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Effect of mHealth in improving antenatal care utilization and skilled birth attendance in low- and middle-income countries: a systematic review protocol.
JBI Database of Systematic Reviews and Implementation Reports. 2017 Jul; 15(7):1778-1782.REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify and synthesize the best available evidence on the effect of mobile health (mHealth) interventions in antenatal care utilization and skilled birth attendance in low- and middle-income countries.More specifically, the review questions are as follows.
Professional care delivery or traditional birth attendants? The impact of the type of care utilized by mothers on under-five mortality of their children.
Tropical Medicine and Health. 2018; 46(1)Background: Because of the high under-five mortality rate, the government in Zambia has adopted the World Health Organization (WHO) policy on child delivery which insists on professional maternal care. However, there are scholars who criticize this policy by arguing that although built on good intentions, the policy to ban traditional birth attendants (TBAs) is out of touch with local reality in Zambia. There is lack of evidence to legitimize either of the two positions, nor how the outcome differs between women with HIV and those without HIV. Thus, the aim of this paper is to investigate the effect of using professional maternal care or TBA care by mothers (during antenatal, delivery, and postnatal) on under-five mortality of their children. We also compare these outcomes between HIV-positive and HIV-negative women. Methods: By relying on data from the 2013-2014 Zambia Demographic Health Survey (ZDHS), we carried out propensity score matching (PSM) to investigate the effect of utilization of professional care or TBA during antenatal, childbirth, and postnatal on under-five mortality. This method allows us to estimate the average treatment effect on the treated (ATT). Results: Our results show that the use of professional care as opposed to TBAs in all three stages of maternal care increases the probability of children surviving beyond 5 years old. Specifically for women with HIV, professional care usage during antenatal, at birth, and during postnatal periods increases probability of survival by 0.07 percentage points (p.p), 0.71 p.p, and 0.87 p.p respectively. Similarly, for HIV-negative women, professional care usage during antenatal, at birth, and during postnatal periods increases probability of survival by 0.71 p.p, 0.52 p.p, and 0.37 p.p respectively. However, although there is a positive impact when mothers choose professional care over TBAs, the differences at all three points of maternal care are small. Conclusion: Given our findings, showing small differences in under-five child's mortality between utilizers of professional care and utilizers of TBAs, it may be questioned whether the government's intention of completely excluding TBAs (who despite being outlawed are still being used) without replacement by good quality professional care is the right decision. © 2018 The Author(s).
WHO recommendations on antenatal care for a positive pregnancy experience: Summary. Highlights and key messages from the World Health Organization’s 2016 Global Recommendations for Routine Antenatal Care.
Geneva, Switzerland, WHO, 2018 Jan. 10 p. (WHO/RHR/18.02; USAID Cooperative Agreement No. AID-OAA-A-14-00028)This brief highlights the WHO’s 2016 ANC recommendations and offers countries policy and program considerations for adopting and implementing the recommendations. The recommendations include universal and context-specific interventions. The recommended interventions span five categories: routine antenatal nutrition, maternal and fetal assessment, preventive measures, interventions for the management of common physiologic symptoms in pregnancy, and health system-level interventions to improve the utilization and quality of ANC.
The continuum of HIV care in South Africa: implications for achieving the second and third UNAIDS 90-90-90 targets.
AIDS. 2017 Feb 20; 31(4):545-552.BACKGROUND: We characterize engagement with HIV care in South Africa in 2012 to identify areas for improvement towards achieving global 90-90-90 targets. METHODS: Over 3.9 million CD4 cell count and 2.7 million viral load measurements reported in 2012 in the public sector were extracted from the national laboratory electronic database. The number of persons living with HIV (PLHIV), number and proportion in HIV care, on antiretroviral therapy (ART) and with viral suppression (viral load <400 copies/ml) were estimated and stratified by sex and age group. Modified Poisson regression approach was used to examine associations between sex, age group and viral suppression among persons on ART. RESULTS: We estimate that among 6511 000 PLHIV in South Africa in 2012, 3300 000 individuals (50.7%) accessed care and 32.9% received ART. Although viral suppression was 73.7% among the treated population in 2012, the overall percentage of persons with viral suppression among all PLHIV was 23.8%. Linkage to HIV care was lower among men (38.5%) than among women (57.2%). Overall, 47.1% of those aged 0-14 years and 47.0% of those aged 15-49 years were linked to care compared with 56.2% among those aged above 50 years. CONCLUSION: Around a quarter of all PLHIV have achieved viral suppression in South Africa. Men and younger persons have poorer linkage to HIV care. Expanding HIV testing, strengthening prompt linkage to care and further expansion of ART are needed for South Africa to reach the 90-90-90 target. Focus on these areas will reduce the transmission of new HIV infections and mortality in the general population.
