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Journal of Population Research. 2017 Sep; 34(3):279-301.This paper analyses the trends and regional variations in the target achievement of MDG 5 of improving maternal health in Bangladesh. Based on the analysis of secondary data a comparison is made between the rate of progress required for each indicator of the goal to achieve its target by 2015 from 2000, the current rate of progress (between 2000 and 2011) and the rate of progress required between 2011 and 2015 to achieve the targets. The findings suggest a substantial difference among the regions with respect to the adopted indicators of improving maternal health. For example, consistent with the highest and lowest levels of maternal mortality ratio (MMR), the divisions (administrative regions) of Khulna and Sylhet respectively also have the highest and lowest percentages of births delivered in health facilities and assisted by skilled health personnel. However, the second highest percentage of births delivered in a health facility in Chittagong does not accord with its high MMR. This kind of variation reveals that overall improvement in MMR may not necessarily result in complete achievement of the goal of improved maternal health. Rather, there are some gaps and challenges in each region, which need to be addressed and acted upon accordingly. The findings of this paper contribute to knowledge about the persistence of regional inequalities in MDG 5 in Bangladesh, even if the goals are met at the national level. The findings will also be useful in preparing a road map for ensuring the health and wellbeing of all mothers in Bangladesh under the new Sustainable Development Goals.
Washington, D.C., Population Council, The Evidence Project, 2018 May. 2 p. (Activity Brief)At the request of the Ghana Health Service (GHS), the Evidence Project, through the Population Council and with funding from USAID/Ghana, is studying the feasibility and acceptability of Sayana® Press self-injection, and by extension, informing its introduction in Ghana. The primary objectives of the seven-month study are to assess the feasibility of introducing Sayana® Press self-injection and its acceptability among both health workers and injectable clients. Results from the study are expected to inform the national strategy, including procurement and scale-up of Sayana® Press in the public and private sectors. The Ghana Health Service has a strong commitment to task shifting to accelerate access to modern contraceptive methods. GHS’s commitment to engaging all relevant stakeholders in the public, private and NGOs sectors in the study process provides an excellent model for maximizing research utilization.
Out of the shadows and 6000 reasons to celebrate: An update from FIGO's fistula surgery training initiative.
International Journal of Gynaecology and Obstetrics. 2018 Jun; 141(3):280-283.Obstetric fistula is a devastating childbirth injury caused by unrelieved obstructed labor. Obstetric fistula leads to chronic incontinence and, in most cases, significant physical and emotional suffering. The condition continues to blight the lives of 1-2 million women in low-resource settings, with 50 000-100 000 new cases each year adding to the backlog. A trained, skilled fistula surgeon is essential to repair an obstetric fistula; however, owing to a global shortage of these surgeons, few women are able to receive life-restoring treatment. In 2011, to address the treatment gap, FIGO and partners released the Global Competency-Based Fistula Surgery Training Manual, the first standardized curriculum to train fistula surgeons. To increase the number of fistula surgeons, the FIGO Fistula Surgery Training Initiative was launched in 2012, and FIGO Fellows started to enter the program to train as fistula surgeons. Following a funding boost in 2014, the initiative has grown considerably. With 52 fellows involved and a new Expert Advisory Group in place, the program is achieving major milestones, with a record-breaking number of fistula repairs performed by FIGO Fellows in 2017, bringing the total number of repairs since the start of the project to more than 6000. (c) 2018 International Federation of Gynecology and Obstetrics.
Tracking progress towards universal coverage for women’s, children’s and adolescents’ health: The 2017 report.
Washington, D.C., UNICEF, 2017. 268 p.This is the first Countdown to 2030 report in the context of the 2030 agenda for sustainable development and the Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescent’s Health (2016–2030). It synthesizes data on the current situation and trends in reproductive, maternal, newborn and child health and nutrition from a wide array of sources including the profiles on the 81 Countdown priority countries, which together account for 95% of maternal deaths and 90% of deaths among children under age 5. (Excerpt)
Implementation of Rotavirus Surveillance and Vaccine Introduction - World Health Organization African Region, 2007-2016.
