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Ko SH, Sakai H. Water sanitation, hygiene and the prevalence of diarrhea in the rural areas of the delta region of Myanmar. JOURNAL OF WATER AND HEALTH 2022; 20:149-156. [PMID: 35100162 DOI: 10.2166/wh.2021.192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Myanmar is an agriculture-based country with 70% of the total population residing in rural areas. Around half of the total population in Myanmar has to consume water from unimproved sources. The prevalence of diarrhea due to contaminated drinking water is high even in urban areas. The urban community may expect the provision of municipal water supply in the near future if the current revolution against military dictatorship succeeds. However, the rural areas have less or no chance to get quality water because of a lot of other prioritized tasks. Household water treatment is encouraged to be implemented as one of the national water safety plans for rural water supply in Myanmar. This study explored the diarrhea prevention awareness of the rural community using a questionnaire survey. The microbial quality parameters of drinking water sources were also examined. Fecal coliform contamination was detected in all examined drinking water sources. A significant association was found between drinking untreated water and the occurrence of diarrhea. The percentage of people who applied the diarrhea preventive measures was low. Even if they knew how to prevent the disease, very few people applied the measures in reality. Therefore, measures to cause behavioral change should be initiated, together with awareness raising, to promote diarrhea prevention in the community.
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Affiliation(s)
- Shane Htet Ko
- Department of Civil and Environmental Engineering, School of Urban Environmental Sciences, Tokyo Metropolitan University, 1-1, Minami-Osawa, Hachioji City, Tokyo 192-0397, Japan E-mail:
| | - Hiroshi Sakai
- Department of Civil and Environmental Engineering, School of Urban Environmental Sciences, Tokyo Metropolitan University, 1-1, Minami-Osawa, Hachioji City, Tokyo 192-0397, Japan E-mail:
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Ezezika O, Ragunathan A, El-Bakri Y, Barrett K. Barriers and facilitators to implementation of oral rehydration therapy in low- and middle-income countries: A systematic review. PLoS One 2021; 16:e0249638. [PMID: 33886584 PMCID: PMC8062013 DOI: 10.1371/journal.pone.0249638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Oral rehydration therapy (ORT) is an effective and cheap treatment for diarrheal disease; globally, one of the leading causes of death in children under five. The World Health Organization launched a global campaign to improve ORT coverage in 1978, with activities such as educational campaigns, training health workers and the creation of designate programming. Despite these efforts, ORT coverage remains relatively low. The objective of this systematic review is to identify the barriers and facilitators to the implementation of oral rehydration therapy in low and middle-income countries. METHODS A comprehensive search strategy comprised of relevant subject headings and keywords was executed in 5 databases including OVID Medline, OVID Embase, OVID HealthStar, Web of Science and Scopus. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. RESULTS The search identified 1570 citations and following removal of duplicates as well as screening according to our inclusion/exclusion criteria, 55 articles were eligible for inclusion in the review. Twenty-three countries were represented in this review, with India, Bangladesh, Egypt, Nigeria, and South Africa having the most representation of available studies. Study dates ranged from 1981 to 2020. Overarching thematic areas spanning the barriers and facilitators that were identified included: availability and accessibility, knowledge, partnership engagement, and design and acceptability. CONCLUSION A systematic review of studies on implementation of ORT in low- and middle-income countries (LMICs) highlights key activities that facilitate the development of successful implementation that include: (1) availability and accessibility of ORT, (2) awareness and education among communities, (3) strong partnership engagement strategies, and (4) adaptable design to enhance acceptability. The barriers and facilitators identified under the CIFR domains can be used to build knowledge on how to adapt ORT to national and local settings and contribute to a better understanding on the implementation and use of ORT in LMICs. The prospects for scaling and sustaining ORT (after years of low use) will increase if implementation research informs local applications, and implementers engage appropriate stakeholders and test assumptions around localized theories of change from interventions to expected outcomes. REGISTRATION A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD420201695).
