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Bourret KM, Larocque S, Hien A, Hogue C, Muray K, Lukusa AT, Ngabo AM. Midwives' integration of post abortion manual vacuum aspiration in the Democratic Republic of Congo: a mixed methods case study & positive deviance assessment. BMC Health Serv Res 2020; 20:1136. [PMID: 33302962 PMCID: PMC7726277 DOI: 10.1186/s12913-020-05997-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Despite a recognized need for midwives to provide post abortion care, there exist barriers preventing them from integrating lifesaving skills such as manual vacuum aspiration (MVA) into practice. This collaborative research with the Professional Association of Congolese Midwives (SCOSAF), sought to understand how certain midwives in the Democratic Republic of Congo (DRC) have overcome barriers to successfully integrate MVA for post abortion care. Specifically, in order to provide locally-driven solutions to the problem of inadequate post abortion care in the DRC, this study aimed to identify examples of positive deviance, or midwives who had successfully integrated MVA in complex working environments following an in-service training facilitated by their midwifery association, SCOSAF. Methods Creswell’s mixed method comparative case study design was used to identify positive deviant midwives who had practiced MVA one or more times post training and to explore their strategies and enabling factors. Other midwives who had not practiced MVA post training permitted for a comparison gro cup and further interpretations. Sources of data included a sequential survey and semi-structured interviews. Results All 102 midwives invited to be surveyed were recruited and 34% reported practicing MVA post training (positive deviant midwives). No statistical significance was found between the two groups’ demographics and practice facility type. Overall, both groups had positive attitudes regarding midwifery-led MVA and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies. Conclusion Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for their overall impact on the diffusion of midwifery-led MVA to improve access to safe, respectful reproductive care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05997-7.
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Affiliation(s)
- Kirsty M Bourret
- School of Midwifery, Faculty of Health Sciences, Laurentian University, 935 Ramsey Lake road, Sudbury, ON, Canada.
| | - Sylvie Larocque
- School of Nursing, Faculty of Health Sciences, Laurentian University, Sudbury, Canada
| | - Amélie Hien
- Department of French studies, Laurentian University, Sudbury, Canada
| | - Carol Hogue
- Jules & Uldeen Terry Professor Emerita of Maternal and Child Health, Professor Emerita of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Kalum Muray
- School of Nursing, Faculty of Health Sciences, Laurentian University, Sudbury, Canada
| | - Aurélie Thethe Lukusa
- Département Kimbanguiste de Santé, Société Congolaise de la Pratique Sage-femme, Matadi, République Démocratique du Congo
| | - Abel Minani Ngabo
- Société Congolaise de la Pratique Sage-femme, Institut Supérieur des Sciences Infirmières, Kinshasa, République Démocratique du Congo
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Izugbara C, Wekesah FM, Sebany M, Echoka E, Amo-Adjei J, Muga W. Availability, accessibility and utilization of post-abortion care in Sub-Saharan Africa: A systematic review. Health Care Women Int 2019; 41:732-760. [PMID: 31855511 DOI: 10.1080/07399332.2019.1703991] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
At the 1994 ICPD, sub-Saharan African (SSA) states pledged, inter alia, to guarantee quality post-abortion care (PAC) services. We synthesized existing research on PAC services provision, utilization and access in SSA since the 1994 ICPD. Generally, evidence on PAC is only available in a few countries in the sub-region. The available evidence however suggests that PAC constitutes a significant financial burden on public health systems in SSA; that accessibility, utilization and availability of PAC services have expanded during the period; and that worrying inequities characterize PAC services. Manual and electrical vacuum aspiration and medication abortion drugs are increasingly common PAC methods in SSA, but poor-quality treatment methods persist in many contexts. Complex socio-economic, infrastructural, cultural and political factors mediate the availability, accessibility and utilization of PAC services in SSA. Interventions that have been implemented to improve different aspects of PAC in the sub-region have had variable levels of success. Underexplored themes in the existing literature include the individual and household level costs of PAC; the quality of PAC services; the provision of non-abortion reproductive health services in the context of PAC; and health care provider-community partnerships.
