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Koffi AK, Muhoza P, Ahmed S, Anglewicz P, OlaOlorun F, Omoluabi E, Thiongo M, Gichangi P, Guiella G, Akilimali P, Sodani PR, Tsui A, Radloff S. Trends in and Correlates of Short-Acting Contraceptive Stock-Outs: Multicountry Analysis of Performance Monitoring for Action Agile Platform Data. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300411. [PMID: 38744488 PMCID: PMC11216709 DOI: 10.9745/ghsp-d-23-00411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 04/16/2024] [Indexed: 05/16/2024]
Abstract
Understanding trends in contraceptive stock-outs, as well as their structural and demand-side correlates, is critical for policymakers and program managers to identify strategies to further anticipate, reduce, and prevent stock-outs. We analyzed trends as well as supply- and demand-side correlates of short-acting contraceptive method stock-outs by using data from multiple rounds of Performance Monitoring for Action Agile surveys. These data longitudinally measured contraceptive availability over 2 years (between November 2017 and January 2020) across 2,134 public and private service delivery points (SDPs) from urban areas of 5 countries (Burkina Faso, Democratic Republic of the Congo [DRC], India, Kenya, and Nigeria). For each country, we analyzed the trends and used multilevel mixed-effect logistic regression to model the odds of short-acting contraceptive stock-outs, adjusting for key structural and demand-side factors of the SDPs. Stock-outs in short-acting contraceptive methods were common in health facilities and varied markedly, ranging from as low as 2.9% (95% confidence interval [CI]=1.7%, 5.1%) in India to 51.0% (95% CIs=46.8%, 56.0%) in Kenya. During the observation period, stock-out rates decreased by 28% in the SDP samples in India (aOR=0.72, P<.001) and 8% in Nigeria (aOR=0.92, P<.001) but increased by 15% in DRC (aOR=1.15; P=036) and 5% in Kenya (aOR=1.05, P=003) with each round of data collection. Correlates of stock-out rates included the facility managerial authority (private versus public), whether the facility was rated high quality, whether the facility was at an advanced tier, and whether there was high demand for short-acting contraceptives. In conclusion, stock-outs of short-acting contraceptives are still common in many settings. Measuring and monitoring contraceptive stock-outs is crucial for identifying and addressing issues related to the availability and supply of short-acting contraceptives.
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Affiliation(s)
- Alain K Koffi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Pierre Muhoza
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Elizabeth Omoluabi
- Centre for Research, Evaluation Resources and Development, Ife, Nigeria
- Statistics and Population Studies Department, University of the Western Cape, Bellville, South Africa
| | - Mary Thiongo
- International Centre for Reproductive Health Kenya, Nairobi, Kenya
| | - Peter Gichangi
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - Pierre Akilimali
- Ecole de Santé Publique de l'Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Plesons M, Torondel B, Caruso BA, Hennegan J, Sommer M, Haver J, Keiser D, van Eijk AM, Zulaika G, Mason L, Phillips-Howard PA. Research priorities for improving menstrual health across the life-course in low- and middle-income countries. Glob Health Action 2023; 16:2279396. [PMID: 38010372 PMCID: PMC10795652 DOI: 10.1080/16549716.2023.2279396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Research on menstrual health is required to understand menstrual needs and generate solutions to improve health, wellbeing, and productivity. The identification of research priorities will help inform where to invest efforts and resources. OBJECTIVES To identify research priorities for menstrual health across the life-course, in consultation with a range of stakeholder groups from a variety of geographic regions, and to identify if menstrual health research priorities varied by expertise. METHODS A modified version of the Child Health and Nutrition Research Initiative approach was utilized to reach consensus on a set of research priorities. Multisector stakeholders with menstrual health expertise, identified through networks and the literature, were invited to submit research questions through an online survey. Responses were consolidated, and individuals were invited to rank these questions based on novelty, potential for intervention, and importance/impact. Research priority scores were calculated and evaluated by participants' characteristics. RESULTS Eighty-two participants proposed 1135 research questions, which were consolidated into 94 unique research questions. The mean number of questions did not differ between low- and middle-income country (LMIC) and high-income country (HIC) participants, but significantly more questions were raised by participants with expertise in mental health and WASH. Sixty-six participants then ranked these questions. The top ten-ranked research questions included four on 'understanding the problem', four on 'designing and implementing interventions', one on 'integrating and scaling up', and one on 'measurement'. Indicators for the measurement of adequate menstrual health over time was ranked the highest priority by all stakeholders. Top ten-ranked research questions differed between academics and non-academics, and between participants from HICs and LMICs, reflecting differences in needs and knowledge gaps. CONCLUSIONS A list of ranked research priorities was generated through a consultative process with stakeholders across LMICs and HICs which can inform where to invest efforts and resources.
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Affiliation(s)
- Marina Plesons
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Belen Torondel
- Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Bethany A. Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Julie Hennegan
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jacquelyn Haver
- School Health and Nutrition, Department of Education and Children Protection, Save the Children US, Washington, DC, USA
| | | | - Anna M. van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Onwujekwe O, Mbachu C, Okeibunor J, Ezema GU, Ejiofor N, Braka F, Thiam A, Koua EL, Chamla D, Gueye AS. What are the research priorities for strengthening public health emergency preparedness and response in Africa? Health Res Policy Syst 2023; 21:107. [PMID: 37872548 PMCID: PMC10594758 DOI: 10.1186/s12961-023-01059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Research evidence is needed to strengthen capacities in emergency preparedness and response (EPR). However, the absence of a clear research agenda limits the optimal use of research evidence. This paper reports on the prioritization of research questions and topics that could contribute to evidence-informed strengthening of EPR capacities in the African region. METHODS The priority-setting consisted of desk review and stakeholder consultation workshop. Twenty-nine people participated in the workshop, including representatives from WHO regional office and EPR focal points in Africa, representatives of research institutions, and partners from Science for Africa Foundation, United Nations Children's Fund and Africa Center for Disease Control. Modified Delphi technique was used to systematically arrive at specific and cross-cutting research priorities in the three broad areas of the EPR, which are program Implementation, Clinical and Epidemiology. The research questions/topics were ranked on five-point Likert scale (1 = very low to 5 = very high) based on seven agreed-on criteria. Research priority score was calculated for each question as the mean of the criteria scores. RESULTS A total of 123 research questions comprising, 29 on Epidemiology, 22 on Clinical, 23 on program Implementation, and 49 on cross-cutting issues were ranked. The top ten research priorities were: knowledge and skills of healthcare workers in detecting and responding effectively to disease outbreaks; quality of data (accuracy, timeliness, completeness) for epidemic prone diseases; determinants of vaccine hesitancy; determinants of infection transmission among health care workers during PHE; effective measures for protecting health workers from highly infectious pathogens in PHE; strategies to improve the effectiveness of contact tracing for epidemic prone diseases; effectiveness of current case definitions as screening tools for epidemic and pandemic prone diseases; measures to strengthen national and sub-national laboratory capacity for timely disease confirmation within the Integrated Diseases Surveillance and Response framework; factors affecting prompt data sharing on epidemic-prone diseases; and effective strategies for appropriate community participation in EPR. CONCLUSIONS The collaborative multi-stakeholder workshop produced a starting list of priority research questions and topics for strengthening EPR capacities in Africa. Action needs to be taken to continuously update the research agenda and support member States to contextualize the research priorities and commission research for timely generation and uptake of evidence.
