1.  Title: Starting with the classroom: updating family planning knowledge in East Africa. Author: IntraHealth International. Capacity Project Source: Chapel Hill, North Carolina, IntraHealth International, Capacity Project, 2009 Feb. [2] p. (Voices No. 28) Abstract: In Kenya, a dedicated midwifery tutor is working hard to train students at Aga Khan University but worries that he isn't teaching them the latest information and techniques. Many of his fellow instructors are in the same situation. "We had our last refresher training ten years ago," he laments. In Tanzania, a midwifery tutor from Tumaini University Faculty of Nursing observes, "Many nurses who are providing service have never been updated on new issues [in family planning]. It will be our responsibility to see how we can help as a training institution because we will send our students to some of these clinics." To build instructors' capacity and address the knowledge gaps, the Capacity Project partnered with East, Central and Southern Africa (ECSA) Health Community and Africa's Health in 2010 to deliver a week-long workshop on Contemporary Issues in Family Planning for midwifery tutors in Kenya, Tanzania and Uganda. Held in Dar es Salaam in April 2008, the workshop updated the knowledge of 22 tutors and enabled them to teach their students more effectively. A quantitative and qualitative evaluation showed the workshop to be highly successful. Average scores climbed from 58% on the pre-test to 81% on the post-test. Additionally, 94% reported that they have used the workshop information and resources to update their colleagues. (excerpt) Language: English Keywords: AFRICA, SUB SAHARAN | PROGRESS REPORT | EVALUATION | MIDWIVES AND MIDWIFERY | NURSE-MIDWIVES | FAMILY PLANNING EDUCATION | SEX EDUCATION | USAID | CAPACITY BUILDING | WORKSHOPS | CONTRACEPTION | MATERNAL-CHILD HEALTH SERVICES | PERFORMANCE IMPROVEMENT | AUDIOVISUAL AIDS | Africa | Developing Countries | Health Personnel | Delivery of Health Care | Health | Education | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Program Sustainability | Programs | Organization and Administration | Family Planning | Primary Health Care | Health Services | Management | Educational Methods | Educational Activities Document Number: 325236 |
| 2. Title: After receiving USAID | DELIVER Project logistics training, access to health products improves in Nepal. Author: John Snow [JSI]. DELIVER Source: Arlington, Virginia, JSI, DELIVER, 2009 Jul. [2] p. (Success Story) Abstract: Just three years ago, under the previous health commodity distribution system in Nepal, the average stockout rate for family planning was 8.2 percent; for maternal and child health commodities it was 22.9 percent. Many women and children did not have the health commodities they needed. To prevent stockouts and to increase the availability of health commodities nationwide, the USAID | DELIVER PROJECT partnered with the Government of Nepal / Ministry of Health and Population (Logistics Management Division / Department of Health Services [LMD / DOHS]) and others to develop a series of logistics training programs. The goal was to create an efficient pull system that the country could use to manage stock levels at all health facilities. The project and the LMD collaborated to successfully implement two training programs -- one for community logistics and one for web-based logistics management information systems (LMISs). Conducted by the Nepali government, the USAID | DELIVER PROJECT, and their partners, these trainings taught community and district health workers how to improve the national health commodity logistics system and how to ease the transition to the new district-level pull system, which allows each health facility to determine the amount of stock that it needs to order. As a result, after 25 of the poorly performing districts participated in the training programs, stockouts of key commodities in their health facilities -- condoms, vitamin A capsules, iron tablets, cotrimoxazole, oral rehydration salt, and oxytocin decreased, while product availability for the end user increased. (Excerpt) Language: English Keywords: NEPAL | SUMMARY REPORT | COMMUNITY-BASED DISTRIBUTION WORKERS | USAID | LOGISTICS | DISTRIBUTIONAL ACTIVITIES | TRAINING PROGRAMS | INFORMATION RETRIEVAL SYSTEMS | INTERNET | HEALTH FACILITIES | PERFORMANCE IMPROVEMENT | Developing Countries | Asia, Southern | Asia | Community Workers | Health Personnel | Delivery of Health Care | Health | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Management | Organization and Administration | Program Activities | Programs | Education | Data Storage and Retrieval | Information Processing | Information | Information Networks | Communication Document Number: 331664 |
| 3. Title: Laboratory logistics handbook: A guide to designing and managing laboratory logistics systems. Author: John Snow [JSI]. DELIVER Source: Arlington, Virginia, JSI, DELIVER, 2009 Jun. 83 p. (USAID Contract No. GPO-I-01-06-00007-00) Abstract: The importance of quality laboratory services is indisputable. The expansion of programs for human immunodeficiency virus and acquired immunodeficiency syndrome (AIDS), tuberculosis, and malaria requires strong and supportive laboratory services. For antiretroviral therapy (ART) in particular, there has been a growing recognition of this importance, given the number of laboratory tests required to effectively diagnose and monitor AIDS treatment. The need to improve laboratory services for all of these disease programs provides an opportunity to strengthen laboratories in health systems overall so they can accommodate the needs of the communities they serve. This document describes the function and organization of laboratory services and the commodities needed for laboratory services, and it discusses supply chain considerations for management of laboratory commodities. Language: English Keywords: GLOBAL | MANUAL | LABORATORY | LOGISTICS | EQUIPMENT AND SUPPLIES | INGREDIENTS AND CHEMICALS | INFORMATION RETRIEVAL SYSTEMS | STANDARDS | QUALITY CONTROL | STORAGE AND WAREHOUSES | PERSONNEL MANAGEMENT | HEALTH POLICY | FINANCIAL ACTIVITIES | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Management | Organization and Administration | Data Storage and Retrieval | Information Processing | Information | Research Methodology | Policy | Political Factors | Sociocultural Factors | Economic Factors Document Number: 331659 |
