Peace Corps Community Health Promoter
Condom Distribution and Promotion Program
Quilalí, Nueva Segovia
Quilalí, Nueva Segovia is a municipality of Nicaragua located in the northern mountains. This town is home to approximately 13,000 residents within the 19 neighborhoods of the urban center, and an additional 19,600 residing in the 78 rural communities. The Ministry of Health (MINSA) has addressed adolescent pregnancy to be a top-priority for the municipality due to its average of 29% which is above the national average of 25% (1).
Quilalí’s Community Health Promotor for the Peace Corps completed a community and sector analysis that consisted of two components: in-depth interviews and surveys. Through interviewing a wide-variety of community leaders and members, a common theme was revealed: pregnancy in adolescents is the leading health concern for the municipality. This lead the PCV to focus her survey on condom and contraceptive perceptions and behaviors within adolescents. Embarrassment was shown to be a leading reason why adolescents have or would choose to not seek out condoms, and significant gender disparities in condom negotiation abilities was also shown, presenting the need to educate on gender roles and stereotypes and provide adolescents with training on assertive and effective communication strategies.
Condoms, which are readily available and free through all MINSA facilities, are dramatically underused due to a lengthy procurement process and strong cultural stigmas regarding this aspect of sexual reproductive health. As condoms have a 98% effectiveness of pregnancy prevention if used correctly and consistently, in addition to the significant advantages of sexually-transmitted infection and HIV prevention, their accessibility and acceptance is vital to the reduction of pregnancies in adolescents (2).
The proposed Condom Distribution and Promotion Program (CDPP) has the goal that adolescents of sectors 1 and 2 of Quilalí experience improved sexual reproductive health outcomes due to an increased accessibility of MINSA condoms and enhanced condom knowledge. This initiative strives to reduce the sociocultural “embarrassment” surrounding sexual reproductive health through community-based education and promotion techniques, all while making condoms more accessible to adolescents through distribution sites at local businesses.
Monitoring and evaluation strategies over the year of the project will be used to determine outcomes and impact, which will be vital in defining how to scale the project up to include select rural health sectors. The collaboration between MINSA and their network of Community Health Workers; the public high school; and community members on the CDPP will be powerful in challenging the stigma that exists around condom procurement and use. This strong emphasis on community engagement and active participation will build the base to ensure the sustainability of the CDPP with the hopes of making a lasting impact through challenging the perceptions, increasing accessibility, and promoting the use of condoms for improving sexual reproductive health outcomes and reducing pregnancy in adolescents.
Addressing syndemic HIV, GBV, and Housing Insecurity at an AIDS service organization in NYC
As articulated in the National HIV/AIDS Strategy  and the New York State Blueprint to End the Epidemic , social determinants-based approaches are critical to the public health eﬀort to end the AIDS epidemic in the USA. Syndemics theory, a conceptual framework that considers disease in the context of co-morbid conditions, provides a model for developing programs that address the influence of social and structural factors on health. This framework has been eﬀectively used to describe and address co-morbid Substance Abuse, Domestic Violence, and AIDS (SAVA) , as well as other AIDS-related complexes (e.g. AIDS and TB ; AIDS and MSM ), suggesting that it may be a useful tool for re-sponding to other multi-factor issues.
Numerous studies have established the strong associations between HIV and homelessness , HIV and gender-based violence (GBV) , and homelessness and GBV , suggesting the possibility of a three-factor Housing Insecurity, Violence, and AIDS (HIVA) syndemic. Given the utility of syn-demic theory in guiding responses to other AIDS-related complexes, individuals aﬀected by HIVA may benefit from integrated service programs informed by syndemic theory.
Gay Men’s Health Crisis (GMHC), is an AIDS service organization that aims to “uplift the lives ” of people aﬀected by HIV through a variety of social and support service programs. In response to a no-tice of funding availability from the United States Department of Justice (DoJ) and the United States Department of Housing and Urban Development (HUD), GMHC developed an integrated pilot pro-gram to address the syndemic needs of people living with HIV/AIDS (PLWHA) who are homeless and have experienced GBV. The following brief describes GMHC’s proposed program and provides a model for AIDS service organizations aiming to implement a syndemics-based program for people aﬀected by the HIVA syndemic.
Exploring the Impact of Effective Leadership and Management for Successful Programming
Leaders and managers/supervisors play a critical role in setting the culture and pace of the work environment for their organization. Utilizing real case studies, effective and poor leadership and management strategies will be analyzed. Leadership and management can have significant effects on all levels of an organization. These individuals have the authority to make decisions, lead teams, organize structure, and ultimately are responsible for producing successful outcomes. Without proper leadership, it makes it difficult for employees to discern if they are on the right track. When obstacles and challenges arise, The Challenge Model can be utilized to stay focused and move from vision to action to yield the desired results and goals. Particularly in public health, strong leadership & management is essential to guide projects and programs, and overall strengthen communities and health systems. Leadership and management skills can be taught through the use of workshops, seminars, and coaching methods.
Key Words: Leadership, Management, Development, Community-based Intervention
Cigarettes and Plain Packaging
Adapting Australian Tobacco Policy to a US Context
Cigarette smoking is the leading cause of preventable death in the United States (1). Each year, approximately 480,000 people in the US die from the effects of smoking, which accounts for about twenty percent of all US deaths (1). This mortality rate is higher than that in European countries, even though Europeans are more likely to smoke than Americans (2).
Due to the significance of smoking on US death rates, the Centers for Disease Control and Prevention (CDC) has identified the reduction of tobacco use as a public health priority (3). The federal government has supported countless anti-tobacco initiatives to combat this harm, with pronounced success: adult smoking rates have steadily declined from forty-two percent in 1965 to fifteen percent in 2015 (1,4). However, the US Department of Health and Human Services (HHS) continues to pursue smoking reduction strategies, with the goal of lowering smoking prevalence rates to twelve percent in adults and sixteen percent in youth by 2020 (5).
One of the strategies employed to combat harms from smoking is limiting tobacco-related marketing. Marketing tactics of tobacco manufacturers have been significantly correlated with smoking initiation; therefore, the limitation of cigarette advertising can potentially result in subsequent reductions in smoking (6). Many countries have implemented anti-marketing policies related to smoking, among which Australia has been particularly successful. Since the 1980s, Australia has experienced marked declines in smoking prevalence (7), in part due to their aggressive prohibitions on tobacco-related advertising (8). Australia has been hailed as a leader in anti-smoking policy making, especially because of their implementation of a unique “plain-packaging” regulation in 2012 (8). This legislation requires that all tobacco products be packaged in “plain dark brown packs, with 75% front-of-pack graphic health warnings and the brand name and variant limited to a standardized font size and type” (9). These guidelines prevent tobacco manufacturers from promoting their product through appealing packaging design, which has been correlated with purchaser decision-making (10).
Social and Economic Mobility
Global Trends and What Social Sector Leaders Can Do
Despite the increasing adoption of isolationist policies by developed countries, globalization remains an important engine for upward social and economic mobility. Despite evidence that social mobility has increased in some emerging countries, disparities in the distribution of resources that drive social mobility still exist, with poor and vulnerable households bearing the brunt. Geared towards social sector leaders, trends of social mobility in India, South Africa, Brazil and the United States are analyzed; and recommendations for how such leaders can increase mobility opportunities for the poor are made. By developing policies and programs aimed at the poor, such as digital inclusion programs, policies that create affordable housing options in urban areas, and increased access to higher education, social sector leaders can more equitably distribute resources while continuing to drive the rise of social mobility opportunities.