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Affiliation(s)
- Obidimma Ezezika
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- African Centre for Innovation and Leadership Development, Abuja, Nigeria
| | - Apira Ragunathan
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Yasmine El-Bakri
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
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Pérez MC, Minoyan N, Ridde V, Sylvestre MP, Johri M. Comparison of registered and published intervention fidelity assessment in cluster randomised trials of public health interventions in low- and middle-income countries: systematic review. Trials 2018; 19:410. [PMID: 30064484 PMCID: PMC6069979 DOI: 10.1186/s13063-018-2796-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/09/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cluster randomised trials (CRTs) are a key instrument to evaluate public health interventions. Fidelity assessment examines study processes to gauge whether an intervention was delivered as initially planned. Evaluation of implementation fidelity (IF) is required to establish whether the measured effects of a trial are due to the intervention itself and may be particularly important for CRTs of complex interventions conducted in low- and middle-income countries (LMICs). However, current CRT reporting guidelines offer no guidance on IF assessment. The objective of this review was to study current practices concerning the assessment of IF in CRTs of public health interventions in LMICs. METHODS CRTs of public health interventions in LMICs that planned or reported IF assessment in either the trial protocol or the main trial report were included. The MEDLINE/PubMed, CINAHL and EMBASE databases were queried from January 2012 to May 2016. To ensure availability of a study protocol, CRTs reporting a registration number in the abstract were included. Relevant data were extracted from each study protocol and trial report by two researchers using a predefined screening sheet. Risk of bias for individual studies was assessed. RESULTS We identified 90 CRTs of public health interventions in LMICs with a study protocol in a publicly available trial registry published from January 2012 to May 2016. Among these 90 studies, 25 (28%) did not plan or report assessing IF; the remaining 65 studies (72%) addressed at least one IF dimension. IF assessment was planned in 40% (36/90) of trial protocols and reported in 71.1% (64/90) of trial reports. The proportion of overall agreement between the trial protocol and trial report concerning occurrence of IF assessment was 66.7% (60/90). Most studies had low to moderate risk of bias. CONCLUSIONS IF assessment is not currently a systematic practice in CRTs of public health interventions carried out in LMICs. In the absence of IF assessment, it may be difficult to determine if CRT results are due to the intervention design, to its implementation, or to unknown or external factors that may influence results. CRT reporting guidelines should promote IF assessment. TRIAL REGISTRATION Protocol published and available at: https://doi.org/10.1186/s13643-016-0351-0.
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Affiliation(s)
- Myriam Cielo Pérez
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis, Pavillon R, Tour Saint-Antoine Porte S03.414, Montréal, Québec, H2X 0A9, Canada.,Département de médicine sociale et préventive, École de santé publique (ESPUM), Université de Montréal, 7101, avenue du Parc, 3e étage, Montréal, Québec, H3N 1X9, Canada
| | - Nanor Minoyan
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis, Pavillon R, Tour Saint-Antoine Porte S03.414, Montréal, Québec, H2X 0A9, Canada.,Département de médicine sociale et préventive, École de santé publique (ESPUM), Université de Montréal, 7101, avenue du Parc, 3e étage, Montréal, Québec, H3N 1X9, Canada
| | - Valéry Ridde
- Institut de Recherche en Santé Publique Université de Montréal (IRSPUM), Pavillon 7101 Avenue du Parc, P.O. Box 6128, Centre-ville Station, Montréal, Québec, H3C 3J7, Canada.,Institut de Recherche Pour le Développement (IRD), Le Sextant 44, bd de Dunkerque, CS 90009 13572, Cedex 02, Marseille, France
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis, Pavillon R, Tour Saint-Antoine Porte S03.414, Montréal, Québec, H2X 0A9, Canada.,Département de médicine sociale et préventive, École de santé publique (ESPUM), Université de Montréal, 7101, avenue du Parc, 3e étage, Montréal, Québec, H3N 1X9, Canada
| | - Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis, Pavillon R, Tour Saint-Antoine Porte S03.414, Montréal, Québec, H2X 0A9, Canada. .,Département de gestion, d'évaluation, et de politique de santé, École de santé publique, Université de Montréal, 7101, avenue du Parc, 3e étage, Montréal, Québec, H3N 1X9, Canada.