| 4. Title: The logistics handbook: A practical guide for supply chain managers in family planning and health programs. Author: John Snow [JSI]. DELIVER Source: Arlington, Virginia, JSI, DELIVER, 2009 Jul. 182 p. (USAID Contract No. GPO-I-01-06-00007-00) Oringinally published in 2004. Abstract: The Logistics Handbook includes the major aspects of logistics management with an emphasis on contraceptive supplies. The text should be helpful to managers who work with supplies every day as well as managers who assess and design logistics systems for entire programs. Policymakers may find the text useful in exploring the inputs needed to create an effective logistics system. Key terms and concepts are clearly defined and explained, and the design and implementation of management information systems and inventory control are discussed in detail. Storage and quality control practices are also discussed, and overviews of forecasting and procurement processes are included. Language: English Keywords: DEVELOPING COUNTRIES | MANUAL | USAID | FAMILY PLANNING PROGRAMS | LOGISTICS | CONTRACEPTIVE METHODS | DRUGS | INFORMATION RETRIEVAL SYSTEMS | RECORDS | QUALITY CONTROL | MONITORING | STORAGE AND WAREHOUSES | IMPLEMENTATION | PLANNING | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Family Planning | Management | Organization and Administration | Contraception | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Data Storage and Retrieval | Information Processing | Information | Evaluation | Programs Document Number: 331681 |
| 5. Title: Spatial analysis of logistics indicator data for health commodities. Author: John Snow [JSI]. DELIVER Source: Arlington, Virginia, JSI, DELIVER, 2009 Jul. 6 p. Abstract: The USAID | DELIVER PROJECT has developed robust monitoring and evaluation tools to quantitatively and qualitatively assess the performance of logistics systems for essential health commodities. The purpose of this paper is to explore how analysis of stock indicators by location provides added value to these data sets, through a relatively minor investment in GPS devices and GIS software. Beginning with visual examination of logistics indicator data within a geographic context and progressing to network analysis, each of the spatial analysis methods presented in this paper presents its own set of strengths and weaknesses, yet they all excel in providing insights into the logistics system that might not otherwise be understood or even observed by simply looking at tabular data of stock levels for different facilities in the health system. Since a logistics system is inherently a geographically heterogeneous entity, using cartographic and spatial analysis tools may prove to be a crucial asset in assisting managers to identify key questions related to the performance of the logistics system and focus on potential causes and solutions. Moving forward, it will be useful to build off of the descriptive strengths of the spatial analysis methods described herein and begin building more robust statistical models that measure correlation between different components of the logistics system and commodity availability, while still accounting for the geographical variability of the data. (Excerpts) Language: English Keywords: ZAMBIA | PARAGUAY | SUMMARY REPORT | PILOT PROJECTS | DATA COLLECTION | DATA ANALYSIS | USAID | LOGISTICS | GEOGRAPHY | INFORMATION RETRIEVAL SYSTEMS | DISTANCE | STREETS AND ROADS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | South America, Central | South America | Latin America | Americas | Studies | Research Methodology | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Management | Organization and Administration | Social Sciences | Science | Data Storage and Retrieval | Information Processing | Information | Geographic Factors | Population | Transportation | Economic Factors Document Number: 331660 |
| 6. Title: USAID | DELIVER Project. No product? No program. Logistics for health. Author: John Snow [JSI]. DELIVER Source: Arlington, Virginia, JSI, DELIVER, 2009 Aug. [2] p. Abstract: The USAID | DELIVER PROJECT, a U.S. Agency for International Development (USAID)-funded project, works with national and international partners to increase the availability of essential health commodities for customers around the world. The project strengthens in-country supply chains and the host country's ability to manage them; works with partners to create a supportive policy environment for health commodities; and, upon request, procures and delivers health commodities. We work with a wide range of health products -- contraceptives and condoms; essential drugs; and select commodities for HIV and AIDS, laboratories, malaria, maternal and child health, infectious diseases, and avian influenza (AI). (Excerpt) Language: English Keywords: GLOBAL | SUMMARY REPORT | USAID | DELIVERY OF HEALTH CARE | LOGISTICS | TRANSPORTATION | CONDOMS | DRUGS | INFLUENZA | MALARIA PREVENTION | BED NETS | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Health | Management | Organization and Administration | Economic Factors | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Viral Diseases | Diseases | Malaria | Parasitic Diseases | Parasite Control | Public Health Document Number: 331661 |
