GHSP Journal, Volume 4, Issue 3

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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

Image: Staff at the Lunsar Ebola treatment unit in Sierra Leone transfer patient data from the high-risk zone to the low-risk zone. ©2015 Reshma Roshania

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.

September 2016 | Volume 4 | Issue 3

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

Also, GHSP recently published two supplements which we think you will find interesting and useful.

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Table of Contents


Effective LARC Providers: Moving Beyond Training (Republication)

Effective and productive providers are the key to successful provision of long-acting reversible contraceptives (LARCs). But LARCs demand more of providers than short-acting resupply methods. In addition to sound training, key elements to developing highly productive providers of LARCs include a thorough understanding of the service delivery system context; selecting providers with the most potential, especially from mid-level cadres; strong mentoring and supportive supervision; and attention to the supply chain and to demand-side support.


Moving Medicine, Moving Minds: Helping Developing Countries Overcome Barriers to Outsourcing Health Commodity Distribution to Boost Supply Chain Performance and Strengthen Health Systems

Senegal and other developing countries are improving access to health commodities by outsourcing supply chain logistics to private providers. To achieve broader, lasting reform, we must support further adoption of the outsourced model; assist country-led cost-benefit analyses; and help governments build capacity to manage contracts and overcome other barriers.

Priya Agrawal, Iain Barton, Roberto Dal Bianco, Dana Hovig, David Sarley, Prashant Yadav


Accessible Contraceptive Implant Removal Services: An Essential Element of Quality Service Delivery and Scale-Up

Use of contraceptive implants has surged in recent years, yet emerging data show a deficit of service delivery capacity and coverage for implant removals. The number of projected removals needed in the 69 FP2020 focus countries in 2018 (4.9–5.8 million) is more than twice that estimated for 2015 (2.2 million). We must proactively plan and execute high-quality implant removal services in order to fulfill the exceptional promise of implants in meeting client needs and advancing toward FP2020 goals.

Megan Christofield, Maryjane Lacoste

Using Qualitative Methods to Validate and Contextualize Quantitative Findings: A Case Study of Research on Sexual Behavior and Gender-Based Violence Among Young Swazi Women

Nesting qualitative data collection methods within quantitative studies improves results by assessing validity and providing depth and context. Using data from 3 sources from Swaziland, we triangulate qualitative and quantitative findings to highlight how different methodologies produce discrepant data regarding risky sexual behaviors among young women. We found that women reported similar numbers of lifetime sex partners in all sources, but the proportion reporting multiple and concurrent partnerships was several times higher in qualitative interviews. In addition, qualitative data can provide deeper understanding of how participants, such as those experiencing gender-based violence, understood the experiences behind the quantitative statistics.

Allison Ruark, Rebecca Fielding-Miller

Vouchers: A Hot Ticket for Reaching the Poor and Other Special Groups With Voluntary Family Planning Services

Vouchers can be a highly effective tool to increase access to and use of family planning and reproductive health services, especially for special populations including the poor, youth, and postpartum women. Voucher programs need to include social and behavior change communication with clients and quality assurance for providers, whether in the private or public sector. In the longer term, voucher programs can strengthen health systems capacity and provide a pathway to strategic purchasing such as insurance or contracting.

Elaine P Menotti, Marguerite Farrell


Successful Implementation of a Multicountry Clinical Surveillance and Data Collection System for Ebola Virus Disease in West Africa: Findings and Lessons Learned

Despite resource and logistical constraints, International Medical Corps cared for thousands at 5 Ebola treatment units in Liberia and Sierra Leone between 2014 and 2015 while collecting hundreds of data points on each patient. To facilitate data collection and global reporting in future humanitarian responses, standardized data forms and databases, with clear definitions of clinical and epidemiological variables, should be developed and adopted by the international community.

Reshma Roshania, Michaela Mallow, Nelson Dunbar, David Mansary, Pranav Shetty, Taralyn Lyon, Kacey Pham, Matthew Abad, Erin Shedd, Anh-Minh A Tran, Sarah Cundy, Adam C Levine

Safety and Acceptability of Community-Based Distribution of Injectable Contraceptives: A Pilot Project in Mozambique

Trained community health workers, including traditional birth attendants (TBAs), safely and effectively administered injectables in northern Mozambique; two-thirds of the women choosing injectables had never used contraception before. Including TBAs in the Ministry of Health’s recent task sharing strategy can improve rural women’s access to injectables and help meet women’s demand for contraception.