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Affiliation(s)
- Obinna Onwujekwe
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, 400001, Nigeria
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, 400001, Nigeria
| | - Chinyere Mbachu
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, 400001, Nigeria.
- Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, 400001, Nigeria.
| | - Joseph Okeibunor
- World Health Organisation Regional Office for Africa (AFRO), Brazzaville, Congo
| | - Godwin Uchenna Ezema
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, 400001, Nigeria
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, 400001, Nigeria
- Enugu State Primary Healthcare Development Agency, Enugu, Nigeria
| | - Nonso Ejiofor
- World Health Organisation Regional Office for Africa (AFRO), Brazzaville, Congo
| | - Fiona Braka
- World Health Organisation Regional Office for Africa (AFRO), Brazzaville, Congo
| | - Adama Thiam
- World Health Organisation Regional Office for Africa (AFRO), Brazzaville, Congo
| | - Etien Luc Koua
- World Health Organisation Regional Office for Africa (AFRO), Brazzaville, Congo
| | - Dick Chamla
- World Health Organisation Regional Office for Africa (AFRO), Brazzaville, Congo
| | - Abdou Salam Gueye
- World Health Organisation Regional Office for Africa (AFRO), Brazzaville, Congo
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Britton LE, Tumlinson K, Williams CR, Wambua D, Onyango D, Mantell E, George M. Findings from a mixed-methods journey map study of barriers to family planning in western Kenya. Health Care Women Int 2022; 45:144-160. [PMID: 36394947 PMCID: PMC10188649 DOI: 10.1080/07399332.2022.2135097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/09/2022] [Indexed: 11/18/2022]
Abstract
Our objective was to map and prioritize barriers to high-quality family planning care in western Kenya. We conducted key informant interviews (n = 19); focus group discussions with clients (n = 55); mystery client visits (n = 180); unannounced visitors (n = 120); and direct observation of client-provider interactions (n = 256) at public facilities offering family planning. We synthesized the data into a client and a provider journey map, which we used to facilitate client (n = 9) and provider (n = 12) discussions. For both groups, stockouts were frequent, impactful, and important barriers. Clients also reported male partner resistance, insufficient counseling, and informal fees were priority barriers.
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Affiliation(s)
- Laura E. Britton
- Columbia University School of Nursing, New York City, United States
| | - Katherine Tumlinson
- Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Caitlin R. Williams
- Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | | | - Dickens Onyango
- Kisumu County Department of Health, Kisumu, Kenya
- Utrecht University Netherlands and Institute of Tropical Medicine, Antwerp, Netherlands
| | - Elise Mantell
- Columbia University School of Nursing, New York City, United States
| | - Maureen George
- Columbia University School of Nursing, New York City, United States
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Zuniga C, Wollum A, Grindlay K, Douglas-Durham E, Higgins S, Barr-Walker J, Blanchard K. The impacts of contraceptive stock-outs on users, providers, and facilities: A systematic literature review. Glob Public Health 2020; 17:83-99. [PMID: 33253043 DOI: 10.1080/17441692.2020.1850829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Contraceptive stock-outs are a world-wide problem, yet published research on the impacts of contraceptive stock-outs have not been comprehensively reviewed and synthesised. This systematic review highlights findings about the impacts of contraceptive stock-outs on users, providers, and facilities and identifies topics that should be explored to ensure everyone can access their preferred method of contraception. We systematically searched PubMed, Embase, Web of Science, Popline, and JSTOR for studies addressing the impacts of contraceptive stock-outs. Of 435 studies, 25 publications addressed the impacts of contraceptive stock-outs. Only two articles focused solely on contraceptive stock-outs; the remaining studies examined stock-outs alongside other factors that may influence contraceptive service provision. Studies discussed how stock-outs limited individuals' ability to use their preferred contraceptive method, influenced where contraceptive methods were obtained and how much they cost, and limited providers' and facilities' abilities to provide contraceptive care. Comparing the impacts of contraceptive stock-outs across studies was challenging, as reliability of stock was sometimes not distinguished from overall method availability, and studies used variable methods to measure stock-outs. Evidence presented in this review can inform efforts to ensure that preferred contraceptive methods are consistently available and accessible to all.
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Affiliation(s)
| | | | | | | | | | - Jill Barr-Walker
- ZSFG Library, University of California, San Francisco, MA, USA.,Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, MA, USA
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Ali M, Azmat SK, Hamza HB, Rahman MM. Assessing Effectiveness of Multipurpose Voucher Scheme to Enhance Contraceptive Choices, Equity, and Child Immunization Coverage: Results of an Interventional Study from Pakistan. J Multidiscip Healthc 2020; 13:1061-1074. [PMID: 33061411 PMCID: PMC7533244 DOI: 10.2147/jmdh.s245900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/14/2020] [Indexed: 11/23/2022] Open
Abstract
Background Pakistan has a high total fertility and unmet contraceptive need and is the fifth most populous country. This research aims to assess the effectiveness of a subsidized, multi-purpose voucher intervention to enhance the client–provider interaction for improved contraceptive counseling resulting in a potential increase in the modern methods uptake, continued use, and its impact on equity through better targeting, while increasing uptake of postnatal care and child immunization among women from the lowest two wealth quintiles in rural and urban communities of Punjab province, Pakistan. Methods We used a quasi-experimental design with pre- and post-phases in intervention and control sites in Punjab province (August 2012–March 2015). To detect a 20% increase in modern contraceptive prevalence rate compared to baseline, 1276 women were enrolled in each arm. Difference-in-differences (DID) estimates are reported for key variables. Absolute and relative index of inequality including concentration curves and concentration index are used to describe the magnitude and extent of equity. Results With no net increase in modern contraception use, the intervention area, however, reported a low modern method discontinuation rate. Vaccination rates for BCG increased significantly by 14%, and 5% each for DPT, HBV, and measles. Concentration index and slope index of inequalities for first-time use of modern contraceptives, knowledge of contraceptives, receiving ANC, and delivery at health facilities were negative, indicating that the use of these services was more concentrated among the disadvantaged in intervention areas than the wealthy counterparts. Conclusion This Greenstar-led multiple voucher model did not significantly increase modern contraceptive use in the intervention study area but positively impacted equity. The integrated approach combining contraception with child immunization led to an increase in immunization coverage. It will be important for public policy decision-makers to assess the usefulness of this approach, as a long-term provision of free contraceptive services may lead to dependency in targeted communities.
