3.  Title: Guinea. Village health committees drive family planning uptake: communities play lead role in increased acceptability, availability. Author: Diakite O; Keita DR; Mwebesa W Source: Washington, D.C., Core Group, [2009]. 8 p. Abstract: This document highlights the Village Health Committee (VHC), a vital player in the child survival project and the integration of family planning work within Save the Children's portfolio in Guinea. The document briefly describes the committee's purpose, membership, and tasks. It focuses on a handful of the people and activities that exemplified the VHCs' unique role in ensuring that family planning was not only accessible but acceptable to the villagers they served. The document concludes with some outcomes of Save the Children's family planning component in Mandiana and Kouroussa. In effect, the VHCs' stellar success in building demand for contraception (when coupled with modest investments in existing health workers' ability to supply modern methods) resulted in a sustained increase in the use of contraception in the project zone. Language: English Keywords: GUINEA | PROGRESS REPORT | EVALUATION | COMMUNITY | RURAL POPULATION | USAID | COMMUNITY HEALTH SERVICES | DELIVERY OF HEALTH CARE | PROGRAM ACCESSIBILITY | QUALITY OF HEALTH CARE | PERFORMANCE IMPROVEMENT | RURAL HEALTH SERVICES | FAMILY PLANNING | HEALTH SERVICES EVALUATION | PROGRAM ACCEPTABILITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Residence Characteristics | Population Distribution | Geographic Factors | Population | Population Characteristics | Demographic Factors | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Primary Health Care | Health Services | Health | Program Evaluation | Programs | Organization and Administration | Management Document Number: 325193 |
| 4. 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 |
| 5. Peer Reviewed Title: Improved access to comprehensive emergency obstetric care and its effect on institutional maternal mortality in rural Mali. Author: Fournier P; Dumont A; Tourigny C; Dunkley G; Drame S Source: Bulletin of the World Health Organization. 2009 Jan;87(1):30-8. Abstract: OBJECTIVE: To evaluate the effect of a national referral system that aims to reduce maternal mortality rates through improving access to and the quality of emergency obstetric care in rural Mali (sub-Saharan Africa). METHODS: A maternity referral system that included basic and comprehensive emergency obstetric care, transportation to obstetric health services and community cost-sharing schemes was implemented in six rural health districts in Kayes region between December 2002 and November 2005. In an uncontrolled 'before and after' study, we recorded all obstetric emergencies, major obstetric interventions and maternal deaths during a 4-year observation period (1 January 2003 to 30 November 2006): the year prior to the intervention (P-1); the year of the intervention (P0), and 1 and 2 years after the intervention (P1 and P2, respectively). The primary outcome was the risk of death among obstetric emergency patients, calculated with crude case fatality rates and crude odds ratios. Analyses were adjusted for confounding variables using logistic regression. FINDINGS: The number of women receiving emergency obstetric care doubled between P-1 and P2, and the rate of major obstetric interventions (mainly Caesarean sections) performed for absolute maternal indications increased from 0.13% in P-1 to 0.46% in P2. In women treated for an obstetric emergency, the risk of death 2 years after implementing the intervention was half the risk recorded before the intervention (odds ratio, OR: 0.48; 95% confidence interval, CI: 0.30-0.76). Maternal mortality rates decreased more among women referred for emergency obstetric care than among those who presented to the district health centre without referral. Nearly half (47.5%) of the reduction in deaths was attributable to fewer deaths from haemorrhage. CONCLUSION: The intervention showed rapid effects due to the availability of major obstetric interventions in district health centres, reduced transport time to such centres for treatment, and reduced financial barriers to care. Our results show that national programmes can be implemented in low-income countries without major external funding and that they can rapidly improve the coverage of obstetric services and significantly reduce the risk of death associated with obstetric complications. Language: English Keywords: MALI | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | RURAL POPULATION | PREGNANT WOMEN | EMERGENCY SERVICES | PROGRAM ACCESSIBILITY | COMMUNITY HEALTH SERVICES | MATERNAL MORTALITY | HEALTH SERVICES EVALUATION | TRANSPORTATION | OBSTETRICS | PREGNANCY COMPLICATIONS | COMMUNITY FINANCING | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Mortality | Population Dynamics | Medicine | Diseases | Financial Activities Document Number: 341163 |
| 6. Title: Guatemala: Using supply chain modeling and simulation to analyze the Ministry of Health supply chain. Author: Gibney J; Sanchez A; Lamadrid C Source: Arlington, Virginia, John Snow [JSI], DELIVER, 2009 Mar. 38 p. (USAID Contract No. GPO-I-01-06-00007-00) Abstract: This activity analyzed the characteristics of the integrated logistics system in three departments in Guatemala: Sololá, Totonicapán, and Jutiapa. This paper identifies some of the obstacles to achieving contraceptive availability for the underserved and vulnerable populations; it also offers options for improving equity in access for family planning commodities. The study identifies elements in the Ministry of Public Health and Social Welfare’s (MSPAS) logistics system that could impede the availability and accessibility of contraceptives. By using supply chain simulation and optimization modeling software, with geographic information system tools, the authors propose system-related solutions that could improve the performance of the overall MSPAS. Language: English Keywords: GUATEMALA | RECOMMENDATIONS | GOVERNMENT AGENCIES | LOGISTICS | HEALTH SERVICES EVALUATION | CONTRACEPTIVE AVAILABILITY | OBSTACLES | NEEDS | CONTRACEPTIVE DISTRIBUTION | PERFORMANCE IMPROVEMENT | GEOGRAPHY | INFORMATION RETRIEVAL SYSTEMS | TRANSPORTATION | Central America | Latin America | Americas | Developing Countries | Organizations | Political Factors | Sociocultural Factors | Management | Organization and Administration | Program Evaluation | Programs | Contraception | Family Planning | Economic Factors | Distributional Activities | Program Activities | Social Sciences | Science | Data Storage and Retrieval | Information Processing | Information Document Number: 331663 |
