GHSP Journal, Volume 5, Issue 1

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GHSP. GLOBAL HEALTH: SCIENCE AND PRACTICE. Dedicated to what works in global health programs. Photo: The Right To Play intervention in Pakistan encouraged girls' engagement in sports by holding tournaments and community events. ©Right to Play Pakistan

Image: The Right To Play intervention in Pakistan encouraged girls’ engagement in sports by holding tournaments and community events. © Right To Play Pakistan

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 2017 | Volume 5 | Number 1

Read the March 2017 issue of GHSP to find answers to these questions and more. View a list of all articles by article type below or online.

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Table of Contents


Can We Expect Results-Based Financing to Improve Quality of Care?

Performance-based incentives as currently employed appear poorly adapted for improving quality of clinical processes. They mainly measure structural items that, while easier to measure, are remote from actual clinical quality, and they could even perversely lead to heightened attention to those factors at the expense of clinical quality.

Winners of the Consortium of Universities for Global Health–Global Health: Science and Practice Annual Student Manuscript Contest

The 2 inaugural winners of the CUGH–GHSP Annual Student Manuscript Contest describe (1) the American Mock World Health Organization model for engaging students in global health policy and diplomacy, and (2) a successful Indo-U.S. twinning model of global health academic partnership led by students.

James D Shelton, Pierre Buekens, Elizabeth Grant


“New Users” Are Confusing Our Counting: Reaching Consensus on How to Measure “Additional Users” of Family Planning

FP2020’s overarching goal is framed around the new metric of “additional users.” This measure inherently captures population-level change but has been conflated with other ambiguous metrics, such as “new users.” Therefore, we propose a standard set of terms to provide more consistent measurement. Although commonly used service-level metrics cannot be directly compared to the population-level metric of additional users, we describe 2 modeling approaches that can allow service-level data to inform estimates of additional users.

Aisha Dasgupta, Michelle Weinberger, Ben Bellows, Win Brown

CDC’s Male Circumcision Recommendations Represent a Key Public Health Measure

Frisch and Earp, opponents of male circumcision, have criticized draft recommendations from the CDC that advocate counseling men and parents of newborn boys in the United States about the benefits and risks of male circumcision. We provide a rebuttal to Frisch and Earp’s criticisms and contend that the recommendations are entirely appropriate and merit consideration for policy development.

Brian J Morris, John N Krieger, Jeffrey D Klausner


Excellent Family Planning Progress in Nigeria Reported by PMA2020

Modern method contraceptive prevalence among married women in Nigeria has jumped to 16.0% in 2016 compared with <10% in 2013.

  • Notable increases were observed in the South as well as in some Northern states that had strong programming.
  • Most of the increase was in the uptake of highly effective implants.
  • But substantial unmet need for family planning remains, especially among the poorest quintile.
  • Implants and IUDs are not offered in many facilities and stock-outs are common, suggesting further progress is achievable with improved program effort.


Youth Voucher Program in Madagascar Increases Access to Voluntary Family Planning and STI Services for Young People

Program accomplishments during the first 18 months: (1) More than 58,000 free vouchers distributed to young people, of which 74% were redeemed. (2) 79% chose long-acting reversible contraceptives (LARCs) and 51% received STI counseling. Client profile data snapshot: 69% had never previously used contraception and 96% were 20 or younger.

Eva Burke, Judy Gold, Lalaina Razafinirinasoa, Anna Mackay

Community Health Workers as Social Marketers of Injectable Contraceptives: A Case Study from Ethiopia

Volunteer community health workers (CHWs) administered injectable contraceptives to women in the community for a small fee while providing counseling and referrals for other methods. Over nearly 3 years, more than 600 CHWs provided an estimated 15,410 injections. The model has the potential to improve sustainability of community-based distribution programs by incorporating social marketing principles to partially recover commodity costs and compensate CHWs.

Karen Weidert, Amanuel Gessessew, Suzanne Bell, Hagos Godefay, Ndola Prata

A Non–Gas-Based Cryotherapy System for the Treatment of Cervical Intraepithelial Neoplasia: A Mixed-Methods Approach for Initial Development and Testing

A non–gas-based treatment device for early cervical cancer treatment, adapted for use in low-resource settings to improve ease of use, portability, and durability, performed similarly to a standard gas-based cryotherapy device in small-scale testing. A large randomized clinical trial is currently underway for further assessment.

Miriam Cremer, Proma Paul, Katie Bergman, Michael Haas, Mauricio Maza, Albert Zevallos, Miguel Ossandon et al.

Comparing Women’s Contraceptive Preferences With Their Choices in 5 Urban Family Planning Clinics in Ghana

Women’s method choice largely matched their stated desired duration of effectiveness but not their desires to avoid certain side effects. While most women reported they were counseled about side effects, many fewer reported being specifically counseled about common menstrual side effects with their chosen method, including side effects the women said would cause them to stop using the method.

