When mothers survive, families thrive. That's why K4Health is highlighting opportunities for integrating family planning with maternal, newborn, & child health (MNCH) services. Visit Integrating Family Planning & MNCH Services for the latest evidence and tools--and stay tuned for a vibrant blog series!
If anything positive has come out of the ongoing Ebola crisis in West Africa, it’s that we can finally put to rest a longstanding debate—namely, whether it’s more effective in global health to focus on specific issues (such as HIV and maternal health), or to take a systems-based approach, looking at the whole of a country’s capacity to provide health care to its people.
I find visual tools such as logic models, theoretical frameworks, program matrices, etc. very useful and effective for my work. These tools communicate a shared vision and explain how our strategies and programmatic components lead to expected outcomes.
To optimize opportunities to make groundbreaking advances in contraceptive research and development (R&D), the global health community must help connect the dots to facilitate new partnerships between groups that often work in silos. For example, there is the company in the U.S. that is developing a promising drug delivery platform but hasn’t yet considered applying the research to contraceptive products. There is the university scientist who has an idea for a new contraceptive product but is unsure whether similar investments are being made in the private sector. There is the small company based in the global South that wants to enter the international market but lacks experience registering its contraceptive products in sub-Saharan Africa.
For all of these groups, the financial and regulatory barriers to advancing new contraceptive methods through the pipeline can be substantial. In recent years, funding for contraceptive R&D has sharply declined in both the private and public sectors. A new report recently issued by Policy Cures indicates that in 2013, only US$63 million was invested in developing new contraceptive products that would meet the needs of women in low- and middle-income countries. In comparison, US$580 million and US$549 million were invested in R&D for prevention and treatment of tuberculosis and malaria respectively. Another challenge is that organizations may lack the skills and capacity in-house that are needed to take a product from the discovery phase through to introduction. In addition, companies often do not have financial incentives to develop new contraceptives designed to address the needs of women in low-resource settings if there is little potential for a commercial market in developing countries. Finally, some organizations — particularly small manufacturers located in emerging markets — often have difficulty navigating the complex international regulatory environment.
As a rookie player to the game of mothering, I recently realized I had taken for granted the pleasant labor and delivery unit I experienced with the birth of my first child in October 2013. I was coached, cared for, and, most importantly, respected by all of the labor and delivery unit staff – isn’t that what everyone experiences? Unfortunately, I came to find out that the answer is “no.”
This spring I had the opportunity to interview Meredith, a Certified Nurse-Midwife who works for Zanmi Lasante, the sister organization of Partners in Health in Haiti. She enlightened me to the fact that not all women have a positive or respectful experience during childbirth. One unfortunate result is that some women, upon hearing about or having a negative experience, choose to deliver at home without a skilled birth attendant. This puts them at risk of childbirth-related complications.
How did a K4Health Toolkit help Meredith strengthen respectful maternity care in Haiti? Watch our new video to find out!
If you are like Meredith and have used a Toolkit or a Toolkit resource in your work in an impactful way, I would love to hear your story.
“To be frank, I was going through a process when my wife was pregnant. A process of finding the true meaning of being a father.”
The old trope of a man nervously pacing the hospital’s waiting area, wringing his hands, while his wife labors in a private back room is reserved for old movies and nostalgia, right? That may not be true, according to State of the World’s Fathers, the world’s first report to provide a global view of the state of men’s contributions to parenting and caregiving.
Even before the delivery room, some men are missing out on the chance to be involved. While more than 80% of fathers in Cambodia, the Maldives and Rwanda were present at a pre-natal check up for their youngest child, less than 20% of fathers in Burundi, Pakistan and Zambia made the trip. Traditional expectations of what it means to be a man – and a woman – alongside sometimes unsupportive, or unprepared health systems and restrictive policies, set up barriers to men’s full participation in maternal, newborn and child health.
The Roadmap for Health, Measurement and Accountability, Measurement and Accountability for Results in Health (MA4Health).
We recently gathered with global leaders to endorse The Roadmap for Health Measurement and Accountability and the Five-Point Call to Action at the Measurement and Accountability for Results in Health Summit. Convened by USAID, the World Bank, and the World Health Organization, the Summit emphasized the need for systematic measurement of health data, collaborative partnerships, and shared purpose and responsibility among health professionals. The roadmap, along with the commitment of global leaders, is meant to serve as a platform for collaboration on health measurement as we move into the post-2015 era.
