• Blog post

    This post originally appeared on the PSI Impact blog.

    EECO female condom marketing

    © PSI/Gareth Bentley

    Gloria dreams of a contraceptive and HIV prevention method that she can control. As a university student in Zambia, Gloria goes on dates in between working and studying. Some of the men have potential. She could imagine marrying one of them and having children together someday. Gloria relies on her partners to use male condoms—but sometimes they don’t, leaving her frustrated and scared.

  • Blog post
    happy Woman's Condom couple

    The EECO team hopes that targeted marketing and education will lead to an increased interest in female condom products, and thus more protected sex. Photo: PSI

    Imagine a woman named Cynthia who lives in Malawi.

    Cynthia’s boyfriend Ben doesn’t like to use condoms. And she doesn’t feel like she can insist on condom use. At 20 years old, Cynthia dreams of finishing her studies before having kids. She doesn’t want to get pregnant right now, or risk contracting HIV. Without the use of condoms, Cynthia feels she has few options.

    Cynthia is an archetype, a fictional character typical of a broader group. Globally, there are many women like Cynthia who lack negotiating power within their relationship to insist on condom use. Women account for just over half of the 37 million people worldwide who are living with HIV or AIDS1. In sub-Saharan Africa, the rate of new infection disproportionately affects women, with the highest burden among young women ages 15-242. Condoms are a well-known method of preventing both sexually transmitted infections and unintended pregnancy, but for many women, this isn’t an option. Due to this gender-based inequality, there is a dire need for methods that are woman-initiated.

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    PATH's Dawn Seymour discusses scenarios that implementers may face in transitioning from paper to digital records.

    PATH's Dawn Seymour discusses scenarios that implementers may face in transitioning from paper to digital records. Photo: Jarret Cassaniti

    During the 2017 Global Digital Health Forum session on Injecting Digital Technology into Old-School Immunization Systems, Dawn Seymour from PATH discussed the value of electronic immunization registries. Despite the benefits of such registries, including more accurate data, she and her colleagues Sang Dao Dinh and Hieu Tran explained some challenges when transitioning from legacy, paper-based systems in Zambia, Tanzania, and Vietnam to digital versions.

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    Abstract Submission Deadline Extended to November 6, 2015

    The East, Central and Southern Africa Health Community

    The East, Central and Southern Africa Health Community is a regional inter-governmental health organization that fosters and promotes regional cooperation in health among its ten member states.

    Contribute to the health policy conversation! The East, Central, and Southern Africa Health Community (ECSA-HC) has extended the deadline for submitting abstracts to its 62nd ECSA Health Ministers Conference, to be held from 30th November to 4th December, 2015, in Port Louis, Mauritius.

    The theme of the Conference is Transitioning from Millennium Development Goals to Sustainable Development Goals. The Conference will address the theme by examining four areas:

    1. Enhancing universal health coverage through innovations in health financing for risk protection
    2. Surveillance and control of emerging health conditions (NCDs and trauma)
    3. Regional collaboration in the surveillance and control of communicable diseases
    4. Innovations in health professional training using the College of Health Sciences model

  • Blog post
    Tweet About ECSA Health Community Best Practices Forum

    This month I had the privilege of attending the East Central and Southern African Health Community’s (ECSA-HC) 8th Best Practices Forum in Tanzania. In addition to sharing best practices in universal health coverage, human resources for health, and communicable and non-communicable diseases, the Forum celebrated ECSA-HC’s 40th anniversary of fostering regional cooperation to improve health.

    Forum attendees also welcomed ECSA-HC’s new Director General, Professor Yoswa Dambisya, an expert in human resources for health.

    According to it's website, ECSA-HC is an intergovernmental organization that "works with countries and partners to raise the standard of health for the people of the ECSA region by promoting efficiency and effectiveness of health services through cooperation, collaboration, research, capacity building, policy development and advocacy. Member states of the ECSA Health Community include Kenya, Lesotho, Malawi, Mauritius, Seychelles, Swaziland, United Republic of Tanzania, Uganda, Zambia, and Zimbabwe." 

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    © 2009 Cindi Cohen, Courtesy of Photoshare

    A community health prevention volunteer demonstrates the proper use of condoms to a group of women from the rural community of Tevele, Massinga district, Mozambique. The community of Tevele has formed a Community Health Initiative to address the most significant health issues in their community, including HIV/AIDS. © 2009 Cindi Cohen, Courtesy of Photoshare

    A growing portion of the world’s population has never lived in a world without HIV and AIDS. Since the advent of the global pandemic, more than 39 million people around the world have lost their lives to HIV-related causes. Another 35 million are currently living with HIV. Of these, about a third, or 12.9 million people, are receiving antiretroviral therapy (ART). This represents more than a 60% increase since the end of 2011, when only eight million people had access—a heartening success.