MMWR. Morbidity and Mortality Weekly Report. 2017 Nov 03; 66(43):1192-1196.Rotavirus is a leading cause of severe pediatric diarrhea globally, estimated to have caused 120,000 deaths among children aged <5 years in sub-Saharan Africa in 2013 (1). In 2009, the World Health Organization (WHO) recommended rotavirus vaccination for all infants worldwide (2). Two rotavirus vaccines are currently licensed globally: the monovalent Rotarix vaccine (RV1, GlaxoSmithKline; 2-dose series) and the pentavalent RotaTeq vaccine (RV5, Merck; 3-dose series). This report describes progress of rotavirus vaccine introduction (3), coverage (using estimates from WHO and the United Nations Children's Fund [UNICEF]) (4), and impact on pediatric diarrhea hospitalizations in the WHO African Region. By December 2016, 31 (66%) of 47 countries in the WHO African Region had introduced rotavirus vaccine, including 26 that introduced RV1 and five that introduced RV5. Among these countries, rotavirus vaccination coverage (completed series) was 77%, according to WHO/UNICEF population-weighted estimates. In 12 countries with surveillance data available before and after vaccine introduction, the proportion of pediatric diarrhea hospitalizations that were rotavirus-positive declined 33%, from 39% preintroduction to 26% following rotavirus vaccine introduction. These results support introduction of rotavirus vaccine in the remaining countries in the region and continuation of rotavirus surveillance to monitor impact.
Seattle, Washington, IHME, 2014. 182 p.Zambia has seen remarkable improvement in childhood survival over the past two decades. While the scale-up of malaria control interventions has been proposed as one of the biggest drivers behind that improvement, little research has been done on how much of the reduction in childhood mortality may be attributed to malaria control and how much is the result of improvements in other child health interventions. To address this knowledge gap, the University of Zambia (UNZA) and the Institute for Health Metrics and Evaluation (IHME) worked together on the Malaria Control Policy Assessment (MCPA) project. The goal of MCPA was to harness existing data in Zambia and use rigorous statistical methods to quantify the impact of malaria control and other child health interventions on under-5 mortality trends across districts. We found that between 1990 and 2010, a combination of rapidly scaled up child health interventions contributed to an additional 11% of declines in under-5 mortality across Zambia. We looked at the combined effect of these interventions because the scale-up in ownership of insecticide-treated nets (ITNs) and use of indoor residual spraying (IRS) coincided with the scale-up in three other key child health interventions: the pentavalent vaccine, exclusive breastfeeding, and services to help prevent mother-to-child transmission of HIV (PMTCT) at health facilities. Isolating the specific impact of each intervention is not possible. Nevertheless, jointly, these interventions contributed significantly to the reduction of under-5 mortality throughout the country. The MCPA project in Zambia produced district-level trends for key child health outcomes and interventions from 1990 to 2010. This is the first time that annual estimates for under-5 mortality and intervention coverage have been generated at the district level. In this report, district profiles detail trends in child health over time and benchmark the districts’ performance across indicators. With this information, local and national policymakers and health officials can identify areas of successful health service delivery and detect early signs of declining intervention coverage or stalled progress. This report shows that Zambia is succeeding on several fronts in child health. First, countrywide reductions in under-5 mortality were also accompanied by improvements in equity across districts, as some of the districts with the highest mortality rates in 1990 recorded some of the greatest declines by 2010. Second, coverage of key malaria control interventions, such as ITN ownership, increased dramatically in many districts. Third, the majority of districts were successful in quickly increasing coverage of the pentavalent vaccine after its introduction in 2005. Finally, rates of exclusive breastfeeding markedly rose in most districts, reflecting