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Affiliation(s)
| | | | - Meroji Sebany
- International Center for Research on Women, Washington, D.C, USA
| | - Elizabeth Echoka
- Centre for Public Health Research, Kenya Medical Research Institute - KEMRI, Nairobi, Kenya
| | - Joshua Amo-Adjei
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Winstoun Muga
- African Population & Health Research Center, Nairobi, Kenya
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Ameh CA, Mdegela M, White S, van den Broek N. The effectiveness of training in emergency obstetric care: a systematic literature review. Health Policy Plan 2019; 34:257-270. [PMID: 31056670 PMCID: PMC6661541 DOI: 10.1093/heapol/czz028] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 12/19/2022] Open
Abstract
Providing quality emergency obstetric care (EmOC) reduces the risk of maternal and newborn mortality and morbidity. There is evidence that over 50% of maternal health programmes that result in improving access to EmOC and reduce maternal mortality have an EmOC training component. The objective was to review the evidence for the effectiveness of training in EmOC. Eleven databases and websites were searched for publications describing EmOC training evaluations between 1997 and 2017. Effectiveness was assessed at four levels: (1) participant reaction, (2) knowledge and skills, (3) change in behaviour and clinical practice and (4) availability of EmOC and health outcomes. Weighted means for change in knowledge and skills obtained, narrative synthesis of results for other levels. One hundred and one studies including before-after studies (n = 44) and randomized controlled trials (RCTs) (n = 15). Level 1 and/or 2 was assessed in 68 studies; Level 3 in 51, Level 4 in 21 studies. Only three studies assessed effectiveness at all four levels. Weighted mean scores pre-training, and change after training were 67.0% and 10.6% for knowledge (7750 participants) and 53.1% and 29.8% for skills (6054 participants; 13 studies). There is strong evidence for improved clinical practice (adherence to protocols, resuscitation technique, communication and team work) and improved neonatal outcomes (reduced trauma after shoulder dystocia, reduced number of babies with hypothermia and hypoxia). Evidence for a reduction in the number of cases of post-partum haemorrhage, case fatality rates, stillbirths and institutional maternal mortality is less strong. Short competency-based training in EmOC results in significant improvements in healthcare provider knowledge/skills and change in clinical practice. There is emerging evidence that this results in improved health outcomes.
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Affiliation(s)
- Charles A Ameh
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Mselenge Mdegela
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Sarah White
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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Fullerton J, Butler MM, Aman C, Reid T, Dowler M. Abortion-related care and the role of the midwife: a global perspective. Int J Womens Health 2018; 10:751-762. [PMID: 30538585 PMCID: PMC6260173 DOI: 10.2147/ijwh.s178601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The International Confederation of Midwives (ICM) represents 132 midwifery associations in 113 countries. The ICM disseminates the Essential Competencies for Basic Midwifery Practice (EC) that describes the global scope of midwifery practice. The basic (core) and expanded (additional or optional) role of midwives in providing abortion-related care services was first described in 2010. A literature review about three items that are particularly critical to access to abortion services was conducted. Findings that emerged in the recent 2016-2017 update study about these three items are presented. Methods A modified Delphi study was administered via the Internet in a series of three rounds. Thirty-seven statements of abortion-related knowledge and skill were presented. Results A total of 895 individuals participated. The total of respondents across all three rounds represented 90 of the 105 member countries at the time of the study. The role of midwives in providing comprehensive abortion care, including referral for abortion and provision of postabortion family planning, achieved the necessary 85% agreement to be designated as essential (basic) knowledge or skill for the global scope of midwifery practice. The provision of medication abortion and performance of manual vacuum aspiration abortion were designated as optional for midwives who wished to provide these services. Endorsement of these latter practices was highest in both Francophone and Anglophone regions of Africa, Asian Pacific countries, and countries at a lower state of economic development. Conclusion The role of midwives in provision of abortion-related care services was reaffirmed in the recent Delphi study to inform the update to the EC. The role of midwives as direct providers of medical and vacuum aspiration abortions was reaffirmed for those individual midwives who wish to obtain the requisite competency to provide those services, in jurisdictions where these services are legally authorized.