KEY WORDS Social mobility, economic mobility, inequality, social sector, development, poverty, poverty alleviation, digital inclusion, affordable housing, higher education, India, South Africa, Brazil, United States
Improving Health Through Household Water Treatment: An Intervention in Pommern, Tanzania
Waterborne diarrheal disease causes an estimated 4 billion cases and 1.9 deaths annually in children under 5 years, and a total of 19% of all deaths in developing countries4. In the rural Iringa region, home to the village of Pommern, childhood diarrheal prevalence is 15.4%, higher than the national average of 14.6%14. While improved water infrastructure to deliver clean, safe water to all is the ultimate goal, in the interim the village of Pommern needs a solution to affect reductions in waterborne illness. Household water treatment (HWT) allows for purification of water in the home before consumption and can reduce diarrheal illness by up to 45%24. Ultramembrane filtration is the most highly regarded method of HWT according to the WHO, and is extremely effective at eliminating harmful bacteria, viruses, and protozoa24. I have presented several strategic implementation plans of LifeStraw brand filtration systems in Pommern to provide every individual with clean, safe water to support improvements in health and reductions in disease.
Key Words: Tanzania, Water quality, Household water treatment, Safe water, Filtration,
An analysis of the gap between available healthcare services and deficiencies in care and treatment among patients with Chronic Kidney Disease in Chinandega and León, Nicaragua
Currently, there is an epidemic of Chronic Disease of unknown causes (CKDu) in the farming communities of Chinandega and León, Nicaragua. An increase in the incidence rate of CKDu over the past decade have resulted in increases in patient demand for specific services and treatment beyond what the government is able to sufficiently provide. El Ministerio de Salud (MINSA) in Nicaragua has responded by developing the Norma y Protocolo Para El Abordaje De La Enfermedad Renal Crónica, a medical provider protocol guideline for early detection, treatment and management of patients with CKD/u1 and by building sub-clinics that specializes in CKD/u in high impact areas. However, quality and access to care and treatment for CKD/u is compromised by a set of systemic issues arising from resource shortages, lack of programming and poor implementation of key initiatives by MINSA and sub agencies. This paper discusses systemic issues that undermine the quality of patient care, the economic impact of CKDu on Nicaragua’s healthcare system, medical resource shortages and patient barriers to care in areas most affected.
To address these issues, I suggest that MINSA create a CKDu Task Force that collaboratively provides recommendations to improve dissemination, training and provider education on the CKD protocol guideline and to address areas of unmet needs and service gaps that improve the quality of care and health outcomes among patients with CKD/u.
Examining the World Health Organization Policy of Declaration of a Public Health Emergency of International Concern
Public health events like large outbreaks of disease cannot always be contained within a nation and often pose a threat to global health. When such an event occurs, the WHO Director-General and an International Health Regulations (IHR) Emergency Committee can declare a Public Health Emergency of International Concern (PHEIC) to contain the potential spread. This paper examines the process of declaring a PHEIC and the time of declaration for different outbreaks. I compare the Ebola outbreak of 2014 with the current Zika outbreak and declaration of a PHEIC examining the impact of the speed of international decision-making and its impact on the severity of the outbreak. I identify both political and economic factors that help explain the two and a half month difference in time to the declaration of a PHEIC in these two outbreaks. Based on my review of these two events, I recommend that in order to reduce delay in declaration and increase global public health security in the future, the IHR be amended to include the need for external assistance as a primary condition and to interpret an international threat more liberally.
Key Words: Public Health Emergency of International Concern (PHEIC), World Health Organization (WHO), International Health Regulations (IHR), Ebola, Zika
Reducing Maternal Mortality in Nicaragua through Improving Quality of Emergency Obstetric Care Services
Over the past decade, Nicaragua has made significant progress in increasing the rates of facility-based delivery, with a current rate of approximately 88%. Despite this progress, the maternal mortality ratio remains high at 150 deaths per 100,000 live births.
Data from peer-reviewed articles was evaluated to assess the current status of Emergency Obstetric Care (EmOC) services in Nicaragua. These indicators were compared to the WorldHealth Organization’s standardized process indicator recommendations for the provision of EmOC. This analysis revealed that poor geographic coverage of facilities, particularly in the Caribbean region, is a likely constraint contributing to maternal mortality. Weak management of human resources, especially in regards to weekend hours and policies prohibiting nurses to practice basic EmOC, also negatively influence quality of EmOC services.
The following set of recommendations has been made for improving the provision of EmOC services in Nicaragua. First, the Nicaraguan Ministry of Health (MINSA) must take action by mapping all EmOC facilities in the country to determine where the discrepancies are. To address availability, EmOC facilities need to be established where appropriate. Second, MINSA should lift the ban preventing nurses from providing basic EmOC, provide financial incentives for employees in more-expensive regions, and establish policies and procedures to prevent facilities from being closed or understaffed on the weekends. Lastly, MINSA must work with the informal health system—the brigadistas and parteras—to alleviate any miscommunication and demonstrate support, as they are the backbone for promoting institutional deliveries.
It is vital that MINSA acts to address these inequalities in the provision of EmOC services, as these urgent quality issues are costing the lives of many women that could have otherwise been prevented.
Key Words: Basic Emergency Obstetric Care, Comprehensive Emergency Obstetric Care, maternal mortality, institutionalized delivery
Treatment of Neonatal Abstinence Syndrome in Massachusetts Hospitals
This policy brief discusses how opioid addiction affects pregnant women and their children who are subsequently born with a physical dependency to drugs, a condition referred to as neonatal abstinence syndrome (NAS). Through a literature review, current statistics and offerings for prevention and treatment programs for NAS were determined, with an in-depth evaluation on treatment options available in Massachusetts hospitals and resources available throughout the child’s development. Based on this review, prevention measures were highlighted as gaps in NAS programs and treatment in Massachusetts, and should be developed from best practices demonstrated in other states to effectively eliminate opioid abuse, and its far-reaching effects on children, in the state.
Key Words: Neonatal abstinence syndrome, intervention, women, babies, opioids, addiction, prevention, Massachusetts
Multiple Country Scale Up of Religious Leader Sensitivity Training on LGBT Human Rights
Fendall Award Winner for 2016
In recent years, the international community has made significant strides to ensure that the human rights of lesbian, gay, bisexual, and transgender (LGBT) persons are protected. One of the first major efforts occurred in 2006 with the development of the Yogyakarta Principles. This document was created by a panel of human rights experts that consisted of a past UN High Commissioner for Human Rights, UN Special Procedures, judges, treaty bodies, and several others (Yogyakarta Principles, 2006). These Principles provide a foundation that links international human rights laws to its application in sexual and gender identity (SOGI) issues. Examples of rights addressed in the Yogyakarta Principles include the following: Rights to Universal Enjoyment of Human Rights, Non-Discrimination and Recognition before the Law; Rights to Human and Personal Security; and Rights of Participation in Cultural and Family Life.