the country’s investments in improving child nutrition and breastfeeding practices (WBTi 2008). These successes were accompanied by concerning trends for three key child health interventions in Zambia. First, most districts saw a decline in the 2000s in antenatal care (ANC4), which is the proportion of pregnant women 15 to 49 years old who had four or more visits to a health facility during pregnancy. This finding is particularly worrisome given that districts generally increased levels of ANC4 during the 1990s. Second, coverage of polio immunization dropped in some of the districts that are considered at high risk for polio importation from neighboring countries. Third, in some areas of Zambia, skilled birth attendance declined to very low levels. Targeting these areas for improvement should be a priority to ensure that the country’s achievements in child health continue into the present decade. With a focus on districts, findings from the MCPA project in Zambia provide side-by-side comparisons of health performance over time, geography, and intervention type. The child health landscape is remarkably heterogeneous across districts, highlighting the need for continuous and timely assessment of district-level trends. With regularly collected and analyzed district health information, policymakers can have the evidence base to make targeted, data-driven decisions for achieving greater and more equitable health gains in Zambia
Seattle, Washington, IHME, 2014. 26 p.Pushing the Pace: Progress and Challenges in Fighting Childhood Pneumonia examines recent gains in reducing child deaths from pneumonia. This report advances our understanding of the burden of childhood pneumonia and its toll within the context of the leading killers of children; global trends in funding to address pneumonia; and health system factors involved in the effective prevention, diagnosis, and treatment of pneumonia. With a special focus on countries with the highest number of child pneumonia deaths, this report shows the data and evidence that we currently have – and continue to need – to make pneumoniaa disease that no child dies from, in any corner of the world.
Progress in partnership: 2017 progress report on the Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescents’ Health.
Geneva, Switzerland, World Health Organization [WHO], 2017. 79 p.Globally, the health and well-being of women, children and adolescents are improving faster than at any point in history, even in many of the poorest nations. The transformation is due in great measure to one of the most successful global health initiatives in history: Every Woman Every Child (EWEC). Since its launch by the United Nations in 2010, partners worldwide have made nearly 650 commitments, and more than US$ 45 billion has been disbursed to scale up evidence-based interventions. Greater momentum has been building over the past two years, with more than 200 commitments made since September 2015, when the UN together with governments, the private sector and civil society launched the updated Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescents’ Health (EWEC Global Strategy). This human rights-based strategy is a detailed roadmap for countries to reduce inequities, strengthen fragile health systems and foster multisector approaches in order to end all preventable deaths of women, children and adolescents and ensure their well-being. The EWEC movement puts the EWEC Global Strategy into practice through country-led, multistakeholder engagement and collaboration, and mutual accountability for results, resources and rights. Its core partners include the H6 Partnership (UNAIDS, UNICEF, UNFPA, UN Women, WHO and the World Bank Group), the Partnership for Maternal, Newborn & Child Health (PMNCH) and the Global Financing Facility in support of EWEC. This report details the current situation in relation to the EWEC Global Strategys targets and objectives, analyses commitments, implementation and impact between September 2015 and December 2016, and presents the agreed priorities and milestones for further coordination and action from 2018 to 2020. Further progress reports will be produced annually to underpin the Independent Accountability Panels recommendations and to support annual reporting to the World Health Assembly and the High- Level Political Forum on Sustainable Development.
