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Tanzania economic update: the power of investing in girls: educating girls and ending child marriage in Tanzania.
[Washington, D.C.], World Bank, 2019 Jan. 79 p.This report is the 11th in a series of updates on the economy of Tanzania published by the World Bank. Unlike others in the series however, this report has a special focus on the economic implications of girls’ education and child marriage. The report builds on some of the analysis from the study looking at the economic impact of child marriage conducted by the World Bank and International Center for Research on Women. The authors find that overall child marriage and early child bearing are still prevalent, and girls’ educational attainment is on average low. Overall, ending child marriage in Tanzania could lead to: up to US$311 million in education budget savings by 2030; up to US$219 million benefit from reduced under 5 mortality by 2030; US$5 billion in welfare benefits through reduced population growth by 2030. The report concludes with policy recommendations to increase opportunities for adolescent girls, including strategies to improve access to and quality of education, to change social norms that perpetuate gender stereotypes, to empower girls, and to increase economic opportunities for girls.
Juba, South Sudan, Oxfam, 2019 Feb. 46 p.This research found that 71% of women and girls between 15 and 49 years old living in Nyal, South Sudan, were married before 18, and 10% were married before 15. These findings are based on a survey carried out among about 200 women and girls, and on almost 30 interviews and focus groups with local decision makers and practitioners, and boys and girls between 13 and 18 years old. Millions of people have been affected by the conflict that started in 2013 in South Sudan, and women and girls continue to suffer from rape and abduction for sexual slavery. Many people living in the most affected areas have fled to Nyal, a region still affected by increased poverty, food insecurity and sexual violence driven by the conflict. While it is difficult to identify any increase in child marriage rates due to the conflict, because there was no data available on child marriage in Nyal before the conflict, the rates are alarming. With this report, Oxfam urges government, donors, and humanitarian actors to take action to address gender inequality and support community-based action to address this pressing issue.
The effect of implementation strength of basic emergency obstetric and newborn care (BEmONC) on facility deliveries and the met need for BEmONC at the primary health care level in Ethiopia.
BMC Pregnancy and Childbirth. 2018; 18(123): p.Background: Basic emergency obstetric and newborn care (BEmONC) is a primary health care level initiative promoted in low- and middle-income countries to reduce maternal and newborn mortality. Tailored support, including BEmONC training to providers, mentoring and monitoring through supportive supervision, provision of equipment and supplies, strengthening referral linkages, and improving infection-prevention practice, was provided in a package of interventions to 134 health centers, covering 91 rural districts of Ethiopia to ensure timely BEmONC care. In recent years, there has been a growing interest in measuring program implementation strength to evaluate public health gains. To assess the effectiveness of the BEmONC initiative, this study measures its implementation strength and examines the effect of its variability across intervention health centers on the rate of facility deliveries and the met need for BEmONC. Methods: Before and after data from 134 intervention health centers were collected in April 2013 and July 2015. A BEmONC implementation strength index was constructed from seven input and five process indicators measured through observation, record review, and provider interview; while facility delivery rate and the met need for expected obstetric complications were measured from service statistics and patient records. We estimated the dose–response relationships between outcome and explanatory variables of interest using regression methods. Results: The BEmONC implementation strength index score, which ranged between zero and 10, increased statistically significantly from 4.3 at baseline to 6.7 at follow-up (p < .05). Correspondingly, the health center delivery rate significantly increased from 24% to 56% (p < .05). There was a dose–response relationship between the explanatory and outcome variables. For every unit increase in BEmONC implementation strength score there was a corresponding average of 4.5 percentage points (95% confidence interval: 2.1–6.9) increase in facility-based deliveries; while a higher score for BEmONC implementation strength of a health facility at follow-up was associated with a higher met need. Conclusion: The BEmONC initiative was effective in improving institutional deliveries and may have also improved the met need for BEmONC services. The BEmONC implementation strength index can be potentially used to monitor the implementation of BEmONC interventions.
