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Setting the national agenda and sharing contraceptive responsibilities: Spotlight on vasectomy access and uptake in South Africa. Report.
[Cape Town, South Africa], AIDS Accountability International, . 46 p.This report represents exploratory consultative work in the area of vasectomy awareness, uptake and provision in South Africa and seeks to strengthen a regional discussion on shared contraceptive responsibility as a gender transformative approach.
Baltimore, Maryland, Advance Family Planning, Bill & Melinda Gates Institute for Population and Reproductive Health, 2018 Jan. 4 p.This case study explores that, despite Lagos State’s investment in family planning, hidden, out-of-pocket costs prevented achieving the goal. Moreover, the advocates’ attainment of a policy directive to address this lacked additional funding to carry it out. The study highlights the importance of advocates’ follow-through--and how the SMART approach enabled them to carry a commitment toward implementation.
Role of Religious Leaders in Promoting Contraceptive Use in Nigeria: Evidence From the Nigerian Urban Reproductive Health Initiative.
Global Health, Science and Practice. 2018 Oct 3; 6(3):500-514.BACKGROUND: Despite the many supply- and demand-side interventions aimed at increasing contraceptive uptake, the modern contraceptive prevalence rate in Nigeria has remained very low (9.8%). Religion is an important part of the sociocultural fabric of many communities. As such, religious leaders have the power to inhibit or facilitate effective adoption of contraceptive methods to support family health. We assess the association of exposure to religious leaders' tailored scriptural family planning messages with contraceptive use in Nigeria. METHODS: This cross-sectional study used data from a Measurement, Learning and Evaluation Project survey conducted in 2015 in 4 Nigerian states-Federal Capital Territory, Kaduna, Kwara, and Oyo. The final study sample was restricted to 9,725 non-pregnant women aged 15 to 49 years. Data analysis included descriptive statistics and binary logistic regression analysis to explore significant relationships between current use of a modern contraceptive method, exposure to family planning messages from religious leaders, and selected background characteristics. RESULTS: About 2 in 5 women reported being exposed to family planning messages from religious leaders in the past year. Bivariate results revealed a higher uptake of modern contraceptives among women with high exposure to different NURHI interventions (35.5%) compared with respondents in the low or medium exposure categories (14.5% and 24.5%, respectively). The multivariable analysis revealed significantly higher contraceptive uptake among women who had exposure to family planning messages from religious leaders relative to those with no exposure (odds ratio=1.70; 95% confidence interval, 1.54 to 1.87; P<.001). This association remained significant after adjustment for background characteristics and other selected variables. CONCLUSION: Interventions that engage clerics of different faiths as change agents for shaping norms and informing behaviors about family planning and contraceptive use are crucial for increasing contraceptive uptake in Nigeria. (c) Adedini et al.
Geneva, Switzerland, WHO, 2018. 32 p. (WHO/CDS/TB/2018.22)The 2018 United Nations General Assembly High-Level Meeting (HLM) on Tuberculosis and the current revision of the Roadmap for childhood tuberculosis together present an important moment to consolidate and advance advocacy, commitment, resource mobilization and joint efforts by all stakeholders to provide health care and address the burden of TB among children The first Roadmap, published five years ago, helped to draw the childhood TB epidemic into the global spotlight after decades of neglect. Today, we are closer to a generation of children free from TB. Armed with new knowledge about how 10% of all TB affects and manifests in children under 15 years of age, we have a clearer vision of what is needed, how to deliver it -and the priority actions and enhanced investments that are urgently required. The 2018 Roadmap incorporates an additional critical population: adolescents. Despite making up 1 in 6 of the world’s people, adolescents have been largely overlooked as global momentum to address TB has grown. Spanning the ages of 10-19 years, adolescents are both at risk of TB and represent an important population for TB control. They often present with infectious TB and frequently have multiple contacts in congregate settings, such as schools and other educational institutions. Nevertheless, few countries capture TB data in suitably age-disaggregated ways to allow full understanding of its impact in this group and even fewer provide the adolescent-friendly services our young people need to access diagnosis and care.