| 7. Title: Technological profile assessment of voluntary HIV counseling and testing centers in Brazil. Author: Grangeiro A; Escuder MM; Wolffenbuttel K; Pupo LR; Nemes MI; Monteiro PH Source: Revista de Saude Publica. 2009 Jun;43(3):427-36. Abstract: OBJECTIVE: To characterize and analyze technological profiles of voluntary HIV counseling and testing centers in Brazil. METHODS: A structured self-completion questionnaire with 78 questions was used. This questionnaire was answered by 320 (83.6%) of the 383 Brazilian centers, in 2006. Responses that characterized the services' technological profile were analyzed using K-means clustering technique. Associations between the profiles described and the municipal contexts were analyzed using the chi-square and residue analysis for proportions, and ANOVA and Bonferroni for means. RESULTS: Centers showed significant deficiencies to guarantee adequate services. A total of four technological profiles were identified. The 'care' profile (21.6%) predominated among the services instituted before 1993, in areas with high AIDS incidence and in large cities. The 'prevention' profile (30.0%), prevalent between 1994 and 1998, was the type that best complies with the Ministry of Health's norms, with better readiness and productivity indicators. The 'care and prevention' profile (26.9%), included in the AIDS services, predominated between 1999 and 2002, and developed the most comprehensive set of activities, including STD treatment. The 'testing' profile (21.6%) was the most precarious, found where the epidemic is most recent and with a lower number of people tested. CONCLUSIONS: Counseling and testing centers constitute a set of heterogeneous services. In addition, service implementation guidelines have not been completely incorporated in Brazil, thus having and influence on low resolution and productivity indicators and also the inadequate development of prevention activities. Language: EnglishPortuguese Keywords: BRAZIL | RESEARCH REPORT | HEALTH PERSONNEL | VOLUNTARY COUNSELING AND TESTING | HIV PREVENTION | AIDS PREVENTION | HEALTH SERVICES EVALUATION | QUESTIONNAIRES | SEXUALLY TRANSMITTED DISEASES | TREATMENT | South America, Eastern | South America | Latin America | Americas | Developing Countries | Delivery of Health Care | Health | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | HIV Infections | Viral Diseases | Diseases | AIDS | Program Evaluation | Programs | Organization and Administration | Reproductive Tract Infections | Infections Document Number: 342658 |
| 8. Title: Baseline survey on functioning of abortion services in government approved CAC centers in three pilot districts of Nepal. Author: Karki C; Ojha M; Rayamajhi RT Source: Kathmandu University Medical Journal. 2009 Jan- Mar;7(25):31-9. Abstract: BACKGROUND: Abortion has been legalized in Nepal since September 2002 and under this law, Comprehensive Abortion Care (CAC) service is being provided through listed service providers and listed health facilities from 2004. Nepal Government has prioritized the national safe abortion program and is working with many government and non government partners for providing this service. Till date medical abortion services are not made available at any of the health facility. Government is now preparing to introduce this service in six selected pilot districts. OBJECTIVE: This survey was carried out to assess the functioning of existing abortion services in 12 Government approved CAC sites of three districts. MATERIALS AND METHODS: Direct observation of the functioning of these centers, assessment of physical facilities and service provider's skill was done. At the same time service provider's attitude and knowledge on CAC service and other abortion services were also assessed through semi structured interviews. Quality of record keeping and the feasibility of initiating the medical abortion service in these sites were also studied. RESULT: Number of listed centers in six pilot districts was twenty nine. Study districts have 16 listed centers. Visited sites were twelve; four managed by Government and eight by non government organizations. Thirty three thousand nine hundred and twenty women have availed this service so far: only 4.76% of them received service from Government facilities. Marie Stopes International (MSI) topped the list in providing service to the maximum number of clients (75.64%) and Family planning association of Nepal (FPAN) was the second. MSI centre was also first to initiate the service. Government facilities provide 24 hours service unlike private facilities which are open only up to 5.00 pm. Cost for the service varies from rupees 900/- to rupees 1365/- and is cheaper at Government facilities. Private sectors have separate setups and Government have allocated some space within their already existing infrastructure for CAC service. Private sectors were better in providing the information to public about the availability of service. There were total 20 trained service providers for first trimester abortion service. They are more at Government facilities. They seem to be positive to CAC service and had good knowledge and skill of service delivery. Complications were not recorded at most of the sites. Pain management and infection prevention practice needs improvement at the Government sites. All the sites had identified their referral sites and had one or the other arrangement for referral. CONCLUSION: CAC service has become accessible and affordable to Nepalese women even at peripheral level. CAC sites are functioning well. Initiation of medical abortion and second trimester abortion services at these sites are feasible and would expand the option and choices available. Language: English Keywords: NEPAL | RESEARCH REPORT | ABORTION | PILOT PROJECTS | HEALTH PERSONNEL | HEALTH SERVICES EVALUATION | FEES | ATTITUDES | KNOWLEDGE | EQUIPMENT AND SUPPLIES | Developing Countries | Asia, Southern | Asia | Fertility Control, Postconception | Family Planning | Studies | Research Methodology | Delivery of Health Care | Health | Health Facilities | Program Evaluation | Programs | Organization and Administration | Financial Activities | Economic Factors | Psychological Factors | Behavior | Sociocultural Factors | Medical Procedures | Medicine | Health Services Document Number: 342477 Notification |