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Affiliation(s)
- Moazzam Ali
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Syed Khurram Azmat
- Department of Technical Services, Greenstar Social Marketing, Karachi, Pakistan
| | - Hasan Bin Hamza
- Health Policy, System Strengthening and Information Analysis Unit, Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Md Mizanur Rahman
- Department of Global Health Policy, School of International Health, The University of Tokyo, Tokyo, Japan
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Ali M, Cordero JP, Khan F, Folz R. 'Leaving no one behind': a scoping review on the provision of sexual and reproductive health care to nomadic populations. BMC WOMENS HEALTH 2019; 19:161. [PMID: 31842838 PMCID: PMC6916058 DOI: 10.1186/s12905-019-0849-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 11/14/2019] [Indexed: 11/10/2022]
Abstract
BACKGRUND Marginalized groups, such as nomadic populations across the world, have perhaps the least access to modern reproductive health (RH) services. This scoping review aims to identify barriers to access to RH services faced by nomadic populations from the existing literature and to highlight possible opportunities to address them. METHODS Key databases, including PubMed, Popline, Google Scholar, and Google Advanced were searched for relevant articles published between 2002 and 2019. A total 344 articles were identified through database online searches, and 31 were included in the review. RESULTS Nomadic people face complex barriers to healthcare access that can be broadly categorized as external (geographic isolation, socio-cultural dynamics, logistical and political factors) and internal (lifestyle, norms and practices, perceptions) factors. To effectively address the needs of nomadic populations, RH services must be available, accessible and acceptable through tailored and culturally sensitive approaches. A combination of fixed and mobile services has proven effective among mobile populations. Low awareness of modern RH services and their benefits is a major barrier to utilization. Partnership with communities through leveraging existing structures, networks and decision-making patterns can ensure that the programmes are effectively implemented. CONCLUSION Further research is needed to better understand and address the RH needs of nomadic populations. Though existing evidence is limited, opportunities do exist and should be explored. Raising awareness and sensitization training among health providers about the specific needs of nomads is important. Improved education and access to information about the benefits of modern RH care among nomadic communities is needed. Ensuring community participation through involvement of nomadic women and girls, community leaders, male partners, and trained traditional birth attendants are key facilitators in reaching nomads. However, participatory programmes also need to be recognized and supported by governments and existing health systems.
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Affiliation(s)
- Moazzam Ali
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, CH-1211, Geneva, Switzerland.
| | - Joanna Paula Cordero
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, CH-1211, Geneva, Switzerland
| | - Faria Khan
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, CH-1211, Geneva, Switzerland
| | - Rachel Folz
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, CH-1211, Geneva, Switzerland
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Ontiri S, Mutea L, Muganda M, Mutanda P, Ajema C, Okoth S, Orero S, Odhiambo R, Biesma R, Stekelenburg J, Kabue M. Protocol for a prospective mixed-methods longitudinal study to evaluate the dynamics of contraceptive use, discontinuation, and switching in Kenya. Reprod Health 2019; 16:134. [PMID: 31488170 PMCID: PMC6727395 DOI: 10.1186/s12978-019-0797-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background More women are accessing modern contraceptive use in Kenya, however, contraceptive discontinuation has stagnated over the decades. Any further increase in contraceptive use will most likely be from past users, hence understanding the dynamics of discontinuation while addressing quality of family planning services offered at health facilities and communities is critical for increasing the contraceptive prevalence rate and reducing the unmet need of family planning. The paper presents a study protocol that intends to evaluate the dynamics of contraceptive use, discontinuation, and switching among women of reproductive age initiating use of a contraceptive method. Methods This longitudinal mixed-methods study is being conducted in Migori and Kitui counties, Kenya. A formative assessment using Interviews with adolescents, older women, heterosexual couples, health care workers, and community health volunteers explored barriers to contraceptive continuation and perspectives on discontinuation utilizing a qualitative cross sectional study design. Following the formative assessment, a client-centered intervention focusing on improving quality of family planning services, including counseling, will be implemented in 10 health facilities. A 24-month prospective cohort study among women of reproductive age initiating contraception with follow-up at 3, 6, 12, and 24 months will then be undertaken to assess the discontinuation rates, examine the dynamics of contraceptive use, discontinuation and switching, and further explore barriers and enablers for contraceptive continuation and switching among the study population. Discussion In sub-Saharan Africa, contraceptive discontinuation studies have mainly been based on survey data that is collected retrospectively. By implementing a longitudinal mixed-methods study, we gain deeper insights into the contraceptive dynamics influencing the decision to continue, discontinue, and even switch following implementation of a client-centered intervention that enhances quality of care. Additionally, the study will shed more light on the profile of women discontinuing contractive use and further explore individual and couple-level dynamics influencing decision-making on continuation and discontinuation. The findings of this study will provide information that can be used to develop and implement human-centered interventions that focus on improving quality of family planning services and consequently improved continuation rates and overall satisfaction with method. Trial registration The study is registered with the Clinical Trials Registry, NCT03973593.
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Affiliation(s)
- Susan Ontiri
- Jhpiego Corporation, An affiliate of Johns Hopkins University, Nairobi, Kenya.
| | | | - Maxwell Muganda
- Jhpiego Corporation, An affiliate of Johns Hopkins University, Nairobi, Kenya
| | - Peter Mutanda
- Jhpiego Corporation, An affiliate of Johns Hopkins University, Nairobi, Kenya
| | - Carolyne Ajema
- Jhpiego Corporation, An affiliate of Johns Hopkins University, Nairobi, Kenya
| | - Stephen Okoth
- Jhpiego Corporation, An affiliate of Johns Hopkins University, Nairobi, Kenya
| | - Solomon Orero
- Jhpiego Corporation, An affiliate of Johns Hopkins University, Nairobi, Kenya
| | - Ruth Odhiambo
- Jhpiego Corporation, An affiliate of Johns Hopkins University, Nairobi, Kenya
| | - Regien Biesma
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Mark Kabue
- Jhpiego Corporation, An affiliate of Johns Hopkins University, Baltimore, MD, USA
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Ali M, Azmat SK, Hamza HB, Rahman MM, Hameed W. Are family planning vouchers effective in increasing use, improving equity and reaching the underserved? An evaluation of a voucher program in Pakistan. BMC Health Serv Res 2019; 19:200. [PMID: 30922318 PMCID: PMC6440079 DOI: 10.1186/s12913-019-4027-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 03/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Low modern contraceptive prevalence rate and high unmet need in Pakistan aggravates the vulnerabilities of unintended pregnancies and births contributing to maternal morbidity and mortality. This research aims to assess the effectiveness of a free, single-purpose voucher approach in increasing the uptake, use and better targeting of modern contraceptives among women from the lowest two wealth quintiles in rural and urban communities of Punjab province, Pakistan. Methods A quasi-interventional study with pre- and post-phases was implemented across an intervention (Chakwal) and a control district (Bhakkar) in Punjab province (August 2012–January 2015). To detect a 15% increase in modern contraceptive prevalence rate compared to baseline, 1276 women were enrolled in each arm. Difference-in-Differences (DID) estimates are reported for key variables, and concentration curves and index are described for equity. Results Compared to baseline, awareness of contraceptives increased by 30 percentage points among population in the intervention area. Vouchers also resulted in a net increase of 16% points in current contraceptive use and 26% points in modern methods use. The underserved population demonstrated better knowledge and utilized the modern methods more than their affluent counterparts. Intervention area also reported a low method-specific discontinuation (13.7%) and high method-specific switching rates (46.6%) amongst modern contraceptive users during the past 24 months. The concentration index indicated that voucher use was more common among the poor and vouchers seem to reduce the inequality in access to modern methods across wealth quintiles. Conclusion Vouchers can substantially expand contraceptive access and choice among the underserved populations. Vouchers are a good financing tool to improve equity, increase access, and quality of services for the underserved thus contributing towards achieving universal health coverage targets.