South African Medical Journal. 2017 Nov 27; 107(12):1058-1064.Background. Many people living with HIV in South Africa (SA) are not aware of their seropositive status and are diagnosed late during the course of HIV infection. These individuals do not obtain the full benefit from available HIV care and treatment services. Objectives. To describe the prevalence of late presentation for HIV care among newly diagnosed HIV-positive individuals and evaluate sociodemographic variables associated with late presentation for HIV care in three high-burden districts of SA. Methods. We used data abstracted from records of 8 138 newly diagnosed HIV-positive individuals in 35 clinics between 1 June 2014 and 31 March 2015 to determine the prevalence of late presentation among newly diagnosed HIV-positive individuals in selected high-prevalence health districts. Individuals were categorised as ‘moderately late’, ‘very late’ or ‘extremely late’ presenters based on specified criteria. Descriptive analysis was performed to measure the prevalence of late presentation, and multivariate regression analysis was conducted to identify variables independently associated with extremely late presentation. Results. Overall, 79% of the newly diagnosed cases presented for HIV care late in the course of HIV infection (CD4+ count =500 cells/ µL and/or AIDS-defining illness in World Health Organization (WHO) stage III/IV), 19% presented moderately late (CD4+ count 351 -500 cells/µL and WHO clinical stage I or II), 27% presented very late (CD4+ count 201 - 350 cells/µL or WHO clinical stage III), and 33% presented extremely late (CD4+ count =200 cells/µL and/or WHO clinical stage IV) for HIV care. Multivariate regression analysis indicated that males, non-pregnant women, individuals aged >30 years, and those accessing care in facilities located in townships and inner cities were more likely to present late for HIV care. Conclusions. The majority of newly diagnosed HIV-positive individuals in the three high-burden districts (Gert Sibande, uThukela and City of Johannesburg) presented for HIV care late in the course of HIV infection. Interventions that encourage early presentation for HIV care should be prioritised in SA and should target males, non-pregnant women, individuals aged >30 years and those accessing care in facilities located in inner cities and urban townships.
Maternal and Child Nutrition. 2017 Dec 22; 1-9.The World Health Organization (WHO) recommends iron-folic acid (IFA) supplementation during pregnancy to improve maternal and infant health outcomes. Multiple micronutrient (MMN) supplementation in pregnancy has been implemented in select countries and emerging evidence suggests that MMN supplementation in pregnancy may provide additional benefits compared to IFA alone. In 2015, WHO, the United Nations Children's Fund (UNICEF), and the Micronutrient Initiative held a “Technical Consultation on MMN supplements in pregnancy: implementation considerations for successful incorporation into existing programmemes,” which included a call for indicators needed for monitoring, evaluation, and surveillance of MMN supplementation programs. Currently, global surveillance and monitoring data show that overall IFA supplementation programs suffer from low coverage and intake adherence, despite inclusion in national policies. Common barriers that limit the effectiveness of IFA-which also apply to MMN programs-include weak supply chains, low access to antenatal care services, low-quality behavior change interventions to support and motivate women, and weak or non-existent monitoring systems used for programme improvement. The causes of these barriers in a given country need careful review to resolve them. As countries heighten their focus on supplementation during pregnancy, or if they decide to initiate or transition into MMN supplementation, a priority is to identify key monitoring indicators to address these issues and support effective programs. National and global monitoring and surveillance data on IFA supplementation during pregnancy are primarily derived from cross-sectional surveys and, on a more routine basis, through health and logistics management information systems. Indicators for IFA supplementation exist; however, the new indicators for MMN supplementation need to be incorporated. We reviewed practice-based evidence, guided by the WHO/Centers for Disease Control and Prevention logic model for vitamin and mineral interventions in public health programs, and used existing manuals, published literature, country reports, and the opinion of experts, to identify monitoring, evaluation, and surveillance indicators for MMN supplementation programs. We also considered cross-cutting indicators that could be used across programme settings, as well as those specific to common delivery models, such as antenatal care services. We then described mechanisms for collecting these data, including integration within existing government monitoring systems, as well as other existing or proposed systems. Monitoring data needs at all stages of the programme lifecycle were considered, as well as the feasibility and cost of data collection. We also propose revisions to global-, national-, and subnational-surveillance indicators based on these reviews.
