GHSP Journal, Volume 4, Issue 1 – Sharing Experiences and Results from the Global Health Community

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GHSP. GLOBAL HEALTH: SCIENCE AND PRACTICE. Dedicated to what works in global health programs. Photo: A father in western Kenya feeds his child. Household members such as fathers and grandmothers often exert social influences on a mother's adoption of optimal infant feeding practices.  ©2010 PATH/Evelyn Hockstein

Photo: A father in western Kenya feeds his child. Household members such as fathers and grandmothers often exert social influences on a mother's adoption of optimal infant feeding practices. ©2010 PATH/Evelyn Hockstein

Global Health: Science and Practice (GHSP), a no-fee, peer-reviewed, open-access journal, is targeted to global health professionals, particularly program implementers, to validate their experiences and program results by peer reviewers and to share them with the greater global health community.

March 2016 | Volume 4 | Number 1

Read the March 2016 issue of GHSP to find answers to these questions and more. View a list of all articles by article type below or online.

Visit the GHSP website to read and comment on the articles, and subscribe to receive alerts when new articles and issues are published.

Table of Contents


Birthing Centers Staffed by Skilled Birth Attendants: Can They Be Effective... at Scale?

Peripheral-level birthing centers may be appropriate and effective in some circumstances if crucial systems requirements can be met. But promising models don't necessarily scale well, so policy makers and program managers need to consider what requirements can and cannot be met feasibly at scale. Apparently successful components of the birthing center model, such as engagement of traditional birth attendants and use of frontline staff who speak the local language, appear conducive to use in other similar settings.

GHSP Journal

Abbreviating the Wealth Index to Measure Equity in Health Programs More Easily

Efforts to simplify the construction of the DHS wealth index are encouraged (while recognizing it is constructed differently in each country), but attempts to assess equity in health programs should bear in mind that it is not sufficient to calculate the wealth index just for the participants in the program. The quintile distributions can vary dramatically within sub-populations. Assessments of equity require knowledge of the distribution of potential participants as well as actual participants.

Thomas W Pullum


Social Entrepreneurship: A Case Study From Brazil

Through careful sourcing of commodities, cost-cutting efficiencies, and realistic pricing, 3 large contraceptive social marketing programs evolved into profit-making enterprises while continuing to make low-priced contraceptives available to low-income consumers on a substantial scale.

Phil Harvey

Fertility Awareness Methods: Distinctive Modern Contraceptives

Fertility awareness methods—the Lactational Amenorrhea Method, the Standard Days Method, and the Two Day Method—are safe and effective, and they have important additional benefits that appeal to women and men. Including these modern contraceptives in the method mix expands contraceptive choice and helps women and men meet their reproductive intentions.

Shawn Malarcher, Jeff Spieler, Madeleine Short Fabic, Sandra Jordan, Ellen H Starbird, Clifton Kenon


Expanding Access to the Intrauterine Device in Public Health Facilities in Ethiopia: A Mixed-Methods Study

Following the introduction of IUDs into the Ethiopian public health sector, use of the method increased from <1% in 2011 to 6% in 2014 in a sample of 40 health facilities. This shift occurred in the context of wide method choice, following provider training, provision of post-training supplies, and community-based awareness creation. The IUD was acceptable to a diverse range of clients, including new contraceptive users, those with little to no education, those from rural areas, and younger women, thus suggesting a strong latent demand for IUDs in Ethiopia.

Yewondwossen Tilahun, Sarah Mehta, Habtamu Zerihun, Candace Lew, Mohamad I Brooks, Tariku Nigatu, Kidest Lulu Hagos, Mengistu Asnake, Adeba Tasissa, Seid Ali, Ketsela Desalegn, Girmay Adane

Routine Immunization Consultant Program in Nigeria: A Qualitative Review of a Country-Driven Management Approach for Health Systems Strengthening

Despite challenges in material and managerial support, some state-level consultants appear to have improved routine immunization programming through supportive supervision and capacity building of health facility staff as well as advocacy for timely dispersion of funds. This country-led, problem-focused model of development assistance deserves further consideration.

Meghan O'Connell, Chizoba Wonodi

Is Household Wealth Associated With Use of Long-Acting Reversible and Permanent Methods of Contraception? A Multi-Country Analysis

In general, across the developing world, wealthier women are more likely than poorer women to use long-acting and permanent methods of contraception instead of short-acting methods. Exceptions are Bangladesh, India, and possibly Haiti.

Jorge I Ugaz, Minki Chatterji, James N Gribble, Kathryn Banke

Role of Social Support in Improving Infant Feeding Practices in Western Kenya: A Quasi-Experimental Study

Fathers and grandmothers who participated in separate nutrition dialogue groups supported mothers to improve infant feeding practices including dietary diversity, food consistency, and use of animal-source foods. Future studies should explore using a family-centered approach that engages mothers together with key household influencers.

Altrena G Mukuria, Stephanie L Martin, Thaddeus Egondi, Allison Bingham, Faith M Thuita

Meeting Postpartum Women's Family Planning Needs Through Integrated Family Planning and Immunization Services: Results of a Cluster-Randomized Controlled Trial in Rwanda

Integrating contraceptive services into infant immunization services was effective, acceptable, and feasible without negatively affecting immunization uptake. Yet unmet need for contraception remained high, including among a substantial number of women who were waiting for menses to return even though, at 6 months or more postpartum, they were at risk of an unintended pregnancy. More effort is needed to educate women about postpartum return to fertility and to encourage those desiring to space or limit pregnancy to use effective contraception.