Another notable effort was seen by the United Nations Council of Human Rights’ adoption of two SOGI-related resolutions. The first, passed in July 2011, recognized the occurrence of human rights offences on the grounds of SOGI (Outright Action International, 2016). This resolution requested that the UN Commissioner for Human Rights conduct a study accounting for human rights violations throughout the world, and make a statement addressing the role of international human rights laws to reduce and eventually eliminate those violations (A/HRC/RES/17/19). The second resolution, passed in September 2014, made advocacy against SOGI-related discrimination and violence as a top priority (Human Rights Watch, 2014a). The request this time called for the UN Commissioner for Human Rights to update the study from the first resolution and to attach a viewpoint about best practices for overcoming violence and discrimination (A/HRC/RES/27/32). Overall, the adoption of these two resolutions demonstrates a gradual shift in governments’ perspectives of LGBT human rights (Carroll and Itaborahy, 2015).
Despite efforts from international entities, their member countries, and local advocacy groups, LGBT persons worldwide are still experiencing daily injustices and violations of their rights. This can be seen in the form of discrimination in a variety of settings such as places of employment, healthcare facilities, and educational establishments (OHCHR, 2012). Additionally, LGBT persons in some countries are subject to criminalization and even death solely on the basis of their sexual orientation and gender identity.
Palladium and PEMA Kenya have implemented a program for Sensitivity Training called Facing Our Fears. This paper considers potential next steps following the end of the project. One possible option is to further scale up the project by simultaneously implementing it in three Sub-Saharan African countries.
The purpose of this report is to envision and analyze elements of how this multiple country scale-up can occur. In order to address this, the following report will include:
a set of criteria for choosing countries to implement this program accompanied by a checklist that can be utilized during the initial needs assessment
a situation analysis describing the current status of LGBT human rights in the three countries where the scale-up could potentially occur
an analysis of relevant stakeholders that takes into account key players within the local and international community
a review of best practices for implementation and evaluation of scale-up designs
budgetary considerations for training and additional project needs
Chenzhe Cao and Jenna Bhaloo
Program Toolkit for Tomorrow's Youth Organization Using CommCare
The programs offered by Tomorrow’s Youth Organization (TYO), an American, non-governmental organization based in Nablus, Palestine are multifaceted and dynamic. TYO exists to promote a peaceful outlook and to promote critical, forward thinking among the next generation in the Middle
East “by enabling children, youth, and parents to realize their potential as healthy, active, and
responsible family and community members” (1).
The goal of this toolkit application is to allow staff members at TYO to streamline their registration and
assessment processes of their various programs. This toolkit application will allow TYO staff to
easily input and track individuals involved with various programs at TYO.
The backend of the mobile application is powered by Dimagi’s CommCare platform. Information that TYO staff members input is directly synced with CommCare’s servers using a reliable and stable Internet connection.
The mobile application includes case management, which allow TYO staff members to follow their beneficiaries longitudinally. Each beneficiary case includes demographic information (e.g., name, sex, birthdate) and information about the enrolled program, which the TYO staff member records during the registration process. Users will be able to use the application in both English and Arabic. More details about using the application are included in the Use Cases section of this report. The purpose of this User Manual is to serve as a guide for TYO staff members when using the Program Toolkit application.
This User Manual:
• Provides information on the benefits of CommCare as the platform for TYO’s Program Toolkit application;
• Presents details about how to create a CommCare account and how to get started with learning about the platform and using the application as a web-user or a mobile worker;
• Previews the interfaces used in the mobile application;
• Outlines details regarding each electronic form in the four modules of the application;
• Highlights user management tips and protocol for web users and mobile workers;
• Provides guidance on how to edit forms or modules, export from CommCare, or import new cases from other commonly used software such as Microsoft Excel.
Strengthening Health Human Resources in Albania
Background: Human resources in Albania’s health system fall victim to a vicious cycle of human resource management challenges. Poor staff distribution, underfunded employees, and a culture of informal payments have contributed to a decline in employee moral and subsequent quality of health services in Albania.
Methods: Application of the Human Resources for Health Action Framework (HAF) and support of thorough literature review provide a situational analysis of the current status of Albania’s health system to determine whether the existing challenges can be addressed by establishing a strong human resource management system.
Findings: Within Albania’s current health system exists many of the necessary components for a functioning health system, however, many lack managerial support contributing to decline in services and stalled program development. Human resource management systems play a central role in unifying the health system, which has the potential to improve health system efficiency of quality of services.
Conclusion: Governmental utilization of the Human Resources for Health Action Framework (HAF) may help to focus varying health sector agendas by strengthening the human resource management systems. Human resource systems may then act to synchronize health system development agendas and improve the working environment for employees so quality of health service delivery improves in Albania.
Key Words: Human Resources, Human Resource Management, Human Resources for Health Action Framework, Albania, Semashko Health System, Post-Communist Countries, Health System Development
Evaluation of a Multimedia Interactive Diabetes Education Tool for Low-Literacy Patients and Caretakers at the Boston Medical Center Pediatric Diabetes Clinic
Diabetes is the seventh leading cause of death in the United States, and unfortunately, about half of the adults in the US do not have the literacy and numeracy to adequately comprehend, and apply, the information found in most current medical educational materials. This policy brief presents and analyzes a new program from the Boston Medical Center Pediatric Diabetes Clinic that utilizes multimedia to create an interactive diabetes education program to accommodate low-literacy and low-numeracy patients and their caretakers.
This analysis examines the components and procedures of this educational model, compares it to similar successful initiatives elsewhere in the United States, and provides recommendations for the continued development and implementation of the program. Although, past studies have documented successful interventions to improve diabetes care in adults, currently there are no widely disseminated interactive tools for low-literacy pediatric patients and their caretakers. Patient feedback has been vital to the development of the program, and as prototypes improve, continued feedback can inform future development and lead to stakeholder satisfaction and acceptance.
This paper proposes, among other things, that the application should include a personalized interface with the capacity for patients to set and record goals to increase self-efficacy regarding their diabetes management. A positive evaluation of the efficacy of new education models will provide a vital step toward making these materials widely available.
Key Words: mHealth, low-literacy, diabetes, pediatric care, interactive education
Foods in Revere: A Policy Analysis
Over the past century the food system in United States’ has experienced a dramatic transformation that has vastly altered the way people encounter food on a daily basis. Diets now largely consist of highly processed, artificial, and imported products rather than locally sourced and naturally grown foods. Coinciding with these changes is the rise of obesity in both youth and adult populations. Medical data strongly correlate the obesity epidemic with an increase in morbidity and mortality from chronic disease.
Because an overwhelming majority of youth attend schools for a large part of their day, school feeding programs, such as the National School Lunch Program, provide an excellent opportunity for interventions that address the prevention of obesity at a young age. In this paper, I review the evolution of school feeding programs and their impact on obesity, identify challenges for programmatic change in school feeding programs, and make recommendations for a pilot program that introduces healthier, local produce to school menus in a manner that is acceptable to food service providers.
Ethiopia's Lessons from Maternal, Newborn and Child Health for Non-Communicable Diseases
Ethiopia has made great progress in improving the overall health of its population by improving maternal, newborn and child health (MNCH) . Ethiopia’s Health Extension Program (HEP), developed and implemented by the Ethiopian Ministry of Health (EMH), has provided a strong foundation for this success. As the epidemiologic transition takes place in Ethiopia, the EMH can expand the HEP program by integrating non-communicable disease (NCD) care into the predominantly MNCH services now provided by the program. This policy brief reviews the success of different components of the HEP with respect to MNCH in Ethiopia and discusses how to adapt these best practices to NCDs-related initiatives in Ethiopia.