Geneva, Switzerland, WHO, 2016. 172 p.The World Health Organization has released a new set of antenatal care (ANC) recommendations to improve maternal and perinatal health worldwide. The guidelines seek to reduce the global burden of stillbirths, reduce pregnancy complications and provide all women and adolescents with a positive pregnancy experience. High quality health care during pregnancy and childbirth can prevent deaths from pregnancy complications, perinatal deaths and stillbirths, yet globally, less than two-thirds of women receive antenatal care at least four times throughout their pregnancy. The new ANC model raises the recommended number of ANC visits from four to eight, thereby increasing the number of opportunities providers have to detect and address preventable complications related to pregnancy and childbirth. The guidelines provide 49 recommendations for routine and context-specific ANC visits, including nutritional interventions, maternal / fetal assessments, preventive measures, interventions for common physiological symptoms and health system interventions. Given that women around the world experience maternal care in a wide range of settings, the recommendations also outline several context-specific service delivery options, including midwife-led care, group care and community-based interventions.
Washington, D.C., World Bank, 2011.  p. (Directions in Development)The past half-century has seen enormous changes in the demographic makeup of Latin America and the Caribbean (LAC). In the 1950s, LAC had a small population of about 160 million people, less than today's population of Brazil. Two-thirds of Latin Americans lived in rural areas. Families were large and women had one of the highest fertility rates in the world, low levels of education, and few opportunities for work outside the household. Investments in health and education reached only a small fraction of the children, many of whom died before reaching age five. Since then, the size of the LAC population has tripled and the mostly rural population has been transformed into a largely urban population. There have been steep reductions in child mortality, and investments in health and education have increased, today reaching a majority of children. Fertility has been more than halved and the opportunities for women in education and for work outside the household have improved significantly. Life expectancy has grown by 22 years. Less obvious to the casual observer, but of significance for policy makers, a population with a large fraction of dependent children has evolved into a population with fewer dependents and a very large proportion of working-age adults. This overview seeks to introduce the reader to three groups of issues related to population aging in LAC. First is a group of issues related to the support of the aging and poverty in the life cycle. Second is the question of the health transition. Third is an understanding of the fiscal pressures that are likely to accompany population aging and to disentangle the role of demography from the role of policy in that process.
MCN. American Journal of Maternal/Child Nursing. 2010 Jan-Feb; 35(1):63.The purpose of this article is to describe recent initiatives designed to improve outcomes for Bolivian women and children. It discusses the high infant and maternal mortality rates of Bolivia and stresses the importance of the international community partnering with the Bolivian government and healthcare personnel to provide support and assistance in a coordinated fashion to make a difference in the health and well-being of women and children.
Geneva, Switzerland, World Health Organization, [WHO], 2009. 48 p. (Analytic Case Studies. Initiatives to Increase the Use of Health Services by Adolescents)This case study describes how the Government of Mozambique scaled up its successful youth HIV prevention and sexual and reproductive health program to a national level. Geared toward developing-country governments and nongovernmental organizations, the case study provides a technical overview of the program and its interventions, a detailed description of the scale-up process and lessons learned, and the program's achievements.
Coordination, management and utilization of foreign assistance for HIV / AIDS prevention in Vietnam. Assessment report.