| 7. Title: Public health procurement guide 2010. Author: United States. Agency for International Development [USAID]; John Snow [JSI]. DELIVER Source: Arlington, Virginia, JSI, DELIVER, 2009. [45] p. (USAID Contract No. GPO-I-01-06-00007-00) Abstract: USAID's Public Health Procurement Guide 2010 is an annual publication of current contraceptive and condom ordering procedures for missions. It includes USAID contraceptive ordering procedures and guidance on how to use logistics data and forecasts to calculate contraceptive requirements. Language: English Keywords: DEVELOPING COUNTRIES | MANUAL | STANDARDS | LOGISTICS | CONTRACEPTION | CONDOMS | COLD CHAIN | CONTRACEPTIVE DISTRIBUTION | DISTRIBUTIONAL ACTIVITIES | CONTRACEPTIVE SECURITY | Research Methodology | Management | Organization and Administration | Family Planning | Barrier Methods | Contraceptive Methods | Program Activities | Programs | Contraceptive Availability Document Number: 331472 |
9.  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 |
| 10. Peer Reviewed Title: Community-based skilled birth attendants in Bangladesh: attending deliveries at home. Author: Ahmed T; Jakaria SM Source: Reproductive Health Matters. 2009 May;17(33):45-50. Abstract: Only 15% of births in Bangladesh in 2007 were delivered at health facilities, but the increase over previous years has been significant, and treatment-seeking from a medically trained provider for obstetric complications has also increased. A programme to create a cadre of skilled birth attendants for home births was launched by the Government of Bangladesh in 2004. The training, for community-based health and family planning fieldworkers, covers 74 essential midwifery skills and danger signs for referral. Training of trainers and supervisors for the fieldworkers was also initiated. By the end of 2008 an estimated 4,000 out of a proposed 13,500 skilled birth attendants and 50 of 4,000 proposed supervisors had been trained and were working in 56 districts. There needs to be a full evaluation of the programme and whether it has reduced maternal deaths. Bangladesh now needs to decide how long to invest in this programme and/or whether to train a new cadre of fully qualified midwives, as proposed by the Nursing Council. We believe this programme can only be an interim measure, not a long-term solution, as more women decide to seek institutional delivery and professional midwifery care. For the moment, though, task-shifting seems to have yielded beneficial results and important insights into human resources planning for safe motherhood in Bangladesh. Spanish Abstract: En 2007, sólo el 15% de los partos en Bangladesh ocurrieron en establecimientos de salud. En comparación con años anteriores, este porcentaje ha aumentado considerablemente, al igual que la búsqueda de tratamiento de complicaciones obstétricas brindado por un profesional médico capacitado. En 2004, el Gobierno de Bangladesh lanzó un programa para crear una categoría de asistentes de partos calificados que ayudaran con los partos domiciliares. La capacitación de trabajadores comunitarios de la salud y de planificación familiar, abarca 74 habilidades esenciales de partería y los signos de alarma para dar referencias. También se inició la capacitación de capacitadores y supervisores de los trabajadores de campo. A finales de 2008, aproximadamente 4,000 de los 13,500 asistentes de partos calificados y 50 de los 4,000 supervisores propuestos habían recibido capacitación y estaban trabajando en 56 distritos. Es necesario realizar una evaluación completa del programa y determinar si éste ha logrado disminuir la tasa de muertes maternas. Bangladesh debe decidir por cuánto tiempo continuar invirtiendo en este programa y/o si capacitar a un nuevo grupo de parteras profesionales plenamente cualificadas, como propone el Consejo de Enfermería. Estimamos que este programa es sólo una medida provisional, no una solución de largo plazo, ya que cada vez más aumenta el número de mujeres que deciden buscar atención institucional y cuidados de partería profesionales. No obstante, por ahora la reasignación de tareas parece haber dado buenos resultados e importantes datos sobre los recursos humanos en la planificación de la maternidad sin riesgos en Bangladesh. French Abstract: Au Bangladesh, en 2007, 15% seulement des naissances avaient eu lieu dans un établissement de santé, mais la hausse par rapport aux précédentes années était sensible et le recours aux services d'un prestataire formé médicalement pour les complications obstétricales avait aussi augmenté. En 2004, le Gouvernement a lancé un programme de création d'un groupe d'accoucheuses qualifiés pour les naissances à domicile. La formation des agents de santé et de planification familiale communautaires couvre 74 compétences obstétricales essentielles et les signes de danger exigeant le transfert de la patiente. La formation des formateurs et des superviseurs des agents de terrain a aussi été lancée. Fin 2008, environ 4000 des 13 500 accoucheuses qualifiés envisagés et 50 des 4000 superviseurs prévus avaient été formés et travaillaient dans 56 districts. Il faut mener une évaluation complète du programme et déterminer s'il a diminué les décès maternels. Le Bangladesh doit maintenant décider pendant combien de temps investir dans ce programme et/ou s'il souhaite former un nouveau groupe de sages-femmes pleinement qualifiées, ainsi que l'a proposé le Conseil des infirmières. Nous pensons que ce programme ne peut être qu'une mesure provisoire et non une solution à long terme, à mesure que davantage de femmes opteront pour un accouchement institutionnel et des soins de sages-femmes professionnelles. Pour le moment, néanmoins, la délégation des tâches semble avoir produit des résultats positifs et des connaissances précieuses sur la planification des ressources humaines pour une maternité à moindre risque au Bangladesh. Language: English Keywords: BANGLADESH | PROGRESS REPORT | PILOT PROJECTS | COMMUNITY WORKERS | MIDWIVES AND MIDWIFERY | CHILDBIRTH | REFERRAL AND CONSULTATION | GOVERNMENT PROGRAMS | TRAINING OF TRAINERS | MEDICAL SUPERVISION | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Program Activities | Programs | Organization and Administration | Training Programs | Education | Supervision | Management Document Number: 342014 |