9.  Peer Reviewed Title: Evaluation of simple rapid HIV assays and development of national rapid HIV test algorithms in Dar es Salaam, Tanzania. Author: Lyamuya EF; Aboud S; Urassa WK; Sufi J; Mbwana J; Ndugulile F; Massambu C Source: BMC Infectious Diseases. 2009;9:19. Abstract: BACKGROUND: Suitable algorithms based on a combination of two or more simple rapid HIV assays have been shown to have a diagnostic accuracy comparable to double enzyme-linked immunosorbent assay (ELISA) or double ELISA with Western Blot strategies. The aims of this study were to evaluate the performance of five simple rapid HIV assays using whole blood samples from HIV-infected patients, pregnant women, voluntary counseling and testing attendees and blood donors, and to formulate an alternative confirmatory strategy based on rapid HIV testing algorithms suitable for use in Tanzania. METHODS: Five rapid HIV assays: Determine HIV-1/2 (Inverness Medical), SD Bioline HIV 1/2 3.0 (Standard Diagnostics Inc.), First Response HIV Card 1-2.0 (PMC Medical India Pvt Ltd), HIV1/2 Stat-Pak Dipstick (Chembio Diagnostic System, Inc) and Uni-Gold HIV-1/2 (Trinity Biotech) were evaluated between June and September 2006 using 1433 whole blood samples from hospital patients, pregnant women, voluntary counseling and testing attendees and blood donors. All samples that were reactive on all or any of the five rapid assays and 10% of non-reactive samples were tested on a confirmatory Inno-Lia HIV I/II immunoblot assay (Immunogenetics). RESULTS: Three hundred and ninety samples were confirmed HIV-1 antibody positive, while 1043 were HIV negative. The sensitivity at initial testing of Determine, SD Bioline and Uni-Gold was 100% (95% CI; 99.1-100) while First Response and Stat-Pak had sensitivity of 99.5% (95% CI; 98.2-99.9) and 97.7% (95% CI; 95.7-98.9), respectively, which increased to 100% (95% CI; 99.1-100) on repeat testing. The initial specificity of the Uni-Gold assay was 100% (95% CI; 99.6-100) while specificities were 99.6% (95% CI; 99-99.9), 99.4% (95% CI; 98.8-99.7), 99.6% (95% CI; 99-99.9) and 99.8% (95% CI; 99.3-99.9) for Determine, SD Bioline, First Response and Stat-Pak assays, respectively. There was no any sample which was concordantly false positive in Uni-Gold, Determine and SD Bioline assays. CONCLUSION: An alternative confirmatory HIV testing strategy based on initial testing on either SD Bioline or Determine assays followed by testing of reactive samples on the Determine or SD Bioline gave 100% sensitivity (95% CI; 99.1-100) and 100% specificity (95% CI; 96-99.1) with Uni-Gold as tiebreaker for discordant results. Language: English Keywords: TANZANIA | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | URBAN POPULATION | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | BLOOD DONORS | HIV TESTING | TIME FACTORS | GOVERNMENT PROGRAMS | HEALTH SERVICES EVALUATION | VOLUNTARY COUNSELING AND TESTING | RELIABILITY | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Population Dynamics | Programs | Organization and Administration | Program Evaluation | Measurement Document Number: 330705 |
| 10. Title: Blind optimism: Challenging the myths about private health care in poor countries. Author: Marriott A Source: Oxford, United Kingdom, Oxfam International, 2009 Feb. 55 p. (Oxfam Briefing Paper No. 125) Abstract: 'The realization of the right to health for millions of people in poor countries depends upon a massive increase in health services to achieve universal and equitable access. A growing number of international donors are promoting an expansion of private-sector health-care delivery to fulfil this goal. The private sector can play a role in health care. But this paper shows there is an urgent need to reassess the arguments used in favor of scaling-up private-sector provision in poor countries. The evidence shows that prioritizing this approach is extremely unlikely to deliver health for poor people. Governments and rich country donors must strengthen state capacities to regulate and focus on the rapid expansion of free publicly provided health care, a proven way to save millions of lives worldwide. (Excerpt) Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | EVALUATION | POPULATION | PRIVATE SECTOR | HEALTH SERVICES EVALUATION | PROGRAM ACCESSIBILITY | INEQUALITIES | CAPACITY BUILDING | WORLD BANK | GOVERNMENT PROGRAMS | QUALITY OF HEALTH CARE | DELIVERY OF HEALTH CARE | Macroeconomic Factors | Economic Factors | Program Evaluation | Programs | Organization and Administration | Socioeconomic Factors | Program Sustainability | International Agencies | Organizations | Political Factors | Sociocultural Factors | Health Document Number: 331349 |
| 11. Title: Decentralizing Kenya's health management system: an evaluation. January 2009. Based on further analysis of the 2004 Kenya Service Provision Assessment Survey. Author: Ndavi PM; Ogola S; Kizito PM; Johnson K Source: Calverton, Maryland, Macro International, MEASURE DHS, 2009 Jan. [37] p. (USAID Contract No. GPO-C-00-03-00002-00Kenya Working Papers No. 1) Abstract: Kenya's Ministry of Health (MOH) commitment to address the inherent constraints in the health sector has included deliberate decentralization efforts aimed at strengthening the effective implementation of activities at the district level, and fostering closer coordination and collaboration amongst the line ministries, donors, organizations, and other stakeholders. Among these efforts, local District Health Management Boards (DHMBs) and District Health Management Teams (DHMTs) gradually assumed responsibilities for the operation of the facilities under their jurisdiction through a single line grant, annual work plans, and procurement plans. To assess the current effectiveness of the district health management systems in meeting their responsibilities, we analyze data from a special District Health Management module of the 2004 Kenya Service Provision Assessment Survey to discern the degree to which the DHMTs and DHMBs meet norms and standards in the areas of governance and management, human resource development and management, commodity management, infrastructure development, health care financing, budgeting and management, and performance monitoring. Notably, data on DHMTs and DHMBs were missing for 20 percent of the districts. This level of nonresponse has the potential to weaken the validity of the findings, particularly when the excluded DHMTs are in provinces with some of the worst health indicators in the country. Their exclusion was due to difficult terrain and insecure environment, both of which imply that the right of the population to health care services is compromised. The results of this descriptive analysis indicate that although most of the DHMTs hold meetings frequently, the unavailability of the guidelines on the functioning of the DHMTs made it difficult to determine compliance of DHMTs with any existing norms and standards. The survey missed the opportunity to assess the activities and achievements of the HFMCs and HCMTs, which are important for decentralization. Although most of the DHMTs had documented plans for improving reproductive health, less than a quarter reported implementing their plans on time. Lack of funds and transport were the most cited reasons for failure by DHMTs to meet their supervision targets despite the near universal existence of documented supervision plans. In terms of support of human resources, continuing professional development is an accepted norm in the districts, but there is urgent need to strengthen and expand the scope of updates to serving staff through the establishment of district health training committees