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Social franchising: whatever happened to old-fashioned notions of evidence-based practice? LANCET GLOBAL HEALTH 2017; 6:e130-e131. [PMID: 29275136 DOI: 10.1016/s2214-109x(17)30501-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 11/21/2022]
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Bright T, Felix L, Kuper H, Polack S. A systematic review of strategies to increase access to health services among children in low and middle income countries. BMC Health Serv Res 2017; 17:252. [PMID: 28381276 PMCID: PMC5382494 DOI: 10.1186/s12913-017-2180-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 03/21/2017] [Indexed: 12/02/2022] Open
Abstract
Background Universal Health Coverage is widely endorsed as the pivotal goal in global health, however substantial barriers to accessing health services for children in low and middle-income countries (LMIC) exist. Failure to access healthcare is an important contributor to child mortality in these settings. Barriers to access have been widely studied, however effective interventions to overcome barriers and increase access to services for children are less well documented. Methods We conducted a systematic review of effectiveness of interventions aimed at increasing access to health services for children aged 5 years and below in LMIC. Four databases (EMBASE, Global Health, MEDLINE, and PSYCINFO) were searched in January 2016. Studies were included if they evaluated interventions that aimed to increase: health care utilisation; immunisation uptake; and compliance with medication or referral. Randomised controlled trials and non-randomised controlled study designs were included in the review. A narrative approach was used to synthesise results. Results Fifty seven studies were included in the review. Approximately half of studies (49%) were conducted in sub-Saharan Africa. Most studies were randomised controlled trials (n = 44; 77%) with the remaining studies employing non-randomised designs. Very few studies were judged as high quality. Studies evaluated a diverse range of interventions and various outcomes. Supply side interventions included: delivery of services at or closer to home and service level improvements (eg. integration of services). Demand side interventions included: educational programmes, text messages, and financial or other incentives. Interventions that delivered services at or closer to home and text messages were in general associated with a significant improvement in relevant outcomes. A consistent pattern was not noted for the remaining studies. Conclusions This review fills a gap in the literature by providing evidence of the range and effectiveness of interventions that can be used to increase access for children aged ≤5 years in LMIC. It highlights some intervention areas that seem to show encouraging trends including text message reminders and delivery of services at or close to home. However, given the methodological limitations found in existing studies, the results of this review must be interpreted with caution. Systematic review registration PROSPERO CRD420160334200 Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2180-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
| | - Lambert Felix
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Mohanan M, Giardili S, Das V, Rabin TL, Raj SS, Schwartz JI, Seth A, Goldhaber-Fiebert JD, Miller G, Vera-Hernández M. Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India. Bull World Health Organ 2017; 95:343-352E. [PMID: 28479635 PMCID: PMC5418816 DOI: 10.2471/blt.16.179556] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 12/20/2016] [Accepted: 01/31/2017] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme – the World Health Partners’ Sky Program. Methods We investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Providers were assessed using hypothetical patient vignettes and the standardized patient method both before and after programme implementation, in 2011 and 2014, respectively. Differences in providers’ performance between implementation and nonimplementation areas were assessed using multivariate difference-in-difference linear regression models. Findings The programme did not significantly improve health-care providers’ knowledge or performance with regard to childhood diarrhoea or pneumonia in Bihar. There was a persistent large gap between knowledge of appropriate care and the care actually delivered. Conclusion Social franchising has received attention globally as a model for delivering high-quality care in rural areas in the developing world but supporting data are scarce. Our findings emphasize the need for sound empirical evidence before social franchising programmes are scaled up.
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Affiliation(s)
- Manoj Mohanan
- Sanford School of Public Policy, Duke University, 302 Towerview Drive, 128 Rubenstein Hall, Durham, North Carolina, NC 27708, United States of America (USA)
| | - Soledad Giardili
- Department of Economics, Queen Mary University of London, London, England
| | - Veena Das
- Department of Anthropology, Johns Hopkins University, Baltimore, USA
| | - Tracy L Rabin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, USA
| | - Sunil S Raj
- Indian Institute of Public Health, New Delhi, India
| | - Jeremy I Schwartz
- Department of Internal Medicine, Yale University School of Medicine, New Haven, USA
| | - Aparna Seth
- Sambodhi Research and Communications Pvt. Ltd., New Delhi, India
| | - Jeremy D Goldhaber-Fiebert
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, USA
| | - Grant Miller
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, USA
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Mohanan M, Babiarz KS, Goldhaber-Fiebert JD, Miller G, Vera-Hernández M. Effect Of A Large-Scale Social Franchising And Telemedicine Program On Childhood Diarrhea And Pneumonia Outcomes In India. Health Aff (Millwood) 2016; 35:1800-1809. [DOI: 10.1377/hlthaff.2016.0481] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Manoj Mohanan
