GHSP Journal in Brief: Volume 3, Number 2
Social franchising “should be pursued vigorously” to reach the FP2020 goal of providing access to modern contraception to 120 million additional clients by 2020, report the editors of Global Health: Science and Practice (GHSP) in the new June 2015 issue.
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.
Other articles in the current installment of GHSP cover a range of family planning and other global health topics:
- The government of the Democratic Republic of the Congo (DRC) has shifted its stance on family planning, from near virtual neglect to explicit, strong support, in a period of only two years. In a commentary, Thibaut Mukaba and co-authors document the evolution of the family planning policy environment in the DRC, analyze events that led to the positive change, and identify factors that could influence the durability of this change.
- Diedhiou et al. report on findings from an mLearning pilot in Senegal that delivered family planning refresher training through simple mobile phones using interactive voice response (IVR) technology and SMS text messaging. Using a spaced-education approach, in which questions and detailed explanations were spaced and repeated over time, the pilot enrolled 20 public-sector nurses and midwives to test the mobile delivery platform. Health workers’ knowledge of contraceptive side effects increased significantly after the refresher training. The approach was convenient and flexible and did not disrupt routine service delivery, as traditional in-service training usually does.
- Rwanda has achieved impressive gains in contraceptive coverage, rising from about 6% of married women using modern contraception in 2000 to 45% in 2010, but access barriers remain. In a qualitative study of community perceptions of family planning in Rwanda’s southern Kayonza district, Bertrand Farmer et al. find that community members and health workers recognize the value of family planning but traditional and gender norms constrain their use of contraception. Many structural barriers also inhibit contraceptive use, such as limited method choice, transportation fees, and stock-outs.
- K4Health Director Tara Sullivan and colleagues from CCP and USAID break down the essentials of knowledge management (KM)—what it means, how it has evolved, and how it’s been used in global health—and present a case study from Bangladesh to illustrate how KM can be used to support health and development outcomes.
- Voluntary medical male circumcision (VMMC) is a key component of HIV prevention in 14 priority countries in eastern and southern Africa. While VMMC scale-up has been rising since early 2013, most of the 14 priority countries are running behind the pace needed to reach their VMMC goals by the end of 2016. Sgaier, Baer, and colleagues make a number of recommendations to design and implement more effective VMMC demand generation interventions based on extensive field visits to seven of the priority countries.
- Coverage of essential health and nutrition interventions, comprising immunization, food supplements, and pregnancy care and nutrition information, is low in parts of India. Results from integrated household and frontline worker surveys in Bihar state suggest that monetary incentives for product-oriented services such as immunization improve health worker performance and may have spillover effects for information-oriented services such as nutrition information.
- The World Health Organization recommends treating childhood diarrhea with zinc and low-osmolarity oral rehydration salts (ORS). However, in India, zinc is rarely prescribed and has not been available in the public sector until recently. Fischer Walker and co-authors present evaluation findings of a project aimed at accelerating ORS and zinc uptake among public and private providers in Gujarat. The evaluation found that drug-detailing visits to private providers by pharmaceutical representatives seemed less effective than formal training of public providers about appropriate diarrhea treatment, especially in improving knowledge of the correct dosage and duration of zinc treatment.
- Rapid provision of oxytocin after childbirth can prevent postpartum hemorrhage and save mothers’ lives. A study in Karnataka, India, found that preparing oxytocin ahead of time and having it available at the bedside was significantly and robustly associated with its rapid administration after delivery. GHSP editors propose that the benefits could also extend to the newborn by freeing health workers to provide immediate neonatal resuscitation to non-breathing newborns within the 1-minute critical time window.
- New forms of health research aim to guide development and implementation of effective policies, programs, and interventions. In the nutrition field, Pham and Pelletier of Cornell University find that such “action-oriented” research is greatly underrepresented in public health journals and even more so in nutrition journals. They call on all parties in the research enterprise, from research institutions and graduate training programs to journals and research funders, to expand population nutrition research agendas.
- Vogus and Graff from Abt Associates share lessons learned on donor transitions to country ownership in family planning, HIV, and other areas, based on a rapid review of the literature. They lay out six steps that could help ensure successful transition and nine areas to assess a country’s readiness for transition.
- Reporting on key messages from a workshop on evaluation design for complex global health initiatives convened by the Institute of Medicine, Mookherji and Meck highlight the need for evaluators, commissioners, and implementers to develop a robust theory of change to understand how and why global health programs should work, to use multiple analytic methods, and to triangulate evidence to validate results as well as synthesize findings to identify lessons for scale-up or broader application.
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