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Affiliation(s)
- Judith Fullerton
- Retired, School of Medicine, University of California, San Diego, CA, USA,
| | - Michelle M Butler
- Faculty of Science and Health, Dublin City University, Dublin 9, Ireland
| | - Cheryl Aman
- Midwifery Program, University of British Columbia, Vancouver, BC, Canada
| | - Tobi Reid
- Midwifery Program, University of British Columbia, Vancouver, BC, Canada
| | - Melanie Dowler
- Midwifery Program, University of British Columbia, Vancouver, BC, Canada
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Christmals CD, Gross J, Aziato L, Armstrong SJ. The State of Nursing Research in Ghana: An Integrative Literature Review. SAGE Open Nurs 2018; 4:2377960818783820. [PMID: 33415196 PMCID: PMC7774359 DOI: 10.1177/2377960818783820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/10/2018] [Accepted: 04/07/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION For nursing practice to be responsive to the needs of patients, it must be driven by contextual research evidence. To guide institutional and national nursing research policy, there is need to determine the quantity and quality of nursing research in Ghana. PURPOSE The purpose of this integrative literature review was to quantify, critically evaluate, and describe nursing research publication in Ghana from January 2007 to December 2016 with regard to the country's research capacity to sustain evidence-based practice. RESULTS Sixty (60) out of 749 articles identified from EBSCOhost, ProQuest, PubMed, Science Direct, Scopus, Wiley Online Library, and Google Scholar using three keywords (nursing, health, and Ghana) were included. A total of 60,778 human subjects were used in these studies. There were more quantitative (28) studies than qualitative (23) studies. These studies recorded 219 authors from 120 institutions, 55 of which were outside Ghana. Forty-five percent of the articles were published in journals with impact factor. There was a steady increase in publication in Ghana over the decade. A majority of the studies published in education were in curriculum implementation and evaluation. CONCLUSIONS The increasing number of peer-reviewed nursing research publications in Ghana and the curriculum implementation and evaluation in Ghana signified an increasing capacity of the country to implement and sustain evidence-based practice. RECOMMENDATIONS It is recommended that regular research be conducted to evaluate the responsiveness to old and new nursing programs in Ghana.
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Affiliation(s)
- Christmal D. Christmals
- Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Department of Nursing Education, School of Therapeutic Sciences, University of Witwatersrand, Johannesburg South Africa
| | - Janet Gross
- Morehead State University, KY, USA
- Global Health Services Partnership, US Peace Corps, Liberia
| | - Lydia Aziato
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Accra, Ghana
| | - Susan J. Armstrong
- Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Macleod C, Chiweshe M, Mavuso J. A critical review of sanctioned knowledge production concerning abortion in Africa: Implications for feminist health psychology. J Health Psychol 2016; 23:1096-1109. [DOI: 10.1177/1359105316644294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Taking a feminist health psychology approach, we conducted a systematic review of published research on abortion featured in PsycINFO over a 7-year period. We analysed the 39 articles included in the review in terms of countries in which the research was conducted, types of research, issues covered, the way the research was framed and main findings. Despite 97 per cent of abortions performed in Africa being classifiable as unsafe, there has been no engagement in knowledge production about abortion in Africa from psychologists, outside of South Africa. Given this, we outline the implications of the current knowledge base for feminism, psychology and feminist health psychology in Africa.
