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
- What do providers need to effectively provide LARCs?
- What has 20 years of evidence taught us about postabortion care?
- Are programs ready to remove contraceptive implants?
- Ebola Virus Disease: what it takes for a successful clinical surveillance and data collection system.
- How to ensure timely referrals and adequate followup of children discharged from hospitals in Uganda?
- What psychoeducation interventions are needed for survivors of torture and related trauma in Iraq?
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.
- Introducing Early Infant Male Circumcision for HIV Prevention: Considerations for Policy, Safety, Cost, Acceptability and Demand
- Long-Acting Reversible Contraception Crucial to Meeting Unmet Need Goals by 2020: Key Papers From the 2016 International Conference on Family Planning
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
EDITORIALS
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.
VIEWPOINTS
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.
COMMENTARIES
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.
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.
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.
ORIGINAL ARTICLES
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.
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.
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.
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.
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.
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.
REVIEWS
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.
FIELD ACTION REPORTS
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.
SHORT REPORTS
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.
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