1.  Peer Reviewed Title: PMTCT, HAART, and childbearing in Mozambique: an institutional perspective. Author: Agadjanian V; Hayford SR Source: AIDS and Behavior. 2009 Jun;13(Suppl 1):S103-S112. Abstract: Maternal and Child Health (MCH) units, where VCT/PMTCT/HAART have been integrated with traditional services, play a critical role in the connection between the massive HAART rollout and reproductive behavior. In this article, we use data from semi-structured interviews with MCH workers and ethnographic observations carried out in southern Mozambique to explore this role from the institutional perspective. We find that, along with logistical and workload problems, the de facto segregation of PMTCT/HAART clients within the “integrated” MCH system and the simplistic and uncompromising message discouraging further fertility and stressing condom-based contraception may pose serious challenges to a successful formulation and implementation of reproductive goals among seropositive clients. Although the recency of PMTCT/HAART services may partly explain these challenges, we argue that they are due largely to cultural miscommunication between providers and clients. We show how the cultural gap between the two is bridged by community activists and peer interactions among clients. Language: English Keywords: MOZAMBIQUE | RESEARCH REPORT | HEALTH PERSONNEL | SUPPORT GROUPS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | ANTIRETROVIRAL THERAPY | VOLUNTARY COUNSELING AND TESTING | MATERNAL-CHILD HEALTH SERVICES | INTEGRATED PROGRAMS | HEALTH SERVICES ADMINISTRATION | INTERVIEWS | FERTILITY PREFERENCES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Delivery of Health Care | Health | Social Networks | Friends and Relatives | Family and Household | Sociocultural Factors | Disease Transmission Control | Prevention and Control | Diseases | HIV | HIV Infections | Viral Diseases | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Primary Health Care | Programs | Organization and Administration | Management | Data Collection | Research Methodology | Fertility | Population Dynamics | Demographic Factors | Population Document Number: 341906 |
2.  Title: A comparative analysis of select health facility survey methods applied in low and middle income countries. Author: Edward A; Matsubiyashi T; Fapohunda B; Becker S Source: Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, 2009 Jul. 47 p. (MEASURE Evaluation Working Paper Series WP-09-111USAID Cooperative Agreement No. GHA-A-00-08-00003-00) Abstract: A majority of health systems in developing countries have severe limitations in the technical expertise and research capacity needed to perform independent assessments. Most are heavily reliant on donor support and engage other institutions and academia to undertake these surveys. Hence, it is important to examine the perspectives of the implementers to determine the management utility and plans for future sustainability. A key informant interview guide was developed for interviews with policy planners, implementing agencies, and health providers to examine their perspectives on the management utility of selected approaches. Key informants were interviewed, including policy planners, project directors, systems supervisors / coordinators, and enumerators, and the findings are presented later in this paper. A comparison of the approach to health facility assessment in the specific methods appears next. Based on the results of the review and key informant interviews, this paper discusses the comparative advantage and limitation of HF surveys and their management utility. (Excerpt) Language: English Keywords: DEVELOPING COUNTRIES | TECHNICAL REPORT | COMPARATIVE STUDIES | SURVEY METHODOLOGY | HEALTH FACILITIES | HEALTH SERVICES EVALUATION | QUALITY OF HEALTH CARE | PROGRAM EFFECTIVENESS | INTERVIEWS | HEALTH SERVICES ADMINISTRATION | DECISION MAKING | Studies | Research Methodology | Surveys | Sampling Studies | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Data Collection | Management | Behavior Document Number: 331840 |
| 3. Title: A learning agenda. Author: Eichler R; Levine R Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :79-86. Abstract: What elements of performance incentive programs lead to success? What pitfalls can be avoided? When do performance-based programs generate more bang for the buck than other approaches? What tools are needed to help governments and nongovernmental organizations (NGOs) put performance-based financing in place? Moving beyond the monitoring and evaluation that should be a part of any performance-based program (chapter 4), here we propose an agenda for learning that extends beyond any individual country or program. It is about developing knowledge and tools that can be used widely, rigorously measuring and understanding what works across settings, and creating an ongoing way to share and learn among those who are implementing and studying performance-based programs. (Excerpt) Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | HEALTH PERSONNEL | NEEDS ASSESSMENT | WAGES | HEALTH SERVICES | EVALUATION | HEALTH SERVICES ADMINISTRATION | Delivery of Health Care | Health | Macroeconomic Factors | Economic Factors | Management | Organization and Administration Document Number: 331464 |
| 4. Title: Making payment for performance work. Author: Eichler R; Levine R Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :51-78. Abstract: Here we discuss key issues to consider when designing and the steps to implementing a performance incentives program. Among our examples are those that went wrong as well as those that went right, because valuable lessons can be learned from each. While some of the issues may seem complicated, it is not necessary to get all the details right at the outset: refinements can and should be introduced along the way. Fundamentally different from many traditional approaches to improving the delivery of health services, performance incentives are about establishing what the results should be and then letting the key actors -- the patients, the providers -- figure out how to achieve them. Along the way, learning and fine-tuning are part and parcel of the process. (Excerpt) Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | PERFORMANCE IMPROVEMENT | INCENTIVES | HEALTH SERVICES | QUALITY OF HEALTH CARE | WAGES | DELIVERY OF HEALTH CARE | MONITORING | EVALUATION | HEALTH SERVICES ADMINISTRATION | Management | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Health | Health Services Evaluation | Program Evaluation | Programs | Macroeconomic Factors | Economic Factors Document Number: 331463 |
| 5. Title: Using performance incentives. Author: Eichler R; Levine R Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :23-50. Abstract: When the goal is to reduce needless death and disease, and part of what is getting in the way is a misalignment between health goals and the real-world behaviors of individual patients, health workers, and those who influence them, it may be time to consider performance incentives. These can complement other interventions, such as providing training, revamping infrastructure, and improving the supply of drugs and other inputs. Here we look at how performance incentives can contribute to better health results, increased use of services, enhanced quality, and improved efficiency. To identify the experiences to highlight in this book, we searched the published literature, consulted experts, and included regional and national cases with substantial documented evidence. The evidence discussed here and in the case summaries in part 2 relies on both evaluations conducted with varying degrees of rigor and other sources of information. It comes from qualitative surveys, baseline and endline statistics, contrasts between intervention and comparison groups, and routine program monitoring. (Excerpt) Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | PERFORMANCE IMPROVEMENT | HEALTH SERVICES | INCENTIVES | DELIVERY OF HEALTH CARE | DISEASE PREVENTION | PROGRAM ACTIVITIES | INTERVENTIONS | PREVENTION AND CONTROL | HEALTH SERVICES ADMINISTRATION | EQUIPMENT AND SUPPLIES | Management | Organization and Administration | Health | Policy | Political Factors | Sociocultural Factors | Diseases | Programs | Medical Procedures | Medicine Document Number: 331462 |