Ha Noi, Vietnam, CCRD, 2006 Oct. 82 p. (CCRD Assesssment Report)International assistance for HIV / AIDS prevention and control in Vietnam has significantly contributed to combating this epidemic. However, while current resources have not yet fully met the needs, the management and utilization of resources still had many limitations which affect the effectiveness of foreign assistance and investments. The independent assessment was prepared for the Conference on “the Coordination of Foreign Assistance for HIV / AIDS Prevention and Control”. Analytical assessment and comments on the management and coordination of foreign aid were made on the basis of Government’s official procedures and regulations on those issues. This research was carried out in October, 2006.
World Health and Population. 2008; 10(2):25-39.Our study examines factors influencing demand for contraception for spacing as well as for limiting births in India. Data on socio-economic, demographic and program factors affecting demand for contraception in India are from the National Family Health Survey, 1998--99. The recent document from the National Rural Health Mission has completely ignored the use of contraception in controlling fertility in India. Empirical results of our study suggest giving priority to and focusing attention on supply-side factors such as a regular and sustained supply of quality contraceptive methods to improve accessibility and affordability. Further, strengthening the information, education and communication (IEC) component of the reproductive and child health (RCH) package would allay misapprehensions about the side effects and health risks of contraception. Focusing attention on demand-side factors such as women's empowerment through education, gainful employment and exposure to mass-media would help reduce the unmet demand for family planning. The resulting reduction in fertility would hasten the process of demographic transition and population stabilization in India.
Journal of Health, Population, and Nutrition. 2008 Sep; 26(3):273-9.Bangladesh is currently one of the very few countries in the world, which is on target for achieving the Millennium Development Goal (MDG) 4 relating to child mortality. There have been very rapid reductions in mortality, especially in recent years and among children aged over one month. However, this rate of reduction may be difficult to sustain and may impede the achievement of MDG 4. Neonatal deaths now contribute substantially (57%) to overall mortality of children aged less than five years, and reductions in neonatal mortality are difficult to achieve and have been slow in Bangladesh. There are some interesting attributes of the mortality decline in Bangladesh. Mortality has declined faster among girls than among boys, but the poorest have not benefited from the reduction in mortality. There has also been a relative absence of a decline in mortality in urban areas. The age and cause of death pattern of under-five mortality indicate certain interventions that need to be scaled up rapidly and reach high coverage to achieve MDG 4 in Bangladesh. These include skilled attendance at delivery, postnatal care for the newborn, appropriate feeding of the young infant and child, and prevention and management of childhood infections. The latest (2007) Bangladesh Demographic and Health Survey shows that Bangladesh has made sustained and remarkable progress in many areas of child health. More than 80% of children are receiving all vaccines. The use of oral rehydration solution for diarrhoea is high, and the coverage of vitamin A among children aged 9-59 months has been consistently increasing. However, poor quality of care, misperceptions regarding the need for care, and other social barriers contribute to low levels of care-seeking for illnesses of the newborns and children. Improvements in the health system are essential for removing these barriers, as are effective strategies to reach families and communities with targeted messages and information. Finally, there are substantial health-system challenges relating to the design and implementation, at scale, of interventions to reduce neonatal mortality.
Adolescents, social support and help-seeking behaviour: An international literature review and programme consultation with recommendations for action.