Ana Jacinto, Mahomed Riaz Mobaracaly, Momade Bay Ustáb, Cassimo Bique, Cassandra Blazer, Karen Weidert, Ndola Prata

Scheduled Follow-Up Referrals and Simple Prevention Kits Including Counseling to Improve Post-Discharge Outcomes Among Children in Uganda: A Proof-of-Concept Study

Post-hospital discharge is a vulnerable time for recurrent illness and death among children. An intervention package consisting of (1) referrals for scheduled follow-up visits, (2) discharge counseling, and (3) simple prevention items such as soap and oral rehydration salts resulted in much higher health seeking and hospital readmissions compared with historical controls.

Matthew O Wiens, Elias Kumbakumba, Charles P Larson, Peter P Moschovis, Celestine Barigye, Jerome Kabakyenga, Andrew Ndamira, Lacey English, Niranjan Kissoon, Guohai Zhou, J Mark Ansermino

Intensive Group Learning and On-Site Services to Improve Sexual and Reproductive Health Among Young Adults in Liberia: A Randomized Evaluation of HealthyActions

Combining intensive group learning and provision of on-site reproductive health services through an existing alternative basic education program increased use of contraception and HIV testing and counseling among young out-of-school Liberians.

Rebecca Firestone, Reid Moorsmith, Simon James, Marilyn Urey, Rena Greifinger, Danielle Lloyd, Lisa Hartenberger-Toby, Jewel Gausman, Musa Sanoe

A Randomized Controlled Trial of a Trauma-Informed Support, Skills, and Psychoeducation Intervention for Survivors of Torture and Related Trauma in Kurdistan, Northern Iraq

Providing survivors of torture, imprisonment, and/or military attacks with a counseling program that includes support, skills and psychoeducation by well-trained and supervised community mental health workers can result in moderate yet meaningful improvements in depression and dysfunction.

Judith Bass, Sarah McIvor Murray, Thikra Ahmed Mohammed, Mary Bunn, William Gorman, Ahmed Mohammed Amin Ahmed, Laura Murray, Paul Bolton

Progress in Harmonizing Tiered HIV Laboratory Systems: Challenges and Opportunities in 8 African Countries

Countries have had mixed results in adhering to laboratory instrument procurement lists, with some limiting instrument brand expansion and others experiencing substantial growth in instrument counts and brand diversity. Important challenges to advancing laboratory harmonization strategies include: 1) lack of adherence to procurement policies; 2) lack of an effective coordinating body, and 3) misalignment of laboratory policies, treatment guidelines, and minimum service packages.

Jason Williams, Farouk Umaru, Dianna Edgil, Joel Kuritsky


Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components

Twenty years of postabortion care (PAC) studies yield strong evidence that: 1) misoprostol and vacuum aspiration are comparable in safety and effectiveness for treating incomplete abortion; 2) misoprostol, which can be provided by trained nurses and midwives, shows substantial promise for extending PAC services to secondary hospitals and primary health posts; and 3) postabortion family planning uptake generally increases rapidly–and unintended pregnancies and repeat abortions can decline as a result–when a range of free contraceptives, including long-acting methods, are offered at the point of treatment; male involvement in counseling–always with the woman's concurrence–can increase family planning uptake and support.

Douglas Huber, Carolyn Curtis, Laili Irani, Sara Pappa, Lauren Arrington

Field Action Reports

Improving the Quality of Postabortion Care Services in Togo Increased Uptake of Contraception

The quality improvement approach applied at 5 facilities over about 1 year increased family planning counseling to postabortion clients from 31% to 91%. Of those counseled provision of a contraceptive method before discharge increased from 37% to 60%. Oral contraceptives remained the most popular method, but use of injectables and implants increased. The country-driven approach, which tended to use existing resources and minimal external support, has potential for sustainability and scale-up in Togo and application elsewhere.

Stembile Mugore, Ntapi Tchiguiri K Kassouta, Boniface Sebikali, Laurel Lundstrom, Abdulmumin Saad

Short Reports

Use of the World Health Organization’s Medical Eligibility Criteria for Contraceptive Use Guidance in sub-Saharan African Countries: A Cross-Sectional Study

The revised 2015 World Health Organization guidance expanded the recommended contraceptive options available to breastfeeding women during the early postpartum period to include progestogen-only pills and implants, but a substantial number of surveyed country representatives indicated that as yet their national policies did not allow such women to use these methods at that time. Countries may benefit from support to incorporate MEC guidance into national service delivery guidelines.

Melissa J Chen, Mary E Gaffield, James Kiarie