| 6. Peer Reviewed Title: Maternal health in Gujarat, India: a case study. Author: Mavalankar DV; Vora KS; Ramani KV; Raman P; Sharma B; Upadhyaya M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):235-48. Abstract: Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially-increased political will and social awareness. Language: English Keywords: INDIA | RESEARCH REPORT | CASE STUDIES | MATERNAL HEALTH | MATERNAL HEALTH SERVICES | HEALTH SERVICES ADMINISTRATION | OBSTETRICS | EMERGENCY SERVICES | TRANSPORTATION | MATERNAL MORTALITY | BLOOD SUPPLY | HUMAN RESOURCES | TRAINING PROGRAMS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Health | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Management | Organization and Administration | Medicine | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Equipment and Supplies | Medical Procedures | Education Document Number: 341932 |
| 7. Peer Reviewed Title: Understanding job satisfaction amongst mid-level cadres in Malawi: the contribution of organisational justice. Author: McAuliffe E; Manafa O; Maseko F; Bowie C; White E Source: Reproductive Health Matters. 2009 May;17(33):80-90. Abstract: The migration of doctors and nurses from low- to high-income countries has left many countries relying on mid-level cadres as the mainstay of their health delivery system, Malawi being an example. Although an extremely important resource, little attention has been paid to the management and further development of these cadres. In this paper we use the concept of organisational justice – fairness of treatment, procedures and communication on the part of managers – to explore through a questionnaire how mid-level cadres in jobs traditionally done by higher-level cadres self-assessed their level of job satisfaction. All mid-level health workers present on the day of data collection in 34 health facilities in three health districts of Malawi, one district each from the three geographical regions, were invited to participate; 126 agreed. Perceptions of justice correlated strongly with level of job satisfaction, and in particular perceptions of how well they were treated by their managers and the extent to which they were informed about decisions and changes. Pay was not the only important element in job satisfaction; promotion opportunities and satisfaction with current work assignments were also significant. These findings highlight the important role that managers can play in the motivation, career development and performance of mid-level health workers. Spanish Abstract: Debido a la emigración de médicos y enfermeras de países de bajos ingresos a países de altos ingresos, muchos países, como Malaui, tienen que depender de los prestadores de servicios de nivel intermedio como el pilar del sistema de salud. Aunque son un recurso sumamente importante, no se ha prestado mucha atención al manejo y desarrollo de este grupo de profesionales. En este artículo se utiliza el concepto de justicia organizacional – en el trato, los procedimientos y la comunicación por parte de los administradores – para explorar mediante un cuestionario cómo los profesionales de nivel intermedio en trabajos realizados tradicionalmente por profesionales de nivel superior autoevaluaron su nivel de satisfacción laboral. Se invitó a participar a todos los trabajadores de salud de nivel intermedio presentes el día de la recolección de datos en 34 establecimientos de salud, en tres distritos de salud de Malaui, uno de cada región geográfica; 126 accedieron. Las percepciones de justicia estaban muy correlacionadas con el nivel de satisfacción laboral, en particular las percepciones de cuán bien eran tratados por sus supervisores y hasta qué grado se les informaba sobre las decisiones y los cambios. La paga no era el único elemento importante en la satisfacción laboral; las oportunidades de ascenso y la satisfacción con las asignaciones laborales también eran significativas. Estos hallazgos resaltan el importante papel que pueden desempeńar los administradores en la motivación, el desarrollo profesional y el desempeńo de los trabajadores de salud de nivel intermedio. French Abstract: La migration de médecins et d'infirmičres de pays pauvres vers des pays ŕ revenu élevé oblige beaucoup de pays, dont le Malawi, ŕ s'appuyer sur des cadres moyens comme pivot de leur systčme de santé. Bien qu'il s'agisse d'une ressource extręmement importante, la gestion et le développement ultérieur de ces cadres n'ont gučre reçu d'attention. Dans cet article, nous utilisons le concept de justice organisationnelle – traitement, procédures et communications équitables de la part des superviseurs – pour étudier au moyen d'un questionnaire comment les cadres moyens occupant des emplois traditionnellement dévolus aux cadres supérieurs évaluent leur satisfaction professionnelle. Tous les soignants de niveau intermédiaire présents le jour du recueil des données dans 34 établissements de santé du Malawi, sélectionnés dans un district pour chacune des trois régions géographiques, ont été invités ŕ participer; 126 ont accepté. La maničre de concevoir la justice était fortement corrélée avec le niveau de satisfaction professionnelle, en particulier dans quelle mesure les cadres moyens estimaient ętre bien traités par leur superviseur et ętre informés des décisions et des changements. Le salaire n'était pas le seul élément déterminant: les possibilités d'avancement et la satisfaction quant aux tâches professionnelles actuelles avaient aussi une influence. Ces conclusions soulignent le rôle important que les superviseurs peuvent jouer dans la motivation, les perspectives de carričre et les performances des soignants de niveau intermédiaire. Language: English Keywords: MALAWI | RESEARCH REPORT | SAMPLING STUDIES | NURSES AND NURSING | PARAMEDICAL PERSONNEL | HEALTH SERVICES ADMINISTRATION | ATTITUDES | SATISFACTION | PERCEPTION | MOTIVATION | PERFORMANCE IMPROVEMENT | JOB DESCRIPTION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Management | Organization and Administration | Psychological Factors | Behavior | Personnel Management Document Number: 342017 |