Commitments to the Every Woman Every Child Global Strategy for Women's Children's and Adolescents' Health (2016-2030): Commitments in support of adolescent and young adult health and well-being, 2015-2017.
Geneva, Switzerland, The Partnership for Maternal, Newborn & Child Health, 2018. 11 p.Health and well-being of adolescents and young adults is one of the priorities of the EWEC Global Strategy which calls for accelerated action to more effectively meet their health needs. Adolescent health is central to the EWEC Global Strategy and to achieving the Sustainable Development Goals (SDGs). This deep dive compliments the 2018 report by the Partnership for Maternal, Newborn & Child Health on commitments to the EWEC Global Strategy by analyzing commitments made in support of adolescents and young adults aged 10-24 years.
Seattle, Washington, PATH, 2018 Jul. 42 p.The DMPA-SC Evidence to Practice meeting in Nairobi, Kenya brought together 175 family planning experts, including ministry officials, partners, and donors from 18 countries. Participants met to develop country strategies for increasing voluntary access to subcutaneous DMPA (DMPA-SC, brand name Sayana® Press) within a wide range of contraceptive methods and to inform related policy decisions with current evidence. Available in English, French, and Portuguese, this report summarizes the plenaries, presentations, and discussions held to inform country planning.
Challenges of developing a district child welfare plan in South Africa: lessons from a community-engaged HIV/AIDS research project.
Global Health Promotion. 2018;The Amajuba Child Health and Wellbeing Research Project measured the impact of orphaning due to HIV/AIDS on South African households between 2004 and 2007. Community engagement was a central component of the project and extended through 2010. We describe researcher engagement with the community to recruit participants, build local buy-in, stimulate interest in study findings, and promote integration of government social welfare services for families and children affected by HIV/AIDS. This narrative documents the experience of researchers, drawing also on project reports, public documents, and published articles, with the objective of documenting lessons learned in this collaboration between researchers from two universities and a community in South Africa during a period that spanned seven years. This experience is then analyzed within the context of an applied research, community-engagement framework. © 2018, The Author(s) 2018.
NASN School Nurse. 2018 Sep; 33(5):284-287.Nationally, many adolescents remain at risk for unintended pregnancies and sexually transmitted infections. School nurses can be leaders and change agents in their schools. This article shares the journey of a school nurse in Maine, who used evidence-based data to develop support from administration and key stakeholders to successfully advocate for a needed policy change. That support and advocacy led to a new "Safer Sex" policy.
Washington, D.C., FHI 360, Food and Nutrition Technical Assistance Project [FANTA], 2018 Apr. 293 p. (USAID Cooperative Agreement No. AID-OAA-A-12-00005)This resource provides comprehensive, step-by-step instructions for facilitating a national country-level nutrition advocacy planning process using the PROFILES nutrition advocacy tool and nutrition costing. Designed for practitioners working in and with government and their stakeholders to conduct nutrition advocacy planning in a given country, the manual is based on a process that FANTA developed, field-tested, and refined over several years of facilitating nutrition advocacy in developing countries using a collaborative approach. The process includes the following steps: Step 1. Convene a multisectoral core working group and then conduct a stakeholder meeting on nutrition advocacy using PROFILES and nutrition costing. Step 2. Conduct a PROFILES workshop, present preliminary results, and develop reports. Step 3. Develop cost estimates for nutrition service delivery, present preliminary results, and develop a report. Step 4. Conduct a nutrition advocacy planning workshop and finalize a nutrition advocacy plan and materials. The manual includes planning guidance; session plans for workshop and meeting facilitators; presentations with scripted notes; handouts for workshop and meeting participants; and templates (including the PROFILES spreadsheet workbook) for use in each step of the process.