    As has been the case for three and a half decades, the global health community is working tirelessly to expand access to HIV prevention and treatment services. However, these services alone cannot meet all of the health needs of people at risk of or living with HIV. It is critical that we also improve access to other lifesaving services like family planning and maternal and child health. Yet because of funding shortages, geographical barriers, long wait times, health workforce shortages, and other limitations, many people in need of HIV care and other vital health services remain unreached.

    As a result, both HIV and pregnancy- and childbirth-related complications remain leading causes of death among women of reproductive age worldwide. Many of these deaths could be prevented if unmet need for family planning and reproductive health services were addressed more effectively. Our failure to meet the need for family planning among women living with HIV has grave consequences: The rate of unintended pregnancy among this population ranges from 53% to 84% in some African countries.

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    To me, [community health workers] are very helpful because in most cases I am busy. They have taken over that heavy work. You see, family planning needs a lot of talking to clients and yet I am always busy at the unit with deliveries, antenatal, immunization and many others. So with them I get helped. They have really taken off a big burden from me. 

    ~Achieng Rose, Midwife, Bulumbi Health Clinic, Busia, Uganda

    Global health worker crisis

    © 2013 Todd Shapera, Courtesy of Photoshare

    Community Health Worker Marie Chantal walks into her village of Batamuliza Hururiro, near Rukumo Health Center, Rwanda. © 2013 Todd Shapera, Courtesy of Photoshare

    Right now, we are 7.2 million health workers short of meeting the global population’s health care needs. By 2035, that shortage will reach 12.8 million. Twenty-nine of the 46 sub-Saharan countries are below the World Health Organization’s (WHO) lowest category of 2.5 doctors per 10,000 individuals. Moreover, medical providers are unevenly distributed; in most low-resource countries, doctors and nurses typically live and practice in urban areas, yet the majority of the populations in those countries reside in rural areas. Family planning services, in particular, suffer from grossly inadequate numbers of providers to meet the needs. A 2012 Guttmacher Institute estimate calculated 222 million women with an unmet need for modern contraception in low-resource countries.

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    GHSP Cover Image August 2014

    Public health must operate at a large scale in widely diverse and complex situations, making it a challenge to decide which programmatic approaches to undertake and under what conditions. Randomized controlled trials—the gold standard of evidence-based medicine—have limited utility for public health because they answer precise questions under narrow conditions. Other methodologies are needed that provide information about not only whether something works but also how, when, and why it can work for broad application. In the latest issue of the Global Health: Science and Practice (GHSP) journal, editor-in-chief James Shelton explores some of the methodologies we can use for evidence-based public health decision-making.

  • Blog post

    As a researcher, it has been rare for me to interact directly with the women and men whose lives are intended to be impacted by our work. Typically, my interactions go no further than the data collectors I train. However, when my research was based in Latin America and the Caribbean, I could unobtrusively participate in pilot testing of data collection instruments. Not so in sub Saharan Africa (SSA) where I do not resemble the locals, and as a “muzungu” (foreigner) could be disruptive to the data collection process. Nevertheless, it was in Zambia that I experienced the closest, and some of my more memorable, interactions with health care providers and family planning clients.

    Dawn Chin Quee ties the legs of a chicken in Zambia

    Dawn Chin Quee ties the legs of a chicken in Zambia.

    My experiences in Zambia were gained through a pilot study conducted in Mumbwa and Luangwa districts. The study in Zambia is described in detail in a recently published Global Health: Science and Practice online article that reports on the safety, feasibility, acceptability, and cost-effectiveness of community health worker (CHW) provision of Depo Provera as well as its impact on family planning uptake. Our study found very high uptake of injectables when the method was added to the contraceptive method mix provided by CHWs: during the study period, the CHWs provided protection against pregnancy for one year (couple-year of protection) to 2,206 Depo Provera clients compared with 51 condom clients and 391 pill clients. Of the 1,739 clients new to family planning, 85% chose Depo, and continuation rates were high. Collaboration with our partner, ChildFund Zambia, as well as with the Ministry of Health and many other stakeholders were as rewarding as they were integral to the success of the pilot and scale up.