- Manoj Mohanan is an assistant professor of public policy and economics in the Sanford School of Public Policy at Duke University, an assistant research professor at the Duke Global Health Institute, and faculty research scholar at the Duke Population Research Institute, all in Durham, North Carolina
| | - Kimberly S. Babiarz
- Kimberly S. Babiarz is a research associate in the Center for Primary Care and Outcomes Research (CHP/PCOR), School of Medicine, at Stanford University, in California
| | | | - Grant Miller
- Grant Miller is an associate professor at the School of Medicine, Stanford University; director of the Stanford Center for International Development; senior fellow, Freeman Spogli Institute for International Studies; senior fellow, Stanford Institute for Economic Policy Research; and a research associate at the National Bureau of Economic Research, in Cambridge, Massachusetts
| | - Marcos Vera-Hernández
- Marcos Vera-Hernández is a reader in economics at University College London and a research fellow at the Institute for Fiscal Studies, both in the United Kingdom
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Chakraborty NM, Mbondo M, Wanderi J. Evaluating the impact of social franchising on family planning use in Kenya. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2016; 35:19. [PMID: 27316700 PMCID: PMC5025970 DOI: 10.1186/s41043-016-0056-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND In Kenya, as in many low-income countries, the private sector is an important component of health service delivery and of providing access to preventive and curative health services. The Tunza Social Franchise Network, operated by Population Services Kenya, is Kenya's largest network of private providers, comprising 329 clinics. Franchised clinics are only one source of family planning (FP), and this study seeks to understand whether access to a franchise increases the overall use or provides another alternative for women who would have found FP services in the public sector. METHODS A quasi-experimental study compared 50 catchment areas where there is a Tunza franchise and no other franchised provider with 50 purposively matched control areas within 20 km of each selected Tunza area, with a health facility, but no franchised facility. Data from 5609 women of reproductive age were collected on demographic and socioeconomic status, FP use, and care-seeking behavior. Multivariate logistic regression, with intervention and control respondents matched using coarsened exact matching, was conducted. RESULTS Overall modern contraceptive use in this population was 53 %, with 24.8 % of women using a long-acting or permanent method (LAPM). There was no significant difference in odds of current or new FP use by group, adjusted for age. However, respondents in Tunza catchment areas are significantly more likely to be LAPM users (adj. OR = 1.49, p = 0.015). Further, women aged 18-24 and 41-49 in Tunza catchment areas have a significantly higher marginal probability of LAPM use than those in control areas. CONCLUSIONS This study indicates that access to a franchise is correlated with access to and increased use of LAPMs, which are more effective, and cost-effective, methods of FP. While franchised facilities may provide additional points of access for FP and other services, the presence of the franchise does not, in and of itself, increase the use of FP in Kenya.
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Bishai D, Sachathep K, LeFevre A, Thant HNN, Zaw M, Aung T, McFarland W, Montagu D. Cost-effectiveness of using a social franchise network to increase uptake of oral rehydration salts and zinc for childhood diarrhea in rural Myanmar. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2015; 13:3. [PMID: 25698906 PMCID: PMC4332918 DOI: 10.1186/s12962-015-0030-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/15/2015] [Indexed: 12/01/2022] Open
Abstract
Introduction This paper examines the cost-effectiveness of achieving increases in the use of oral rehydration solution and zinc supplementation in the management of acute diarrhea in children under 5 years through social franchising. The study uses cost and outcome data from an initiative by Population Services International (PSI) in 3 townships of Myanmar in 2010 to promote an ORS-Zinc product called ORASEL. Background The objective of this study was to determine the incremental cost-effectiveness of a strategy to promote ORS-Z use through private sector franchising compared to standard government and private sector practices. Methods Costing from a societal perspective included program, provider, and household costs for the 2010 calendar year. Program costs including ORASEL program launch, distribution, and administration costs were obtained through a retrospective review of financial records and key informant interviews with staff in the central Yangon office. Household out of pocket payments for diarrheal episodes were obtained from a household survey conducted in the study area and additional estimates of household income lost due to parental care-giving time for a sick child were estimated. Incremental cost-effectiveness relative to status quo conditions was calculated per child death and DALY averted in 2010. Health effects included deaths and DALYs averted; the former modeled based on coverage estimates from a household survey that were entered into the Lives Saved Tool (LiST). Uncertainty was modeled with Monte Carlo methods. Findings Based on the model, the promotional strategy would translate to 2.85 (SD 0.29) deaths averted in a community population of 1 million where there would be 81,000 children under 5 expecting 48,373 cases of diarrhea. The incremental cost effectiveness of the franchised approach to improving ORASEL coverage is estimated at a median $5,955 (IQR: $3437-$7589) per death averted and $214 (IQR: $127-$287) per discounted DALY averted. Interpretation Investing in developing a network of private sector providers and keeping them stocked with ORS-Z as is done in a social franchise can be a highly cost-effective in terms of dollars per DALY averted. Electronic supplementary material The online version of this article (doi:10.1186/s12962-015-0030-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David Bishai
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Karampreet Sachathep