Overcoming family planning challenges in Africa: toward meeting unmet need and scaling up service delivery [editorial] Surmonter les Défis de la Planification Familiale en Afrique: vers la Satisfaction des Besoins Non Satisfaits et L’augmentation de la Prestation des Services.
African Journal of Reproductive Health. 2018 Mar; 22(1):9-19.Expanding access to family planning and addressing unmet needs for contraception are key goals for improving reproductive health. Poor access to family planning is associated with unintended pregnancies and poorer maternal and newborn outcomes, including abortion-related morbidity and mortality. Addressing unmet need helps increase contraceptive use and reduces unintended pregnancies, leading to improved health outcomes and broad social and economic benefits for women, their families and societies. Unmet need reflects gaps in both demand and supply of contraceptive services. The challenges posed are greater in low- and middle-income countries (LMICs), especially in sub-Saharan Africa (SSA). Progress to reduce unmet need remains slow and more effective ways are required to expand family planning care on a larger scale. Family planning has long been neglected and poorly implemented in SSA, where the failure to develop a more comprehensive understanding of unmet need and a multi-component intervention package to address it continue to pose major developmental, health and rights challenges. More optimistically, awareness of the rationale for making family planning programs a higher priority to African health systems is increasing and several new regional success stories and implementation models have emerged. These indicate the potential for addressing unmet need and for scaling up family planning service delivery, despite the complexities involved and the added challenge of sustaining scaling up in the prevailing global economic environment. These would be easier to overcome if the research agenda gives more emphasis to scale up. Also, researchers will need to collaborate more with health planners to help outline and refine more successful implementation strategies in a given context. (excerpts)
Lancet. 2018 Feb 3; 391(10119):415.Add to my documents.
Saving the lives of women, newborns and children: A formative study examining opportunities to improve reproductive, maternal, neonatal, and child health outcomes in Nigeria.
African Journal of Reproductive Health. 2017 Sep; 21(3):102-108.Despite economic growth in Nigeria, maternal and infant mortality rates remain among the highest in the world. Civil society organisations (CSOs) play a critical role in ensuring governmental accountability to fulfil commitments that improve health outcomes for women, newborns, and children. This formative study was undertaken to identify: a) policy advocacy priorities b) advocacy challenges, and, c) opportunities for strategic advocacy. Methods consisted of a desk review of key reproductive, maternal, neonatal, child and adolescent health (RMNCAH) policies, surveys with CSOs working on RMNCAH, and key informants from non-governmental organisations (NGOs), and United Nations agencies. Participants identified the need for improved funding for RMNCAH policy implementation, increased civil society input in policy creation, and greater accountability. Increased investment in advocacy capacity building and accountability play an important role in improving health outcomes in Nigeria.
Strengthening health systems to respond to women subjected to intimate partner violence or sexual violence: a manual for health managers.
Geneva, Switzerland, WHO, 2017. 172 p.This manual is intended for health managers at all levels of the health systems. The manual is based on the World Health Organization (WHO) guideline Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines, 2013. Those guidelines inform this manual and its companion clinical handbook for healthcare providers, Health care for women subjected to intimate partner violence or sexual violence, 2014. The manual draws on the WHO health systems building blocks as outlined in Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action..
Women's Studies International Forum. 2018; 67:1-9.Gender justice is experiencing a moment of heightened visibility in India in the wake of the anti-rape protests of 2012/13. This paper seeks to understand this widening of the terrain of gender justice through an exploration of the work of young gender justice workers in Delhi. These young people practiced diverse politics and feminisms that challenge generational arguments of lost radicalism and linear conceptions of feminist history. Further, the messy hybridity of the feminisms and politics of individuals and organizations challenges neat conceptualizations of pure, authentic feminisms and co-opted, depoliticized feminisms. However, in the approach of some young people there is evidence of a distancing from the political and an individualizing and psychologizing of structural problems associated with choice, post and corporate feminisms. This transformation of gender justice into a matter of self-work points to potential risks of an overly inclusive feminism. © 2017 Elsevier Ltd
Prioritising sexuality education in Mississippi and Nigeria: The importance of local actors, policy windows and creative strategy.