and regular monitoring of their activities. An assessment of available infrastructure indicated that repair and maintenance units existed in most districts, with nearly all of the districts contracted with the provincial workshop for repair and maintenance work. Communication facilities between most district hospitals and close to three quarters of the health centers with referral facilities under government management had capacity to communicate easily by telephone or two-way radio with a referral facility to arrange transport during emergencies. The situation was much better for NGO/mission-run facilities. Regarding financing issues, despite existence of both recurrent and development funds, funding for medicines, equipment, and maintaining buildings was inadequate for most districts. Sources for funding for district health services included central government funding supplemented by local government, revolving funds, and other sources. Increased annual budgetary allocations to the agreed 15 percent to ministries of health, in agreement with the Abuja accord, may increase financial resources required for medicines, equipment, and maintenance of buildings. Language: English Keywords: KENYA | ADMINISTRATIVE DISTRICTS | RESEARCH REPORT | HEALTH SURVEYS | ADMINISTRATIVE PERSONNEL | POLICYMAKERS | HEALTH PERSONNEL | GOVERNMENT AGENCIES | DECENTRALIZATION | HEALTH SERVICES EVALUATION | DELIVERY OF HEALTH CARE | QUALITY OF HEALTH CARE | MONITORING | PERFORMANCE IMPROVEMENT | GOVERNMENT FINANCING | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Geographic Factors | Population | Health | Organization and Administration | Organizations | Political Factors | Sociocultural Factors | Program Evaluation | Programs | Evaluation | Management | Financial Activities | Economic Factors Document Number: 329888 |
| 12. Title: Influence of provider training on quality of emergency obstetric care in Kenya. January 2009. Based on further analysis of the 2004 Kenya Service Provision Assessment Survey. Author: Olenja J; Godia P; Kibaru J; Egondi T Source: Calverton, Maryland, Macro International, MEASURE DHS, 2009 Jan. [33] p. (USAID Contract No. GPO-C-00-03-00002-00Kenya Working Papers No. 3) Abstract: In addition to infectious diseases, maternal and neonatal conditions account for a substantial part of the health gap between rich and poor countries. For example, more than 99 percent of maternal deaths occur in the developing world. The majority of the deaths are caused by direct obstetric complications, including haemorrhage, sepsis, eclampsia, obstructed labour, and unsafe abortion practices. In Kenya, complications related to pregnancy and childbirth are leading causes of morbidity and mortality, translating to 414 maternal deaths per 100,000 live births. Although 88 percent of Kenyan women attend antenatal care, only 40 percent deliver in the health facilities, and only 42 percent of all deliveries have skilled attendance at delivery. In the Kenyan context, access to and use of quality emergency obstetric care (EmOC) are essential to efforts aimed at reducing maternal morbidity and mortality. We examine data from the 2004 Kenya Service Provision Assessment (KSPA) to assess the availability of EmOC services in Kenya, and to demonstrate the importance of health worker training in the delivery of these life-saving services. We find that less than 20 percent of maternal health workers interviewed had received training in focused antenatal or postnatal care in the last three years. Among caregivers providing delivery services, only 18 percent had received training in lifesaving skills, and only 37 percent had received training in the prevention of mother-to-child transmission of HIV during the last three years. Our analysis also demonstrates that training is a critical element in the detection and management of complications. Recent training in relevant subject matter was found to be significantly and positively associated with the ability to provide quality care in the event of unsafe abortion and postpartum haemorrhage. Training was also positively associated with the ability to provide appropriate care in the event of a retained placenta. The obvious recommendation is to ensure that up-to-date, quality training is provided to a broad base of health workers at all types of facilities, particularly at the local facilities that are the first point of contact for women experiencing an obstetric emergency. It is recognized that there are logistical obstacles to increasing the number of health workers who receive training. Further, although we isolated the element of training for this analysis, it is clear from these findings that for optimal service outcome, quality-of-care training has to be undertaken within the context of improved infrastructure and as a support to service delivery. Language: English Keywords: KENYA | RESEARCH REPORT | HEALTH SURVEYS | HEALTH PERSONNEL | EMERGENCY PERSONNEL | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MIDWIVES AND MIDWIFERY | EMERGENCY SERVICES | OBSTETRICS | QUALITY OF HEALTH CARE | EDUCATIONAL STATUS | PREGNANCY COMPLICATIONS | DELIVERY OF HEALTH CARE | HEALTH SERVICES EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Health | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Services | Medicine | Program Evaluation | Programs | Organization and Administration | Socioeconomic Status | Socioeconomic Factors | Diseases Document Number: 329886 |
| 13. 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 |
| 14. 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 |
| 15. Title: Rwanda Service Provision Assessment Survey 2007. Author: Rwanda. Ministry of Finance and Economic Planning. National Institute of Statistics; Rwanda. Ministry of Health; Macro International. MEASURE DHS Source: Calverton, Maryland, Macro International, MEASURE DHS, 2008 Sep. 718 p. Also available in French: http://pdf.usaid.gov/pdf_docs/PNADN525.pdf Abstract: The 2007 Rwanda Service Provision Assessment (RSPA) was a national representative survey conducted in 538 health facilities throughout Rwanda. The survey covered hospitals, health centers, dispensaries and health posts, including all public facilities such as government and government-assisted health facilities. The 2007 RSPA used interviews with health service providers and clients and observations of providerclient consultations to obtain information on the capacity of facilities to provide quality services and the existence of functioning systems to support quality services. The areas addressed were the overall facility infrastructure, maternal and child health, reproductive health, tuberculosis, malaria services; and services for sexually transmitted infections and HIV/AIDS. The objective was to assess the strengths and weaknesses of the infrastructure and systems supporting these services, and to assess the adherence to standards in the delivery of services. Language: English Keywords: RWANDA | RESEARCH REPORT | SURVEYS | ORGANIZATIONS | HEALTH FACILITIES | HEALTH SERVICES EVALUATION | DELIVERY OF HEALTH CARE | CHILD HEALTH SERVICES | MATERNAL HEALTH SERVICES | SEXUALLY TRANSMITTED DISEASES | TUBERCULOSIS | MALARIA | HIV INFECTIONS | STANDARDS | QUALITY OF HEALTH CARE | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Sampling Studies | Studies | Research Methodology | Political Factors | Sociocultural Factors | Health | Program Evaluation | Programs | Organization and Administration | Maternal-Child Health Services | Primary Health Care | Health Services | Reproductive Tract Infections | Infections | Diseases | Parasitic Diseases | Viral Diseases Document Number: 329541 |