| 8. Peer Reviewed Title: Improving maternal survival in South Asia--what can we learn from case studies? Author: McPake B; Koblinsky M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):93-107. Abstract: Technical interventions for maternal healthcare are implemented through a dynamic social process. Peoples' behaviours--whether they be planners, managers, providers, or potential users--influence the outcomes. Given the complexity and unpredictability inherent in such dynamic processes, the proposed cause-and-effect relationships in any one context cannot be directly transferred to another. While this is true of all health services, its importance is magnified in maternal healthcare because of the need to involve multiple levels of the health system, multiple types of care providers from the highly skilled specialist to community-level volunteers, and multiple technical interventions, without the ability to measure significant change in the outcome, the maternal mortality ratio. Patterns can be followed however, in terms of outcomes in response to interventions. From these case studies of implementation of maternal health programmes across five states of India, Pakistan, and Bangladesh, some patterns stand out and seem to apply virtually everywhere (e.g., failure of systems to post staff in difficult areas) while others require more data to understand the observed patterns (e.g., response to financial incentives for improving maternal health systems; instituting available accessible safe blood). The patterns formed can provide guidance to programme managers as to what aspects of the process to track and micro-manage, to policy-makers as to what features of a context may particularly influence impacts of alternative maternal health strategies, and to governments more broadly as to the factors shaping dynamic responses that might themselves warrant intervention. Language: English Keywords: ASIA, SOUTHERN | CRITIQUE | CASE STUDIES | MATERNAL MORTALITY | MATERNAL HEALTH SERVICES | CHILDBIRTH | BLOOD SUPPLY | HUMAN RESOURCES | FINANCIAL ACTIVITIES | INCENTIVES | HEALTH SERVICES ADMINISTRATION | HEALTH POLICY | Asia | Developing Countries | Studies | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Equipment and Supplies | Medical Procedures | Medicine | Economic Factors | Policy | Political Factors | Sociocultural Factors | Management | Organization and Administration Document Number: 341940 |
| 9. Title: Management capacity assessment for national health programs: a study of RCH program in India. Author: Ramani KV; Mavalankar D Source: Journal of Health Organization and Management. 2009;23(1):133-42. Abstract: PURPOSE: This paper aims to focus on the management capacity assessment of the Reproductive and Child Health (RCH) program at the state level. DESIGN/METHODOLOGY/APPROACH: Based on an extensive literature survey, and discussions with senior officers in charge of RCH program at the central and state level, the authors have developed a conceptual framework for management capacity assessment. Central to their framework are a few determinants of management capacity, a set of indicators to estimate these determinants, and a management capacity assessment tool to be administered by each state. A pilot survey of the management tool in a few states helped the authors to refine each instrument and finalize the same. A suitable management structure is suggested for effective management of the RCH program based on the population in each state. FINDINGS: The assessment brought out the need to strengthen the planning and monitoring of RCH activities, HR management practices, and inter-departmental coordination. PRACTICAL IMPLICATIONS: The Ministry of Health and Family Welfare, Government of India has accepted the management tool and asked each state to administer it. The recommended management structure is used as a guideline by each state to identify the capacity gaps and take necessary steps to augment its management capacity. ORIGINALITY/VALUE: The authors' framework to assess the management capacity of RCH program is very comprehensive, the management tool is easy to administer, and assessment of capacity gaps can be made quickly. Language: English Keywords: INDIA | EVALUATION REPORT | MATERNAL-CHILD HEALTH SERVICES | FAMILY PLANNING PROGRAMS | GOVERNMENT PROGRAMS | HEALTH SERVICES ADMINISTRATION | CAPACITY BUILDING | MONITORING | PLANNING | IMPLEMENTATION | Asia, Southern | Asia | Developing Countries | Evaluation | Primary Health Care | Health Services | Delivery of Health Care | Health | Family Planning | Programs | Organization and Administration | Management | Program Sustainability Document Number: 341808 |
| 10. Peer Reviewed Title: Study of blood-transfusion services in Maharashtra and Gujarat States, India. Author: Ramani KV; Mavalankar DV; Govil D Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):259-70. Abstract: Blood-transfusion services are vital to maternal health because haemorrhage and anaemia are major causes of maternal death in South Asia. Unfortunately, due to continued governmental negligence, blood-transfusion services in India are a highly-fragmented mix of competing independent and hospital-based blood-banks, serving the needs of urban populations. This paper aims to understand the existing systems of blood-transfusion services in India focusing on Maharashtra and Gujarat states. A mix of methodologies, including literature review (including government documents), analysis of management information system data, and interviews with key officials was used. Results of analysis showed that there are many managerial challenges in blood-transfusion services, which calls for strengthening the planning and monitoring of these services. Maharashtra provides a good model for improvement. Unless this is done, access to blood in rural areas may remain poor. Language: English Keywords: INDIA | EVALUATION REPORT | BLOOD TRANSFUSION | EMERGENCY SERVICES | MATERNAL MORTALITY | BLOOD SUPPLY | SAFETY | HEALTH SERVICES ADMINISTRATION | ORGANIZATION AND ADMINISTRATION | BLOOD DONORS | MONITORING | TRAINING PROGRAMS | Asia, Southern | Asia | Developing Countries | Evaluation | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Demographic Factors | Population | Equipment and Supplies | Public Health | Management | Education Document Number: 341930 |
| 11. Peer Reviewed Title: Maternal health situation in India: a case study. Author: Vora KS; Mavalankar DV; Ramani KV; Upadhyaya M; Sharma B; Iyengar S; Gupta V; Iyengar K Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):184-201. Abstract: Since the beginning of the Safe Motherhood Initiative, India has accounted for at least a quarter of maternal deaths reported globally. India's goal is to lower maternal mortality to less than 100 per 100,000 livebirths but that is still far away despite its programmatic efforts and rapid economic progress over the past two decades. Geographical vastness and sociocultural diversity mean that maternal mortality varies across the states, and uniform implementation of health-sector reforms is not possible. The case study analyzes the trends in maternal mortality nationally, the maternal healthcare-delivery system at different levels, and the implementation of national maternal health programmes, including recent innovative strategies. It identifies the causes for limited success in improving maternal health and suggests measures to rectify them. It recommends better reporting of maternal deaths and implementation of evidence-based, focused strategies along with effective monitoring for rapid progress. It also stresses the need for regulation of the private sector and encourages further public-private partnerships and policies, along with a strong political will and improved management capacity for improving maternal health. Language: English Keywords: INDIA | RESEARCH REPORT | CASE STUDIES | MATERNAL MORTALITY | CAUSES OF DEATH | MATERNAL HEALTH SERVICES | PROGRAM ACCESSIBILITY | QUALITY OF HEALTH CARE | SAFE MOTHERHOOD | OBSTETRICS | EMERGENCY SERVICES | HEALTH SERVICES ADMINISTRATION | UTILIZATION OF HEALTH CARE | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Health Services Evaluation | Maternal Health | Medicine | Management Document Number: 341935 |