Addis Ababa, Ethiopia, United Nations, Economic Commission for Africa, 2015. 112 p.2015 is a watershed year for global development discourse. It marks the winding down of the MDGs, and also the confluence of events which will shape the global development agenda for years to come: the recently concluded Sendai Third UN World Conference on Disaster Risk Reduction; the Third International Conference on Financing for Development; the upcoming United Nations summit for the adoption of the post 2015 development agenda in September; and the United Nations Climate Change Conference (COP 21) in December. These landmark events are ushering in new global agendas and defining their means of implementation. The MDGs have helped focus the efforts of governments and development partners on pressing issues in human development. The Goals have underscored the power of communication in galvanizing global action and resources around a core set of development objectives, and establishing the role which global partnerships can play. Indeed, global initiatives such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the Global Vaccination Alliance (GAVI); and Education for All (EFA) have had a measurable impact on combating diseases specified in MDG 6, and facilitating immunisation and primary school enrolment respectively. As the MDG era comes to an end and the new development agenda is launched, it is timely to reflect on the lessons learned from the MDG experience to inform our next steps. It is in this context that this year’s Africa MDG progress report is written. An important lesson from the MDG experience is that initial conditions influence the pace of progress a country can make on global development agendas. Thus it is not surprising that Africa as a whole will not achieve all the MDGs by 2015. Nevertheless, substantial progress has been achieved on a number of goals and targets. Significant achievements in increasing women’s representation in national parliaments, reducing infant and HIV-related deaths, and enrolling more children in primary schools owe a lot to the effort and commitment of African people and their governments to meet the Goals. The often uncelebrated achievements of countries which have made significant progress without meeting MDG targets also deserve special recognition. This year’s report highlights innovative policies and progammes which countries have adopted to accelerate progress on the MDGs, such as the deployment of community members as health workers, Niger’s Ecole des Maris (School for Husbands) initiative, and the establishment of community-run and -funded schools. It is our hope that publicizing such success stories will not only help document policy innovations for SDG implementation, but also keep the focus on the unfinished business of the MDGs as countries and the global community make the transition to implementation of the post-2015 Development Agenda. The report demonstrates that sustaining and advancing beyond the gains made under the MDGs require new approaches which embrace all three dimensions of sustainability – the environmental, economic and social. Progress under the SDGs will be assessed not only by the results achieved, but also by considering how they were achieved. Method will assume greater relevance in the post-2015 development paradigm. (excerpt)
Indicators on gender, poverty, the environment and progress toward the sustainable development goals in African countries.
Abidjan, Côte d’Ivoire, The Department, 2017. 308 p.This is the eighteenth volume of Gender, Poverty, Environmental Indicators and Progress toward the Sustainable Development Goals in African Countries published by the Statistics Department of the African Development Bank Group. The publication also provides some information on the broad development trends relating to gender, poverty and environmental issues in the 54 African countries.This volume is divided into three main parts. Part I reveals the progress being made by African countries toward the 17 Sustainable Development Goals (SDGs). Part II presents cross-country comparative indicators for gender (section 1), poverty (section 2), and the environment (section 3). Part III provides more detailed data on each of these three themes across each of the 54 African countries.
Vaccine. 2016 May 27; 34(25):2855-62.Hepatitis B infections are responsible for more than 300 thousand deaths per year in the Western Pacific Region. Because of this high burden, the countries and areas of the Region established a goal of reducing hepatitis B chronic infection prevalence among children to less than 1% by 2017. This study was conducted to measure the progress in hepatitis B prevention and assess the status of achievement of the 2017 Regional hepatitis B control goal. A literature review was conducted to identify studies of hepatitis B prevalence in the countries and areas of the region, both before and after vaccine introduction. A mathematical model was applied to assess infections and deaths prevented by hepatitis B vaccination and hepatitis B prevalence in countries without recent empirical data. The majority of countries and areas (22 out of 36) were estimated to have over 8% prevalence of chronic hepatitis B infection among persons born before vaccine introduction. After introduction of hepatitis B vaccine, most countries and areas (24 out of 36) had chronic infection prevalence of less than 1% among children born after vaccine introduction. It was estimated that in the past 25 years immunization programmes in the Western Pacific Region have averted 7,167,128 deaths that would have occurred in the lifetime of children born between 1990 and 2014 if hepatitis B vaccination programmes had not been established. Regional prevalence among children born in 2012 was estimated to be 0.93%, meaning that the Regional hepatitis B control goal was achieved. While additional efforts are needed to further reduce hepatitis B transmission in the region, this study demonstrates the great success of the hepatitis B vaccination efforts in the Western Pacific Region. Copyright (c) 2016 The World Health Organization. Published by Elsevier Ltd.. All rights reserved.