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Amnesty LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Hnin New Nwe Thant
- PSI-Myanmar, 16 West Shwe Gone Dine 4th Street, Bahan Township, Yangon, Myanmar
| | - Min Zaw
- PSI-Myanmar, 16 West Shwe Gone Dine 4th Street, Bahan Township, Yangon, Myanmar
| | - Tin Aung
- PSI-Myanmar, 16 West Shwe Gone Dine 4th Street, Bahan Township, Yangon, Myanmar
| | - Willi McFarland
- Department of Epidemiology, University of California San Francisco, San Francisco, CA USA
| | - Dominic Montagu
- Department of Epidemiology, University of California San Francisco, San Francisco, CA USA
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Nguyen PH, Menon P, Keithly SC, Kim SS, Hajeebhoy N, Tran LM, Ruel MT, Rawat R. Program impact pathway analysis of a social franchise model shows potential to improve infant and young child feeding practices in Vietnam. J Nutr 2014; 144:1627-36. [PMID: 25143372 DOI: 10.3945/jn.114.194464] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
By mapping the mechanisms through which interventions are expected to achieve impact, program impact pathway (PIP) analysis lays out the theoretical causal links between program activities, outcomes, and impacts. This study examines the pathways through which the Alive & Thrive (A&T) social franchise model is intended to improve infant and young child feeding (IYCF) practices in Vietnam. Mixed methods were used, including qualitative interviews with franchise management board members (n = 12), surveys with health providers (n = 120), counseling observations (n = 160), and household surveys (n = 2045). Six PIP components were assessed: 1) franchise management, 2) training and IYCF knowledge of health providers, 3) service delivery, 4) program exposure and utilization, 5) maternal behavioral determinants (knowledge, beliefs, and intentions) toward optimal IYCF practices, and 6) IYCF practices. Data were collected from A&T-intensive areas (A&T-I; mass media + social franchise) and A&T-nonintensive areas (A&T-NI; mass media only) by using a cluster-randomized controlled trial design. Data from 2013 were compared with baseline where similar measures were available. Results indicate that mechanisms are in place for effective management of the franchise system, despite challenges to routine monitoring. A&T training was associated with increased capacity of providers, resulting in higher-quality IYCF counseling (greater technical knowledge and communication skills during counseling) in A&T-I areas. Franchise utilization increased from 10% in 2012 to 45% in 2013 but fell below the expected frequency of 9-15 contacts per mother-child dyad. Improvements in breastfeeding knowledge, beliefs, intentions, and practices were greater among mothers in A&T-I areas than among those in A&T-NI areas. In conclusion, there are many positive changes along the impact pathway of the franchise services, but challenges in utilization and demand creation should be addressed to achieve the full intended impact.
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Affiliation(s)
- Phuong H Nguyen
- International Food Policy Research Institute (IFPRI), Hanoi, Vietnam
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Beyeler N, York De La Cruz A, Montagu D. The impact of clinical social franchising on health services in low- and middle-income countries: a systematic review. PLoS One 2013; 8:e60669. [PMID: 23637757 PMCID: PMC3634059 DOI: 10.1371/journal.pone.0060669] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/01/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The private sector plays a large role in health services delivery in low- and middle-income countries; yet significant gaps remain in the quality and accessibility of private sector services. Clinical social franchising, which applies the commercial franchising model to achieve social goals and improve health care, is increasingly used in developing countries to respond to these limitations. Despite the growth of this approach, limited evidence documents the effect of social franchising on improving health care quality and access. OBJECTIVES AND METHODS We examined peer-reviewed and grey literature to evaluate the effect of social franchising on health care quality, equity, cost-effectiveness, and health outcomes. We included all studies of clinical social franchise programs located in low- and middle-income countries. We assessed study bias using the WHO-Johns Hopkins Rigour Scale and used narrative synthesis to evaluate the findings. RESULTS Of 113 identified articles, 23 were included in this review; these evaluated a small sample of franchises globally and focused on reproductive health franchises. Results varied widely across outcomes and programs. Social franchising was positively associated with increased client volume and client satisfaction. The findings on health care utilization and health impact were mixed; some studies find that franchises significantly outperform other models of health care, while others show franchises are equivalent to or worse than other private or public clinics. In two areas, cost-effectiveness and equity, social franchises were generally found to have poorer outcomes. CONCLUSIONS Our review indicates that social franchising may strengthen some elements of private sector health care. However, gaps in the evidence remain. Additional research should include: further documentation of the effect of social franchising, evaluating the equity and cost-effectiveness of this intervention, and assessing the role of franchising within the context of the greater healthcare delivery system.
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Affiliation(s)
- Naomi Beyeler
- Global Health Group, University of California San Francisco, San Francisco, California, United States of America
| | - Anna York De La Cruz
- Global Health Group, University of California San Francisco, San Francisco, California, United States of America
| | - Dominic Montagu
- Global Health Group, University of California San Francisco, San Francisco, California, United States of America
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