| 12. Title: Child health services in Kenya. January 2009. Based on further analysis of the 2004 Kenya Service Provision Assessment Survey. Author: Wamae A; Kichamu G; Kundu F; Muhunzu I Source: Calverton, Maryland, Macro International, MEASURE DHS, 2009 Jan. [38] p. (USAID Contract No. GPO-C-00-03-00002-00Kenya Working Papers No. 2) Abstract: Given the worrying trends in infant and child mortality rates, there is a clear need to assess current practices in the management of childhood illnesses and to identify opportunities for intervention. The 2004 Kenya Service Provision Assessment Survey (KSPA) findings indicate that most health care providers are not taking care of sick children holistically, but rather are treating children only for the presenting illness. Using data obtained from the 2004 KSPA, this study aims to establish the factors that are associated with the promotion of child health using a holistic approach, such as the Integrated Management of Childhood Illness (IMCI) strategy to manage a sick child. The IMCI strategy aims to reduce morbidity and infant and child mortality by implementing three main components: improving health workers' skills in case management; improving the health systems; and improving family and community childcare practices. Three composite dependent variables representing the holistic approach to child health care were created to measure the following: full assessment of sick child; proper counseling of the child's caretaker; and facility support services for holistic care of sick children. The independent variables used in the analysis include facility type, facility managing authority, region, qualifications of the provider, and sex of the provider. Almost all health providers surveyed missed critical opportunities to conduct a full assessment of the sick children who presented to them for care. According to the survey, enrolled nurses and doctors were doing better in full assessment and counseling of sick children compared to registered nurses and clinical officers. This difference can be attributed to the fact that doctors and enrolled nurses were likely to have received IMCI training in the previous year compared to registered nurses. Notably, about twice as many female health providers as male health providers assessed major signs and thrice as many female health workers assessed for all three danger signs. Female providers were also more likely than male providers to properly monitor child growth. Counseling caretakers on children's illnesses was generally poor, with only one in every five caretakers being counseled in clinics and one in every ten caretakers being counseled in health centres. Male providers were more likely to counsel caretakers than their female counterparts. Providers in private facilities were twice as likely to counsel caretakers as providers in public facilities. The full range of essential equipment was lacking in almost all facilities. Hospitals were more likely to be stocked with all essential equipment, followed by dispensaries and maternities with health centers and clinics the least likely. The results reveal that the quality of care provided to sick children at the first level of health facilities should be improved. Also, help is needed to determine the areas that should be emphasized during the training and supervision of IMCI and other child survival strategies. The KSPA results also suggest the need to improve the skills of more health workers managing children younger than five years and to mobilize more resources for child health. Language: English Keywords: KENYA | RESEARCH REPORT | HEALTH SURVEYS | CHILDREN | HEALTH PERSONNEL | CHILD HEALTH SERVICES | HEALTH SERVICES EVALUATION | QUALITY OF HEALTH CARE | INTEGRATED PROGRAMS | HEALTH SERVICES ADMINISTRATION | COMMUNITY HEALTH SERVICES | COUNSELING | SEX FACTORS | EXAMINATIONS AND DIAGNOSES | PRIVATE SECTOR | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Maternal-Child Health Services | Primary Health Care | Health Services | Program Evaluation | Programs | Organization and Administration | Management | Clinic Activities | Program Activities | Medical Procedures | Medicine | Macroeconomic Factors | Economic Factors Document Number: 329887 |
| 13. Title: Worker retention in human resources for health: catalyzing and tracking change. Author: Yumkella F Source: Chapel Hill, North Carolina, IntraHealth International, Capacity Project, 2009 Mar. [4] p. (Capacity Project Knowledge Sharing Technical Brief No. 15) Abstract: There is increasingly widespread commitment to initiatives to attract and retain skilled workers, especially in rural areas. Retention continues to be a serious challenge in the human resources for health (HRH) crisis. This brief from the Capacity Project updates and documents a previously published resource paper and technical brief which focus on the area of worker retention. The author highlights key findings from three country assessments in Uganda, Tanzania and Liberia. The brief shows how a number of developing countries are employing various strategies to energise the workforce and stem flows. Many practices show promise for wider application across countries, but evidence of successful programmes is seldom documented or shared. Various schemes to improve worker retention are described in countries including Kenya and Zambia. Language: English Keywords: AFRICA, SUB SAHARAN | RECOMMENDATIONS | CRITIQUE | CASE STUDIES | HEALTH PERSONNEL | RURAL POPULATION | CAPACITY BUILDING | BRAIN DRAIN | RURAL-URBAN MIGRATION | HUMAN RESOURCES | SATISFACTION | EMPLOYMENT | HEALTH SERVICES ADMINISTRATION | HEALTH SERVICES EVALUATION | OCCUPATIONAL HEALTH | Africa | Developing Countries | Studies | Research Methodology | Delivery of Health Care | Health | Population Characteristics | Demographic Factors | Population | Program Sustainability | Programs | Organization and Administration | International Migration | Migration | Population Dynamics | Economic Factors | Psychological Factors | Behavior | Macroeconomic Factors | Management | Program Evaluation Document Number: 331350 |
| 14. Title: The state of Africa's children 2008. Child survival. Author: UNICEF Source: New York, New York, UNICEF, 2008 May. 54 p. Abstract: Every year, the United Nations Children's Fund (UNICEF) publishes The State of the World's Children, the most comprehensive and authoritative report on the world's youngest citizens. The State of the World's Children 2008, published in January 2008, examines the global realities of maternal and child survival and the prospects for meeting the health-related Millennium Development Goals (MDGs) - the targets set by the world community in 2000 for eradicating poverty, reducing child and maternal mortality, combating disease, ensuring environmental sustainability and providing access to affordable medicines in developing countries. This year, UNICEF is also publishing the inaugural edition of The State of Africa's Children. This volume and other forthcoming regional editions complement The State of the World's Children 2008, sharpening from a worldwide to a regional perspective the global report's focus on trends in child survival and health, and outlining possible solutions - by means of programmes, policies and partnerships - to accelerate progress in meeting the Millennium Development Goals. (excerpt) Language: English Keywords: AFRICA, SUB SAHARAN | AFRICA, NORTH | TECHNICAL REPORT | CHILD HEALTH | CHILD MORTALITY | CHILD SURVIVAL | CAUSES OF DEATH | PRIMARY HEALTH CARE | CHILD HEALTH SERVICES | COMMUNITY HEALTH SERVICES | COMMUNITY PARTICIPATION | HEALTH POLICY | HEALTH SERVICES ADMINISTRATION | UNICEF | Developing Countries | Africa | Health | Mortality | Population Dynamics | Demographic Factors | Population | Survivorship | Length of Life | Health Services | Delivery of Health Care | Maternal-Child Health Services | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Management | UN | International Agencies | Organizations Document Number: 327008 |