Using an HRM Rapid Assessment Tool in Ragisthan, India
The Rapid Health Human Resource Management Tool was developed by Management Sciences for Health (MSH) to help users develop strategies to evaluate and improve their HRM system. Due to the demonstrated benefits of using the tool among other healthcare organizations of similar scale and scope, I recommend that BHS use the tool to systematically identify problems, gaps and solutions to its HRM processes. In this analysis I will explain the components of the tool, processes involved in using it, and provide examples of its successful utilization in healthcare management settings worldwide. I will then suggest ways to interpret the evaluation results and provide a brief outline to develop and implement an action plan. Analysis of the data provided in the evaluation will position BHS to build successful HRM system for its growing needs.
Death and Denial in the Tuberculosis Capital of the World:
How the Failed Advocacy Efforts of India's TB Program Helped Create the World's Largest National TB Epidemic
At this time, 60% of India’s population is infected with Tuberculosis with over 2 million people developing active disease each year. India suffers the highest TB death toll in the world: 450,000 people, mostly among women, children, HIV+ people, and the poor.
Yet, the Indian TB program (the RNTCP) first claimed that it had achieved its main goals for TB eradication in 2006, and that it now covers “100% of the eligible population” with TB treatment services. This contradiction is the issue that forms the focus of this critique. How can the worst national TB epidemic in the world continue on while the government states that they are successful in their treatment? I determine that the cause of this contradictory messaging is the RNTCPs over-focus on the DOTS treatment scheme, causing a failure to create a viable TB patient advocacy and outreach program (ACSM). Divestment from these ACSM programs has dire consequences for Indian TB patients, causing a cycle of disenfranchisement, low patient/stakeholder involvement in treatment decisions, and thus, poor government services.
This critique is written for any stakeholders that are interested in TB policy change in India. The document explores the reasons for this ACSM policy failure and how it can best be changed in order to better serve India's large TB population. I use the large collection of primary and secondary research I had collected at my practicum at the Harvard Med. Department of Global Health and Social Medicine, my work with activists in Delhi, and interviews from a MDR-TB conference held in Dubai to create a list of recommendations to the RNTCP to fix their ailing ACSM strategy.
My recommendations include ways to increase funding for ACSM and enact activities that organize and empower patients and stakeholders to change local and national TB policy. Examples are instituting community sensitization meetings where educational materials are disseminated and discussed, and district TB Forums where community members can voice their grievances directly to TB district managers.
If India is ever to reach Zero TB Deaths, the Indian Ministry of Health has to feel accountability to their people for their promises. This depends on good TB knowledge in the population, good TB dialogue between policymakers and stakeholders, and appropriate governance that makes the program able to adapt to local demands, all outcomes of a good ACSM program. Because the power to make many treatment decisions lies in the hands of the government, recommendations aimed to build an ACSM program will shift power from policymakers to TB affected communities and open a badly needed dialogue between the Ministry of Health and TB stakeholders.
Key Words: India, tuberculosis, DOTS, RNTCP, NTP, advocacy, communications, education, social mobilization, activism, private sector, funding, treatment, surveillance, diagnosis, revised national tuberculosis program
Re-strategizing Management & Financial Management of the Massachusetts Alliance on Teen Pregnancy, a Non-Profit Organization
The Massachusetts Alliance on Teen Pregnancy, commonly known as the Alliance, is a non-profit organization based in Boston. Like many other non-profit organizations, the Alliance depends on external sources of funding from donors and from contracts in order to carry it out its mission and goals . These external sources of funding often fluctuate from year to year. Financial fluctuations and uncertainties often require the Alliance modify its goals and restructure its management and staff. A great deal of the public health work is spearheaded by non-profit organizations. Non-profits, like the Alliance, suffer from donor dependence and the uncertainties of grand and contract funding cycles. In this policy brief I ask the question “how can non-profits become more financially and managerially stable so they can continue to fulfil their mission and goals. In the brief I will explore the key differences between non-profit organizations and for-profit organizations, identify best practices that can be applied to a non-profit environment, and make recommendations to the Alliance on how to incorporate these best practices from for-profit organizations to ease the burden of uncertain and cyclical funding that puts non-profit missions and goals at risk.
International Aid For Low-Income States Mandating Quarantine
The 2014 Ebola Virus (EV) outbreak in West Africa shed light on current policies regarding quarantine and isolation in African countries and the United States. This report discusses current measures used in response to EV exposure, and presents an analysis of (1) provisions that should be available to citizens during a mandatory government-imposed quarantine and (2) possible alternatives to mandated quarantine. Quarantine is an infection control method used across the world, and it is important to analyze its use in an era where organization like the World Health Organization can respond to emergencies across the globe. In areas with high rates of poverty, it is essential that their basic needs be considered and provided for when a government implements a mandatory quarantine.
Key Words: Quarantine, isolation, outbreak, international aid, humanitarian aid, Ebola
Improving Maternal and Neonatal Health in Balochistan by Implementing an Innovative Conditional Cash Transfer Program
According to the United Nations Population Fund (UNFPA), a woman dies every 20 minutes in Pakistan due to pregnancy and childbirth-related causes. Despite the many efforts that have taken place over the ten years, maternal death remains the leading cause of death of women aged 15-49 years. With a Maternal Mortality Ratio (MMR) for the country at 270/100,000 live births, Pakistan still has one of the highest MMRs in the South Asian region. Many maternal deaths take place in rural areas of Pakistan, where access to high quality health care, specifically family planning and reproductive health services, is extremely limited due to high costs and transportation issues. Cash transfer programs are a possible effective approach to lowering the MMR in Pakistan’s rural areas.
Broadening Reproductive Health Services at Women and Health Alliance International
In Guinea, access to abortion is restricted by law. The inaccessibility of safe abortion forces women wanting to terminate pregnancy to take desperate action. Often these women who seek unsafe abortion suffer from complications and many of them die. It is estimated that 13% of maternal deaths in the sub-Saharan region of Africa are due to abortion-related causes. Currently the most feasible strategies to prevent abortion-related mortality in Guinea would include prevention of unwanted pregnancy and treatment for incomplete abortion.
Women and Health International is currently providing essential obstetric fistula services in Guinea. In order to futher protect the lives of Guinean women, WAHA should incorporate postabortion care and family planning services into their organizational repertoire. Providing these necessary services for women will help to reduce abortion-related mortality in Guinea.
Methods for Reducing Adolescent Pregnancy in Sierra Leone
Sixteen million adolescent girls giving birth each years worldwide, with 95% of these births occurring in low and middle income countries. Adolescent pregnancies carry a greater risk of maternal mortality and other birth complications, as well as for low-birth weight newborns and poorer child health outcomes. In Sierra Leone, 40% of maternal deaths occur in adolescents.
Methods: A literature review was conducted to identify the major determinants of adolescent pregnancy in Sierra Leone. A subsequent literature review of the best practices with which to combat these root causes was then performed.
Findings: The literature review found these major drivers to include poverty and lack of education, low contraceptive use among adolescents, and prevailing gender norms that perpetuate a culture of violence towards women. Multiple strategies to reduce adolescent pregnancy, including programs to keep adolescent girls in school, increase contraceptive use, and reduce violence against women, are explored.
Conclusions: Ultimately, this policy brief seeks to inform Save the Children programming on how to effectively reduce adolescent pregnancy in Sierra Leone. It is recommended that Sierra Leone utilize a Conditional Cash Transfer program, educational contraceptive workshops involving parents, and social media marketing campaigns targeting boys and young men.