| 16. Title: Uganda Service Provision Assessment Survey 2007. Author: Uganda. Ministry of Health; Macro International. MEASURE DHS Source: Calverton, Maryland, Macro International, MEASURE DHS, 2008 Aug. 743 p. Abstract: The 2007 Uganda Service Provision Assessment (USPA) survey collected data from a representative sample of 491 health facilities throughout Uganda. The survey covered all levels of facilities, from HC-IIs to hospitals, and sampled facilities operated by different managing authorities, including government, private-for-profit, parastatal, and faith-based organisations. Survey personnel collected information using facility audit questionnaires, interviews with health service providers, observations of client-provider consultations, and exit interviews with clients, not only to assess the capacity of facilities to provide quality services, but also to assess the existence of functioning systems to support these services. The survey addressed overall facility infrastructure and resources as well as services for child health; family planning; maternal health; and specific infectious diseases, including sexually transmitted infections (STIs), tuberculosis (TB), malaria, and HIV/AIDS. One of the objectives of the survey was to assess the strengths and weaknesses of the infrastructure and systems supporting these services. The survey also sought to assess the adherence to standards in the delivery of curative care for sick children and adult STIs, family planning, and antenatal care (ANC). Language: English Keywords: UGANDA | RESEARCH REPORT | SURVEYS | ORGANIZATIONS | HEALTH FACILITIES | HEALTH SERVICES EVALUATION | DELIVERY OF HEALTH CARE | CHILD HEALTH SERVICES | MATERNAL HEALTH SERVICES | SEXUALLY TRANSMITTED DISEASES | TUBERCULOSIS | MALARIA | HIV INFECTIONS | STANDARDS | QUALITY OF HEALTH CARE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Sampling Studies | Studies | Research Methodology | Political Factors | Sociocultural Factors | Health | Program Evaluation | Programs | Organization and Administration | Maternal-Child Health Services | Primary Health Care | Health Services | Reproductive Tract Infections | Infections | Diseases | Parasitic Diseases | Viral Diseases Document Number: 329540 |
| 17. 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 |
| 18. Peer Reviewed Title: Male circumcision for HIV prevention: A prospective study of complications in clinical and traditional settings in Bungoma, Kenya. Author: Bailey RC; Egesah O; Rosenberg S Source: Bulletin of the World Health Organization. 2008 Sep;86(9):669-677. Abstract: Male circumcision reduces the risk of HIV acquisition by approximately 60%. Male circumcision services are now being introduced in selected populations in sub-Saharan Africa and further interventions are being planned. A serious concern is whether male circumcision can be provided safely to large numbers of adult males in developing countries. This prospective study was conducted in the Bungoma district, Kenya, where male circumcision is universally practised. Young males intending to undergo traditional or clinical circumcision were identified by a two-stage cluster sampling method. During the July-August 2004 circumcision season, 1007 males were interviewed 30-89 days post- circumcision. Twenty-four men were directly observed during and 3, 8, 30 and 90 days post-circumcision, and 298 men underwent clinical exams 45-89 days post-procedure. Twenty-one traditional and 20 clinical practitioners were interviewed to assess their experience and training. Inventories of health facilities were taken to assess the condition of instruments and supplies necessary for performing safe circumcisions. Of 443 males circumcised traditionally, 156 (35.2%) experienced an adverse event compared with 99 of 559 (17.7%) circumcised clinically (odds ratio: 2.53; 95% confidence interval: 1.89-3.38). Bleeding and infection were the most common adverse effects, with excessive pain, lacerations, torsion and erectile dysfunction also observed. Participants were aged 5 to 21 years and half were sexually active before circumcision. Practitioners lacked knowledge and training. Proper instruments and supplies were lacking at most health facilities. Extensive training and resources will be necessary in sub-Saharan Africa before male circumcision can be aggressively promoted for HIV prevention. Two-thirds of African men are circumcised, most by traditional or unqualified practitioners in informal settings. Safety of circumcision in communities where it is already widely practised must not be ignored. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | CLINICAL RESEARCH | MEN | MALE CIRCUMCISION | TRADITIONAL HEALTH PRACTICES | COMPLICATIONS | HIV PREVENTION | HEALTH SERVICES EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Culture | Sociocultural Factors | Diseases | HIV Infections | Viral Diseases | Program Evaluation | Programs | Organization and Administration Document Number: 328092 |
| 19. Peer Reviewed Title: Can mothers rely on the Brazilian health system for their deliveries? An assessment of use of the public system and out-of-pocket expenditure in the 2004 Pelotas Birth Cohort Study, Brazil. Author: Barros AJ; Santos IS; Bertoldi AD Source: BMC Health Services Research. 2008 Mar 18;8:57. Abstract: In a country where comprehensive free health care is provided via a public health system (SUS), an unexpected high frequency of catastrophic out-of-pocket expenditure has been described. We studied how deliveries were financed among mothers of a birth cohort and whether they were an important source of household out-of-pocket expenditure. All deliveries occurring in the city of Pelotas, Brazil, during 2004, were recruited for a birth cohort study. All mothers were interviewed just after birth and three months later. Comprehensive data on the pregnancy, delivery, birth conditions and newborn health were collected, along with detailed information on expenses related to the delivery. The majority of the deliveries (81%) were financed by the public health system, a proportion that increased to more than 95% among the 40% poorest mothers. Less than 1% of these mothers reported some out-of-pocket expenditure. Even among those mothers covered by a private health plan, nearly 50% of births were financed by the SUS. Among the 20% richest, a third of the deliveries were paid by the SUS, 50% by private health plans and 17% by direct payment. The public health system offered services in quantity and quality enough to attract even beneficiaries of private health plans and spared mothers from the poorest strata of the population of practically any expense. (author's) Language: English Keywords: BRAZIL | RESEARCH REPORT | COHORT ANALYSIS | MOTHERS | PREGNANT WOMEN | CHILDBIRTH | NATIONAL HEALTH SERVICES | FEES | MATERNAL-CHILD HEALTH SERVICES | HEALTH SERVICES EVALUATION | QUALITY OF HEALTH CARE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Health Services | Delivery of Health Care | Health | Financial Activities | Economic Factors | Primary Health Care | Program Evaluation | Programs | Organization and Administration Document Number: 326351 |
