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.
CCP | Associate Managing Editor, Global Health: Science and Practice
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.
John Snow Inc. (JSI) | Sr. Technical Advisor, Immunization
A no-missed-opportunities approach recognizes that every service contact presents an opportunity to comprehensively address women’s and children's health needs. Credit: Chelsea Cooper, MCHIP
When Lorpu*, a mother in Liberia, brought her baby to a clinic to receive routine immunizations, she was also counseled about family planning and offered a contraceptive method. Lorpu expressed relief about having received same-day provision of both family planning and immunization services: “When I go for [my child’s] vaccine, I can also get family planning. I don’t have to leave and come back.”
Lorpu received these integrated services as part of a pilot program in Liberia implemented by the U.S. Agency for International Development’s (USAID) predecessor flagship Maternal and Child Health Integrated Program (MCHIP) and the Liberian Ministry of Health and Social Welfare. In participating clinics, women who brought their infants for routine immunization services were provided brief messages about family planning by the vaccinator and offered a referral for same-day services. This approach, now used by MCHIP’s successor program, the flagship Maternal and Child Survival Program (MCSP), has led to substantial increases in family planning uptake, and women have expressed positive feedback about the convenience of having access to both family planning and immunization services during the same visit.