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Affiliation(s)
- Moazzam Ali
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland.
| | - Syed Khurram Azmat
- Division of Health Information Systems, Hospital for Sick Children, Toronto, Canada.,Department of Uro-gynecology, University of Ghent, Ghent, Belgium
| | - Hasan Bin Hamza
- Health Policy, System Strengthening and Information Analysis Unit, Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Md Mizanur Rahman
- Department of Global Health Policy, School of International Health, The University of Tokyo, Tokyo, Japan
| | - Waqas Hameed
- Department of Research, Monitoring and Evaluation, Marie Stopes Society, Karachi, Pakistan
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Pfitzer A, Maly C, Tappis H, Kabue M, Mackenzie D, Healy S, Srivastava V, Ndirangu G. Characteristics of successful integrated family planning and maternal and child health services: Findings from a mixed-method, descriptive evaluation. F1000Res 2019; 8:229. [PMID: 32047599 PMCID: PMC6993833 DOI: 10.12688/f1000research.17208.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Most postpartum women in low- and middle-income countries want to delay or avoid future pregnancies but are not using modern contraception. One promising strategy for increasing the use of postpartum family planning (PPFP) is integration with maternal, newborn and child health (MNCH) services. However, there is limited evidence on effective service integration strategies. We examine facilitators of and barriers to effective PPFP integration in MNCH services in Kenya and India. Methods: We conducted a cross-sectional, mixed-method study in two counties in Kenya and two states in India. Data collection included surveying 215 MNCH clients and surveying or interviewing 82 health care providers and managers in 15 health facilities across the four sites. We analyzed data from each country separately. First, we analyzed quantitative data to assess the extent to which PPFP was integrated within MNCH services at each facility. Then we analyzed qualitative data and synthesized findings from both data sources to identify characteristics of well and poorly integrated facilities. Results: PPFP integration success varied by service delivery area, health facility, and country. Issues influencing the extent of integration included availability of physical space for PPFP services, health workforce composition and capacity, family planning commodities availability, duration and nature of support provided. Conclusions: Although integration level varied between health facilities, factors enabling and hindering PPFP integration were similar in India and Kenya. Better measures are needed to verify whether services are integrated as prescribed by national policies.
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Affiliation(s)
- Anne Pfitzer
- Maternal and Child Survival Program, Jhpiego, Washington, DC, 20036, USA
| | | | | | | | - Devon Mackenzie
- Maternal and Child Survival Program, Jhpiego, Washington, DC, 20036, USA
| | - Sadie Healy
- Molloy Consultants, Cincinnati, OH, 45208, USA
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Grollman C, Cavallaro FL, Duclos D, Bakare V, Martínez Álvarez M, Borghi J. Donor funding for family planning: levels and trends between 2003 and 2013. Health Policy Plan 2018. [PMID: 29534176 PMCID: PMC5894079 DOI: 10.1093/heapol/czy006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The International Conference on Population and Development in 1994 set targets for donor funding to support family planning programmes, and recent initiatives such as FP2020 have renewed focus on the need for adequate funding to rights-based family planning. Disbursements supporting family planning disaggregated by donor, recipient country and year are not available for recent years. We estimate international donor funding for family planning in 2003–13, the period covering the introduction of reproductive health targets to the Millennium Development Goals and up to the beginning of FP2020, and compare funding to unmet need for family planning in recipient countries. We used the dataset of donor disbursements to support reproductive, maternal, newborn and child health developed by the Countdown to 2015 based on the Organization for Economic Cooperation and Development Creditor Reporting System. We assessed levels and trends in disbursements supporting family planning in the period 2003–13 and compared this to unmet need for family planning. Between 2003 and 2013, disbursements supporting family planning rose from under $400 m prior to 2008 to $886 m in 2013. More than two thirds of disbursements came from the USA. There was substantial year-on-year variation in disbursement value to some recipient countries. Disbursements have become more concentrated among recipient countries with higher national levels of unmet need for family planning. Annual disbursements of donor funding supporting family planning are far short of projected and estimated levels necessary to address unmet need for family planning. The reimposition of the US Global Gag Rule will precipitate an even greater shortfall if other donors and recipient countries do not find substantial alternative sources of funding.
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Affiliation(s)
- Christopher Grollman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Francesca L Cavallaro
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK and
| | - Diane Duclos
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK and
| | - Victoria Bakare
- School of Medicine, King's College London, Guy's Campus, Great Maze Pond, London SE1 9RT, UK
| | - Melisa Martínez Álvarez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Ajumobi O, Uhomoibhi P, Onyiah P, Babalola O, Sharafadeen S, Ughasoro MD, Adamu AMY, Odeyinka O, Orimogunje T, Maikore I, Shekarau E, Ogunwale A, Afolabi R, Udeh S, Ndubuisi A, Umoette N, Nguku P, Ajayi IO. Setting a Nigeria national malaria operational research agenda: the process. BMC Health Serv Res 2018; 18:459. [PMID: 29914453 PMCID: PMC6004659 DOI: 10.1186/s12913-018-3224-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Employing malaria operational research (MOR) findings in planning national malaria control programmes is gaining increased attention. The malaria control foci are diverse, resources are limited; therefore, agreeing on priority areas is critical. Hitherto, the process of prioritising MOR questions in Nigeria has been limited to few stakeholders. In support of the National Malaria Elimination Programme's (NMEP) effort at setting a MOR agenda, the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP) in collaboration with NMEP conducted preliminary exploratory study to identify key malaria research gaps and needs, and provide data to inform setting a robust national MOR agenda. The process of generating data is presented in this paper. METHODS A twelve-member task-team comprising NFELTP, university researchers and NMEP officers was commissioned. Following an inaugural meeting the task-team developed a framework of activities and held five planning meetings, conducted five-week online and self-administered paper-based surveys, key informant interview (KII), two-day desk review workshop, seven-day qualitative data analysis, ten-day result and five-day report writing workshops. Paired group members conducted the interviews across six geopolitical zones of Nigeria. Abridged study report was used for a two-day MOR setting agenda stakeholders' workshop. RESULTS A structured framework, study protocol and data collection instruments were developed and submitted for ethical approval. The instruments included survey questionnaire for detailed information on researchers and other stakeholders' experience with MOR, the gaps and needs in thematic MOR areas; KII and Delphi guides. After an initial scoping review, primary data were collected from purposively selected survey participants using mixed methods: - online survey (n = 100), self-administered paper-based survey (n = 85), KII (n = 40), desk review workshop (n = 22) and Delphi interviews (n = 8). Comprehensive lists of research gaps/bottlenecks and needs were generated for each thematic area in malaria control. These were used at a two-day national MOR setting stakeholder workshop (n = 54) to guide the development of national MOR agenda document. CONCLUSIONS A systematic approach involving broad stakeholder engagement provided data and evidence-based information for development of a robust national MOR agenda. The processes involved are recommended for use in malaria endemic settings.
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Affiliation(s)
- Olufemi Ajumobi
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria. .,African Field Epidemiology Network, Abuja, Nigeria.