| 20. Title: Perceptions of quality of reproductive care services in Bolivia: Use of photo prompts and surveys as an impetus for change. Author: Bender DE; Santander A; Patino W; Wasserman MR Source: Health Care for Women International. 2008 May;29(5):484-506. Abstract: Surveys are sometimes used to assess women's perceptions of the quality of reproductive health care, but less empowered women may feel uncomfortable expressing their views in this method. We demonstrate the use of a participatory approach, combining a standard survey with an innovative photonarrative method. Women in Cochabamba, Bolivia, were asked to participate in exit surveys (n = 108). A subsample did photonarratives (n = 20). The survey showed rural women had less access to care, but photonarratives revealed the cause - fear. Women asserted quality of care was high, but photonarratives contradicted survey results. Staff used photonarratives to select action items for quality improvement. (author's) Language: English Keywords: BOLIVIA | RESEARCH REPORT | METHODOLOGICAL STUDIES | SURVEYS | WOMEN | REPRODUCTIVE HEALTH | QUALITY OF HEALTH CARE | VISUAL AIDS | PERCEPTION | FEAR | HEALTH SERVICES EVALUATION | South America, Central | South America | Latin America | Americas | Developing Countries | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Health | Program Evaluation | Programs | Organization and Administration | Educational Methods | Educational Activities | Education | Psychological Factors | Behavior | Emotions Document Number: 326445 |
| 21. Peer Reviewed Title: Action monitoring for equity and gender in health. Author: Bhuiya A; Hanifi SM; Mahmood SS Source: Journal of Health, Population, and Nutrition. 2008 Sep;26(3):378-83. Abstract: Equity and gender, despite being universal concerns for all health programmes in Bangladesh, are often missing in many of the health agenda. The health programmes fail to address these important dimensions unless these are specifically included in the planning stage of a programme and are continually monitored for progress. This paper presents the situation of equity in health in Bangladesh, innovations in monitoring equity in the use of health services in general and by the poor in particular, and impact of targeted non-health interventions on health outcomes of the poor. It was argued that an equitable use of health services might also result in enhanced overall coverage of the services. The findings show that government services at the upazila level are used by the poor proportionately more than they are in the community, while at the private facilities, the situation is reverse. Commonly-used monitoring tools, at times, are not very useful for the programme managers to know how well they are doing in reaching the poor. Use of benefit-incidence ratio may provide a quick feedback to the health facility managers about their extent of serving the poor. Similarly, Lot Quality Assurance Sampling can be an easy-to-use tool for monitoring coverage at the community level requiring a very small sample size. Although health problems are biomedical phenomena, their solutions may include actions beyond the biomedical framework. Studies have shown that non-health interventions targeted towards the poor improve the use of health services and reduce mortality among children in poor households. The study on equity and health deals with various interlocking issues, and the examples and views presented in this paper intend to introduce their importance in designing and managing health and development programmes. Language: English Keywords: BANGLADESH | METHODOLOGICAL STUDIES | ACTION RESEARCH | SAMPLING STUDIES | WOMEN IN DEVELOPMENT | INEQUALITIES | GENDER ISSUES | MONITORING | WOMEN'S HEALTH | UTILIZATION OF HEALTH CARE | SEX FACTORS | POVERTY | HEALTH SERVICES EVALUATION | IMPACT | Developing Countries | Asia, Southern | Asia | Research Methodology | Studies | Economic Development | Economic Factors | Socioeconomic Factors | Sociocultural Factors | Evaluation | Health | Health Services | Delivery of Health Care | Population Characteristics | Demographic Factors | Population | Program Evaluation | Programs | Organization and Administration | Communication Document Number: 328884 |
| 22. Peer Reviewed Title: [Infant mortality from preventable causes in Brazil: An ecological study in 2000 -- 2002] Mortalidade infantil por causas evitáveis no Brasil: um estudo ecológico no período 2000 -- 2002. Author: Boing AF; Boing AC Source: Cadernos de Saude Publica. 2008 Feb;24(2):447-455. Abstract: This study aims to test the associations between infant mortality from preventable causes in Brazil and socioeconomic factors, including those pertaining to health services and investments. This was an ecological study using 296 Brazilian counties (municipalities) with more than 80,000 inhabitants each as the analytical units. Kruskall-Wallis and ANOVA tests were performed to compare independent variables according to infant mortality quartile, and Pearson and Spearman's correlation coefficients were computed to test the associations. As the infant mortality quartile from preventable causes increases, there is a gradual decrease in the municipal human development index, per capita gross domestic product, households with bathrooms and indoor plumbing, total health expenditures per inhabitant, and physicians per 1,000 inhabitants, and an increase in the Gini coefficient. Improved socioeconomic conditions and public health investments are strongly associated with reduction of infant mortality from preventable causes. This knowledge should permeate actions aimed at minimizing the number and unequal distribution of such deaths. (author's) Language: Portuguese Keywords: BRAZIL | RESEARCH REPORT | INFANT MORTALITY | DEATH RATE | INFANT | HEALTH SERVICES | SOCIOECONOMIC FACTORS | HEALTH SERVICES EVALUATION | Developing Countries | South America, Eastern | South America | Latin America | Americas | Mortality | Population Dynamics | Demographic Factors | Population | Youth | Age Factors | Population Characteristics | Delivery of Health Care | Health | Economic Factors | Program Evaluation | Programs | Organization and Administration Document Number: 326488 |