The introduction of new policies and strategies to reduce inequities and improve child health in Kenya: A country case study on progress in child survival, 2000-2013.
PloS One. 2017; 12(8):e0181777.As of 2015, only 12 countries in the World Health Organization's AFRO region had met Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across the African region, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Kenya was one of the countries selected for an in-depth case study due to its insufficient progress in reducing under-five mortality, with only a 28% reduction between 1990 and 2013. This paper presents indicators, national documents, and qualitative data describing the factors that have both facilitated and hindered Kenya's efforts in reducing child mortality. Key barriers identified in the data were widespread socioeconomic and geographic inequities in access and utilization of maternal, neonatal, and child health (MNCH) care. To reduce these inequities, Kenya implemented three major policies/strategies during the study period: removal of user fees, the Kenya Essential Package for Health, and the Community Health Strategy. This paper uses qualitative data and a policy review to explore the early impacts of these efforts. The removal of user fees has been unevenly implemented as patients still face hidden expenses. The Kenya Essential Package for Health has enabled construction and/or expansion of healthcare facilities in many areas, but facilities struggle to provide Emergency Obstetric and Neonatal Care (EmONC), neonatal care, and many essential medicines and commodities. The Community Health Strategy appears to have had the most impact, improving referrals from the community and provision of immunizations, malaria prevention, and Prevention of Mother-to-Child Transmission of HIV. However, the Community Health Strategy is limited by resources and thus also unevenly implemented in many areas. Although insufficient progress was made pre-2015, with additional resources and further scale-up of new policies and strategies Kenya can make further progress in child survival.
Prevention of mother-to-child transmission of HIV Option B+ cascade in rural Tanzania: The One Stop Clinic model.
PloS One. 2017; 12(7):e0181096.BACKGROUND: Strategies to improve the uptake of Prevention of Mother-To-Child Transmission of HIV (PMTCT) are needed. We integrated HIV and maternal, newborn and child health services in a One Stop Clinic to improve the PMTCT cascade in a rural Tanzanian setting. METHODS: The One Stop Clinic of Ifakara offers integral care to HIV-infected pregnant women and their families at one single place and time. All pregnant women and HIV-exposed infants attended during the first year of Option B+ implementation (04/2014-03/2015) were included. PMTCT was assessed at the antenatal clinic (ANC), HIV care and labour ward, and compared with the pre-B+ period. We also characterised HIV-infected pregnant women and evaluated the MTCT rate. RESULTS: 1,579 women attended the ANC. Seven (0.4%) were known to be HIV-infected. Of the remainder, 98.5% (1,548/1,572) were offered an HIV test, 94% (1,456/1,548) accepted and 38 (2.6%) tested HIV-positive. 51 were re-screened for HIV during late pregnancy and one had seroconverted. The HIV prevalence at the ANC was 3.1% (46/1,463). Of the 39 newly diagnosed women, 35 (90%) were linked to care. HIV test was offered to >98% of ANC clients during both the pre- and post-B+ periods. During the post-B+ period, test acceptance (94% versus 90.5%, p<0.0001) and linkage to care (90% versus 26%, p<0.0001) increased. Ten additional women diagnosed outside the ANC were linked to care. 82% (37/45) of these newly-enrolled women started antiretroviral treatment (ART). After a median time of 17 months, 27% (12/45) were lost to follow-up. 79 women under HIV care became pregnant and all received ART. After a median follow-up time of 19 months, 6% (5/79) had been lost. 5,727 women delivered at the hospital, 20% (1,155/5,727) had unknown HIV serostatus. Of these, 30% (345/1,155) were tested for HIV, and 18/345 (5.2%) were HIV-positive. Compared to the pre-B+ period more women were tested during labour (30% versus 2.4%, p<0.0001). During the study, the MTCT rate was 2.2%. CONCLUSIONS: The implementation of Option B+ through an integrated service delivery model resulted in universal HIV testing in the ANC, high rates of linkage to care, and MTCT below the elimination threshold. However, HIV testing in late pregnancy and labour, and retention during early ART need to be improved.