Meeting the Unmet Need:
Increasing Access to Contraception
through Community Health Volunteers in Liberia
Liberia has one of the highest maternal mortality rates in the world due to a lack of access to health services and an unmet need for contraception. In an effort to improve maternal and reproductive health, Liberia has begun to utilize a Community Health Volunteer (CHV) program to provide health services, including family planning, to rural populations. While some family planning methods such as pills and condoms are distributed country-wide through CHVs, injectable depot medroxyprogesterone acetate (DMPA), the country’s most popular family planning method, is currently provided by only 17% of Community Health Volunteers. This policy explores the possibility of scaling up the DMPA training to all Community Health Volunteers and elucidates the positive impact DMPA provision could have on rural women’s health.
Social media & public health:
Leveraging new media communication tools in the 21st century
Option Three Special Project
This 2-credit course is designed to give public health students an overview of the social and new media landscape. Students will learn about various popular social media platforms, engage and interact in online communities, and learn best practices to utilize these new media in public health. Other topics include theory to support the use of social media, examples from the field, monitoring and metrics for evaluation, and planning.
Looking Beyond Government and Gates
Analysis of an Alternatively Funded Program
The rise of global health funding at the turn of the century also marks the current domination in funding pathways by a few key players, including USAID and the Gates Foundation. Their susceptibility in funding stability was clearly marked following the global recession in 2008 (Gates saw nearly a 40 percent decline in international giving following the recession), and questions regarding the effectiveness and efficiency of their work have been raised. With these questions in mind, I have looked carefully at Casa Guatemala, a Guatemalan orphanage and boarding school funded independent of both grants and government, to analyze the quality of their program in light of their funding sources. They simultaneously run a full service hotel and restaurant to fund their program, and while they do have shortcoming similar to those seen in traditionally funding programs, I project if they were to add on a staff member to streamline their work plan and direction of the organization, Casa Guatemala could become an efficient and effective alternatively funded program.
The Feasibility of a Sustainable Cardiac Surgery Program in Rwanda
Rheumatic heart disease (RHD) is one of the largest preventable burdens for people in the developing world. Very little global money is committed to RHD and it is very difficult for a developing country to create a cardiac surgery program, the only treatment for advanced RHD. Rwanda has been working for many years with Team Heart and other Partner organizations to perform cardiac surgery on a temporary and intermittent basis while working to create a sustainable surgery program. However, there are many obstacles to developing and sustaining such a program. Besides the financing and budgeting issues that most countries struggle with to develop a sustainable cardiac surgery program the Rwandan government must 1) retain local cardiac surgeons and prevent staff turnover of specialized personnel 2) establish an effective and consistent supply chain management system, 3) provide cardiac surgery at a cost affordable to the Rwandan people, and 4) continue to be supported by Team Heart and the other Partners. Primary prevention through diagnosis and antibiotic prophylaxis must be strengthened, surveillance data must be improved to understand the scope of RHD and post operative care and drug accessibility must be enhanced for patients. This paper discusses all of these issues and presents a plan to address the problems. If implemented, Rwanda can develop and sustain a cardiac surgery program.
Key Words: rheumatic heart disease, acute rheumatic fever, cardiac surgery, sustainability
The Role of Contractual Health Care Delivery in Post-Conflict Health System Development: Transferrable Lessons from Afghanistan
Afghanistan has emerged as a model for health system development for post-conflict, underdeveloped, and deeply poor nations. As a part of the post-Taliban reconstruction plan, the Joint Donor Mission established a contracting-out policy that encourages domestic and international NGOs to deliver a preset Basic Package of Health Services to efficiently and equitably distribute care and resources. The success of the contracting policy has not only improved population health, but has also allowed the Afghan Ministry of Public Health to strengthen its own technical and managerial capacity. This successful contracting model lies upon three unique caveats that act as takeaway lessons for other emerging and post-conflict nations: (1) building a monitoring and evaluation plan into the model, (2) maintaining the Ministry’s role as the ultimate authority while still engaging them through the creation of an education model to increase their capacity, and (3) building basic healthcare packages to be delivered nationwide, aimed at alleviating the most pressing and common healthcare needs. Future missions are encouraged to examine and adapt the model for possible implementation in other poor, underdeveloped, or post-conflict nations.
Key Words: Health Systems, Development, Contracting, Afghanistan, Basic Package of Health Services, Post-Conflict, Emerging, Joint Donor Mission, Ministry of Public Health, Strengthening Mechanism, Monitoring and Evaluation, Scorecard
Although Ethiopia has made significant progress in reducing maternal mortality since the early 1990’s, it still has one of the highest Maternal Mortality Ratios (MMR) in the world with 676 deaths per 100,000 live births. Postpartum Hemorrhage (PPH) is one of the leading causes of maternal mortality in the country. With less than 10% of all births attended by skilled health personnel the majority of women are without access to timely prevention and treatment of pregnancy and birth complications. The Federal Ministry of Health of Ethiopia has developed the Health Extension Program (HEP) as part of its Health Sector Development Program, to provide community based primary health services in rural regions with a primary focus on maternal and reproductive health services. Part of the maternal health intervention package is the community-based administration of misoprostol for the prevention of PPH through active management of third stage labor.
This policy memorandum reviews the progresses and challenges of the policy implementation, to make evidence-based recommendations that would yield better maternal health outcomes.
Health Extension Workers (HEWs) do not prioritize delivery services and administration of misoprostol as detailed in the maternal health package. They are least confident in providing safe delivery services compared to other activities within the sixteen intervention packages. There is a dire need to train HEWs to improve implementation of existing policy to effectively prevent PPH and improve maternal health.
The FMoH of Ethiopia will greatly benefit from restructuring the HEP to be more inclusive of hands-on skills regarding safe delivery and misoprostol use. In addition, misoprostol usage data among the different regions should be used to monitor programs and strengthen supervision. Finally, although Ethiopia will likely not achieve MDG5 by 2015, efforts to improve maternal health should be strengthened nationwide through a concerted effort among providers in different levels of the health sector development.
Key Words: Ethiopia, Maternal Health, Maternal Mortality, Misoprostol, Postpartum Hemorrhage
Recommendations for Implementing Sustainable Behavior Change Activities into Uganda Village Project’s Water, Sanitation and Hygiene Program
The Uganda Village Project (UVP) implements a comprehensive set of public health programs in rural villages of Uganda’s most impoverished sub-counties. Many of their projects focus on access to physical hardware such as bed nets and construction of latrines. This report presents my analysis of the Water, Sanitation and Hygiene (WASH) program being implemented by UVP.
Based on conversations with UVP Executive Staff, analysis of WASH data from previous Healthy Villages, thorough literature review, and my own experience working as a summer intern for the organization in 2013, I have compiled a series of ten recommendations that UVP can use to integrate behavior change communications activities into their WASH program.
The UVP WASH program lacks activities geared towards sustainable behavior change. I have grouped my recommendations into two broad categories: improved training methods and changes to the structure of the summer internship program. A third category of general recommendations is provided to aid in any changes made to programmatic WASH activities which will maximize the benefits of implementing these recommendations.