| 23. Peer Reviewed Title: [Monitoring of infant growth by health services in Pernambuco State, Brazil] Acompanhamento do crescimento em crianças menores de um ano: situação nos serviços de saúde em Pernambuco, Brasil. Author: Carvalho MF; Lira PI; Romani Sde A; Santos IS; Veras AA; Batista Filho M Source: Cadernos de Saude Publica. 2008 Mar;24(3):675-85. Abstract: A situational diagnosis was performed on infant growth monitoring in Greater Metropolitan Recife and in the interior of the State of Pernambuco, Brazil, using the database from the Survey on Maternal and Child Health in the State of Pernambuco, 1998, which included 816 infants (< 1 year of age) and 120 health units. Epi Info version 6.04 was used for the analysis. In the health services infrastructure, 15.8% of the health units lacked infant scales and the Child's Health Card, and 75.4% lacked the guidelines for monitoring growth and development. Of these variables, the first two showed a difference between the two study areas. As for process evaluation, 81.2% of the mothers had the Child's Health Card, 53.1% of the children had been weighed, and only 21% had been measured. Mothers had received insufficient orientation. These variables also showed differences between the two study areas. Care for children with nutritional risk received little attention in the two areas, although there was a difference between the interior and Metropolitan Recife. In conclusion, monitoring of infant growth has not been effectively consolidated in the State of Pernambuco. (author's) Language: Portuguese Keywords: BRAZIL | RESEARCH REPORT | GROWTH | INFANT | DATA ANALYSIS | QUALITY OF HEALTH CARE | HEALTH SERVICES EVALUATION | Developing Countries | South America, Eastern | South America | Latin America | Americas | Child Development | Biology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Research Methodology | Program Evaluation | Programs | Organization and Administration Document Number: 326493 |
| 24. Peer Reviewed Title: Community-based newborn care in Bangladesh [letter] Author: Chakraborty H Source: Lancet. 2008 Nov 1;372(9649):1541; author reply 1541-2. Abstract: Language: English Keywords: BANGLADESH | CRITIQUE | CLINICAL TRIALS | METHODOLOGICAL STUDIES | STUDY DESIGN | DATA ANALYSIS | INFANT | COMMUNITY HEALTH SERVICES | HEALTH SERVICES EVALUATION | DATA QUALITY | SAMPLING ERRORS | NEONATAL MORTALITY | DEATH RATE | BIAS | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Primary Health Care | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Error Sources | Measurement | Infant Mortality | Mortality | Population Dynamics Document Number: 330041 |
| 25. Peer Reviewed Title: Haiti's forgotten emergency. Author: Chatterjee P Source: Lancet. 2008 Aug 23;372(9639):615-618. Abstract: Haiti's new Prime Minister has stated that improving health care on the island will be one of her top priorities. But repairing the health system in a country plagued by turmoil, natural disasters, and a serious HIV/AIDS epidemic is not going to be an easy task. Initiatives to improve the situation are derailed by the constant political upheavals and bloodshed on the island. Haiti's high population density and its decrepit infrastructure mean that it is also vulnerable to devastation from natural disasters such as floods, mudslides, and hurricanes. The author reports on Haiti's political issues and their affect on health care. Language: English Keywords: HAITI | CRITIQUE | EVALUATION | WOMEN IN DEVELOPMENT | CHILDREN | DISASTER RELIEF | NATURAL DISASTERS | POLITICAL FACTORS | WAR | DELIVERY OF HEALTH CARE | QUALITY OF HEALTH CARE | GOVERNMENT FINANCING | HEALTH SERVICES EVALUATION | CHILD NUTRITION | BRAIN DRAIN | Caribbean | Americas | Developing Countries | Economic Development | Economic Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Financial Activities | Environment | Sociocultural Factors | Health | Program Evaluation | Programs | Organization and Administration | Nutrition | International Migration | Migration | Population Dynamics Document Number: 308336 |
| 26. 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 |
| 27. Peer Reviewed Title: An assessment of postabortion care in three regions in Ethiopia, 2000 to 2004. Author: Fetters T; Tesfaye S; Clark KA Source: International Journal of Gynecology and Obstetrics. 2008 Apr;101(1):100-106. Abstract: The objective was to assess postabortion care services in 3 regions in Ethiopia following provider training and service improvements between 2000 and 2004. Data on availability and quality of services were collected at 119 facilities in 3 regions of Ethiopia before and after postabortion care (PAC) provider training in 42 of the sites; supervision, supplies, and equipment were also provided. Changes over time, changes attributable to the training intervention, and overall self-reported improvements in PAC were assessed for outcomes of interest, including availability of uterine evacuation services, postabortion contraceptive methods and supply availability (including manual vacuum aspiration [MVA]), and minimum-skilled providers. Between 2000 and 2004, the capacity for offering uterine evacuation increased from 57% to 79% among intervention facilities, while remaining relatively constant among the comparison facilities. The training intervention was significantly associated with improvements in the availability and use of MVA, the availability of a minimum number of skilled providers and availability of postabortion contraceptive services. The proportion of uterine evacuation procedures performed with MVA increased among comparison facilities, but increased even more among intervention facilities, from 14% to 50% of procedures. Training and supporting providers in comprehensive PAC effectively improve women's access to PAC services in Ethiopia, but more attention must be paid to training midlevel providers, extending services into health centers, pain management, and provision of postabortion contraceptives. (author's) Language: English Keywords: ETHIOPIA | RESEARCH REPORT | EVALUATION | WOMEN | POSTABORTION CARE | TRAINING PROGRAMS | HEALTH SERVICES EVALUATION | ABORTION | INTERVENTIONS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Education | Program Evaluation | Programs | Organization and Administration | Fertility Control, Postconception | Family Planning Document Number: 325436 Notification |