| | | | - Pamela Onyiah
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Obafemi Babalola
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Salami Sharafadeen
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Maduka D Ughasoro
- Department of Paediatrics, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Al-Mukhtar Y Adamu
- Department of Medical Microbiology and Parasitology, Faculty of Clinical Sciences, Bayero University, Kano, Nigeria
| | - Oluwaseun Odeyinka
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | | | - Akintayo Ogunwale
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of General Studies, Oyo State College of Agriculture and Technology, Igboora, Oyo State, Nigeria
| | - Rotimi Afolabi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Sylvester Udeh
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Akpuh Ndubuisi
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Ntiense Umoette
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Patrick Nguku
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,African Field Epidemiology Network, Abuja, Nigeria
| | - IkeOluwapo O Ajayi
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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13
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Mackenzie D, Pfitzer A, Maly C, Waka C, Singh G, Sanyal A. Postpartum family planning integration with maternal, newborn and child health services: a cross-sectional analysis of client flow patterns in India and Kenya. BMJ Open 2018; 8:e018580. [PMID: 29615443 PMCID: PMC5892750 DOI: 10.1136/bmjopen-2017-018580] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Maternal, newborn and child health (MNCH) services represent opportunities to integrate postpartum family planning (PPFP). Objectives were to determine levels of MNCH-family planning (FP) integration and associations between integration, client characteristics and service delivery factors in facilities that received programmatic PPFP support. DESIGN AND SETTING Cross-sectional client flow assessment conducted during May-July 2014, over 5 days at 10 purposively selected public sector facilities in India (4 hospitals) and Kenya (2 hospitals and 4 health centres). PARTICIPANTS 2158 client visits tracked (1294 India; 864 Kenya). Women aged 18 or older accessing services while pregnant and/or with a child under 2 years. INTERVENTIONS PPFP/postpartum intrauterine device-Bihar, India (2012-2013); Jharkhand, India (2009-2014); Embu, Kenya (2006-2010). Maternal, infant and young child nutrition/FP integration-Bondo, Kenya (2011-2014). PRIMARY OUTCOME MEASURES Proportion of visits where clients received integrated MNCH-FP services, client characteristics as predictors of MNCH-FP integration and MNCH-FP integration as predictor of length of time spent at facility. RESULTS Levels of MNCH-FP integration varied widely across facilities (5.3% to 63.0%), as did proportion of clients receiving MNCH-FP integrated services by service area. Clients travelling 30-59 min were half as likely to receive integrated services versus those travelling under 30 min (OR 0.5, 95% CI 0.4 to 0.7, P<0.001). Clients receiving MNCH-FP services (vs MNCH services only) spent an average of 10.5 min longer at the facility (95% CI -0.1 to 21.9, not statistically significant). CONCLUSIONS Findings suggest importance of focused programmatic support for integration by MNCH service area. FP integration was highest in areas receiving specific support. Integration does not seem to impose an undue burden on clients in terms of time spent at the facility. Clients living furthest from facilities are least likely to receive integrated services.
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Affiliation(s)
- Devon Mackenzie
- Jhpiego/Maternal and Child Survival Program, Washington, DC, USA
| | - Anne Pfitzer
- Jhpiego/Maternal and Child Survival Program, Washington, DC, USA
| | | | | | | | - Abanti Sanyal
- Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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14
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Reiss K, Penfold S, Alabi O, Ali M, Hopkins K, Ngo TD, Odogwu K, Douthwaite M, Ezire O, Udoh U, Effiom E, Munroe ES. Safety, Quality, and Acceptability of Contraceptive Subdermal Implant Provision by Community Health Extension Workers Versus Nurses and Midwives in Nigeria: Protocol for a Quasi-Experimental, Noninferiority Study. JMIR Res Protoc 2018; 7:e67. [PMID: 29500162 PMCID: PMC5856922 DOI: 10.2196/resprot.8721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background As part of its Family Planning 2020 commitment, the Nigerian government is aiming for a contraceptive prevalence rate of 36% by 2018, and in 2014, approved a policy to allow community health extension workers (CHEWs), in addition to doctors, nurses, and midwives, to provide contraceptive subdermal implants. There is a lack of rigorous evidence on the safety of long-acting reversible contraceptive provision, such as implants, among lower cadres of health providers. Objective This study aimed to compare implant provision by CHEWs versus nurses and midwives up to 14 days post insertion. Methods The quasi-experimental, noninferiority study will take place in public sector facilities in Kaduna and Ondo States. In each state, we will select 60 facilities, and from these, we will select a total of 30 nurses and midwives and 30 CHEWs to participate. Selected providers will be trained to provide implant services. Once trained, providers will recruit a minimum of 8125 women aged between 18 and 49 years who request and are eligible for an implant, following comprehensive family planning counseling. During implant insertion, providers will record data about the process and any adverse events, and 14 days post insertion, providers will ask 4410 clients about adverse events arising from the implant. Supervisors will observe 792 implant insertions to assess service provision quality and ask clients about their satisfaction with the procedure. We will conclude noninferiority if the CI for the difference in the proportion of adverse events between CHEWs and nurses and midwives on the day of insertion or 14 days post insertion lies to the right of −2%. Results In September and October 2015, we trained 60 CHEWs and a total of 60 nurses and midwives from 12 local government areas (LGAs) in Kaduna and 23 LGAs in Ondo. Recruitment took place between November 2015 and December 2016. Data analysis is being finalized, and results are expected in March 2018. Conclusions The strength of this study is having a standard care (nurse and midwife provision) group with which CHEW provision can be compared. The intervention builds on existing training and supervision procedures, which increases the sustainability and scalability of CHEW implant provision. Important limitations include the lack of randomization due to nurses and midwives in Nigeria working in separate types of health care facilities compared with CHEWs, and that providers self-assess their own practices. It is unfeasible to observe all procedures independently, and observation may change practice. Although providers will be trained to conduct implant removals, the study time will be too short to reach the sample size required to make noninferiority comparisons for removals. Trial Registration ClinicalTrials.gov NCT03088722; https://clinicaltrials.gov/ct2/show/NCT03088722 (Archived by WebCite at http://www.webcitation.org/6xIHImWvu)
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Affiliation(s)
- Kate Reiss
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Evidence to Action Team, Technical Services Department, Marie Stopes International, London, United Kingdom
| | - Suzanne Penfold
- Evidence to Action Team, Technical Services Department, Marie Stopes International, London, United Kingdom
| | | | - Moazzam Ali
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Thoai Dinh Ngo
- Poverty, Gender and Youth Programme, Population Council, New York, NY, United States
| | | | - Megan Douthwaite
- Evidence to Action Team, Technical Services Department, Marie Stopes International, London, United Kingdom
| | | | - Uko Udoh
- Department of Health Planning, Research and Statistics, Federal Ministry of Health, Abuja, Nigeria
| | | | - Erik S Munroe
- Evidence to Action Team, Technical Services Department, Marie Stopes International, London, United Kingdom
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15
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Kapiriri L, Chanda-Kapata P. The quest for a framework for sustainable and institutionalised priority-setting for health research in a low-resource setting: the case of Zambia. Health Res Policy Syst 2018; 16:11. [PMID: 29452602 PMCID: PMC5816391 DOI: 10.1186/s12961-017-0268-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 11/21/2017] [Indexed: 11/17/2022] Open
Abstract
Background Priority-setting for health research in low-income countries remains a major challenge. While there have been efforts to systematise and improve the processes, most of the initiatives have ended up being a one-off exercise and are yet to be institutionalised. This could, in part, be attributed to the limited capacity for the priority-setting institutions to identify and fund their own research priorities, since most of the priority-setting initiatives are driven by experts. This paper reports findings from a pilot project whose aim was to develop a systematic process to identify components of a locally desirable and feasible health research priority-setting approach and to contribute to capacity strengthening for the Zambia National Health Research Authority. Methods Synthesis of the current literature on the approaches to health research prioritisations. The results of the synthesis were presented and discussed with a sample of Zambian researchers and decision-makers who are involved in health research priority-setting. The ultimate aim was for them to explore the different approaches available for guiding health research priority-setting and to identify an approach that would be relevant and feasible to implement and sustain within the Zambian context. Results Based on the evidence that was presented, the participants were unable to identify one approach that met the criteria. They identified attributes from the different approaches that they thought would be most appropriate and proposed a process that they deemed feasible within the Zambian context. Conclusion While it is easier to implement prioritisation based on one approach that the initiator might be interested in, researchers interested in capacity-building for health research priority-setting organisations should expose the low-income country participants to all approaches. Researchers ought to be aware that sometimes one shoe may not fit all, as in the case of Zambia, instead of choosing one approach, the stakeholders may select desirable attributes from the different approaches and piece together an approach that would be feasible and acceptable within their context. An approach that builds on the decision-makers’ understanding of their contexts and their input to its development would foster local ownership and has a greater potential for sustainability. Electronic supplementary material The online version of this article (10.1186/s12961-017-0268-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health and Aging, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada.