| 15. Peer Reviewed Title: Palestinian primary health care in light of the National Strategic Health Plan 1999 -- 2003. Author: Abu Mourad T; Radi S; Shashaa S; Lionis C; Philalithis A Source: Public Health. 2008 Feb;122(2):125-139. Abstract: In 1994, the Palestinian Health Authority took over responsibility for primary health care (PHC) in Gaza Strip and West Bank. This paper reports on the Palestinian National Strategic Health Plan (PNSHP 1999-2003). The extent to which the PHC objectives were achieved is discussed, together with areas that still require improvement. This descriptive study used content analysis with a retrospective review of data gathered from the PNSHP and other related reports and publications. The crude death rate and total fertility rate had improved, but the infant mortality rate had increased by the end of the study period. Heart diseases were the primary cause of death in Palestine. Acceptable vaccination coverage had mainly been achieved, particularly for tetanus, diphtheria, measles and polio. There were still concerns regarding water supply and other sanitary conditions, a notable increase in the incidence of vector-borne diseases, especially cutaneous Leishmaniasis in West Bank, and mental health had worsened by the end of the study period. Certain health promotion and environmental health actions should be undertaken urgently by the Palestinian health care services to cope with environmental and sanitary conditions, and to further improve health status regarding communicable and non-communicable diseases in Palestinians. Health research and surveys are insufficient and should be undertaken regularly. The main barrier to the success of the PNSHP was the lack of follow-up due to political and socio-economic instability. There is an urgent need for international intervention and support. (author's) Language: English Keywords: GAZA | WEST BANK | RESEARCH REPORT | RETROSPECTIVE STUDIES | PRIMARY HEALTH CARE | NATIONAL HEALTH SERVICES | GOVERNMENT PROGRAMS | HEALTH STATUS INDEXES | HEALTH POLICY | HEALTH SERVICES ADMINISTRATION | HEALTH SERVICES EVALUATION | Developing Countries | Middle East | Studies | Research Methodology | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Management | Program Evaluation Document Number: 323984 |
| 16. Peer Reviewed Title: Care at first-level facilities for children with severe pneumonia in Bangladesh: A cohort study. Author: Chowdhury EK; El Arifeen S; Rahman M; Hoque DM; Hossain MA Source: Lancet. 2008 Sep 6-12;372(9641):822-830. Abstract: Guidelines on integrated management of childhood illness (IMCI) for severe pneumonia recommend referral to hospitals. However, in many settings, children who are referred do not actually attend hospital, which severely limits appropriate care. We aimed to assess the safety and effectiveness of modified guidelines that allowed most children with severe pneumonia to be treated locally in first-level facilities, with referral only for those with danger signs or other severe classifications. We did an observational cohort study in ten first-level health facilities in Matlab, rural Bangladesh that had implemented IMCI guidelines. We assessed children with severe pneumonia who were aged between 2 and 59 months, and for whom we could obtain complete information, in two cohorts: 261 children who presented to these facilities between May, 2003, and April, 2004 (before implementation of the modified guidelines) and 1271 children between September, 2004, and August, 2005 (after full implementation). We obtained information about the characteristics and management of their illness, including referrals and admissions to hospital, from facility records. Staff visited households to obtain details of treatment, socioeconomic information, and final outcome, including mortality data. 245 (94%) of 261 children who had severe pneumonia were referred to hospital before the guidelines were modified, compared with 107 (8%) of 1271 after implementation (p<0-0001). 94 (36%) children with severe pneumonia received correct management before the guidelines were modified, compared with 1145 (90%) children after implementation (p<0-0001). Before modification of the guidelines, three children with severe pneumonia who presented at first-level facilities died, with a case-fatality rate of 1-1%; after modification, seven children died, with a case-fatality rate of 0-6% (p=0-39). Local adaptation of the IMCI guidelines, with appropriate training and supervision, could allow safe and effective management of severe pneumonia, especiallyif compliance with referral is difficult because of geographic, financial, or cultural barriers. (author's) Language: English Keywords: BANGLADESH | RESEARCH REPORT | COHORT ANALYSIS | CHILDREN | PNEUMONIA | HEALTH FACILITIES | QUALITY OF HEALTH CARE | CHILD HEALTH SERVICES | HEALTH SERVICES ADMINISTRATION | Developing Countries | Asia, Southern | Asia | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Pulmonary Effects | Physiology | Biology | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Maternal-Child Health Services | Primary Health Care | Health Services | Management Document Number: 328169 |
| 17. Peer Reviewed Title: Health-sector responses to intimate partner violence in low- and middle-income settings: A review of current models, challenges and opportunities. Author: Colombini M; Mayhew S; Watts C Source: Bulletin of the World Health Organization. 2008 Aug;86(8):635-642. Abstract: There is growing recognition of the public-health burden of intimate partner violence (IPV) and the potential for the health sector to identify and support abused women. Drawing upon models of health-sector integration, this paper reviews current initiatives to integrate responses to IPV into the health sector in low- and middle-income settings. We present a broad framework for the opportunities for integration and associated service and referral needs, and then summarize current promising initiatives. The findings suggest that a few models of integration are being replicated in many settings. These often focus on service provision at a secondary or tertiary level through accident and emergency or women's health services, or at a primary level through reproductive or family-planning health services. Challenges to integration still exist at all levels, from individual service providers' attitudes and lack of knowledge about violence to managerial and health systems' challenges such as insufficient staff training, no clear policies on IPV, and lack of coordination among various actors and departments involved in planning integrated services. Furthermore, given the variety of locations where women may present and the range and potential severity of presenting health problems, there is an urgent need for coherent, effective referral within the health sector, and the need for strong local partnership to facilitate effective referral to external, non-health services. (author's) Language: English Keywords: GLOBAL | DEVELOPING COUNTRIES | RESEARCH REPORT | LITERATURE REVIEW | VIOLENCE AGAINST WOMEN | HEALTH SERVICES | HEALTH SERVICES ADMINISTRATION | INTEGRATED PROGRAMS | BEST PRACTICES | HEALTH AND WELFARE PLANNING | Domestic Violence | Crime | Social Problems | Sociocultural Factors | Delivery of Health Care | Health | Management | Organization and Administration | Programs | Social Planning | Economic Factors Document Number: 327932 |