Morbidity and Mortality Weekly Report. 2017 Aug 18; 66(32):854-858.What is already known about this topic? Afghanistan is one of three countries where transmission of indigenous wild poliovirus (WPV) has never been interrupted. The Southern and Eastern regions of the country continue to be the main areas where WPV cases and positive environmental samples are identified. What is added by this report? The number of WPV type 1 cases reported in Afghanistan has declined yearly since 2014 when 28 cases were reported to 13 in 2016, indicating continued progress toward eradication. Factors contributing to this decline include increased focus on hard-to-reach populations, improved partner coordination, and successful negotiation to obtain access for campaigns, resulting in fewer children being missed during campaigns. During the October 2016 National Immunization Days (NIDs) 4.4% of children were missed because of security issues; <1% of children were missed because of insecurity during the May 2017 NIDs. The identification of a new corridor for transmission between Afghanistan and Pakistan in the Southeastern region, as well as ongoing case detection in the Southern region, highlight persistent immunity gaps. What are the implications for public health practice? To interrupt poliovirus transmission, Afghanistan’s polio program will benefit from further refinement of strategies to vaccinate hard-to-reach populations and improve campaign quality, especially in the south. Prioritizing coordination between Afghanistan and Pakistan on surveillance and vaccination activities for their shared mobile populations is important to stop ongoing cross-border transmission and reduce the risk for poliovirus circulation in hard-to-reach areas of Afghanistan.
New York, New York, UNFPA, 2016 Jan. 104 p.Universal access to reproductive health affects and is affected by many aspects of life. It involves individuals’ most intimate relationships, including negotiation and decision-making within these relationships, and interactions with health providers regarding contraceptive methods and options. This report seeks to identify areas where reproductive health has advanced or not according to four main indicators: Adolescent birth rate, contraceptive prevalence rate, unmet need for family planning rate, proportion of demand for contraception satisfied.
[Washington, D.C.], Feed the Future, 2017. 28 p.Feed the Future has shown that progress in fighting global hunger is possible. By bringing partners together to invest in agriculture and nutrition, we have helped millions of families around the world lift themselves out of hunger and poverty. Feed the Future’s 2017 Progress Snapshot reports about our results through the years and relates the stories of lives changed.
London, United Kingdom, Girls Not Brides, 2016 Sep. 44 p.Child marriage has been practised for centuries around the world, cutting across countries, religions and ethnicities – undermining the potential of girls everywhere. Yet five years ago, little attention was paid to the issue. Much has changed since. Developed by Girls Not Brides, this report reflects on what progress has been made towards addressing child marriage in the last five years, how working in partnership has helped catalyse this change, and what remains to be done. The report covers several areas of progress, including: trends of child marriage rates; global and regional commitments; strengthening legal and policy frameworks; building a movement; creating an understanding of what needs to be done; and funding for the field. It ends on a seven-point list of recommendations to build on progress thus far and make a difference in the lives of millions of girls.
Geneva, World Health Organization [WHO], 2017. 114 p.This report presents the first ever estimates of the population using ‘safely managed’ drinking water and sanitation services – meaning drinking water free from contamination that is available at home when needed, and toilets whereby excreta are treated and disposed of safely. It also documents progress towards ending open defecation and achieving universal access to basic services. The report identifies a number of critical data gaps that will need to be addressed in order to enable systematic monitoring of Sustainable Development Goal (SDG) targets and to realize the commitment to ‘leave no one behind’.