Global Public Health. 2018 Dec; 13(12):1807-1819.Mississippi and Nigeria are two socially conservative places unlikely to prioritise sexuality education. Nonetheless, Mississippi passed a bill in 2011 mandating all school districts to offer sexuality education, and Nigeria approved a national sexuality education curriculum in 2001. To identify the factors that drove the process of prioritisation of sexuality education in each context, we conducted more than 70 semi-structured interviews with nongovernmental organisations/nonprofits, donor organisations and federal and state ministries involved in the prioritisation and implementation of sexuality education in Mississippi and Nigeria. Prioritisation of sexuality education occurred for similar reasons in both Mississippi and Nigeria: (1) local individuals and organisations committed to sexuality education and supported by external actors; (2) the opening of a policy window that made sexuality education a solution to a pressing social problem (teen pregnancy in Mississippi and HIV/AIDS in Nigeria) and (3) strategic action on the part of proponents. We conclude that promoting sexuality education in challenging contexts requires fostering committed local individuals and organisations, identifying external resources to support implementation costs and building on existing relationships of trust between actors, even if those relationships are unrelated to sexuality education.
AIDS and Behavior. 2017 Jul; 21(Suppl 1):114-120.Big data can be used to assess perceptions about public health issues. This study assessed social media data from Twitter to inform communication campaigns to promote HIV testing and reduce discrimination related to HIV/AIDS or towards key populations to the HIV epidemic, and its potential utility to evaluate such campaigns through HIV testing uptake. Tweets from Brazil were collected from January 2014 to March 2015 and filtered by four categories of keywords including discrimination, HIV prevention, HIV testing, and HIV campaigns. In total over 100,000 geo-located tweets were extracted and analyzed. A dynamic online dashboard updated daily allowed mapping trends, anomalies and influencers, and enabled its use for feedback to campaigns, including correcting misconceptions. These results encourage the use of social networking data for improved messaging in campaigns. Clinical HIV test data was collected monthly from the city of Curitiba and compared to the number of tweets mapped to the city showing a moderate positive correlation (r = 0.39). Results are limited due to the availability of the HIV testing data. The potential of social media as a proxy for HIV testing uptake needs further validation, which can only be done with higher frequency and higher spatial granularity of service delivery data, enabling comparisons with the social media data. Such timely information could empower early response immediate media messaging to support programmatic efforts, such as HIV prevention, testing, and treatment scale up.
Efforts to monitor Global progress on individual and community demand for immunization: Development of definitions and indicators for the Global Vaccine Action Plan Strategic Objective 2.
Vaccine. 2017 Jun 16; 35(28):3515-3519.The Second Strategic Objective of the Global Vaccine Action Plan, "individuals and communities understand the value of vaccines and demand immunization as both their right and responsibility", differs from the other five in that it does not focus on supply-side aspects of immunization programs but rather on public demand for vaccines and immunization services. This commentary summarizes the work (literature review, consultations with experts, and with potential users) and findings of the UNICEF/World Health Organization Strategic Objective 2 informal Working Group on Vaccine Demand, which developed a definition for demand and indicators related to Strategic Objective 2. Demand for vaccines and vaccination is a complex concept that is not external to supply systems but rather encompasses the interaction between human behaviors and system structure and dynamics. Copyright (c) 2017. Published by Elsevier Ltd.
HIV viral load monitoring among key populations in low- and middle-income countries: challenges and opportunities.