The roadmap and call to action are quite timely. Although we have made great strides, the health data agenda is unfinished. Limited access to data and usability of data both remain significant challenges to improving measurement and accountability for health. Donors, implementers, and governments all need accessible and usable data, yet they all have varying needs and capacities. As Jon Schwabish, Senior Economist at the Urban Institute and Policyviz.com, put it, we need more “human readable” data. Usable data should be available to those who need it, when they need it, and where they need it.
Source: The Flying Doctors Photo Collection, 2014. Rural Road Rescue.
How can we improve health and lower the number of preventable deaths in Africa?
In the 2015 Gates Annual Letter, Bill and Melinda Gates predicted that better health “will be driven by innovation in technology—ranging from new vaccines and hardier crops to much cheaper smartphones and tablets—and by innovations that help deliver those things to more people.”
I agree: The potential for new technology to revolutionize and disrupt current models of healthcare delivery is enormous. However, from my experience working in the medical field in Africa, I know that existing healthcare tools, if better utilized, could start saving lives there today. These may not be as thrilling as the latest app or gadget, but they have enormous potential if used correctly. In its own way, that’s pretty exciting.
From the cover of GHSP: A BlueStar social franchisee provider in Senegal talks with prospective clients about service offerings on opening day. Global franchisors MSI and PSI have rapidly scaled their family planning social franchising programs in recent years. Credit: Nils Elzenga/Marie Stopes International.
Social franchising organizes small, independent health care businesses into quality-assured networks. It leverages the vast resources of private-sector health facilities in low- and middle-income countries to expand access to and quality of services by building facilities’ capacity to deliver important yet underprovided services, such as inserting and removing implants and IUDs.
Two landmark articles published in the newest issue of GHSP showcase the accomplishments made by Marie Stopes International (MSI) and Population Services International (PSI), two of the largest global franchisor entities. Sarah Thurston and colleagues from MSI and PSI report on their social franchising footprint between 2013 and 2014. In just one year, the total couple-years of protection (CYPs) delivered by the two organizations combined grew by a remarkable 25%—from 8.6 million to 10.8 million. Reporting on detailed results from MSI’s program, Munroe, Hayes, and Taft describe many other positive accomplishments, including reaching a high proportion of young women aged 15–24 and low-income women living on under US$2.50/day. In addition, a very high proportion of MSI social franchising clients (68%) chose to use long-acting reversible contraceptives (LARCs), confirming findings reported by Curry et al. in the previous GHSP issue that LARCs can be delivered successfully in many settings.
During a Facebook Q&A chat coinciding with the release, Dr. Marlene Temmerman, WHO Director of the Department of Reproductive Health and Research, explained that among the most substantial updates in the latest MEC edition are the addition of four new contraceptive methods and the relaxed recommendations on use of progestin-only pills and implants by breastfeeding women.
The four new methods added to the fifth MEC edition are:
Subcutaneous DMPA (follows current MEC recommendations for intramuscular DMPA)
Sino-implant (II) (follows current MEC recommendations for levonorgestrel implants)
Ulipristal acetate (UPA) emergency contraceptive pills (follows current MEC recommendations for levonorgestrel and combined oral contraceptives used as emergency contraception, except for breastfeeding women the MEC category is 2 for UPA instead of 1; category 2 means that the advantages of using the method generally outweigh the risks while category 1 indicates there is no restriction on use of the method)
Progesterone-releasing vaginal ring (the previous MEC edition included recommendations only for the combined contraceptive vaginal ring)
The change that is getting the most buzz in the global health field though is the increased contraceptive options for breastfeeding women under six weeks postpartum. In the previous edition of the MEC, generally the only reversible contraceptives that such women could use were barriers methods and the lactational amenorrhea method (LAM). Now, WHO recommends that breastfeeding women under 6 weeks postpartum can also generally use progestin-only pills and implants (MEC category 2; advantages of using the method generally outweigh the risks). The change brings the WHO recommendations more in line with those from other normative bodies, including the US Centers for Disease Control and Prevention and the UK’s Royal College of Obstetricians and Gynaecologists.