MMWR. Morbidity and Mortality Weekly Report. 2017 Jul 21; 66(28):753-757.In 2013, at the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR), a regional goal was established to eliminate measles and control rubella and congenital rubella syndrome* by 2020 (1). WHO-recommended measles elimination strategies in SEAR countries include 1) achieving and maintaining >/=95% coverage with 2 doses of measles-containing vaccine (MCV) in every district, delivered through the routine immunization program or through supplementary immunization activities (SIAs)dagger; 2) developing and sustaining a sensitive and timely measles case-based surveillance system that meets targets for recommended performance indicators; and 3) developing and maintaining an accredited measles laboratory network (2). In 2014, Bangladesh, one of 11 countries in SEAR, adopted a national goal for measles elimination by 2018 (2,3). This report describes progress and challenges toward measles elimination in Bangladesh during 2000-2016. Estimated coverage with the first MCV dose (MCV1) increased from 74% in 2000 to 94% in 2016. The second MCV dose (MCV2) was introduced in 2012, and MCV2 coverage increased from 35% in 2013 to 93% in 2016. During 2000-2016, approximately 108.9 million children received MCV during three nationwide SIAs conducted in phases. During 2000-2016, reported confirmed measles incidence decreased 82%, from 34.2 to 6.1 per million population. However, in 2016, 56% of districts did not meet the surveillance performance target of >/=2 discarded nonmeasles, nonrubella cases section sign per 100,000 population. Additional measures that include increasing MCV1 and MCV2 coverage to >/=95% in all districts with additional strategies for hard-to-reach populations, increasing sensitivity of measles case-based surveillance, and ensuring timely transport of specimens to the national laboratory will help achieve measles elimination.
Confronting Challenges in Monitoring and Evaluation: Innovation in the Context of the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive.
Journal of Acquired Immune Deficiency Syndromes. 2017 May 01; 75 Suppl 1:S66-S75.The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), which was launched in 2011, set a series of ambitious targets, including a reduction of new HIV infections among children by 90% by 2015 (from a baseline year of 2009) and AIDS-related maternal mortality by 50% by 2015. To reach these targets, the Global Plan called for unprecedented investments in the prevention of mother-to-child transmission of HIV (PMTCT), innovative new approaches to service delivery, immense collective effort on the programmatic and policy fronts, and importantly, a renewed focus on data collection and use. We provide an overview of major achievements in monitoring and evaluation across Global Plan countries and highlight key challenges and innovative country-driven solutions using PMTCT program data. Specifically, we describe the following: (1) Uganda's development and use of a weekly reporting system for PMTCT using short message service technology that facilitates real-time monitoring and programmatic adjustments throughout the transition to a "treat all" approach for pregnant and breastfeeding women living with HIV (Option B+); (2) Uganda's work to eliminate parallel reporting systems while strengthening the national electronic district health information system; and (3) how routine PMTCT program data in Nigeria can be used to estimate HIV prevalence at the local level and address a critical gap in local descriptive epidemiologic data to better target limited resources. We also identify several ongoing challenges in data collection, analysis, and use, and we suggest potential solutions.
[London, United Kingdom, IPPF, 2015]. 2 p.The Planned Parenthood Association of Ghana (PPAG, the IPPF Member Association in Ghana) and other civil society organizations (CSOs) have identified a number of ‘high priority’ pledges: progress towards these pledges is critical for increasing access to modern family planning (FP) methods. The government has made some progress towards its pledges, but existing efforts are not enough to deliver on its promises by 2020. In additional, other problems and gaps have emerged. The government must address these problems urgently. Civil society calls on the government of Ghana to: Implement the Family Planning Costed Implementation Plan (CIP) and the National Condom and Lubricant Strategy, 2016–2020 (NCLS), in consultation with civil society organizations. The CIP and the NCLS are comprehensive, complementary plans that, if realized, would deliver on many FP2020 objectives; Increase the national budgetary allocation for family planning and protect funds for procuring and delivering family planning services. From 2003 to 2010, on average, the government funded only 23% of contraceptives, while donors funded 77% (USAID/Delivery project, CPT 2010); Facilitate the implementation of comprehensive sexuality education (CSE) in schools, including by mandating CSE in the Education Policy on Adolescents.