Lisa S Dulli, Marga Eichleay, Kate Rademacher, Steve Sortijas, The´ophile Nsengiyumva

The Single-Visit Approach as a Cervical Cancer Prevention Strategy Among Women With HIV in Ethiopia: Successes and Lessons Learned

With the single-visit approach for cervical cancer prevention, women with positive "visual inspection of the cervix with acetic acid wash" (VIA) test results receive immediate treatment of the precancerous lesion with cryotherapy. The approach worked successfully for women with HIV in Ethiopia in secondary and tertiary health facilities, with high screening and cryotherapy treatment rates. Sustainability and appropriate scale-up of such programs must address wider health system challenges including human resource constraints and shortage of essential supplies.

Netsanet Shiferaw, Graciela Salvador-Davila, Konjit Kassahun, Mohamad I Brooks, Teklu Weldegebreal, Yewondwossen Tilahun, Habtamu Zerihun, Tariku Nigatu, Kidest Lulu, Ismael Ahmed, Paul D Blumenthal, Mengistu Asnake

Mapping the Prevalence and Sociodemographic Characteristics of Women Who Deliver Alone: Evidence From Demographic and Health Surveys From 80 Countries

An estimated 2.2 million women surveyed in low- and middle-income countries between 2005 and 2015 gave birth alone. This practice was concentrated in West and Central Africa and parts of East Africa. Women who delivered with no one present were very poor, uneducated, older, and of higher parity. Experience from northern Nigeria suggests the practice can be reduced markedly by mobilizing religious and civil society leaders to improve community awareness about the critical importance of having an attendant present.

Nosakhare Orobaton, Anne Austin, Bolaji Fapohunda, Dele Abegunde, Kizzy Omo

Casas Maternas in the Rural Highlands of Guatemala: A Mixed-Methods Case Study of the Introduction and Utilization of Birthing Facilities by an Indigenous Population

In an isolated mountainous area of Guatemala with high maternal mortality, an NGO-sponsored approach engaged communities to operate local, culturally appropriate birthing facilities and is achieving high and equitable utilization. Likely success factors: community engagement and ownership, close location of facilities, perceived high quality of services, and engagement of traditional birth attendants in the birthing process and as advocates for facility use.

Ira Stollak, Mario Valdez, Karin Rivas, Henry Perry

A Dedicated Postpartum Intrauterine Device Inserter: Pilot Experience and Proof of Concept

Use of the inserter was found to be safe, with high fundal placement in 82% of cases. Complete expulsion occurred in 7.5% of cases and partial expulsion was detected in 10%, comparable with rates in other studies using standard IUD insertion techniques. Further study and use of the dedicated inserter may reveal increased convenience and reduced risk of infection among users and could improve acceptability of postpartum IUD provision among providers.

Sharad Singh, Vinita Das, Anjoo Agarwal, Rupali Dewan, Pratima Mittal, Renita Bhamrah, Klaira Lerma, Paul D Blumenthal


Simplified Asset Indices to Measure Wealth and Equity in Health Programs: A Reliability and Validity Analysis Using Survey Data From 16 Countries

Many program implementers have difficulty collecting and analyzing data on program beneficiaries' wealth because a large number of survey questions are required to construct the standard wealth index. We created country-specific measures of household wealth with as few as 6 questions that are highly reliable and valid in both urban and rural contexts.

Nirali M Chakraborty, Kenzo Fry, Rasika Behl, Kim Longfield

Measurement of Health Program Equity Made Easier: Validation of a Simplified Asset Index Using Program Data From Honduras and Senegal

Piggy-backing on an existing representative household survey that includes an asset index, it is possible to assess the socioeconomic distribution of program beneficiaries at low cost. The typically large number of questions used to construct the asset index, however, deters many implementers from adopting this approach. This study demonstrates that the number of questions can be significantly reduced to a subset that takes only a few minutes to administer without substantially altering findings or policy recommendations. The relevant subset is country-specific and thus necessitates tailored country questionnaires.

Alex Ergo, Julie Ritter, Davidson R Gwatkin, Nancy Binkin


Results-Based Financing in Mozambique's Central Medical Store: A Review After 1 Year

The RBF scheme, which paid incentives for verified results, steadily improved the CMS's performance over 1 year, particularly for supply and distribution planning. Key apparent success factors: 1) the CMS had full discretion over how to spend the funds, 2) payment was shared with and dependent on all staff, which encouraged teamwork, 3) performance indicators were challenging yet achievable, and 4) the quarterly payment cycle was frequent enough to be motivating. Recommendations for future programs: focus on both quality and quantity indicators; strengthen results verification processes; and work toward institutionalizing the approach.

Cary Spisak, Lindsay Morgan, Rena Eichler, James Rosen, Brian Serumaga, Angela Wang

GHSP is supported by the U.S. Agency for International Development and published by the Knowledge for Health project at the Johns Hopkins Center for Communication Programs.

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