| 11. Title: Laboratory challenges in the scaling up of HIV, TB, and malaria programs: The interaction of health and laboratory systems, clinical research, and service delivery. Author: Birx D; de Souza M; Nkengasong JN Source: American Journal of Clinical Pathology. 2009 Jun;131(6):849-51. Abstract: Strengthening national health laboratory systems in resource-poor countries is critical to meeting the United Nations Millennium Development Goals. Despite strong commitment from the international community to fight major infectious diseases, weak laboratory infrastructure remains a huge rate-limiting step. Some major challenges facing laboratory systems in resource-poor settings include dilapidated infrastructure; lack of human capacity, laboratory policies, and strategic plans; and limited synergies between clinical and research laboratories. Together, these factors compromise the quality of test results and impact patient management. With increased funding, the target of laboratory strengthening efforts in resource-poor countries should be the integrating of laboratory services across major diseases to leverage resources with respect to physical infrastructure; types of assays; supply chain management of reagents and equipment; and maintenance of equipment. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | HIV INFECTIONS | TUBERCULOSIS | MALARIA | LABORATORY | NEEDS | INTEGRATED PROGRAMS | HUMAN RESOURCES | LOGISTICS | TRAINING ACTIVITIES | STANDARDS | QUALITY CONTROL | Viral Diseases | Diseases | Infections | Parasitic Diseases | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Economic Factors | Programs | Organization and Administration | Management | Training Programs | Education | Research Methodology Document Number: 341768 |
| 12. Title: Malawi. Laboratory services and supply chain assessment. Author: Butao D; Felling B; Msipa P Source: Arlington, Virginia, John Snow [JSI], DELIVER, 2009 Feb. [95] p. (USAID Contract No. GPO-I-01-06-00007-00) Abstract: In January and February 2009, the Ministry of Health (MOH), with technical assistance from the USAID | DELIVER PROJECT, Task Order 1, conducted an assessment of laboratory services and the management of the supply chain for laboratory commodities and equipment in government and Christian Health Association of Malawi (CHAM) health facilities in Malawi. The assessment’s overall objective was to provide the MOH with information on the current status of laboratory services and the supporting supply chain that could be used to develop the Five-Year Strategic Laboratory Plan. During the assessment, a quantitative baseline was established on which to measure future improvements to laboratory services and the supporting supply chain. This report presents the methodology and findings of the assessment, as well as recommendations to improve the supply chain to support laboratory services in Malawi. Language: English Keywords: MALAWI | EVALUATION REPORT | GOVERNMENT AGENCIES | USAID | LABORATORY | LOGISTICS | EQUIPMENT AND SUPPLIES | INFORMATION RETRIEVAL SYSTEMS | QUALITY CONTROL | STORAGE AND WAREHOUSES | TRANSPORTATION | PERFORMANCE IMPROVEMENT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Evaluation | Organizations | Political Factors | Sociocultural Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Management | Organization and Administration | Data Storage and Retrieval | Information Processing | Information | Economic Factors Document Number: 331662 |
| 13. Title: Zambia: National long term forecasting and quantification for family planning commodities, 2009-2015. Author: Bwembya M; Mbewe RK Source: Arlington, Virginia, John Snow [JSI], DELIVER, 2009. 23 p. (USAID Contract No. GPO-I-01-06-00007-00) Abstract: In December 2008, the Ministry of Health (MOH) and the Society for Family Health (SFH), with technical assistance from the USAID | DELIVER PROJECT, conducted a national long term quantification of contraceptive needs from 2009 -2015. The quantification's overall objective was to calculate the contraceptive requirements for each year of the forecast period and to use those requirements to mobilize resources for the country to support contraceptive commodity security. This report presents the findings of the quantification as well as the methodology used and assumptions made to arrive at these findings. Language: English Keywords: ZAMBIA | SUMMARY REPORT | RESEARCH METHODOLOGY | TECHNICAL ASSISTANCE | USAID | NEEDS ASSESSMENT | CONTRACEPTIVE PREVALENCE | CONTRACEPTIVE SECURITY | COLD CHAIN | LOGISTICS | FUNDS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Programs | Organization and Administration | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Evaluation | Contraceptive Usage | Contraception | Family Planning | Contraceptive Availability | Management | Financial Activities | Economic Factors Document Number: 331474 |