| | - Pascalina Chanda-Kapata
- Department of Diseases Surveillance Control and Research, Ministry of Health, Lusaka, Zambia
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16
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Riley C, Garfinkel D, Thanel K, Esch K, Workalemahu E, Anyanti J, Mpanya G, Binanga A, Pope J, Longfield K, Bertrand J, Shaw B. Getting to FP2020: Harnessing the private sector to increase modern contraceptive access and choice in Ethiopia, Nigeria, and DRC. PLoS One 2018; 13:e0192522. [PMID: 29444140 PMCID: PMC5812628 DOI: 10.1371/journal.pone.0192522] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/16/2018] [Indexed: 12/03/2022] Open
Abstract
Background An estimated 214 million women have unmet need for family planning in developing regions. Improved utilization of the private sector is key to achieving universal access to a range of safe and effective modern contraceptive methods stipulated by FP2020 and SDG commitments. Until now, a lack of market data has limited understanding of the private sector’s role in increasing contraceptive coverage and choice. Methods In 2015, the FPwatch Project conducted representative outlet surveys in Ethiopia, Nigeria, and DRC using a full census approach in selected administrative areas. Every public and private sector outlet with the potential to sell or distribute modern contraceptives was approached. In outlets with modern contraceptives, product audits and provider interviews assessed contraceptive market composition, availability, and price. Findings Excluding general retailers, 96% of potential outlets in Ethiopia, 55% in Nigeria, and 41% in DRC had modern contraceptive methods available. In Ethiopia, 41% of modern contraceptive stocking outlets were in the private sector compared with approximately 80% in Nigeria and DRC where drug shops were dominant. Ninety-five percent of private sector outlets in Ethiopia had modern contraceptive methods available; 37% had three or more methods. In Nigeria and DRC, only 54% and 42% of private sector outlets stocked modern contraceptives with 5% and 4% stocking three or more methods, respectively. High prices in Nigeria and DRC create barriers to consumer access and choice. Discussion There is a missed opportunity to provide modern contraception through the private sector, particularly drug shops. Subsidies and interventions, like social marketing and social franchising, could leverage the private sector’s role in increasing access to a range of contraceptives. Achieving global FP2020 commitments depends on the expansion of national contraceptive policies that promote greater partnership and cooperation with the private sector and improvement of decisions around funding streams of countries with large populations and high unmet need like Ethiopia, Nigeria, and DRC.
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Affiliation(s)
- Christina Riley
- Population Services International, Washington, D.C., United States of America
- * E-mail:
| | - Danielle Garfinkel
- Population Services International, Washington, D.C., United States of America
| | - Katherine Thanel
- Population Services International, Washington, D.C., United States of America
| | - Keith Esch
- Population Services International, Washington, D.C., United States of America
| | | | | | - Godéfroid Mpanya
- Association de Santé Familiale, Kinshasa, Democratic Republic of Congo
| | - Arsène Binanga
- Tulane International, Kinshasa, Democratic Republic of Congo
| | - Jen Pope
- Population Services International, Washington, D.C., United States of America
| | - Kim Longfield
- Independent consultant, Washington, D.C., United States of America
| | - Jane Bertrand
- Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
| | - Bryan Shaw
- Institute for Reproductive Health, Georgetown University, Washington, D.C., United States of America
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Lissner CL, Ali M. Systematic Reviews of Mechanisms for Financing Family Planning: Findings, Implications, and Future Agenda. Stud Fam Plann 2018; 47:295-308. [PMID: 27925673 DOI: 10.1111/sifp.12008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The article describes an international collaboration that systematically reviewed the evidence on financing mechanisms for family planning/contraception, assessed the strength of and summarized the evidence, identified research gaps, and proposed a new research agenda to address the gaps. The review found that the evidence base is weak owing to the paucity of studies, diversity in findings, and variations in intervention, study design, and outcome measures. Of more than 17,000 papers reviewed only 38 met the eligibility criteria. A number of general recommendations on the directions and areas of future research can be drawn. There is a strong need for more robust study designs on the effectiveness of financial incentives in family planning.
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Affiliation(s)
- Craig L Lissner
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization (WHO), Geneva
| | - Moazzam Ali
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization (WHO), Geneva
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18
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Improving family planning services delivery and uptake: experiences from the "Reversing the Stall in Fertility Decline in Western Kenya Project". BMC Res Notes 2017; 10:498. [PMID: 29017550 PMCID: PMC5634860 DOI: 10.1186/s13104-017-2821-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 09/30/2017] [Indexed: 11/23/2022] Open
Abstract
Objective In this paper, we reflect on our experiences of implementing a multipronged intervention to improve sexual and reproductive health outcomes. The project used family planning as its entry point and was implemented in two high fertility counties—Busia and Siaya in Kenya. The intervention, implemented by a seven-member consortium, involved: family planning services delivery; regular training of service providers to deliver high quality services; monitoring and evaluation; strengthening of commodity chain delivery and forecasting; school-based and out-of-school based sexuality education; and advocacy and stakeholder engagements at the community, county and national levels. Results Over a 5-year period, the project contributed to raising demand for family planning considerably, evidenced in fertility decline. It also improved the capacity of family planning services providers, increased commitment and awareness of county government and other community stakeholders on the importance of investments in family planning. Our collaborations with organisations interested in sexual and reproductive health issues substantially enhanced the consortium’s ability to increase demand for, and supply of family planning commodities. These collaborations are proving useful in the continuity and sustainability of project achievements. Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2821-4) contains supplementary material, which is available to authorized users.
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Sharma R, Buccioni M, Gaffey MF, Mansoor O, Scott H, Bhutta ZA. Setting an implementation research agenda for Canadian investments in global maternal, newborn, child and adolescent health: a research prioritization exercise. CMAJ Open 2017; 5:E82-E89. [PMID: 28401123 PMCID: PMC5378526 DOI: 10.9778/cmajo.20160088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Improving global maternal, newborn, child and adolescent health (MNCAH) is a top development priority in Canada, as shown by the $6.35 billion in pledges toward the Muskoka Initiative since 2010. To guide Canadian research investments, we aimed to systematically identify a set of implementation research priorities for MNCAH in low- and middle-income countries. METHODS We adapted the Child Health and Nutrition Research Initiative method. We scanned the Child Health and Nutrition Research Initiative literature and extracted research questions pertaining to delivery of interventions, inviting Canadian experts on MNCAH to generate additional questions. The experts scored a combined list of 97 questions against 5 criteria: answerability, feasibility, deliverability, impact and effect on equity. These questions were ranked using a research priority score, and the average expert agreement score was calculated for each question. RESULTS The overall research priority score ranged from 40.14 to 89.25, with a median of 71.84. The average expert agreement scores ranged from 0.51 to 0.82, with a median of 0.64. Highly-ranked research questions varied across the life course and focused on improving detection and care-seeking for childhood illnesses, overcoming barriers to intervention uptake and delivery, effectively implementing human resources and mobile technology, and increasing coverage among at-risk populations. Children were the most represented target population and most questions pertained to interventions delivered at the household or community level. INTERPRETATION Investing in implementation research is critical to achieving the Sustainable Development Goal of ensuring health and well-being for all. The proposed research agenda is expected to drive action and Canadian research investments to improve MNCAH.
