execution.
Alyson B Lipsky, James N Gribble, Linda Cahaelen, Suneeta Sharma
FIELD ACTION REPORTS
Enhancing the Supervision of Community Health Workers With WhatsApp Mobile Messaging: Qualitative Findings From 2 Low-Resource Settings in Kenya
CHWs used WhatsApp with their supervisors to document their work, spurring healthy competition and team building between CHWs in the 2 pilot sites. While there was considerable variation in the number of times each participant posted messages—from 1 message to 270 messages—in total they posted nearly 2,000 messages over 6 months. 88% of messages corresponded to at least 1 of 3 defined supervisory objectives of (1) creating a social environment, (2) sharing communication and information, or (3) promoting quality of services.
Jade Vu Henry, Niall Winters, Alice Lakati, Martin Oliver, Anne Geniets, Simon M Mbae, Hannah Wanjiru
Family Planning Counseling in Your Pocket: A Mobile Job Aid for Community Health Workers in Tanzania
Using mobile job aids can help CHWs deliver integrated counseling on family planning and HIV/STI screening by following a step-by-step service delivery algorithm. Lessons learned during the pilot led to the development of additional features during scale-up to exploit the other major advantages that mHealth offers including: (1) better supervision of health workers and accountability for their performance, (2) improved communication between supervisors and workers, and (3) access to real-time data and reports to support quality improvement.
Smisha Agarwal, Christine Lasway, Kelly L'Engle, Rick Homan, Erica Layer, Steve Ollis, Rebecca Braun, Lucy Silas, Anna Mwakibete, Mustafa Kudrati
Declining HIV Prevalence in Parallel With Safer Sex Behaviors in Burkina Faso: Evidence From Surveillance and Population-Based Surveys
HIV prevalence among pregnant women ages 15-49 declined from 7.1% to 2.0% in urban areas between 1998 and 2014, and from 2.0% to 0.5% in rural areas between 2003 and 2014; similar declines were reported in the Demographic and Health Surveys. During the same time period, individuals reported safer sex behaviors, including delayed sexual debut and reduced number of sex partners among youth, as well as increased condom use at last sex with nonmarital partners among men and women ages 15-49.
Fati Kirakoya-Samadoulougou, Nicolas Nagot, Sekou Samadoulougou, Mamadou Sokey, Abdoulaye Guiré, Issiaka Sombié, Nicolas Meda
Handwashing With a Water-Efficient Tap and Low-Cost Foaming Soap: The Povu Poa "Cool Foam" System in Kenya
The new handwashing system, designed with end user input, features an economical foaming soap dispenser and a hygienic, water-efficient tap for use in household and institutional settings that lack reliable access to piped water. Cost of the soap and water needed for use is less than US$0.10 per 100 handwash uses, compared with US$0.20-$0.44 for conventional handwashing stations used in Kenya.
Jaynie Whinnery, Gauthami Penakalapati, Rachel Steinacher, Noel Wilson, Clair Null, Amy J Pickering
Fertility Awareness Methods Are Not Modern Contraceptives: Defining Contraception to Reflect Our Priorities
A recent article in GHSP calls for classifying fertility awareness methods as "modern contraceptives" despite their inferiority. We believe in a rights-based approach, which considers the real-world conditions that many women face, including constrained sexual agency and low baseline reproductive health literacy. We must demonstrate true commitment to increasing access to the most effective and reliable contraceptive methods.
Kirsten Austad, Anita Chary, Alejandra Colom, Rodrigo Barillas, Danessa Luna, Cecilia Menjívar, Brent Metz, Amy Petrocy, Anne Ruch, Peter Rohloff
Response to Austad: Offering a Range of Methods, Including Fertility Awareness Methods, Facilitates Method Choice
When selecting a contraceptive method, women and men consider various attributes in addition to effectiveness, such as side effects, return to fertility, level of medical intervention, and interference with sexual activity. Offering a range of methods, including fertility awareness methods that meet the standard to be considered modern, helps to address these considerations, facilitating method choice.
Shawn Malarcher, Madeleine Short Fabic, Jeff Spieler, Ellen H Starbird, Clifton Kenon, Sandra Jordan
LETTERS TO THE EDITOR
Perinatal Mortality Due to Pre-Eclampsia in Africa: A Comprehensive and Integrated Approach Is Needed
Moshood Omotayo, Katherine Dickin, Rebecca Stolzfus
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