Sarah D Rominski, Emmanuel SK Morhe, Ernest Maya, Abukar Manu, Vanessa K Dalton

Women’s Limited Choice and Availability of Modern Contraception at Retail Outlets and Public-Sector Facilities in Luanda, Angola, 2012–2015

Despite high rates of unintended pregnancy, access to a wide range of contraceptive methods, especially injectables and long-acting reversible contraceptives (LARCs), is severely limited in both public and private facilities. Knowledge of contraceptive choices is likewise limited, yet a substantial proportion of women are not using their preferred method among the methods they know of.

Benjamin Nieto-Andrade, Eva Fidel, Rebecca Simmons, Dana Sievers, Anya Fedorova, Suzanne Bell et al.


Quality of Care in Performance-Based Financing: How It Is Incorporated in 32 Programs Across 28 Countries

Structural aspects of quality such as equipment and infrastructure were the most frequently measured, with some measurement of processes of clinical care. Further examination is warranted to assess whether variations in how quality of care is incorporated into performance-based financing programs lead to differential effects.

Jessica Gergen, Erik Josephson, Martha Coe, Samantha Ski, Supriya Madhavan, Sebastian Bauhoff


Strategies for Optimal Implementation of Simulated Clients for Measuring Quality of Care in Low- and Middle-Income Countriess

When properly implemented, use of simulated clients (“mystery clients”) can provide insight into actual experiences of real clients and evaluate quality of care. Successful implementation calls for recruiting mystery clients who represent the facility’s clientele, have strong recall of recent events, and are comfortable being undercover data collectors. Developing training protocols and checklists to standardize mystery client behavior and responses is also key.

Anne Fitzpatrick, Katherine Tumlinson

Preventing Peer Violence Against Children: Methods and Baseline Data of a Cluster Randomized Controlled Trial in Pakistan

Peer violence was remarkably high at baseline. Among urban public school students, 94% of 6th-grade boys and 85% of girls reported being victimized by peers in the last 4 weeks. And 85% of boys and 66% of girls reported perpetrating such violence. Boys scored worse on a number of mental health measures. A cluster RCT is underway to evaluate a well-established school-based intervention using sports and games to reduce peer violence.

Judith McFarlane, Rozina Karmaliani, Hussain Maqbool Ahmed Khuwaja, Saleema Gulzar, Rozina Somani, Tazeen Saeed Ali et al.

Field Action Reports

mJustice: Preliminary Development of a Mobile App for Medical-Forensic Documentation of Sexual Violence in Low-Resource Environments and Conflict Zones

The MediCapt mobile app has promise for clinicians to capture medical and forensic evidence of sexual violence and securely transmit the data to legal authorities for potential use in prosecution. We believe this application broadens the traditional scope of mHealth to collecting evidence, and thus name it mJustice.

Ranit Mishori, Michael Anastario, Karen Naimer, Sucharita Varanasi, Hope Ferdowsian, Dori Abel, Kevin Chugh


RAHI–SATHI Indo-U.S. Collaboration: The Evolution of a Trainee-Led Twinning Model in Global Health Into a Multidisciplinary Collaborative Program

RAHI–SATHI presents an innovative twinning model of global health academic partnership, resulting in a number of successful research activities that features trainees or students as the driving force, complemented by strategic institutional support from both sides of the partnership. Others can promote similar student-led initiatives by: (1) accepting an expanded role for trainees in global health programs, (2) creating structured research and program opportunities for trainees, (3) developing a network of faculty and trainees interested in global health, (4) sharing extramural global health funding opportunities with faculty and trainees, and (5) offering seed funding.

Apurv Soni, Nisha Fahey, Abraham Jaffe, Shyamsundar Raithatha, Nitin Raithatha, Anusha Prabhakaran et al.


American Mock World Health Organization: An Innovative Model for Student Engagement in Global Health Policy

The American Mock World Health Organization (AMWHO) provides a platform for students to apply their knowledge of global health policy through simulations of the World Health Assembly (WHA).This model engages and empowers future global leaders in health policy while sharpening their skills in diplomacy, public speaking, and conflict resolution. The major theme for the 2015 AMWHO was universal health coverage, reflecting what the WHA had discussed in preceding months.

Mia Lei, Neha Acharya, Edith Kwok Man Lee, Emma Catherine Holcomb, Veronica Kapoor


Possible Reasons for Limited Effectiveness of a Skills and Drills Intervention to Improve Emergency Obstetric and Newborn Care

Helen A Allott, Helen Smith, Terry Kana, Mselenge Mdegela, Sarah Bar-Zeev, Charles Ameh

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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