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Affiliation(s)
- Renee Sharma
- Centre for Global Child Health (Sharma, Buccioni, Gaffey, Mansoor, Bhutta), The Hospital for Sick Children, Toronto, Ont.; Canadian Partnership for Women and Children's Health (Scott), Ottawa, Ont
| | - Matthew Buccioni
- Centre for Global Child Health (Sharma, Buccioni, Gaffey, Mansoor, Bhutta), The Hospital for Sick Children, Toronto, Ont.; Canadian Partnership for Women and Children's Health (Scott), Ottawa, Ont
| | - Michelle F Gaffey
- Centre for Global Child Health (Sharma, Buccioni, Gaffey, Mansoor, Bhutta), The Hospital for Sick Children, Toronto, Ont.; Canadian Partnership for Women and Children's Health (Scott), Ottawa, Ont
| | - Omair Mansoor
- Centre for Global Child Health (Sharma, Buccioni, Gaffey, Mansoor, Bhutta), The Hospital for Sick Children, Toronto, Ont.; Canadian Partnership for Women and Children's Health (Scott), Ottawa, Ont
| | - Helen Scott
- Centre for Global Child Health (Sharma, Buccioni, Gaffey, Mansoor, Bhutta), The Hospital for Sick Children, Toronto, Ont.; Canadian Partnership for Women and Children's Health (Scott), Ottawa, Ont
| | - Zulfiqar A Bhutta
- Centre for Global Child Health (Sharma, Buccioni, Gaffey, Mansoor, Bhutta), The Hospital for Sick Children, Toronto, Ont.; Canadian Partnership for Women and Children's Health (Scott), Ottawa, Ont
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Khan ME, Hazra A, Kant A, Ali M. Conditional and Unconditional Cash Transfers to Improve Use of Contraception in Low and Middle Income Countries: A Systematic Review. Stud Fam Plann 2016; 47:371-383. [PMID: 27859327 PMCID: PMC5434941 DOI: 10.1111/sifp.12004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This systematic review synthesizes evidence on the impact of conditional and unconditional cash transfers (CCT and UCT) on contraception in low- and middle-income countries. Scientific and gray literature databases were searched from 1994 to 2016 and 11 papers from ten studies were included. Most of the studies had low risk of bias. Cash transfers were used for increasing school attendance or improving health and nutrition, but not directly for contraception. Three studies showed positive impact on contraceptive use and four showed a decrease in fertility outcomes. An increase in childbearing was observed in two studies, and three studies demonstrated no impact on fertility indicators. All studies treated contraceptive use or fertility only as unintended and indirect outcomes. The available evidence on impact of CCT and UCT on contraception is inconclusive due to the limited number of studies, varying outcome measures, and lack of intervention specifically for contraception.
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22
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Campbell OMR, Benova L, Macleod D, Goodman C, Footman K, Pereira AL, Lynch CA. Who, What, Where: an analysis of private sector family planning provision in 57 low- and middle-income countries. Trop Med Int Health 2015; 20:1639-56. [PMID: 26412363 DOI: 10.1111/tmi.12597] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Family planning service delivery has been neglected; rigorous analyses of the patterns of contraceptive provision are needed to inform strategies to address this neglect. METHODS We used 57 nationally representative Demographic and Health Surveys in low- and middle-income countries (2000-2013) in four geographic regions to estimate need for contraceptive services, and examined the sector of provision, by women's socio-economic position. We also assessed method mix and whether women were informed of side effects. RESULTS Modern contraceptive use among women in need was lowest in sub-Saharan Africa (39%), with other regions ranging from 64% to 72%. The private sector share of the family planning market was 37-39% of users across the regions and 37% overall (median across countries: 41%). Private sector users accessed medical providers (range across regions: 30-60%, overall mean: 54% and median across countries 23%), specialised drug sellers (range across regions: 31-52%, overall mean: 36% and median across countries: 43%) and retailers (range across regions: 3-14%, overall mean: 6% and median across countries: 6%). Private retailers played a more important role in sub-Saharan Africa (14%) than in other regions (3-5%). NGOs and FBOs served a small percentage. Privileged women (richest wealth quintile, urban residents or secondary-/tertiary-level education) used private sector services more than the less privileged. Contraceptive method types with higher requirements (medical skills) for provision were less likely to be acquired from the private sector, while short-acting methods/injectables were more likely. The percentages of women informed of side effects varied by method and provider subtype, but within subtypes were higher among public than private medical providers for four of five methods assessed. CONCLUSION Given the importance of private sector providers, we need to understand why women choose their services, what quality services the private sector provides, and how it can be improved. However, when prioritising one of the two sectors (public vs. private), it is critical to consider the potential impact on contraceptive prevalence and equity of met need.
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Affiliation(s)
- Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David Macleod
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine Goodman
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Katharine Footman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Caroline A Lynch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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23
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Zerden ML, Tang JH, Stuart GS, Norton DR, Verbiest SB, Brody S. Barriers to Receiving Long-acting Reversible Contraception in the Postpartum Period. Womens Health Issues 2015. [PMID: 26212318 DOI: 10.1016/j.whi.2015.06.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess why postpartum women who desired long-acting reversible contraception (LARC) did not receive it in the postpartum period and to assess which contraceptive methods they were using instead. STUDY DESIGN This was a subgroup analysis of 324 women enrolled in a randomized, controlled trial to receive or not receive an educational LARC script during their postpartum hospitalization. Participants in this subgroup analysis stated that they were either using LARC (n = 114) or interested in using LARC (n = 210) during a follow-up survey completed after their scheduled 6-week postpartum visit. Modified Poisson regression analysis was used to assess for characteristics associated with using LARC by the time of the follow-up survey. RESULTS Women who were interested in LARC but not using it were more likely to be multiparous (relative risk [RR], 1.59; 95% CI, 1.19-2.11) and to have missed their postpartum visit (RR, 25.88; 95% CI, 3.75-178.44) compared with those using LARC. Among the interested 210 who were not using LARC, the most common reasons provided for non-use were that they were told to come back for another insertion visit (45%), missed the postpartum visit (26%), and could not afford LARC (11%). The most common contraceptive methods used instead of LARC were barrier methods (42%) and abstinence (19%); 18% used no contraceptive method. CONCLUSION Two-thirds (65%) of postpartum women who desired to use LARC did not receive it in the postpartum period and used less effective contraceptive methods. Increasing access to immediate postpartum LARC and eliminating two-visit protocols for LARC insertion may increase postpartum LARC use. As the Affordable Care Act moves toward full implementation, it is necessary to understand the barriers that prevent interested patients from receiving LARC.