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Maxwell L, Voetagbe G, Paul M, Mark A. Does the type of abortion provider influence contraceptive uptake after abortion? An analysis of longitudinal data from 64 health facilities in Ghana. BMC Public Health 2015; 15:586. [PMID: 26104025 PMCID: PMC4478624 DOI: 10.1186/s12889-015-1875-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 05/26/2015] [Indexed: 11/11/2022] Open
Abstract
Background Understanding what factors influence the receipt of postabortion contraception can help improve comprehensive abortion care services. The abortion visit is an ideal time to reach women at the highest risk of unintended pregnancy with the most effective contraceptive methods. The objectives of this study were to estimate the relationship between the type of abortion provider (consultant physician, house officer, or midwife) and two separate outcomes: (1) the likelihood of adopting postabortion contraception; (2) postabortion contraceptors’ likelihood of receiving a long-acting and permanent versus a short-acting contraceptive method. Methods We used retrospective cohort data collected from 64 health facilities in three regions of Ghana. The dataset includes information on all abortion procedures conducted between 1 January 2008 and 31 December 2010 at each health facility. We used fixed effect Poisson regression to model the associations of interest. Results More than half (65 %) of the 29,056 abortion clients received some form of contraception. When midwives performed the abortion, women were more likely to receive postabortion contraception compared to house officers (RR: 1.18; 95 % CI: 1.13, 1.24) or physicians (RR: 1.21; 95 % CI: 1.18, 1.25), after controlling for facility-level variation and client-level factors. Compared to women seen by house officers, abortion clients seen by midwives and physicians were more likely to receive a long-acting and permanent rather than a short-acting contraceptive method (RR: 1.46; 95 % CI: 1.23, 1.73; RR: 1.58; 95 % CI: 1.37, 1.83, respectively). Younger women were less likely to receive contraception than older women irrespective of provider type and indication for the abortion (induced or PAC). Conclusions When comparing consultant physicians, house officers, and midwives, the type of abortion provider is associated with whether women receive postabortion contraception and with whether abortion clients receive a long-acting and permanent or a short-acting method. New strategies are needed to ensure that women seen by physicians and house officers can access postabortion contraception and to ensure that women seen by house officers have access to long-acting and permanent contraceptive methods. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1875-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren Maxwell
- Institute for Health and Social Policy, McGill University, 1130 Pine Ave West, Montréal, QC, H3A 1A3, Canada. .,Ipas, P.O. Box 9990, Chapel Hill, NC, 27515, USA.
| | - Gertrude Voetagbe
- Ipas Ghana, No. 8 Akosombo Road, Airport Residential Area, Accra, Ghana.
| | - Mary Paul
- Ipas, P.O. Box 9990, Chapel Hill, NC, 27515, USA.
| | - Alice Mark
- Ipas, P.O. Box 9990, Chapel Hill, NC, 27515, USA.
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Murphy GT, Goma F, MacKenzie A, Bradish S, Price S, Nzala S, Rose AE, Rigby J, Muzongwe C, Chizuni N, Carey A, Hamavhwa D. A scoping review of training and deployment policies for human resources for health for maternal, newborn, and child health in rural Africa. HUMAN RESOURCES FOR HEALTH 2014; 12:72. [PMID: 25515732 PMCID: PMC4290826 DOI: 10.1186/1478-4491-12-72] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/28/2014] [Indexed: 05/31/2023]
Abstract
BACKGROUND Most African countries are facing a human resources for health (HRH) crisis, lacking the required workforce to deliver basic health care, including care for mothers and children. This is especially acute in rural areas and has limited countries' abilities to meet maternal, newborn, and child health (MNCH) targets outlined by Millennium Development Goals 4 and 5. To address the HRH challenges, evidence-based deployment and training policies are required. However, the resources available to country-level policy makers to create such policies are limited. To inform future HRH planning, a scoping review was conducted to identify the type, extent, and quality of evidence that exists on HRH policies for rural MNCH in Africa. METHODS Fourteen electronic health and health education databases were searched for peer-reviewed papers specific to training and deployment policies for doctors, nurses, and midwives for rural MNCH in African countries with English, Portuguese, or French as official languages. Non-peer reviewed literature and policy documents were also identified through systematic searches of selected international organizations and government websites. Documents were included based on pre-determined criteria. RESULTS There was an overall paucity of information on training and deployment policies for HRH for MNCH in rural Africa; 37 articles met the inclusion criteria. Of these, the majority of primary research studies employed a variety of qualitative and quantitative methods. Doctors, nurses, and midwives were equally represented in the selected policy literature. Policies focusing exclusively on training or deployment were limited; most documents focused on both training and deployment or were broader with embedded implications for the management of HRH or MNCH. Relevant government websites varied in functionality and in the availability of policy documents. CONCLUSIONS The lack of available documentation and an apparent bias towards HRH research in developed areas suggest a need for strengthened capacity for HRH policy research in Africa. This will result in enhanced potential for evidence uptake into policy. Enhanced alignment between policy-makers' information needs and the independent research agenda could further assist knowledge development and uptake. The results of this scoping review informed an in-depth analysis of relevant policies in a sub-set of African countries.