| 14. Peer Reviewed Title: Saving the lives of South Africa's mothers, babies, and children: can the health system deliver? Author: Chopra M; Daviaud E; Pattinson R; Fonn S; Lawn JE Source: Lancet. 2009 Sep 5;374(9692):835-46. Abstract: South Africa is one of only 12 countries in which mortality rates for children have increased since the baseline for the Millennium Development Goals (MDGs) in 1990. Continuing poverty and the HIV/AIDS epidemic are important factors. Additionally, suboptimum implementation of high-impact interventions limits programme effectiveness; between a quarter and half of maternal, neonatal, and child deaths in national audits have an avoidable health-system factor contributing to the death. Using the LiST model, we estimate that 11,500 infants' lives could be saved by effective implementation of basic neonatal care at 95% coverage. Similar coverage of dual-therapy prevention of mother-to-child transmission with appropriate feeding choices could save 37,200 children's lives in South Africa per year in 2015 compared with 2008. These interventions would also avert many maternal deaths and stillbirths. The total cost of such a target package is US$1.5 billion per year, 24% of the public-sector health expenditure; the incremental cost is $220 million per year. Such progress would put South Africa squarely on track to meet MDG 4 and probably also MDG 5. The costs are affordable and the key gap is leadership and effective implementation at every level of the health system, including national and local accountability for service provision. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | ESTIMATION TECHNIQUES | ECONOMIC MODEL | EXCESS MORTALITY | CAUSES OF DEATH | HIV INFECTIONS | INTERVENTIONS | IMPLEMENTATION | HEALTH POLICY | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | PRIMARY HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | PERFORMANCE IMPROVEMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Theoretical Models | Mortality | Population Dynamics | Demographic Factors | Population | Viral Diseases | Diseases | Programs | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Disease Transmission Control | Prevention and Control | Health Services | Delivery of Health Care | Health | Management Document Number: 342802 |
| 15. Peer Reviewed Title: Surgical task shifting in Sub-Saharan Africa. Author: Chu K; Rosseel P; Gielis P; Ford N Source: PLoS Medicine. 2009 May 19;6(5):e1000078. Abstract: Surgically treatable problems account for a significant proportion of disease burden in resourcelimited settings, but are neglected due to lack of skilled professionals, adequate infrastructure and equipment, and the perception that surgical services are complex and expensive. In the absence of trained surgeons, surgical tasks are often performed by non-specialist physicians and non-physician clinicians. While evaluations have proven the effectiveness of such task shifting, this is often done de facto, with little supervisory or training framework in place. As efforts increase to scale up surgical care in the developing world, a number of important lessons from task shifting in the field of HIV/AIDS care could serve to support task shifting in surgery. These include clearly defining the limits of task shifting, ensuring adequate training and supervision, providing adequate recognition and remuneration, developing simplified tools and guidelines, ensuring engagement with regulatory bodies, and mobilizing community health workers. Language: English Keywords: AFRICA, SUB SAHARAN | CRITIQUE | HEALTH PERSONNEL | SURGERY | ANESTHESIA | HUMAN RESOURCES | TRAINING PROGRAMS | AIDS | HIV INFECTIONS | REFERRAL AND CONSULTATION | SUPERVISION | ETHICS | Africa | Developing Countries | Delivery of Health Care | Health | Treatment | Medical Procedures | Medicine | Health Services | Economic Factors | Education | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Management | Sociocultural Factors Document Number: 341772 |
| 16. Peer Reviewed Title: Validation of community health workers' assessment of neonatal illness in rural Bangladesh. Author: Darmstadt GL; Baqui AH; Choi Y; Bari S; Rahman SM; Mannan I; Ahmed AS; Saha SK; Rahman R; Chang S; Winch PJ; Black RE; Santosham M; El Arifeen S Author: Bangladesh Projahnmo-2 (Mirzapur) Study Group Source: Bulletin of the World Health Organization. 2009 Jan;87(1):12-9. Abstract: OBJECTIVE: To estimate the validity (sensitivity, specificity, and positive and negative predictive values) of a clinical algorithm as used by community health workers (CHWs) to detect and classify neonatal illness during routine household visits in rural Bangladesh. METHODS: CHWs evaluated breastfeeding and symptoms and signs of illness in 395 neonates selected randomly from neonatal illness surveillance during household visits on postnatal days 0, 2, 5 and 8. Neonates classified with very severe disease (VSD) were referred to a community-based hospital. Within 12 hours of CHW assessments, physicians independently evaluated all neonates seen in a given day by one CHW, randomly chosen from among 36 project CHWs. Physicians recorded symptoms and signs of illness, classified the illness, and determined whether the newborn needed referral-level care at the hospital. Physicians' identification and classification were used as the gold standard in determining the validity of CHWs' identification of symptoms and signs of illness and its classification. FINDINGS: CHWs' classification of VSD showed a sensitivity of 73%, a specificity of 98%, a positive predictive value of 57% and a negative predictive value of 99%. A maternal report of any feeding problem as ascertained by physician questioning was significantly associated (P < 0.001) with 'not sucking at all' and 'not attached at all' or 'not well attached' as determined clinically by CHWs during feeding assessment. CONCLUSION: CHWs identified with high validity the neonates with severe illness needing referral-level care. Home-based illness recognition and management, including referral of neonates with severe illness by CHWs, is a promising strategy for improving neonatal health and survival in low-resource developing country settings. Language: English Keywords: BANGLADESH | RESEARCH REPORT | VALIDITY | RURAL POPULATION | HEALTH PERSONNEL | NEONATAL DISEASES AND ABNORMALITIES | HOME CARE | PERFORMANCE IMPROVEMENT | CHILD SURVIVAL | CHILD HEALTH | EXAMINATIONS AND DIAGNOSES | Developing Countries | Asia, Southern | Asia | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Diseases | Care and Support | Health Services | Management | Organization and Administration | Survivorship | Length of Life | Mortality | Population Dynamics | Medical Procedures | Medicine Document Number: 341189 |