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Affiliation(s)
- Matthew L Zerden
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology, WakeMed Health and Hospitals, Raleigh, North Carolina.
| | - Jennifer H Tang
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Gretchen S Stuart
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Sarah B Verbiest
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Seth Brody
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology, WakeMed Health and Hospitals, Raleigh, North Carolina
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24
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Azmat SK, Hameed W, Ali M, Ishaque M, Mustafa G, Khan OF, Abbas G, Munroe E. Comparing effectiveness of two client follow-up approaches in sustaining the use of Long Acting Reversible Contraceptives (LARC) among the underserved in rural Punjab, Pakistan: a study protocol and participants' profile. Reprod Health 2015; 12:9. [PMID: 25971781 PMCID: PMC4429346 DOI: 10.1186/1742-4755-12-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/15/2014] [Indexed: 11/29/2022] Open
Abstract
Background Pakistan observes a very high i.e. 37 percent modern contraceptive method related discontinuation rates within 12 months of their initiation. And almost 10 percent of these episodes of discontinuation happened due to the side effects or health concerns experienced by the women. Most importantly, it was noted that more than 12,000 first-level care facilities are located in the rural areas, including rural health centers, basic health units, and family welfare centers, but more than 30% of these facilities are nonfunctional. This paper presents a study protocol and participants’ profiling of a prospective cohort follow-up to compare the effectiveness of household based and telephonic approaches in sustaining the use of Long Acting Reversible Contraceptives (LARC) whilst to facilitate lowering method related discontinuation and increasing switching amongst the contraceptive users. Methods A 12-month multi-centre, non-inferiority prospective user follow-up is employed using three different study categories: a) household based follow-up; b) telephonic follow-up; and c) passive or need-based follow-up along with the hypothetical assumption that the telephonic client follow-up is not inferior to the household based follow-up by continuation rate of LARC and the telephonic follow-up is less-costly than the household based client follow-up. This follow-up will be conducted in 22 health facilities – (16 rural and 6 urban based facilities) in district Chakwal. The first two study categories will receive scheduled but different follow-up from the field workers at 1, 3, 6, 9, and 12 month while the third one i.e. the ‘passive or need-based follow-up’ will serve as a control group. Using sampling software PASS 11, it was estimated to have 414 clients in each study category and around 1366 clients will be recruited to account for 10% attrition rate. Discussion The study will help us to examine a more convenient method of effective follow-up for managing side effects, decreasing method discontinuation and increasing switching amongst users. The study information will also facilitate to develop a robust, effective and efficient mechanism for client follow-up to promote the continuation rates of LARC methods. The follow-up results and lessons learnt will be widely shared with stakeholders for their implementation and streamlining in health system.
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Affiliation(s)
- Syed Khurram Azmat
- Department of Uro-gynecology, Ghent University, Sint-Pietersnieuwstraat 25, B-9000, Ghent, Belgium. .,Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan.
| | - Waqas Hameed
- Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan.
| | - Moazzam Ali
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, 1211, Geneva 27, Switzerland.
| | - Muhammad Ishaque
- Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan.
| | - Ghulam Mustafa
- Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan.
| | - Omar Farooq Khan
- Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan.
| | - Ghazunfer Abbas
- Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan.
| | - Erik Munroe
- Research, Monitoring and Evaluation Department, Marie Stopes International, London, UK.
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Speizer IS, Corroon M, Calhoun L, Lance P, Montana L, Nanda P, Guilkey D. Demand generation activities and modern contraceptive use in urban areas of four countries: a longitudinal evaluation. GLOBAL HEALTH: SCIENCE AND PRACTICE 2014; 2:410-26. [PMID: 25611476 PMCID: PMC4307858 DOI: 10.9745/ghsp-d-14-00109] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Demand generation activities that were significantly associated with increased use of modern contraception in India (Uttar Pradesh), Kenya, Nigeria, and Senegal included: (1) community outreach activities, such as home visits and group discussions about family planning; (2) local radio programs; and (3) branded slogans and print materials circulated widely across the city. Television programming was also significant in India and Nigeria. Exposure to more activities may increase women's likelihood of using contraception. Family planning is crucial for preventing unintended pregnancies and for improving maternal and child health and well-being. In urban areas where there are large inequities in family planning use, particularly among the urban poor, programs are needed to increase access to and use of contraception among those most in need. This paper presents the midterm evaluation findings of the Urban Reproductive Health Initiative (Urban RH Initiative) programs, funded by the Bill & Melinda Gates Foundation, that are being implemented in 4 countries: India (Uttar Pradesh), Kenya, Nigeria, and Senegal. Between 2010 and 2013, the Measurement, Learning & Evaluation (MLE) project collected baseline and 2-year longitudinal follow-up data from women in target study cities to examine the role of demand generation activities undertaken as part of the Urban RH Initiative programs. Evaluation results demonstrate that, in each country where it was measured, outreach by community health or family planning workers as well as local radio programs were significantly associated with increased use of modern contraceptive methods. In addition, in India and Nigeria, television programs had a significant effect on modern contraceptive use, and in Kenya and Nigeria, the program slogans and materials that were blanketed across the cities (eg, leaflets/brochures distributed at health clinics and the program logo placed on all forms of materials, from market umbrellas to health facility signs and television programs) were also significantly associated with modern method use. Our results show that targeted, multilevel demand generation activities can make an important contribution to increasing modern contraceptive use in urban areas and could impact Millennium Development Goals for improved maternal and child health and access to reproductive health for all.
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Affiliation(s)
- Ilene S Speizer
- The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Maternal and Child Health, Chapel Hill, NC, USA The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
| | - Meghan Corroon
- The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
| | - Lisa Calhoun
- The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
| | - Peter Lance
- The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
| | - Livia Montana
- Harvard University Center for Population and Development Studies, Cambridge, MA, USA
| | - Priya Nanda
- International Center for Research on Women, Asia Regional Office, Delhi, India
| | - David Guilkey
- The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA The University of North Carolina at Chapel Hill, Department of Economics, Chapel Hill, NC, USA
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26
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Rogers C, Earnest J. Sexual and reproductive health communication among Sudanese and Eritrean women: an exploratory study from Brisbane, Australia. CULTURE, HEALTH & SEXUALITY 2014; 17:223-36. [PMID: 25346993 DOI: 10.1080/13691058.2014.967302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This exploratory study piloted in Brisbane, Australia, reports on findings from in-depth focus-group discussions conducted with Sudanese and Eritrean women in Brisbane. We investigated and documented their experiences and knowledge of sexual and reproductive health and contraception, and explored their views on sexuality and relationships education within the family environment of minority ethnic communities in Australia. Underpinned by a qualitative psychosocial framework, the study also involved key-informant interviews with health and multicultural not-for-profit sector professionals. Through the knowledge and experiences shared by the participants, the key themes of cultural insensitivity, exclusion and poor communication within the family were highlighted by participants as determining factors in the achievement of sexual and reproductive health and good quality sex and relationships education. Participants proposed recommendations for how minority ethnic communities in Australia can more effectively support and communicate within the family environment to increase their own and their children's knowledge and understanding.
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Affiliation(s)
- Claire Rogers
- a International Health Program, Curtin University , Perth , Australia
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27
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Gaffield ME, Egan S, Temmerman M. It's about time: WHO and partners release programming strategies for postpartum family planning. GLOBAL HEALTH: SCIENCE AND PRACTICE 2014; 2:4-9. [PMID: 25276558 PMCID: PMC4168603 DOI: 10.9745/ghsp-d-13-00156] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 12/31/2013] [Indexed: 12/04/2022]
Abstract
The postpartum period is a critical time to address high unmet family planning need and to reduce the risks of closely spaced pregnancies. Practical tools are included in the new resource for integrating postpartum family planning at points when women have frequent health system contact, including during antenatal care, labor and delivery, postnatal care, immunization, and child health care.
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Affiliation(s)
| | - Shannon Egan
- Jhpiego, Maternal and Child Health Integrated Program (MCHIP) , Washington, DC , USA
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