[London, United Kingdom, IPPF, 2015]. 2 p.The Family Planning Association of Bangladesh (FPAB, the IPPF Member Association in Bangladesh) and other civil society organizations (CSOs) have identified a number of ‘high priority’ pledges: progress towards these pledges is critical for increasing access to modern family planning (FP) methods. The government has made some progress towards its pledges, but existing efforts are not enough to deliver on its promises by 2020. In addition, other problems and gaps have emerged. The government must address these problems urgently. Civil society calls on the government to: Increase the budgetary allocation to family planning and reduce the resource gap for family planning by 50% by 2021. The government pledged US $40 million per year (or US $380 million by 2021), but since 2009, increases to the annual development budget have not met this commitment; Expand access to long-acting and reversible contraception (LARC) in order to ensure that vulnerable groups have access and choice of family planning methods; Empower women and girls to make family planning choices and freely exercise their sexual and reproductive rights.
[London, United Kingdom, IPPF, 2015]. 2 p.The Zimbabwe National Family Planning Council (ZNFPC, the IPPF Collaborating Partner in Zimbabwe) and other civil society organizations (CSOs) have identified a number of ‘high priority’ pledges: progress towards these pledges is critical for increasing access to modern family planning (FP) methods. Civil society calls on the government to: Facilitate the active participation of girls and young women, including those who are marginalized and those living with HIV, in all aspects of national programming and decision-making relating to HIV and AIDS; Strengthen commitment to women’s health by responding to the health impact of unsafe abortion, a major public health concern, by scaling up post-abortion care and reducing unintended pregnancies through expanded and improved family planning services; Implement evidence-based HIV prevention programmes that address the needs of girls and young women, especially those living in prison or detention centres, those involved in transactional sex or child marriages, survivors of gender-based violence and orphans.
[London, United Kingdom, IPPF, 2015]. 2 p.The Planned Parenthood Association of Zambia (PPAZ, the IPPF Member Association in Zambia) and other civil society organizations (CSOs) have identified a number of ‘high priority’ pledges: progress towards these pledges is critical for increasing access to modern family planning methods. Civil society calls on the government to: Demonstrate that family planning is a top priority on its development agenda by allocating more resources towards family planning. Currently, there are a lot of competing priorities resulting in fewer resources for family planning. Increases to the family planning budget should be sustained in subsequent budgets and the government should consult with civil society to decide how these resources can be used most effectively; Create a dedicated budget line for family planning to ensure that resources are appropriately distributed and used for family planning. CSOs must be involved in the discussion to help formulate clear aims for family planning funding that are informed by their experiences in communities, with the people who need access to services; Allocate government staff and resources to engage with religious and traditional leaders and communities, particularly in the poorest and most under-served areas, to reduce socio-cultural barriers to family planning.
[London, United Kingdom, IPPF, 2015]. 2 p.Rahnuma, Family Planning Association of Pakistan (Rahnuma-FPAP, the IPPF Member Association in Pakistan) and other civil society organizations (CSOs) have identified a number of ‘high priority’ pledges: progress towards these pledges is critical for increasing access to modern family planning (FP) methods. Civil society calls on the government to: Demonstrate political commitment to deliver the FP2020 pledges. To date, there has been slow progress on all family planning indicators due to inadequate financial commitments and ownership by governments and government ministries; Allocate government funding to family planning at the provincial level. Budgets are a responsibility of provincial governments, due to devolution; Invest in effective procurement and logistics systems for family planning to ensure commodity security and address unmet need for family planning, including unmet need for long-acting reversible contraceptives. In the absence of a functioning supply chain, unmet need will increase.