| 17. 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 |
| 18. 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 |
| 19. Title: Haiti: Going to scale with a performance incentive model. Author: Eichler R; Auxila P; Antoine U; Desmangles B 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. :165-188. Abstract: Rewarding NGOs for increasing access to a package of basic services and paying them for achieving population-based performance targets can result in significant increases in essential services such as immunizations and assisted deliveries. Paying NGOs for results strengthens institutional capacity to deliver services from the bottom up. Changes in the design throughout the six years offer lessons for other contexts. Language: English Keywords: HAITI | RESEARCH REPORT | PILOT PROJECTS | MATERNAL HEALTH | CHILD HEALTH | REPRODUCTIVE HEALTH | FAMILY PLANNING | MEASUREMENT | PERFORMANCE IMPROVEMENT | PROGRAM ACTIVITIES | NONGOVERNMENTAL ORGANIZATIONS | ORGANIZATION AND ADMINISTRATION | PROGRAM EVALUATION | MONITORING | Developing Countries | Caribbean | Americas | Studies | Research Methodology | Health | Management | Programs | Organizations | Political Factors | Sociocultural Factors | Evaluation Document Number: 331456 |
| 20. 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 |
| 21. 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 |
| 22. 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 |
| 23. Peer Reviewed Title: Understanding women's experiences with medical abortion: In-depth interviews with women in two Indian clinics. Author: Ganatra B; Kalyanwala S; Elul B; Coyaji K; Tewari S Source: Global Public Health. 2009 May 8;:1-12. Abstract: We explored women's perspectives on using medical abortion, including their reasons for selecting the method, their experiences with it and their thoughts regarding demedicalisation of part or all of the process. Sixty-three women from two urban clinics in India were interviewed within four weeks of abortion completion using a semi-structured in-depth interview guide. While women appreciated the non-invasiveness of medical abortion, other factors influencing method selection were family support and distance from the facility. The degree of medicalisation that women wanted or felt was necessary also depended on the way expectations were set by their providers. Confirmation of abortion completion was a source of anxiety for many women and led to unnecessary interventions in a few cases. Ultimately, experiences depended more on women's expectations about the method, and on the level of emotional and logistic support they received rather than on inherent characteristics of the method. These findings emphasise the circumstances under which women make reproductive choices and underscore the need to tailor service delivery to meet women's needs. Women-centred counselling and care that takes into consideration individual circumstances are needed. Language: English Keywords: INDIA | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | POSTPARTUM WOMEN | URBAN POPULATION | ABORTION | PERCEPTION | MOTIVATION | FEAR | EMOTIONS | LOGISTICS | NEEDS ASSESSMENT | DECISION MAKING | Asia, Southern | Asia | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Puerperium | Reproduction | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Psychological Factors | Behavior | Management | Organization and Administration | Evaluation Document Number: 341474 |
| 24. 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 |
| 25. Peer Reviewed Title: Maternal health: a case study of Rajasthan. Author: Iyengar SD; Iyengar K; Gupta V Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):271-92. Abstract: This case study has used the results of a review of literature to understand the persistence of poor maternal health in Rajasthan, a large state of north India, and to make some conclusions on reasons for the same. The rate of reduction in Rajasthan's maternal mortality ratio (MMR) has been slow, and it has remained at 445 per 1000 livebirths in 2003. The government system provides the bulk of maternal health services. Although the service infrastructure has improved in stages, the availability of maternal health services in rural areas remains poor because of low availability of human resources, especially midwives and clinical specialists, and their non-residence in rural areas. Various national programmes, such as the Family Planning, Child Survival and Safe Motherhood and Reproductive and Child Health (phase 1 and 2), have attempted to improve maternal health; however, they have not made the desired impact either because of an earlier emphasis on ineffective strategies, slow implementation as reflected in the poor use of available resources, or lack of effective ground-level governance, as exemplified by the widespread practice of informally charging users for free services. Thirty-two percent of women delivered in institutions in 2005-2006. A 2006 government scheme to give financial incentives for delivering in government institutions has led to substantial increase in the proportion of institutional deliveries. The availability of safe abortion services is limited, resulting in a large number of informal abortion service providers and unsafe abortions, especially in rural areas. The recent scheme of Janani Suraksha Yojana provides an opportunity to improve maternal and neonatal health, provided the quality issues can be adequately addressed. Language: English Keywords: INDIA | LITERATURE REVIEW | MATERNAL HEALTH | REPRODUCTIVE HEALTH | WOMEN'S STATUS | MATERNAL MORTALITY | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | QUALITY OF HEALTH CARE | SAFE MOTHERHOOD | PERFORMANCE IMPROVEMENT | HUMAN RESOURCES | CONTRACEPTION | ABORTION | Asia, Southern | Asia | Developing Countries | Health | Socioeconomic Factors | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Management | Family Planning | Fertility Control, Postconception Document Number: 341929 Notification |