Geneva, Switzerland, World Health Organization [WHO], Department of Child and Adolescent Health and Development, 2007. 56 p. (WHO Discussion Papers on Adolescence)With this brief introduction and justification, this document presents: The findings from an international literature review on the topic of adolescents and help-seeking behaviour. The results of a programme consultation with 35 adolescent health programmes (including public health sector programmes, university-based adolescent health programmes and non-government organizations (NGO) working in adolescent health) from Latin America (10), the Western Pacific region (4), Asia (20), and the Middle East (1), and the results of six key informant interviews. These results are incorporated into the literature review where relevant. The complete report from this consultation of programmes is found in Appendix 1. Recommendations for action, including a brief outline for developing a set of guidelines for the rapid assessment of social supports to promote the help-seeking of adolescents. This document is part of a WHO project to identify and define evidence-based strategies for influencing adolescent help-seeking and identify research questions and activities to promote improved help-seeking behaviour by adolescents. To achieve this objective, the consultants, with WHO guidance: (1) carried out an international literature review of the topic; (2) sent 67 questionnaires and received 35 questionnaires back from adolescent health programmes on the topic of adolescents and help-seeking in the four regions; and (3) carried out key informant interviews with nine individuals (three in Latin America, three in the Pacific region and three in South Asia). The consultants also developed short case studies of illustrative approaches in promoting help-seeking behaviour. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2007.  p. (WHO Discussion Papers on Adolescence; Issues in Adolescent Health and Development)The World Health Organization (WHO) has been contributing to meeting the Millennium Development Goals (MDGs) by according priority attention to issues pertaining to the management of adolescent pregnancy. Three of the aims of the MDGs - empowerment of women, promotion of maternal health, and reduction of child mortality - embody WHO's key priorities and its policy framework for poverty reduction. The UN Special Session on Children has focused on some of the key issues affecting adolescents' rights, including early marriage, access to sexual and reproductive health services, and care for pregnant adolescents. This review of the literature was conducted to identify (1) the major factors affecting the pregnancy outcome among adolescents, related to their physical immaturity and inappropriate or inadequate healthcare-seeking behaviour, and (2) the socioeconomic and political barriers that influence their access to health-care services and information. The review also presents programmatic evidence of feasible measures that can be taken at the household, community and national levels to improve pregnancy outcomes among adolescents. (excerpt)
Journal of Health, Population and Nutrition. 2006 Dec; 24(4):377-379.A new target-universal access to reproductive health by 2015-was endorsed in October 2006 under Millennium Development Goal 5 (MDG 5) to improve maternal health. And while the international reproductive health community could finally celebrate this official recognition of reproductive health on "centre stage of international efforts to defeat poverty and preventable illness" (1), the field reality is far from the target. What does it take to improve sexual and reproductive healthcare practices, including self-care practices at the home and use of services? Generated by a call for papers on these topics, this issue of the Journal contains selected papers describing current practices, examining specific barriers to improved practices, and providing results of interventions aimed at improving self-care practices or use of services. Most practices described relate to improving maternal and newborn* health or care; only two articles provide information on practices in other sexual and reproductive health areas-one on male sexuality and another on women with HIV/AIDS. No papers were received concerning care-seeking for family planning, menstrual regulation, or abortion care-a red flag perhaps signaling the marginalization of these topics in the current day. (excerpt)
The practice of antenatal care: comparing four study sites in different parts of the world participating in the WHO Antenatal Care Randomised Controlled Trial. [Práctica de controles prenatales: comparación de cuatro centros de estudio en diferentes lugares del mundo que participaron en el Estudio Controlado Aleatorizado de Control Prenatal de la OMS]