Key Words: Safe Water, Sanitation, Hygiene, Community-Led Total Sanitation, Behavior Change
Scaling-Up Nutrition in the DRC:
Policy changes to improve childhood malnutrition
Worldwide malnutrition can be linked to 45% of childhood deaths, making it an issue that has drawn global attention. Being one of the top five contributing countries to this burden and having the highest malnutrition levels in sub-Saharan Africa, the Democratic Republic of the Congo (DRC) has signed an agreement to work on scaling-up nutrition. Through analysis of the current management of the DRC's health system, key policy stakeholders, and relevant interventions already being done within the country, this policy brief seeks to provide recommendations to the Ministry of Health in the DRC on scaling-up nutrition. Recommendations fall into three broad categories: (1) managing nutrition programs, (2) influencing policy decisions, and (3) planning and implementing relevant interventions in the national nutrition program. By taking into consideration these recommendations, the Ministry of Health can begin scaling-up nutritional efforts in the country thereby improving the health of the DRC's children.
Key Words: Malnutrition, Democratic Republic of the Congo, policy, scale-up
Delphine M. Kwankam
Sustainability Framework of Community Health Worker Programs:
An Example of Medicines for Humanity CHW Program in Cameroon
In the last decade since the institution of the Millennium Development Goals (MDG) for health, there has been a better appreciation of the role of Community Health Worker Programs in strengthening health systems in developing countries. Despite this movement towards a community focused primary health care, CHW programs in Cameroon are few and far between. The goal of this paper is to propose a template for sustainable CHW programs in Cameroon. To accomplish this goal, I develop a CHW sustainability framework which consists of two major pillars; organization and resources and technology. Organization is the set of policies and procedures necessary to implement a sustainable CHW program while resources and technology are the tools that facilitate and enhance program implementation. Organization consists of two components; community engagement and good program management. Resources and technology constitutes funding and the use of mobile technology. I analyze the sustainability framework against the current CHW program in Cameroon. Finally, I propose five recommendations that if implemented will contribute towards a sustainable CHW program in Cameroon. The recommendations focus on better community engagement, integration of CHWs into the health system, the use of mobile technology for service delivery and referrals, competence based training and institution continuing education opportunities for CHWs.
Key Words: Sustainability, Community Health Workers, Cameroon, community engagement, funding, good program management, mobile technology
mHealth: Moving Beyond Pilotitis for Sustained Effect via Increased Evaluation
The burgeoning field of mobile health (mHealth) has yet to establish a solid foundation of evidence to support its efficacy. The majority of existing evidence is anecdotal and disparate in nature, leaving a void in terms of actionable epidemiological evidence. Research is needed to assess when, where, and for whom mHealth devices, apps, and systems are advantageous.
A review of currently available literature was conducted. Materials for review were found through performing searches within the MEDLINE, PsychINFO, Global Health, Web of Science, mHealth Evidence and Cochrane libraries. Evidence, supporting and primary, was also found via conducting web searches. While mHealth initiatives have been deployed within the domestic sphere, articles and papers focused on programs implemented within foreign countries were the primary focus.
While the number of published, epidemiological sound articles on mHealth remains quite small, it is growing. Such growth is essential as donor excitement for the field begins to wane in the face of scarce evidence.
Keywords: mHealth, eHealth, Monitoring and Evaluation, Epidemiology
Recommendations for Improvement of Patient Retention in the Government-Sponsored PMTCT Program in Delhi, India
Despite the success of India’s government-sponsored prevention of mother-to-child transmission (PMTCT) program, the issue of mother-to-child (MTCT) transmission of HIV in the country remains significant. This paper will present recommendations to improve the effectiveness of the PMTCT program in Delhi, India, which is overseen by the Delhi State AIDS Control Society (DSACS). A review of the program combined with personal observations from my research conducted with Manju Manak, former Chief Operating Officer at Women’s Action Group CHELSEA, reveal numerous barriers to retaining women in the PMTCT program. These barriers include loss-to-follow-up, lack of knowledge about the PMTCT program, gender discrimination and economic hardship. This paper proposes that DSACS ease the current barriers to patient retention by retraining its outreach workers to better educate women about PMTCT services as well as by adopting loss aversion and incentive strategies. Improvements in patient retention will provide DSACS with the opportunity to further reduce MTCT rates and the burden of pediatric HIV infections in Delhi.
Key Words: HIV/AIDS, India, PMTCT, Early Infant Diagnosis, Antiretroviral Treatment
Medical Mission Data Collection Application Using Mobile Technology
In May 2013, Wide Horizons for Children was presented with the opportunity to digitize data collected during their medical missions trips. In order to do so, three students were tasked with creating a mobile health application that could be used in the field to collect data quickly and efficiently. Using the organization’s existing forms, we built a comprehensive application capable of capturing data from the point of patient intake through to patient discharge. The application is coded to distinguish surgical patients from other patients, with a specific focus on patients’ demographic information. Additionally, we were asked to create a separate application to aid in data collection for a misoprostol program started by the same organization. The primary focus of the project, however, was the medical missions application.
Using the CommCare platform, we created a user-friendly mHealth application to capture data on all patients seen during the weeklong medical mission trips conducted by Wide Horizons for Children in two sites in Ethiopia.
We organized and digitized each of five existing forms into two applications: one for medical mission trips and one for a misoprostol program.
We created training materials on how to use the application and how to retrieve data from the CommCare database. Finally, we Beta tested the application in the field during two separate medical mission trips for functionality.
After months of development, the medical missions application was successfully deployed in Leku, Ethiopia and Adwa, Ethiopia in November 2013. Primary data was collected to judge the functionality of the application and determine if any changes need to be made to improve efficacy. The application is still in development, and we are currently working on bettering the application based on feedback from the recent medical mission trips.
The application can be accessed here: www.commcarehq.org.
Please sign-in using the following information:
The Importance of Cultural Targeting:
An Argument for Race Representation in Helath and Education Materials
Cultural targeting—the creation and/or adaptation of interventions, messages, and education materials to suit the specific characteristics and needs of a cultural community or subpopulation—is becoming increasingly important in the field of public health. Although strides are being made in increasing the cultural targeting of various forms of health messages, anecdotal evidence suggests that culturally appropriate medical and health education images and graphics are still lacking, particularly where instructive anatomical diagrams and pictures are concerned. Because most diagrams and images feature subjects with pale or white skin, patients with darker skin are unlikely to find representation. This compromises efforts to target communities of color with culturally appropriate health messages and education resources, in the increasingly diverse United States and in countries with majority non-white populations.
This paper includes a review of the existing literature on cultural targeting, and an ethnography to determine the availability of racially diverse health imagery.
Improving Access to Contraception in Rural Uganda
Using Community-Based Distribution
In Uganda, each woman gives birth to 6.2 children throughout her reproductive years on average, resulting in a national growth rate of 3.2%, the fifth fastest in the world. Demographic and Health Survey data show however, that 34% of women desire to space or limit their children but do not.
This policy brief reviews recent literature on fertility and contraceptive indicators in Uganda to determine if and where family planning programmatic efforts are most needed. Barriers to access are also reviewed with consideration given to individual and organizational level difficulties. Additionally, literature on successful community-based distribution programs in developing countries is reviewed.
Unmet contraception need is most ubiquitous in rural areas where populations of economically disadvantaged women are greatest. Community-based distribution programs have shown to increase the contraception prevalence rate while reducing fertility in other developing countries. Pilot studies conducted in Uganda also found that community-based distribution of contraception including an injectable, was both safe and effective when administered by a community health worker.