Journal of Nepal Health Research Council. 2018 Jul-Sep; 16(40):359-361.Chlorhexidine is a broad-spectrum antiseptic, effective on gram positive and gram negative bacteria as well as some viruses, having strong skin binding effect. Randomized controlled trials conducted in South Asian countries have proven that the use of chlorhexidine (4% weight/weight) for cord care can reduce neonatal mortality and prevent severe cord infections. Between 2011 and 2017, Nepal completed nationwide scale-up of the use of chlorhexidine by integrating with ongoing maternal and neonatal health programs, under the leadership of the Child Health Division. The chlorhexidine coverage and compliance study (2017) has revealed that the country has achieved 59% coverage of the intervention to date, with lowest use among home births. The strategy should be further strengthened to ensure that every newborn in need is reached with chlorhexidine.
Coaching community health volunteers in integrated community case management improves the care of sick children under-5: experience from Bondo, Kenya.
International Journal of Integrated Care. 2018 Oct 24; 18(4):1-11.Background: Shortages of healthcare workers is detrimental to the health of communities, especially children. This paper describes the process of capacity building Community Health Volunteers (CHVs) to deliver integrated preventive and curative package of care of services to manage common childhood illness in hard-to-reach communities in Bondo Subcounty, Kenya. Methods: A pre-test/post-test single-group design was used to assess changes in knowledge and skills related to integrated community case management (iCCM) among 58 Community Health Volunteers who received a six-day iCCM clinical training and an additional 3-week clinical coaching at health facilities. Thereafter, community health extension workers and health managers provided supportive supervision over a six-month period. Skills were assessed before the six-day training, during coaching, and after six months of iCCM implementation. Results: CHVs knowledge assessment scores improved from 54.5% to 72.9% after the six-day train¬ing (p < 0.001). All 58 CHVs could assess and classify fever and diarrhoea correctly after 3–6 weeks of facility-based clinical coaching; 97% could correctly identify malnutrition and 80%, suspected pneumonia. The majority correctly performed four of the six steps in malaria rapid diagnostic testing. However, only 58% could draw blood correctly and 67% dispose of waste correctly after the testing. The proportion of CHV exhibiting appropriate skills to examine for signs of illness improved from 4% at baseline to 74% after 6 months of iCCM implementation, p < 0.05. The proportion of caregivers in intervention community units who first sought treatment from a CHV increased from 2 to 31 percent (p < 0.001). Conclusions: Training and clinical coaching built CHV’s skills to manage common childhood illnesses. The CHVs demonstrated ability to follow the Kenya iCCM algorithm for decision-making on whether to treat or refer a sick child. The communities’ confidence in CHVs’ ability to deliver integrated case management resulted in modification of care-seeking behaviour.
[Washington, D.C.], Population Services International [PSI], 2018. 24 p.Expanding Effective Contraceptive Options (EECO) is a USAID-funded project led by WCG with PSI and other partners to support the introduction of new contraceptive and dual protection methods. This case study presents EECO’s analysis of consumer insights and market data to develop a marketing strategy for the Woman’s Condom in Malawi and Zambia.
A Behavioral Economics ppproach to reduce the injectable contraceptive discontinuation rate in Ethiopia: A stratified-pair, cluster-randomized field study.
Arlington, Virginia, JSI, Research and Training Institute, 2018. 36 p.Behavioral economics offers one way to design interventions by improving understanding of why people choose as they do and what motivates their decision-making and action. Behavioral economics has recently been used to improve reproductive health programming, suggesting that the approach could potentially be applied to mitigate the contraceptive discontinuation problem in Ethiopia. This report highlights the behavioral economics methodology used to conduct a behavioral diagnosis and design an intervention package to change health-related behaviors and decision-making around the use of injectable contraceptives in Ethiopia. Given that injectable methods are the primary method of choice among married women of reproductive age in the country and that the government sector provides 82% of contraceptive methods, JSI's Last Ten Kilometers project, in collaboration with ideas42, worked with Ethiopia's flagship Health Extension Program (HEP) to design and test behavioral approaches to mitigate the problem of discontinuation of injectable contraceptives. The JSI team implemented a stratified-pair, cluster-randomized experiment in the eight primary health center units (PHCUs), each of which serves about 25,000 people. This report highlights the four stages of behavioral health methodology used in the study, including the various interventions tested, and the results achieved by the end of the two-year activity.