Paediatric and Perinatal Epidemiology. 1998; 12 Suppl 2:116-141.In the preparation of a randomised controlled trial to evaluate a new programme of antenatal care (ANC) in different parts of the world, we conducted a baseline survey of the ANC procedures in all 53 clinics participating in the trial. There were two components of this survey: (1) description of clinic characteristics and services offered: the staff of each clinic was interviewed and direct observation was made by field supervisors, and (2) the actual use of services by pregnant women attending these clinics: we reviewed a random sample of 2913 clinical histories. The clinical units surveyed were offering most of the activities, screening, laboratory tests and interventions recommended as effective according to the Cochrane Pregnancy and Childbirth Database (PCD), although some of these were not available in some sites. On the other hand, some tests and interventions that are considered not effective according to these criteria are reportedly offered. There was a difference across sites in the availability and offer to low-risk women of vaginal examination, evaluation of pelvic size, dental examination, external version for breech presentation and formal risk score classification, and a notable difference in the type of principal provider of ANC. There was a large variation in the actual use of screening and laboratory tests and interventions that should be offered to all women according to Cochrane PCD criteria: some of these are simply not available in a site; others are available, but only a fraction of women attending the clinics are receiving them. The participating sites all purport to follow the traditional `Western' schedule for ANC, but in three sites we found that a high percentage of women initiate their ANC after the first trimester, and therefore do not have either the recommended minimum number of visits during pregnancy or the minimum first trimester evaluation. It is concluded that the variability and heterogeneity of ANC services provided in the four study sites are disturbing to the profession and cast doubts on the rationale of routine ANC. (author's)
Chinese Primary Health Care. 2002; 16(4):33-34.The authors analyzed expenses of Poverty Medical Alleviation for Poor Maternal of Health VI Project Loaned by World Bank, which is based on some of the project counties in five years. The main results are: (1) The Poverty Medical Alleviation Project had improved the utilization equity of Maternal and Child Health in poor areas. (2) Project counties should strengthen the management and sustainability of Poverty Alleviation Fund. (3) Information system should be improved. (author's)
Journal of Family Welfare. 2004; 50 Spec No:26-30.Nearly half a million women are in the child-bearing age and more than 10 million children die each year; most from preventable causes. There is very high clustering of these deaths in just a few countries. The South Asia region contributes almost 50 percent of the total maternal deaths. In this context, child survival and safe motherhood components of the programme has been a direct intervention to reduce infant and child mortality and maternal mortality. The intervention was evidence-based and was supposed to help population stabilization efforts of the government of India, which was another genuine concern of economic planners. Under this programme, Government of India in the early 1990s set a goal of achieving maternal mortality rate of two per 1000 births and infant mortality rate of around 30 by the year 2000. The National Population Policy 2000, The Tenth Five Year Plan (2002-2007) and The National Health Policy 2003 strongly reiterated the government's commitment to achieve the goals to improve the status of human development at the earliest. Such commitments are reflected and highlighted again in the Rural Health Mission approved by the Government of India very recently with additional financial allocation. (excerpt)
Chinese Journal of Health Education. 2003 Jun; 19(6):457-458.The concept of reproductive health is a new one first advanced by World Health Organization (WHO) human health research plan chairman Barzelatto in 1988. In 1994 the WHO Global Policy Council formally adopted a definition of reproductive health; in 1995 the World Health Congress again stressed the importance of the WHO’s global reproductive health strategy, and proposed an international health struggle goal of “universal access to reproductive health by 2015.” The definition and scope of reproductive health. Reproductive health is a physical, mental and social state of well being, but not only a lack of sickness or debilitation. The particular scope includes having a healthy and harmonious sexual physiology and a regular sex life, free from worry of sexually transmitted disease or unwanted pregnancy; people having the ability to have children, but also having scientific adjustments and control of their own reproduction, to freely decide whether to have children, when to have children and how many to have. It requires that the sexes have equal rights to knowledge to make safe, effective and responsible choices; access to methods of reproductive control; use of appropriate health services; safe and comfortable pregnancy and childbirth, with the best opportunity for the mother and infant’s health. Important contents of reproductive health: sexually mature sperm, ovum, pregnancy, period of nursing after birth, regulation of fertility, cure of infertility, reproductive infection and prevention of disease. (excerpt)
Forced Migration Review. 2004 Jan; (19):16-18.Every year more than half a million women die from complications of pregnancy and childbirth. Many more suffer severe disabilities. WHO estimates that 15% of all pregnant women will develop direct obstetric complications such as haemorrhage, obstructed or prolonged labour, pre-eclampsia or eclampsia, sepsis, ruptured uterus, ectopic pregnancy and complications of abortion. If left untreated, they will lead to death or severe disability. Maternal mortality and morbidity can only be reduced by ensuring women with obstetric complications receive good-quality medical treatment without delay. The desperate circumstances of refugee and IDP women fleeing conflict place them at exceptional risk of pregnancy-related death, illness and disability. The target of reducing maternal mortality by 75% by 2015 is a key UN Millennium Development Goal. Because obstetric complications cannot be predicted or prevented, all pregnant women need access to good quality EmOC. (excerpt)