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Affiliation(s)
- Gail Tomblin Murphy
- />WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia B3H 4R2 Canada
- />School of Nursing, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia B3H 4R2 Canada
| | - Fastone Goma
- />School of Medicine, University of Zambia, Nationalist Road, U.T.H., PO Box 50110, Lusaka, Zambia
| | - Adrian MacKenzie
- />WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia B3H 4R2 Canada
| | - Stephanie Bradish
- />WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia B3H 4R2 Canada
| | - Sheri Price
- />WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia B3H 4R2 Canada
- />School of Nursing, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia B3H 4R2 Canada
| | - Selestine Nzala
- />School of Medicine, University of Zambia, Nationalist Road, U.T.H., PO Box 50110, Lusaka, Zambia
| | - Annette Elliott Rose
- />WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia B3H 4R2 Canada
| | - Janet Rigby
- />WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia B3H 4R2 Canada
| | - Chilweza Muzongwe
- />Centre for Primary Care Research, University of Zambia School of Medicine, Nationalist Road, U.T.H., PO Box 50110, Lusaka, Zambia
| | - Nellisiwe Chizuni
- />Centre for Primary Care Research, University of Zambia School of Medicine, Nationalist Road, U.T.H., PO Box 50110, Lusaka, Zambia
| | - Amanda Carey
- />WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia B3H 4R2 Canada
| | - Derrick Hamavhwa
- />Zambia Forum for Health Research, Post-Net Box 261, 23 Chindo Road, Woodlands, Lusaka, Zambia
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Sundaram A, Juarez F, Ahiadeke C, Bankole A, Blades N. The impact of Ghana's R3M programme on the provision of safe abortions and postabortion care. Health Policy Plan 2014; 30:1017-31. [PMID: 25261230 PMCID: PMC4559115 DOI: 10.1093/heapol/czu105] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 11/13/2022] Open
Abstract
In 2006, in response to the high maternal mortality, driven largely by unsafe abortions, the government of Ghana, in partnership with other organizations, launched the reducing maternal mortality and morbidity (R3M) programme in seven districts in Greater Accra, Ashanti and Eastern, to improve comprehensive abortion care services. This article examines whether this intervention made a difference to the provision of safe abortion services and postabortion care (PAC). We also examine the role played by provider attitudes and knowledge of the abortion law, on providers with clinical training in service provision. Primary data on health care providers in Ghana, collected using a quasi-experimental design, were analysed using propensity score weighting. Apart from the treatment group, the sample included two controls: (1) Districts in Accra, Ashanti and Eastern, not exposed to the treatment; and (2) Districts from distant Brong Ahafo, also not exposed to the treatment. The findings show that providers in the treatment group are nearly 16 times as likely to provide safe abortions compared with their peers in Brong Ahafo, and ∼2.5 times as likely compared with providers in the other control group. R3M providers were also different from their peers in providing PAC. Associations between provider attitudes and knowledge of the law on both outcomes were either non-significant or inconsistent including for providers with clinical knowledge of abortion provision. Provider confidence however is strongly associated with service provision. We conclude that the R3M programme is helping safe abortion provision, with the differences being greater with control groups that are geographically distant, perhaps owing to lower contamination from movement of providers between facilities. Increasing provider confidence is key to improving both safe abortion provision and PAC.