| 18. Title: The healthcare system in HIV / AIDS: an inextricable component in the experience of family care. Author: D'Cruz P Source: Critical Public Health. 2008 Jun;18(2):189-209. Abstract: Through a phenomenological study following van Manen?s approach, family care experiences of caregivers and care receivers in the context of HIV/AIDS were studied in Mumbai, India. Data gathered through conversational interviews were analysed using the holistic and highlighting approaches. Interactions with the formal healthcare system contributed to the essential meaning of participants? experiences even though the context of care was primarily familial. These interactions included instances of violations of testing and confidentiality guidelines and refusals to provide treatment in the private and some public health centres, and the provision of instrumental and affective support by the voluntary sector. The poor quality of care at public sector hospitals serving HIV-positive individuals was also described. The paper makes recommendations for improving the interventions of the healthcare system since experiences here are linked to the overall subjective experience of caregiving and care receiving. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | INTERVIEWS | HIV | AIDS | CARE AND SUPPORT | HEALTH SERVICES | HEALTH SERVICES ADMINISTRATION | HEALTH POLICY | QUALITY OF HEALTH CARE | STIGMA | Asia, Southern | Asia | Developing Countries | Data Collection | Research Methodology | HIV Infections | Viral Diseases | Diseases | Delivery of Health Care | Health | Management | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Health Services Evaluation | Program Evaluation | Programs | Social Problems Document Number: 327472 |
| 19. Title: Prescribing in maternity care in Russia: the legacy of Soviet medicine. Author: Danichevski K; McKee M; Balabanova D Source: Health Policy. 2008 Feb;85(2):242-251. Abstract: Remarkably, there has been very little detailed research on clinical practice in Russia and its neighbours in what was the USSR, even though it is known that the USSR was isolated from many international developments, in particular evidence-based medicine. In this study we examine obstetric practice, an area of practice where there is an extensive body of evidence on the appropriateness of many interventions. The study is undertaken in Tula, a region 200 km south of Moscow. Building on earlier detailed analyses of data from the facilities in the region, it reports a series of structured interviews with 52 obstetricians from all 19 facilities in the region, designed to identify patterns of prescribing, supplemented by 36 more detailed re-interviews to explore reasons for the differing practices. The study demonstrates a widespread divergence from internationally accepted practice. Maternity care is extremely medicalised but many non-evidence based medicines are used. Some are heavily marketed by large pharmaceutical companies, some were widely used during the Soviet period but never evaluated, and a few are not known to be used anywhere else in the world. For several conditions, the most widely used drugs are clearly inferior to alternative products and some are used for indications quite different from those in other countries. This study contributes to the growing evidence that much of the care provided in Russian maternity units is ineffective or potentially dangerous but also begins to offer some explanations for why this is, including a lack of access to information and a lack of awareness of the concept of evidence-based practice. (author's) Language: English Keywords: RUSSIA | RESEARCH REPORT | INTERVIEWS | OBSTETRICS | HEALTH SERVICES | QUALITY OF HEALTH CARE | HEALTH SERVICES EVALUATION | PRESCRIPTIONS | EXAMINATIONS AND DIAGNOSES | COMMUNISM | SCIENCE | HEALTH SERVICES ADMINISTRATION | HEALTH POLICY | Asia, Northern | Asia | Developing Countries | Data Collection | Research Methodology | Medicine | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Distributional Activities | Program Activities | Medical Procedures | Socialism | Political Systems | Political Factors | Sociocultural Factors | Management | Policy Document Number: 314022 |
| 20. Peer Reviewed Title: Gender biases and discrimination: A review of health care interpersonal interactions. Author: Govender V; Penn-Kekana L Source: Global Public Health. 2008;3(Suppl 1):90-103. Abstract: A good interpersonal relationship between a patient and provider, as characterized by mutual respect, openness, and a balance in their respective roles in decision-making, is an important marker of quality of care. This review is undertaken from a gender and health equity perspective and illustrates that gender biases and discrimination occur at many levels in the healthcare delivery environment, and affects the patient-provider interaction which can result in health inequities affecting individual health seeking behaviour, access to good quality healthcare, and, ultimately, health outcomes. Interventions will have to be introduced at multiple levels, from health system legislation and policy and gender sensitive training to the development of women and men centred services and health literacy programmes. (author's) Language: English Keywords: GLOBAL | RESEARCH REPORT | LITERATURE REVIEW | RECOMMENDATIONS | HEALTH SERVICES | GENDER ISSUES | SEX FACTORS | SEX DISCRIMINATION | INEQUALITIES | QUALITY OF HEALTH CARE | HEALTH POLICY | HEALTH SERVICES ADMINISTRATION | Delivery of Health Care | Health | Sociocultural Factors | Population Characteristics | Demographic Factors | Population | Social Discrimination | Social Problems | Socioeconomic Factors | Economic Factors | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Policy | Political Factors | Management Document Number: 326611 |
| 21. Title: Hospital management in the context of health sector reform: a planning model in Ethiopia. Author: Hartwig K; Pashman J; Cherlin E; Dale M; Callaway M Source: International Journal of Health Planning and Management. 2008 Jul-Sep;23(3):203-218. Abstract: Through health sector reform in developing countries, Ministries of Health have sought to enhance health care through greater community governance and improved management effectiveness in their public hospitals. In this paper, we present a partnership-mentoring model for enhancing management capacity that has been piloted in Ethiopia and may be useful in other developing countries. The model included needs assessment and baseline evaluation using a hospital management indicator checklist, deployment of 24 Fellows (US and international hospital administrators) for 1 year to work as mentors with hospital management teams in 14 Ethiopian hospitals, continuing didactic and practical training in quality improvement methods for hospital management teams, and 24 management improvement projects to be completed during the year with plans for replication more broadly as appropriate. Surveys of Fellows and Ethiopian managers within the first quarter of onsite activity found high levels of trust in one another's abilities and intent to implement changes. The partnership-mentoring model promotes sustainability and may provide other countries with approaches for improving the quality of hospital care through improved hospital management. Language: English Keywords: ETHIOPIA | RESEARCH REPORT | HEALTH SERVICES ADMINISTRATION | MANAGEMENT | HOSPITALS | CAPACITY BUILDING | PLANNING | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Organization and Administration | Health Facilities | Delivery of Health Care | Health | Program Sustainability | Programs Document Number: 308020 |