| 28. Peer Reviewed Title: Nurses, community health workers, and home carers: Gendered human resources compensating for skewed health systems. Author: George A Source: Global Public Health. 2008;3 Suppl 1:75-89. Abstract: This review examines the experiences of nurses, community health workers, and home carers in health systems from a gender analysis. With respect to nursing, current discussions around delegation take place over layers of historical struggle that mark the evolution of nursing as a profession. Female community health workers also struggle to be recognized as skilled workers, in addition to defending at a personal level the legitimacy of their work, as it transgresses traditional norms proscribing morality and the place of women in society, at times with violent consequences. The review concludes by exploring the characteristics of, and challenges faced by, home carers, who fail to be recognized as workers at all. A key finding is that these mainly female frontline health workers compensate for the shortcomings of health systems through individual adjustments, at times to the detriment of their own health and livelihoods. So long as these shortcomings remain as private, individual concerns of women, rather than the collective responsibility of gender, requiring public acknowledgement and resolution, health systems will continue to function in a skewed manner, serving to replicate inequalities in the health labour force and in society more broadly. (author's) Language: English Keywords: GLOBAL | LITERATURE REVIEW | WOMEN | NURSES AND NURSING | COMMUNITY WORKERS | HEALTH PERSONNEL | HOME CARE | GENDER ISSUES | HUMAN RESOURCES | HEALTH SERVICES EVALUATION | Demographic Factors | Population | Delivery of Health Care | Health | Care and Support | Health Services | Sociocultural Factors | Economic Factors | Program Evaluation | Programs | Organization and Administration Document Number: 326808 |
| 29. Peer Reviewed Title: How much does quality of child care vary between health workers with differing durations of training? An observational multicountry study. Author: Huicho L; Scherpbier RW; Nkowane AM; Victora CG Source: Lancet. 2008 Sep 13;372(9642):910-6. Abstract: BACKGROUND: Countries with high rates of child mortality tend to have shortages of qualified health workers. Little rigorous evidence has been done to assess how much the quality of care varies between types of health workers. We compared the performance of different categories of health workers who are trained in Integrated Management of Childhood Illness (IMCI). METHODS: We analysed data obtained from first-level health facility surveys in Bangladesh (2003), Brazil (2000), Uganda (2002), and Tanzania (2000). We compared the clinical performance of health workers with longer duration of preservice training (those with >4 years of post-secondary education in Brazil or >3 years in the other three countries) and shorter duration (all other health workers providing clinical care). We calculated quality of care with indicators of assessment, classification, and management of sick children according to IMCI guidelines. Every child was examined twice, by the IMCI-trained health worker being assessed andby a gold-standard supervisor. FINDINGS: 272 children were included in Bangladesh, 147 in Brazil, 231 in Tanzania, and 612 in Uganda. The proportions of children correctly managed by health workers with longer duration of preservice training in Brazil were 57.8% (n=43) versus 83.7% (n=61) for those with shorter duration of training (p=0.008), and 23.1% (n=47) versus 32.6% (n=134) (p=0.03) in Uganda. In Tanzania, those with longer duration of training did better than did those with shorter duration in integrated assessment of sick children (mean index of integrated assessment 0.94 [SD 0.15] vs 0.88 [0.13]; p=0.004). In Bangladesh, both categories of health worker did much the same in all clinical tasks. We recorded no significant difference in clinical performance in all the other clinical tasks in the four countries. INTERPRETATION: IMCI training is associated with much the same quality of child care across different health worker categories, irrespective of the duration and level of preservice training. Strategies for scaling up IMCI and other child-survival interventions might rely on health workers with shorter duration of preservice training being deployed in underserved areas. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | CROSS-CULTURAL COMPARISONS | CLINICAL RESEARCH | HEALTH PERSONNEL | TRAINING PROGRAMS | CHILD HEALTH SERVICES | QUALITY OF HEALTH CARE | TIME FACTORS | CHILD MORTALITY | PRIMARY HEALTH CARE | EDUCATIONAL STATUS | HEALTH SERVICES EVALUATION | Comparative Studies | Studies | Research Methodology | Delivery of Health Care | Health | Education | Maternal-Child Health Services | Health Services | Program Evaluation | Programs | Organization and Administration | Population Dynamics | Demographic Factors | Population | Mortality | Socioeconomic Status | Socioeconomic Factors | Economic Factors Document Number: 328500 |
| 30. Title: India's Revised National Tuberculosis Control Programme: Looking beyond detection and cure. Author: Kelkar-Khambete A; Kielmann K; Pawar S; Porter J; Inamdar V Source: International Journal of Tuberculosis and Lung Disease. 2008 Jan;12(1):87-92. Abstract: SETTING: Pune District, Maharashtra State, India. OBJECTIVES: To examine delays experienced by patients in accessing directly observed treatment. DESIGN: Data were collected from 117 new sputum-positive patients using a semi-structured interview schedule. RESULTS: Patient delays as well as diagnostic and treatment delays, which reflect the performance of a National TB Programme, were minimal. Provider delays, however, contributed significantly to delayed entry into India's Revised National TB Control Programme (RNTCP). Patients had to resort to multiple contacts with providers due to limitations of these providers in diagnosing or directing patients to the RNTCP. Patients who consulted a private provider participating in the public-private mix (PPM) were more likely to be suspected (OR 2.63, 90% CI 1.04-6.64) and referred (OR 6.8, 95%CI 2.08-22.21) to the RNTCP. Once the patients entered the RNTCP, the response of the system was rapid, with diagnosis offered and treatment initiated within on average 7 days. CONCLUSION: Interventions aimed at providers to encourage early suspicion and referral to the RNTCP, such as the PPM, are more important in improving patient access to TB care than those focusing on reducing patient delays. Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | TARGET POPULATION | TUBERCULOSIS | COMMUNICABLE DISEASE CONTROL | GOVERNMENT PROGRAMS | USER COMPLIANCE | UTILIZATION OF HEALTH CARE | ANTIBIOTICS | LABORATORY EXAMINATIONS AND DIAGNOSES | HEALTH SERVICES EVALUATION | REFERRAL AND CONSULTATION | TIME FACTORS | PROGRAM ACCESSIBILITY | Developing Countries | Asia, Southern | Asia | Research Methodology | Program Design | Programs | Organization and Administration | |