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Affiliation(s)
- Aparna Sundaram
- Research Division, Guttmacher Institute, New York, NY, USA, Centro de Estudios Demográfico, Urbanos y Ambientales, El Colegio de Méico, Mexico and Institute for Statistical, Social, and Economic Research, University of Ghana, Legon, Ghana
| | - Fatima Juarez
- Research Division, Guttmacher Institute, New York, NY, USA, Centro de Estudios Demográfico, Urbanos y Ambientales, El Colegio de Méico, Mexico and Institute for Statistical, Social, and Economic Research, University of Ghana, Legon, Ghana Research Division, Guttmacher Institute, New York, NY, USA, Centro de Estudios Demográfico, Urbanos y Ambientales, El Colegio de Méico, Mexico and Institute for Statistical, Social, and Economic Research, University of Ghana, Legon, Ghana
| | - Clement Ahiadeke
- Research Division, Guttmacher Institute, New York, NY, USA, Centro de Estudios Demográfico, Urbanos y Ambientales, El Colegio de Méico, Mexico and Institute for Statistical, Social, and Economic Research, University of Ghana, Legon, Ghana
| | - Akinrinola Bankole
- Research Division, Guttmacher Institute, New York, NY, USA, Centro de Estudios Demográfico, Urbanos y Ambientales, El Colegio de Méico, Mexico and Institute for Statistical, Social, and Economic Research, University of Ghana, Legon, Ghana
| | - Nakeisha Blades
- Research Division, Guttmacher Institute, New York, NY, USA, Centro de Estudios Demográfico, Urbanos y Ambientales, El Colegio de Méico, Mexico and Institute for Statistical, Social, and Economic Research, University of Ghana, Legon, Ghana
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O’Malley G, Marseille E, Weaver MR. Cost-effectiveness analyses of training: a manager's guide. HUMAN RESOURCES FOR HEALTH 2013; 11:20. [PMID: 23688059 PMCID: PMC3684521 DOI: 10.1186/1478-4491-11-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 04/19/2013] [Indexed: 06/02/2023]
Abstract
The evidence on the cost and cost-effectiveness of global training programs is sparse. This manager's guide to cost-effectiveness analysis (CEA) is for professionals who want to recognize and support high quality CEA. It focuses on CEA of training in the context of program implementation or rapid program expansion. Cost analysis provides cost per output and CEA provides cost per outcome. The distinction between these two analyses is essential for making good decisions about value. A hypothetical example of a cost analysis compares the cost per trainee of a computer-based anti-retroviral therapy (ART) training to a more intensive ART training. In a CEA of the same example, cost per trainee who met ART clinical performance standards is compared. The cost analysis is misleading when the effectiveness differs across trainings. Two additional hypothetical examples progress from simple to more complex costs and from a narrow to a broader scope: 1) CEA of the cost per ART patient with 95% adherence that compares the performance of doctors to counselors who attend additional training, and 2) CEA of the cost per infant HIV infection averted for a Prevention of Mother to Child Transmission program that compares the current program to one with additional training. To create an evidence base on CEA of training, more well-designed analyses and data on the cost of training are needed. Analysts should understand more about how capacity is built, how quality is improved within a health facility, and the costs associated with them. Considering the life of an investment in training, evaluations are needed on how many trainees apply the skills taught, how long trainees continue to apply them, and how long the content of the training conforms to national or international guidelines. Better data on effectiveness of training is also needed. It is feasible to measure effectiveness by clinical performance standards, or intermediate outcomes and coverage. Intermediate outcomes and coverage can also be combined with published estimates on health outcomes.
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Affiliation(s)
- Gabrielle O’Malley
- Department of Global Health, International Training and Education Center for Health, University of Washington, 901 Boren, Suite 1100, Seattle, WA, USA
| | - Elliot Marseille
- Health Strategies International, 555 59th Street, Oakland, CA, 94609, USA
| | - Marcia R Weaver
- Department of Global Health, International Training and Education Center for Health, University of Washington, 901 Boren, Suite 1100, Seattle, WA, USA
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Abstract
Forty per cent of the world's women are living in countries with restrictive abortion laws, which prohibit abortion or only allow abortion to protect a woman's life or her physical or mental health. In countries where abortion is restricted, women have to resort to clandestine interventions to have an unwanted pregnancy terminated. As a consequence, high rates of unsafe abortion are seen, such as in Sub-Saharan Africa where unsafe abortion occurs at rates of 18-39 per 1 000 women. The circumstances under which women obtain unsafe abortion vary and depend on traditional methods known and types of providers present. Health professionals are prone to use instrumental procedures to induce the abortion, whereas traditional providers often make a brew of herbs to be drunk in one or more doses. In countries with restrictive abortion laws, high rates of maternal death must be expected, and globally an estimated 66 500 women die every year as a result of unsafe abortions. In addition, a far larger number of women experience short- and long-term health consequences. To address the harmful health consequences of unsafe abortion, a postabortion care model has been developed and implemented with success in many countries where women do not have legal access to abortion. Postabortion care focuses on treatment of incomplete abortion and provision of postabortion contraceptive services. To enhance women's access to postabortion care, focus is increasingly being placed on upgrading midlevel providers to provide emergency treatment as well as implementing misoprostol as a treatment strategy for complications after unsafe abortion.
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Affiliation(s)
- Vibeke Rasch
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.
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