A community-based contraception distribution program in Uganda is a financially and programmatically feasible solution to address Uganda’s high unmet contraception need. To implement a successful program, the Ministry of Health will need to educate stakeholders and strengthen political commitment, utilize existing policies and earmark funds for district programs, collaborate with partners to design and implement a CBD program and strengthen Village Health Teams throughout the country.
Key Words: community-based distribution, family planning, contraception, reproductive health, community health workers, medroxprogesterone acetate, injectable, DMPA
A Literature Review Exploring Advocacy and Mobile Technology
This literature review was performed at the request at Pathfinder International (Pathfinder) to inform their future work in advocacy and mobile technology (mAdvocacy). The paper focuses on forms of advocacy that enable patient feedback and improve quality of care. The process of the literature review revealed that advocacy can be classified into three main categories: 1.) supporting quality of care in institutions; 2.) supporting patients’ use of information to improve self-advocacy; and 3.) encouraging participation in the monitoring of institutions. The results of the literature review indicate there is little use of mobile technology to present opportunities to patients to provide feedback to their healthcare providers. As such, Pathfinder has the opportunity to apply mAdvocacy uniquely to improve patient feedback and quality of care.
Key Words: advocacy, mobile technology, mHealth, self-advocacy, Pathfinder International
Reducing Delays in the Decision to Seek Delivery Care in Women Attending Antenatal Care at Maison de Naissance
Delay in care seeking behavior is a significant problem effecting women utilizing prenatal services at Maison de Naissance regardless of their ultimate delivery location. Delays in seeking health care have negative impacts on maternal and infant delivery outcomes. Lack of knowledge of the signs and symptoms of labor is the primary reason for this delay. Increasing maternal knowledge, encouraging partner support, and strengthening patient-provider communication are feasible straight forward, low-cost initiatives to enhance Maison de Naissance existing services.
Approaching the Millennium Development Goals:
Recommendations for Maternal Mortality Interventions in Morocco
A signatory of the Millennium Development Goals (MDGs), Morocco is one of 18 countries expected to achieve MDG 5 by 2015. The maternal mortality rate (MMR) estimated at 100 deaths per 100,000 live births in 2012 has declined sixty-percent since 1990. To ensure that Morocco achieves and surpasses MDG 5 by 2015, the Ministry of Health should intensify efforts to lower maternal mortality among the rural poor by providing quality emergency obstetric care (EmOC). The Ministry of Health should prioritize EmOC efforts in three main areas: 1. increasing the number of skilled professionals, 2. increasing EmOC technology available in health facilities, 3. strengthening monitoring and evaluation of maternal health programs.
Fundamentals of Developing a Basic Health Package (BHP)
This brief provides an introduction to the fundamentals of developing a Basic Health Package (BHP) as a health system strengthening mechanism in low resource settings. The BHP approach focuses on prioritizing health conditions, treatment methods and vulnerable populations.
A real-life case study of El Salvador, a PAHO member country in transition, provides an example of a country that has recognized the need to improve and strengthen its health system. In the brief using applicable demographic, epidemiologic, economic and social indicators, the author will show how El Salvador could develop and use a BHP to improve its health care system as it adjusts to current transitional conditions.
Check out Alexandra's Brief AHulme CE.docx
Preventing Intentional Interpersonal Violence in Jamaica
How can the medical fraternity in Jamaica go beyond its current responsibilities that are, by in large reactive, technical interventions to develop and implement an informed, preventive, proactive, empowered, comprehensive, collaborative and evidence-based program that transforms the community’s dismal epidemiologic Intentional Interpersonal Violence (IIPV) statistics to comparative world levels? This policy analysis will describe the current situation with regard to IIPV in Jamaica and make recommendations to the Medical Association of Jamaica (MAJ) to reduce IIPV and its impact on physicians and other health care providers.
View Sonia's CE IHCE finally2.docx
Rapid Disagnostic Testing for to Improve Maternal and Child Health Outcomes
There are many disorders in pregnancy that can affect both maternal and newborn health, and when detected early can be treated or monitored for greatly improved outcomes. In many places access to tests for these disorders is very limited or not available to much of the population, and the disorders are simply not detected early enough to make the necessary treatment changes, or not detected at all until problems with delivery or maternal or newborn health occur. Diagnostics For All (DFA) is a company that is developing inexpensive and reliable paper-based tests for some of these disorders. This policy brief will discuss the merits of greatly increasing access to such rapid diagnostic testing. The paper will present some options and strategies for the best target uses of this newer paper-based technology still in developmental phases.
View Lia's Policy Brief CE policy brief final.docx
Video Documentary on ASHA Urban CHW's
Using Asha Community Health and Development Society as a model, this short documentary explores how Community Health Workers (CHWs) can be used to provide pregnant women living in urban slums with essential maternal health care and encourage them to give birth in safe settings with skilled care. CHWs and pregnant women from urban slums across Delhi provide their voices and perspectives on maternal health care in their communities. With footage and photos taken in multiple urban slums in Delhi, this documentary provides a glimpse into the way organizations can work with limited resources to improve the health and lives of urban poor women.
Engaging the Government of the Islamic Republic of Afghanistan to Address the Maternal and Newborn Care Needs of Urban Internally Displaced Persons
Since the surge of U.S. troops began entering Afghanistan in December 2009, political instability and conflict-related displacement of civilians has increased dramatically. Many of the civilians that have relocated within Afghanistan due to conflict, referred to as internally displaced persons, have moved to urban areas for relative safety. This vulnerable population has yet to be included in policies and interventions to address maternal and newborn care, likely due to their informal status, limited resources, and conflicting policies regarding the treatment of internally displaced persons. As the high rates of maternal and infant mortality in Afghanistan are well documented, the need for services that address these issues is clear.
This analysis offers recommendations for the role Management Sciences for Health can play in supporting the official policies of the government of Afghanistan to improve maternal and newborn care for internally displaced persons in urban settings.
Practical Methods of Improving Access to Safe Drinking Water in Ghana
Vestergaard Frandsen (VF) is a for-profit company that invests in technologies to mitigate waterborne disease. Their latest product, a household water filter, was created to improve the quality of water before consumption; but a lack of interest and financial support from donors and government in water quality interventions has made distribution of VF’s product challenging. VF therefore commissioned three Boston University (BU) students to research and to analyze the current benefits of household water treatment and safe storage (HWTS) and create a presentation aimed at increasing donor and government interest.
As a consultant, I spent two months at the VF office in Accra, Ghana, working as a team with two other BU students conducting research on the health impacts of HWTS. The research entailed gathering secondary source data on health outcomes and cost effectiveness of water quality interventions from NGOs and government agencies in Accra, as well as performing our own qualitative interviews to assess the importance of safe drinking water to Ghanaian people.
Our research revealed that HWTS is a low cost, effective, accessible, and culturally acceptable solution to improve drinking water and prevent diarrheal disease. It is proven more effective than source water treatment and even sanitation. These results were compiled into two formal presentations, one for donors and another for the government of Ghana that could be used as an advocacy tool by VF in the future.
Key Words: Health promotion, water purification system, infectious disease
Are Migrant Workers sufficiently covered under HIV/AIDS programming in India?