In: Programming for male involvement in reproductive health. Report of the meeting of WHO Regional Advisers in Reproductive Health, WHO / PAHO, Washington DC, USA, 5-7 September 2001. Geneva, Switzerland, World Health Organization [WHO], 2002. 88-103. (WHO/FCH/RHR/02.3)Health sector priorities are ideally set according to a number of variables, including: burden of disease; whether effective and proven ‘solutions’ are available; and the calculated cost-effectiveness of those solutions. In the case of sexual health services, we argue in this paper that this conceptual framework is useful for programme planning, but needs to take into account one important additional element: the client’s perspective. We further argue that the sexual health of men in south Asia can not be adequately addressed unless men’s beliefs about their bodies, men’s health priorities, and men’s sexual health concerns are evaluated, interpreted and acted upon. Services which do not correspond to men’s own perceived sexual health needs are unlikely to attract men as clients, and thus remove many of the opportunities for male involvement in other aspects of reproductive and sexual health prevention and care. Men’s own sexual health priorities may not correspond exactly with the priorities of public health programmes; we therefore discuss how the two sets of concerns may be reconciled and men brought more equitably into programmes. Finally, we outline areas which may be of particular concern to programme managers if this approach is adopted. (author’s)
The application of the National Health Accounts framework to HIV / AIDS in Rwanda. [Application du cadre de la Comptabilité Nationale de la Santé au VIH/SIDA au Rwanda]
Bethesda, Maryland, Abt Associates, Partnerships for Health Reform, 2001 Feb. xv, 51 p. (Special Initiatives Report No. 31; USAID Contract No. HRN-C-00-95-00024)This paper describes how a National Health Accounts exercise on HIV/AIDS in Rwanda was designed and implemented, what data was captured, and how HIV/AIDS-specific expenditures were determined. The findings regarding expenditures on HIV in Rwanda are both critical and informative, and the process by which data was gathered is also significant. This documentation of the process, challenges, shortcomings, and successes of HIV/AIDS funding in Rwanda will be useful for others seeking to replicate the study elsewhere. The comparison of HIV/AIDS-related costs (prevention, treatment, and mitigation) within overall health expenditures reveals that AIDS prevention is primarily financed by donor funds, whereas treatment costs place the heaviest financial burden on households. This is because no financial support system exists to facilitate patients’ access to care. Thus, the patient’s socioeconomic background and ability to pay user fees define access to treatment of HIV/AIDS-related diseases. Based on this analysis, the report makes recommendations for policies to improve the financial information process, the sustainability and affordability of health care, and the equity of access to health care in the Rwandan health sector in general and in the HIV/AIDS sector in particular. (author's)
New York, New York, UNFPA, 1994. ix, 59 p. (Rapport d'Evaluation No. 7)This evaluation was made at the request of the United Nations Population Fund (UNFPA) with the goal of evaluating strategies of information, education and communication (IEC) in support of the Family Planning Program (FP) financed by this organization, in order to improve the planning and implementation of future strategies. This evaluation took into consideration a broad number of projects implemented in different countries and regions, and separated them into two categories. The first category includes projects regarding FP or an IEC component (integrated approach); the second category includes projects that refer exclusively to IEC (independent approach). Generally speaking, those projects contributed to raising the level of knowledge about the utilization of family planning methods. In every country we visited, we found a difference between the level of knowledge, which is relatively satisfactory, and the level of practice, which is weaker. The analysis of performances per type of configuration shows that the projects with an IEC integrated component reinforce the capacity of the services to accomplish their functions by giving them resources and necessary means, elaborating tools and methods of investigation, realization and evaluation. The knowledge and the use of FP services are amplified by the information, the sensitization and the education of the populations. The intersectorial and multi-disciplinary coordination of the participants involved in the performance and the IEC activities is even better because this coordination takes place in an environment that integrates MCH (Maternal and Child Health)/ FP/ IEC services. (excerpt)
China Population Today. 2002 Jun; 19(3):17.This news article reports on Shanghai Family Planning Commission Minister Zhang Weiqing's visit to the headquarters of Marie Stopes International in London and the clinic founded by Marie Stopes in 1921. The visitors were impressed by the client-friendly environment and its warm and easy atmosphere. They asked questions about the clinic's relationship with the local health department; its advantages in providing community services, scope of service, cost, clients' evaluation of its service quality; and possible litigation.