| 26. Title: Task sharing in family planning. Author: Janowitz B; Stanback J Source: [Unpublished] 2009. [4] p. Abstract: Many developing countries face strains in meeting the demands for provision of health services because of limited medical personnel. This situation has been exacerbated by the continued "brain drain" of highly trained medical professionals, and, more recently, by the increased demand for HIV services, especially in countries with a generalized epidemic. This has led to renewed interest in task sharing, also known as task shifting. A key feature of task sharing is that those with less medical or paramedical training can provide some of the same services with the same quality as those with more training. While the term “task sharing” is new, the concept has been applied for many years in family planning programs as various tasks became shared between doctors and nurses or between nurses and community health workers. The consensus reported in a recent WHO document, ‘Task Shifting to Tackle Health Worker Shortages’, was that task sharing “will positively affect health outcome. In family planning, perhaps the most important reason for task shifting is to bring services to women with poor access. Since it is not always cost effective to build clinics in sparsely populated rural areas, women will either be forced to travel long distances for services or non-clinic-based services must be provided in local communities. (Excerpts) Language: English Keywords: GLOBAL | CRITIQUE | HEALTH PERSONNEL | FAMILY PLANNING PROGRAMS | PROGRAM ACCESSIBILITY | NEEDS | QUALITY OF HEALTH CARE | COMMUNITY-BASED DISTRIBUTION | TRAINING ACTIVITIES | SUPERVISION | CONTRACEPTIVE USAGE | Delivery of Health Care | Health | Family Planning | Program Evaluation | Programs | Organization and Administration | Economic Factors | Health Services Evaluation | Nonclinical Distribution | Distributional Activities | Program Activities | Training Programs | Education | Management | Contraception Document Number: 331837 |
| 27. Title: The number of procedures required to achieve optimal competency with male circumcision: findings from a randomized trial in Rakai, Uganda. Author: Kiggundu V; Watya S; Kigozi G; Serwadda D; Nalugoda F; Buwembo D; Settuba A; Anyokorit M; Nkale J; Kighoma N; Ssempijja V; Wawer M; Gray RH Source: BJU International. 2009 Aug;104(4):529-32. Abstract: OBJECTIVE: To assess the number of procedures required to achieve optimal competency (time required for surgery with minimal adverse events) in Rakai, Uganda, and thus facilitate the development of guidelines for training providers, as male circumcision reduces the acquisition of human immunodeficiency virus (HIV) in men and is recommended for HIV prevention. PATIENTS AND METHODS: In a randomized trial, 3011 men were circumcised, using the sleeve method, by six physicians who had completed training, which included 15-20 supervised procedures. The duration of surgery from local anaesthesia to wound closure, moderate or severe surgery-related adverse events (AEs), and wound healing were assessed in relation to the number of procedures done by each physician. RESULTS: The median age of the patients was 24 years. The number of procedures per surgeon was 20-981. The mean time required to complete surgery was approximately 40 min for the first 100 procedures and declined to 25 min for the subsequent 100 circumcisions. After controlling for the number of procedures there was no significant difference in duration of the surgery by patient HIV status or age. The rate of moderate and severe AEs was 8.8% (10/114) for the first 19 unsupervised procedures after training, 4.0% for the next 20-99 (13/328) and 2.0% for the last 100 (P for trend, 0.003). All AEs resolved with management. CONCLUSION: The completion of more than 100 circumcisions was required before newly trained physicians achieved the optimum duration of surgery. AEs were higher immediately after training and additional supervision is needed for at least the first 20 procedures after completing training. Language: English Keywords: UGANDA | RESEARCH REPORT | CLINICAL TRIALS | PHYSICIANS | HIV PREVENTION | MALE CIRCUMCISION | COMPLICATIONS | TRAINING PROGRAMS | SUPERVISION | ANESTHESIA | STANDARDS | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Health Personnel | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Education | Management | Organization and Administration | Treatment | Population Dynamics | Demographic Factors | Population Document Number: 342642 |