Journal of the International AIDS Society. 2017 Nov; 20 Suppl 7INTRODUCTION: Key populations bear a disproportionate HIV burden and have substantial unmet treatment needs. Routine viral load monitoring represents the gold standard for assessing treatment response at the individual and programme levels; at the population-level, community viral load is a metric of HIV programme effectiveness and can identify "hotspots" of HIV transmission. Nevertheless, there are specific implementation and ethical challenges to effectively operationalize and meaningfully interpret viral load data at the community level among these often marginalized populations. DISCUSSION: Viral load monitoring enhances HIV treatment, and programme evaluation, and offers a better understanding of HIV surveillance and epidemic trends. Programmatically, viral load monitoring can provide data related to HIV service delivery coverage and quality, as well as inequities in treatment access and uptake. From a population perspective, community viral load data provides information on HIV transmission risk. Furthermore, viral load data can be used as an advocacy tool to demonstrate differences in service delivery and to promote allocation of resources to disproportionately affected key populations and communities with suboptimal health outcomes. However, in order to perform viral load monitoring for individual and programme benefit, health surveillance and advocacy purposes, careful consideration must be given to how such key population programmes are designed and implemented. For example, HIV risk factors, such as particular sex practices, sex work and drug use, are stigmatized or even criminalized in many contexts. Consequently, efforts must be taken so that routine viral load monitoring among marginalized populations does not cause inadvertent harm. Furthermore, given the challenges of reaching representative samples of key populations, significant attention to meaningful recruitment, decentralization of care and interpretation of results is needed. Finally, improving the interoperability of health systems through judicious use of biometrics or identifiers when confidentiality can be maintained is important to generate more valuable data to inform monitoring programmes. CONCLUSIONS: Opportunities for expanded viral load monitoring could and should benefit all those affected by HIV, including key populations. The promise of the increasing routinization of viral load monitoring as a tool to advance HIV treatment equity is great and should be prioritized and appropriately implemented within key population programmatic and research agendas. (c) 2017 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.
Gender-transformative HIV programming. Identifying and meeting the needs of women and girls in all their diversity.
Hove, United Kingdom, International HIV / AIDS Alliance, 2018 Feb. 40 p. (Good Practice Guide)This guide is one of a series of good practice guides, and contains information, strategies and resources to help HIV programmers identify and meet the needs of women and girls in all their diversity. Evidence shows that HIV flourishes in conditions of inequality and lack of accountability. In many countries, HIV prevalence continues to rise among women, especially adolescent girls, young women and women from key populations. The relationship between gender and HIV is two-fold: while gender affects susceptibility to HIV and the impact of HIV, HIV also influences gender inequality and human rights more generally. This guide considers the many ways in which gender and HIV interact, and how this is influenced by variables such as education, income, age, ethnicity, race, disability, migrant status, health, location, and sexual orientation. It contains tools, evidence and good practice to ensure that HIV programming responds to and addresses harmful gender norms, structures and stereotypes that act as a barrier to HIV prevention, treatment and care, and the realisation of sexual and reproductive health and rights.
Bethesda, Maryland, Abt Associates, Sustaining Health Outcomes through the Private Sector Plus Project [SHOPS Plus], 2018 Jan. 28 p. (Brief)The global movement to reach universal health coverage presents opportunities to advance family planning goals. The family planning community has a keen interest in whether and how the full range of contraceptive services can be made accessible, particularly to underserved populations such as youth or the poor, within broader initiatives that aim to achieve universal health coverage. This brief describes common approaches used to finance health within the context of universal health coverage and the significance of these approaches for family planning. The authors focus on the role of private health providers and the mechanisms used to pay them. Making progress toward universal health coverage and satisfying unmet need for family planning is a long-term process, but one that can be accelerated. Advocates can champion better coverage of family planning by building the evidence base, promoting inclusion of private providers, and gaining a better understanding of the concepts and language of health financing.