| 22. Peer Reviewed Title: Communal violence in Gujarat, India: Impact of sexual violence and responsibilities of the health care system. Author: Khanna R Source: Reproductive Health Matters. 2008 May;16(31):142-152. Abstract: Situations of chronic conflict across the globe make it imperative to draw attention to its gendered health consequences, particularly the violation of women's reproductive and sexual rights. Since early 2002 in Gujarat, western India, the worst kind of state-sponsored violence against Muslims has been perpetrated, which continues to this day. This paper describes the history of that violence and highlights the mental and physicial consequences of sexual and gender-based violence and the issues that need to be addressed by the police, the health care system and civil society. It draws upon several reports, including from the International Initiative for Justice and the Medico Friend Circle, which documented the reproductive, sexual and mental health consequences of the violence in Gujarat, and the lacunae in the responses of the health system. The paper calls for non-discrimination to be demonstrated by health personnel in the context of conflict and social unrest. Their training should include conflict as a public health problem, their roles and responsibilities in prevention, treatment and documentation of this "disease", and focus on relevant medico-legal methodology and principles, the psychological impact of sexual assault on victims, and the legal significance of medical evidence in these cases. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | HISTORICAL REVIEW | WOMEN | VIOLENCE AGAINST WOMEN | RAPE | REPRODUCTIVE RIGHTS | HEALTH SERVICES | HEALTH SERVICES ADMINISTRATION | POLICE | CIVIL SOCIETY | HINDUISM | ISLAM | RELIGIOUS ASPECTS | Developing Countries | Asia, Southern | Asia | Demographic Factors | Population | Domestic Violence | Crime | Social Problems | Sociocultural Factors | Human Rights | Political Factors | Delivery of Health Care | Health | Management | Organization and Administration | Corrections Officers | Government | Economic Factors | Religion Document Number: 327198 |
| 23. Peer Reviewed Title: Implementation of a new birth record in three hospitals in Jordan: a study of health system improvement. Author: Khresheh R; Barclay L Source: Health Policy and Planning. 2008 Jan;23(1):76-82. Abstract: This study tested the introduction of a new integrated clinical record in Jordan where currently no clinical report links antenatal, birth and postnatal care for women. As a result, no continuity of information is provided to clinicians nor are there national statistics on trends, or performance of hospitals around birth. Our study was conducted in the Jordanian Ministry of Health, the maternity wards and registration departments of three hospitals in Jordan and in the Maternal and Child Health Centres located near these hospitals. We used an exploratory, descriptive design and practice-research engagement to investigate and report on the process of change to improve and implement the new birth record. Through engaging practitioners in research, care improved, the quality of reporting changed, managers developed more effective measures of hospital performance and policy makers were provided with information that could form the basis of a national maternity data monitoring system. Quantitative and qualitative audit data demonstrated improved clinical reporting, organizational development and sustained commitment to the new record from clinicians, managers and policy leaders. (author's) Language: English Keywords: JORDAN | RESEARCH REPORT | PILOT PROJECTS | ACTION RESEARCH | MATERNAL HEALTH SERVICES | HOSPITALS | DATA COLLECTION | DATA QUALITY | BIRTH RECORDS | QUALITY OF HEALTH CARE | HEALTH SERVICES ADMINISTRATION | Developing Countries | Middle East | Studies | Research Methodology | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Health Facilities | Data Analysis | Vital Statistics | Population Statistics | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Management Document Number: 314032 |
| 24. Title: Assessing health system performance in developing countries: A review of the literature. Author: Kruk ME; Freedman LP Source: Health Policy. 2008;85:263-276. Abstract: With the setting of ambitious international health goals and an influx of additional development assistance for health, there is growing interest in assessing the performance of health systems in developing countries. This paper proposes a framework for the assessment of health system performance and reviews the literature on indicators currently in use to measure performance using online medical and public health databases. This was complemented by a review of relevant books and reports in the grey literature. The indicators were organized into three categories: effectiveness, equity, and efficiency. Measures of health system effectiveness were improvement in health status, access to and quality of care and, increasingly, patient satisfaction. Measures of equity included access and quality of care for disadvantaged groups together with fair financing, risk protection and accountability. Measures of efficiency were appropriate levels of funding, the cost-effectiveness of interventions, and effective administration. This framework and review of indicators may be helpful to health policy makers interested in assessing the effects of different policies, expenditures, and organizational structures on health outputs and outcomes in developing countries. (author's) Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | METHODOLOGICAL STUDIES | HEALTH SERVICES EVALUATION | HEALTH SERVICES ADMINISTRATION | MEASUREMENT | PROGRAM EFFECTIVENESS | PROGRAM EFFICIENCY | QUALITY OF HEALTH CARE | SATISFACTION | INEQUALITIES | COST EFFECTIVENESS | Program Evaluation | Programs | Organization and Administration | Management | Research Methodology | Psychological Factors | Behavior | Socioeconomic Factors | Economic Factors | Evaluation Indexes | Quantitative Evaluation | Evaluation Document Number: 324409 |
| 25. Peer Reviewed Title: Equity of skilled birth attendant utilization in developing countries: financing and policy determinants. Author: Kruk ME; Prescott MR; Galea S Source: American Journal of Public Health. 2008 Jan;98(1):142-147. Abstract: Developing countries with higher health care spending have greater overall utilization of maternal health services than do countries with lower spending. However, the rich tend to disproportionately use these services. We assessed whether redistributive government policies in the context of higher levels of health spending were associated with more-equitable use of skilled birth attendants (doctors, nurses, or midwives) between rich and poor. We used data from Demographic and Health Surveys of 45 developing countries and disaggregated by wealth quintile. Multivariable regression analyses were used to assess the joint effect of higher health care expenditures, the wealth distribution of women's fifth-grade education (a proxy for redistributive policy environment within the central government) and the overall proportion of women with fifth-grade education (a proxy for female literacy and an indicator of governments' commitment to girls' education). We found that utilization of skilled birth attendants was more equitable when higher health expenditures were accompanied by redistributive education policies. Higher health care expenditures should be accompanied by redistributive policies to reduce the gap in utilization of skilled birth attendants between poorer and richer women in developing countries. (author's) Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | MATERNAL HEALTH SERVICES | HEALTH PERSONNEL | UTILIZATION OF HEALTH CARE | PROGRAM ACCESSIBILITY | SOCIOECONOMIC STATUS | HEALTH POLICY | HEALTH SERVICES ADMINISTRATION | ECONOMIC FACTORS | GOVERNMENT | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Socioeconomic Factors | Policy | Political Factors | Sociocultural Factors | Management Document Number: 314042 |