| 28. Title: Audit for maternal and newborn health services in resource-poor countries. Author: Kongnyuy EJ; van den Broek N Source: BJOG. 2009 Jan;116(1):7-10. Abstract: Each year more than 536 000 women worldwide die from complications of pregnancy and childbirth. Many more survive but will suffer ill health and disability as a result of these complications. In addition, an estimated 4 million neonatal deaths occur each year, accounting for almost 40% of all deaths in children younger than 5 years. The key strategies that have been identified to reduce this global burden are the presence of skilled birth attendants, the availability of essential (or emergency) obstetric care4 and newborn care. To have major effects on maternal outcomes, it is crucial that these elements are not just available but also of high quality. And assessment of quality requires effective clinical audit. However, anyone who has undertaken a clinical audit will realise that the practice is not as simple as the theory, and 'closing the loop' (to achieve the desired endpoint of improvements in clinical care) is often difficult. So the process of clinical audit itself must be critically evaluated. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | SUMMARY REPORT | INFANT | INFANT HEALTH | QUALITY OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | NEEDS ASSESSMENT | PERFORMANCE IMPROVEMENT | COST EFFECTIVENESS | MEASUREMENT | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Child Health | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Evaluation | Management | Evaluation Indexes | Quantitative Evaluation | Research Methodology Document Number: 330471 |
| 29. Title: Facility-based maternal death review in three districts in the central region of Malawi: an analysis of causes and characteristics of maternal deaths. Author: Kongnyuy EJ; Mlava G; van den Broek N Source: Women's Health Issues. 2009 Jan-Feb;19(1):14-20. Abstract: PURPOSE: We sought to determine the causes and characteristics maternal deaths that occur in health facilities in Malawi. METHODS: Forty-three maternal deaths were reviewed in 9 hospitals in 3 districts in Central Malawi over a 1-year period. Causes and avoidable factors of maternal deaths were identified during the review, and recommendations made and implemented. MAIN FINDINGS: There were 28 (65.1%) direct obstetric deaths and 15 (34.9%) indirect obstetric deaths. The major causes of maternal deaths were postpartum hemorrhage (25.6%), postpartum sepsis (16.3%), HIV/AIDS (16.3%), ruptured uterus (7.0%), complications of abortion (7.0%), anemia (7.0%), antepartum hemorrhage (4.7), and eclampsia (4.7). Two thirds of the women were referred either from another health facility (51.2%) or by a traditional birth attendant (TBA; 11.6%), and up to 79.1% were critically ill on admission. Four groups of factors that contributed to maternal deaths were identified: 1) health worker factors, 2) administrative factors, 3) patient/family factors, and 4) TBA factors. The major health worker factors were inadequate resuscitation (69.8%), lack of obstetric life-saving skills (60.5%), inadequate monitoring (55.8%), initial assessment incomplete (46.5%), and delay in starting treatment (46.5%). The most common administrative factor was lack of blood for transfusion (20.9%). The major problems encountered include shortage of staff and other resources, difficulty in maintaining anonymity, poor quality of data, and difficulty in implementing recommendations. CONCLUSION: Adequate training on obstetric life-saving skills, addressing HIV/AIDS, and raising community awareness could be important factors for reducing maternal mortality in Malawi and countries with similar socioeconomic profiles. Language: English Keywords: MALAWI | RESEARCH REPORT | MOTHERS | INFANT | HEALTH PERSONNEL | MATERNAL MORTALITY | CAUSES OF DEATH | BLEEDING | POSTPARTUM | PERFORMANCE IMPROVEMENT | EVALUATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Mortality | Population Dynamics | Signs and Symptoms | Diseases | Puerperium | Reproduction | Management | Organization and Administration Document Number: 331041 |
| 30. Title: Provision of contraceptive counseling by internal medicine residents. Author: Lohr PA; Schwarz EB; Gladstein JE; Nelson AL Source: Journal of Women's Health. 2009 Jan-Feb;18(1):127-31. Abstract: BACKGROUND: Internists care for women of reproductive age, but little is known about internists' training in contraceptive counseling or provision of contraceptive methods. METHODS: We surveyed 152 residents in nine internal medicine programs in Los Angeles County during the 2004-2005 academic year. The self-administered, 29-item survey included demographic, contraceptive practice pattern, and training variables. Descriptive statistics and multivariable logistic regression were used to illustrate counseling and prescribing practices and to identify predictors of counseling and provision of contraceptives. RESULTS: Most (95%) future internists surveyed reported clinical responsibility for women of reproductive age. However, few (17%) routinely provided contraceptive counseling, and 39% rarely or never provided contraceptive counseling. Residents had prescribed contraception on a median of 2 (range 0-30) occasions in the past year. Some formal education in contraceptive methods was reported by 51% of respondents; however, 75% of residents reported a desire for more training about contraception. CONCLUSIONS: Internal medicine residents commonly care for women of reproductive age but infrequently assess or address contraceptive needs. Further training on how to provide contraception is desired by many internal medicine residents. Language: English Keywords: UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | MEDICAL STUDENTS | WOMEN | REPRODUCTIVE AGE | CONTRACEPTIVE METHODS | CONTRACEPTION | NEEDS | COUNSELING | PERFORMANCE IMPROVEMENT | Developed Countries | North America | Americas | Students | Education | Demographic Factors | Population | Reproduction | Family Planning | Economic Factors | Clinic Activities | Program Activities | Programs | Organization and Administration | Management Document Number: 331217 |
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