[Arlington, Virginia], John Snow Research and Training Institute, Advancing Partners and Communities, . 3 p. (USAID Agreement No. AID-OAA-A-12-00047)The Ugandan National Drug Authority recently approved a plan that will allow licensed and accredited private drug shops to stock and administer injectable contraception beginning in 20 districts. Drug shops will now be able to help meet the growing demand for family planning in rural and hard-to-reach areas by improving the availability of high quality and reliable commodities and services. This policy change was the result of years of Ministry of Health-supported research, stakeholder engagement, and advocacy by FHI 360 and partners under both the U.S. Agency for International Development (USAID)-funded Advancing Partners & Communities project (led by JSI) and the PROGRESS project (2008-2013) led by FHI 360. This brief captures the key lessons learned in the successful advocacy process to open this service delivery channel.
Prioritizing health needs: Institutionalizing integration through population, health, and environment advocacy in East Africa.
Watertown, Massachusetts, Pathfinder International, 2018 Jan. 8 p. (HoPE-LVB Advocacy Brief; USAID Award No. AID-OAA-A-11-00024)Communities in and around the Lake Victoria Basin experience a number of interconnected challenges. These challenges include dependence on diminishing natural resources, pervasive poverty, food insecurity, poor sexual and reproductive health outcomes, and inaccessible health services. At the same time, the ecosystem itself faces substantial degradation. To address these intertwined challenges and foster healthy and engaged communities, Pathfinder International has been advancing an integrated population, health, and environment (PHE) initiative called Health of People and Environment-Lake Victoria Basin (HoPE-LVB) since 2011, in partnership with several environmental and health sector partners in Uganda, Kenya, and the US. This brief describes the strong advocacy component used by the project to ensure institutionalization and expansion of successfully tested approaches, particularly collaboration with the Lake Victoria Basin Commission as an institutional partner.
Watertown, Massachusetts, Pathfinder International, 2018 Jan. 8 p. (HoPE-LVB Sustainability Brief; USAID Award No. AID-OAA-A-11-00024)Communities in and around the Lake Victoria Basin, in Kenya and Uganda, experience interconnected challenges. These challenges include dependence on diminishing natural resources, pervasive poverty, food insecurity, poor sexual and reproductive health outcomes, and inaccessible health services. At the same time, the ecosystem itself faces substantial degradation. To address these intertwined challenges and foster healthy and engaged communities, Pathfinder International has been advancing an integrated population, health and environment (PHE) initiative Health of People and Environment-Lake Victoria Basin (HoPE-LVB) since 2011. The project applied the ExpandNet / World Health Organization (WHO) systematic scaling-up approach of Beginning with the End in Mind to ensure successful institutionalization and expansion of the project. This brief provides lessons to implementers and donors on how institutionalization emerged as a critical pathway towards scale-up and sustainability of integrated programming.
Applying ExpandNet’s Systematic Approach to Scaling Up in an Integrated Population, Health and Environment Project in East Africa.
Social Sciences. 2018 Jan 2; 7(1):17 p.While the importance of pursuing integrated population, health and environment (PHE) approaches and ensuring their sustainable expansion to regional and national levels have been widely affirmed in the development field, little practical experience and evidence exist about how this can be accomplished. This paper lays out the systematic approach to scale up developed by ExpandNet and subsequently illustrates its application in the Health of People and Environment in the Lake Victoria Basin (HoPE-LVB) project, which is an integrated PHE project implemented in Uganda and Kenya from 2012–2017. Results demonstrate not only the perceived relevance of pursuing integrated development approaches by stakeholders but also the fundamental value of systematically designing and implementing the project with focused attention to scale up, as well as the challenges involved in operationalizing commitment to integration among bureaucratic agencies deeply grounded in vertical departmental approaches.
Eliminating HIV & AIDS in India: A roadmap to zero new HIV infections, zero discrimination & zero AIDS-related deaths.
Indian Journal of Medical Research. 2016 Dec; 144(6):789-792.Over the past decade, India has made a significant progress in tackling its HIV epidemic. For ongoing improvement in HIV response, India needs an effective prevention programme (PrEP), protection against discrimination, reduced stigma, strong leadership and advocates, greater access to routine HIV screening and, most importantly, treatment and optimum patient care. (excerpt)