| 26. Peer Reviewed Title: The effectiveness of contracting-out primary health care services in developing countries: a review of the evidence. Author: Liu X; Hotchkiss DR; Bose S Source: Health Policy and Planning. 2008 Jan;23(1):1-13. Abstract: The purpose of this study is to review the research literature on the effectiveness of contracting-out of primary health care services and its impact on both programme and health systems performance in low- and middle-income countries. Due to the heightened interest in improving accountability relationships in the health sector and in rapidly scaling up priority interventions, there is an increasing amount of interest in and experimentation with contracting-out. Overall, while the review of the selected studies suggests that contracting-out has in many cases improved access to services, the effects on other performance dimensions such as equity, quality and efficiency are often unknown. Moreover, little is known about the system-wide effects of contracting-out, which could be either positive or negative. Although the study results leave open the question of how contracting-out can be used as a policy tool to improve overall health system performance, the results indicate that the context in which contracting-out is implemented and the design features of the interventions are likely to greatly influence the chances for success. (author's) Language: English Keywords: GLOBAL | DEVELOPING COUNTRIES | LITERATURE REVIEW | RESEARCH ACTIVITIES | PRIMARY HEALTH CARE | PRIVATE SECTOR | HEALTH POLICY | HEALTH SERVICES ADMINISTRATION | QUALITY OF HEALTH CARE | PROGRAM ACCESSIBILITY | PROGRAM EFFICIENCY | ECONOMIC FACTORS | Research Methodology | Health Services | Delivery of Health Care | Health | Macroeconomic Factors | Policy | Political Factors | Sociocultural Factors | Management | Organization and Administration | Health Services Evaluation | Program Evaluation | Programs Document Number: 314031 |
| 27. Peer Reviewed Title: Innovations in Rwanda's health system: looking to the future. Author: Logie DE; Rowson M; Ndagije F Source: Lancet. 2008 Jul 19;372(9634):256-261. Abstract: Rwanda is making substantial progress towards improvement of health and is working towards achievement of the Millennium Development Goals, which is a challenging task because the country has had genocide in 1994, has few natural resources, is landlocked, and has high population growth. Like many impoverished sub-Saharan countries, Rwanda's health system has had an uncoordinated plethora of donors, shortage of health staff, inequity of access, and poor quality of care in health facilities. This report describes three health system developments introduced by the Rwandan government that are improving these barriers to care- i.e., the coordination of donors and external aid with government policy, and monitoring the effectiveness of aid; a country-wide independent community health insurance scheme; and the introduction of a performance-based pay initiative. If these innovations are successful, they might be of interest to other sub-Saharan countries. However, Rwanda still does not have sufficient financial resources for health and will need additional external aid for some time to attain the Millennium Development Goals. (author's) Language: English Keywords: RWANDA | RESEARCH REPORT | MONITORING | HEALTH PERSONNEL | HEALTH SERVICES | HEALTH SERVICES ADMINISTRATION | QUALITY OF HEALTH CARE | PERFORMANCE IMPROVEMENT | PROGRAM EVALUATION | GOVERNMENT PROGRAMS | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Evaluation | Delivery of Health Care | Health | Management | Organization and Administration | Health Services Evaluation | Programs Document Number: 327887 |
| 28. Title: Traumatic birth leads to creation of birth networks in India. Author: Malik R Source: Midwifery today With International Midwife. 2008 Autumn;(87):56-8, 69. Abstract: The author shares how her birth experiences in India led her to create Birth India, a birth network that aims to promote the benefits of natural childbirth and best practices to achieve normal birth. Language: English Keywords: INDIA | COMMUNITY RELATIONS | HEALTH SERVICES ADMINISTRATION | MALARIA PREVENTION | NURSE-MIDWIVES | PREGNANCY COMPLICATIONS | TRADITIONAL MEDICINE | WOMEN'S HEALTH Document Number: 329474 |
| 29. Peer Reviewed Title: Working with communities, governments and academic institutions to make pregnancy safer. Author: Mathai M Source: Best Practice and Research Clinical Obstetrics and Gynaecology. 2008;22(3):465-476. Abstract: The major medical causes of maternal death and the effective interventions to prevent maternal death due to these causes are known. Yet, every year, an estimated 529,000 women die during and following pregnancy and childbirth. Most of these deaths occur in developing countries where other non-medical determinants of maternal health influence the accessibility to these interventions. Improvements in maternal health can be achieved through a health systems approach. Care should be provided as a continuum throughout the life cycle and across health facilities through the health system. Communities, professional organizations and academic institutions should work actively with the government to: provide a package of service, based on population health needs, that is close to home; ensure availability of essential medicines and commodities; address financial barriers to receiving care; strengthen the health workforce; and gather and use information to improve maternal health. (author's) Language: English Keywords: GLOBAL | DEVELOPING COUNTRIES | CRITIQUE | MATERNAL MORTALITY | MATERNAL HEALTH | MATERNAL HEALTH SERVICES | SAFE MOTHERHOOD | COMMUNITY PARTICIPATION | COMMUNITY HEALTH SERVICES | GOVERNMENT PROGRAMS | HEALTH AND WELFARE PLANNING | HEALTH SERVICES ADMINISTRATION | ANTENATAL CARE | PROGRAM ACCESSIBILITY | Mortality | Population Dynamics | Demographic Factors | Population | Health | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Organization and Administration | Programs | Social Planning | Economic Factors | Management | Program Evaluation Document Number: 326415 |
| 30. Title: Health providers' perceptions of adolescent sexual and reproductive health care in Swaziland. Author: Mngadi PT; Faxelid E; Zwane IT; Hojer B; Ransjo-Arvidson AB Source: International Nursing Review. 2008 Jun;55(2):148-155. Abstract: The aim was to explore health providers' perceptions of adolescent sexual and reproductive healthcare services in Swaziland. Fifty-six healthcare providers, working in 11 health clinics in Swaziland in 2005, were surveyed using a semi-structured questionnaire. The data were analysed by descriptive statistics and content analysis to identify key themes. Most participants were women with a mean age of 36 years and a mean number of 6 years in the profession. Services provided included STIs/HIV/AIDS advice, pre- and post-test counselling and testing on HIV, contraceptives and condom use. Half of the nurses/midwives had no continued education and lacked supervision on adolescent sexual and reproductive health care. The majority had unresolved moral doubts, negative attitudes, values and ethical dilemmas towards abortion care between the law, which is against abortion, and the reality of the adolescents' situation. Forty-four wanted to be trained on post-abortion care while eight on how to perform abortions. Twenty-six wanted the government to support adolescent-friendly services and to train heathcare providers in adolescent sexual and reproductive health services. The curricula within nursing and midwifery preservice education need to be reviewed to incorporate comprehensive services for adolescents. There is need for provision of comprehensive services for adolescents in Swaziland and appropriate youth-friendly services at all levels. There is need for nurse/ midwifery participation, advocacy and leadership in policy development. (author's) Language: English Keywords: SWAZILAND | RESEARCH REPORT | SURVEYS | HEALTH PERSONNEL | ADOLESCENT HEALTH SERVICES | REPRODUCTIVE HEALTH | HEALTH SERVICES ADMINISTRATION | PERCEPTION | NEEDS ASSESSMENT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Sampling Studies | Studies | Research Methodology | Delivery of Health Care | Health | Health Services | Management | Organization and Administration | Psychological Factors | Behavior | Evaluation Document Number: 326615 |
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