In India, increasing awareness of the HIV prevalence in the population has led to growing recognition of migrant workers as an important target population for HIV/AIDS prevention, care and treatment services. The prevalence of HIV amongst migrants is 3.61%, the highest in any group, after the High Risk Groups of FSW, MSM and IDUs and twelve times higher than that of general population. This is related to migrant worker’s increased risk behavior patterns while residing away from home, placing them at higher risk for contracting HIV. When they return home they become a source of HIV transmission, fueling the epidemic in low prevalence areas. Currently, the majority of programming in India has been focused on destination areas such as larger industrial cities and urban centers where migrants travel for employment. This does not prevent transmission at the source, where spouses and local sex networks are at heightened risk. The aim of this brief is to unveil the rising threat that migration has placed on the health of the source communities, identifying the major gaps in coverage and providing possible solutions for successful HIV programming in source areas.
Migration, HIV, Informal Workers, Source, Destination, Female Sex Workers, Extramarital sex, Community systems, ICTC, ANC, HIV treatment, NACO, India, NACP III.
El Shady Bekele
Breastfeeding and the Latina Community- Past Interventions and a Current Proposed Study
At one of the community health centers where the Midwifes at Mount Auburn Hospital practice, they have started a program to increase the amount of exclusive breastfeeding among Latino mothers. There are two phases to this project; the first consists of having new mothers complete surveys on their breastfeeding habits and their opinions of breastfeeding versus formula feeding their babies. The second phase involves randomizing mothers during their last trimester into either a breastfeeding peer support group or a control group which receives standard breastfeeding education. The hypothesis is that there will be a 30% increase in the rate of exclusive breast feeding among the women in the support group. At this point the project is still in the first phase of the project. Surveys have been collected from 5 women. I will summarize the data that has been collect so far and write a summary of the data to gain a better understanding of the baseline for the Latina mothers in this community. The purpose of writing this brief is to summarize the information from the surveys conducted so far and to determine how to proceed in the future with the project.
Key Words: Breastfeeding, peer support group, Latina, Centering Pregnancy
Policy Recommendations to Circle of Health International in Haiti
Circle of Health International (COHI) became operational in Fond Parisien, Haiti immediately after the January 2010 earthquake. COHI’s response to the disaster has led to the development of the only clinic consistently providing women’s health services in South East Haiti, an area experiencing the economic and migration effects of the earthquake, but largely under the radar of relief organizations flooding into the country.
Although COHI’s efforts have led to a number of meaningful results to date, including safely delivering 197 infants, referring and transporting 18 deliveries for emergency obstetric care, and providing over 1000 prenatal visits, there are several program areas in which current policies do not align with the expressed needs of the community. As the sole continuous source of reproductive health services in the area, COHI must take every step possible to maximize the reach of their efforts. Like many facilities, the Obstetric Clinic staffed and supported by COHI lacks adequate resources to meet immediate needs. Since additional funds from other sources are unlikely to materialize, COHI must appropriately allocate and manage existing resources to best meet the expressed needs of women in the community.
Based on an analysis of COHI’s existing reproductive health service programming in Fond Parisien, I recommend that COHI increase interaction between Obstetric Clinic staff and community members, emphasize family planning services, and integrate Obstetric Clinic management and supply with the existing Christ Pour Tous system to ensure that resources are being invested wisely and women’s health programming continues beyond COHI’s involvement. By adopting the following recommended shifts in program emphasis, COHI could increase the number of women and families in this region reached by their existing women’s health programming. Implementing community outreach activities, re-prioritizing clinic service availability to include family planning, and establishing a reliable pharmaceutical supply chain could increase the number of women and families benefiting from by COHI’s on-going efforts. In order to ensure the women living in this area continue to have access to high quality care after its direct support of the clinic concludes, COHI should also initiate the process of transitioning supply and operational management system of the Obstetric Clinic to the existing Christ Pour Tous management through with the Obstetric Clinic operates.
Improving the Performance of Nurses in Upper Egypt using the Client-Provider Communication (CPC) Rating Form
Management Sciences for Health (MSH), a not-for-profit non-governmental international health organization, is implementing a USAID funded project: Improving the Performance of Nurses (IPN) in Upper Egypt. The goal of the project is to improve the quality of health care delivered in hospitals in rural Egypt. The LDP empowers nurses to improve the quality and accessibility of health services in three areas: infection control, basic nursing care and client-provider communication (CPC).
From September thru December 2010, I conducted my field practicum on the IPN Project in Aswan, Egypt. In collaboration with the MSH Monitoring and Evaluation (M&E) Advisor, I conducted research on techniques to improve treatment adherence and health outcomes and reviewed their Patient Satisfaction Survey (PSS) as a tool to measure CPC in hospitals in Upper Egypt. In spite of the fact that CPC is critical to quality improvement, in our review we found that only a small fraction of IPN nurses’ quality improvement projects focused on CPC as compared to infection control and basic nursing care.
Because high quality interpersonal communication skills are known to improve treatment adherence and health outcomes, CPC is a competency of equal importance to clinical skills and medical knowledge. Having a tool to accurately measure CPC provides a mechanism for nursing staff to identify areas for improvement in this focus area.
Our conclusion was that the PSS was an insufficient proxy measure of CPC. Consequently, we decided to develop a better instrument for measuring CPC. This paper analyzes existing assessment tools for measuring CPC, selects appropriate and useful elements from them, describes a new tool to assess CPC based on pilot testing, and recommends ongoing use of this new tool in the LDP quality improvement program.
Key Words: client provider communication, interpersonal communication, nurses, Egypt, quality improvement, patient centered care
Proposal for a Home-Based Care Program at St. Paul’s Health Center
HIV/AIDS is an issue throughout Kenya, but the rates in the Nyanza province are well above the country average. The barriers to accessing and continuing care exacerbate this high rate of infection. Patients commonly default on appointments and lose access to live-saving medicines. Common Hope for Health has recognized this problem and proposes a home-based care (HBC) program to be run out of St. Paul’s Health Center (SPHC), nestled in the heart of the Nyanza province.
The HBC program goal is to reduce the number of patients who default on appointments and improve the health outcomes of these individuals. To do so, the program’s main objective is to achieve an 85 percent reduction in patients who have defaulted on their appointments by the end of year 5.
Reaching these patients in their homes gives them the best opportunity to improve their health and reengage with SPHC. Successful patients from SPHC will be hired as home-based care workers (HBCW). The 4-6 month intervention will carried out by HBCWs in the homes of clients. The main areas of focus include the provision of necessary medications, education, and counseling.
Funding proposal, HIV/AIDS, home-based care, appointment defaulting, community engagement, CHW, health clinic, Kenya, rural, ART, adherence, health education
An Introduction of a Program to Include Men in Family Planning and Reproductive Health Services and Decisions in Cambodia for Chan Theary, Director of Reproductive and Child Health Alliance
To the Director of RACHA, I am proposing a program to be implemented in Mondol Kiri province. According to the 2005 DHS in Cambodia, Mondol Kiri has the lowest rates of married couples ever using contraceptives at 21%.11 This program will be called Involving Males in Reproductive Health Practices (MIRHP). MIRHP will be a five-year project, and will be designed based on the evidence from previous Male Involvement projects and activities. The activities will consist of a mass media campaign to reach men, and a home-based education for married men aged 18-55.
Increasing Access to Life-saving HIV Medications in Zimbabwe
Despite a decreasing trend in the past 10 years, HIV prevalence in Zimbabwe remains one of the highest in the world. The government of Zimbabwe provides first-line antiretroviral (ARV) therapy free-of-charge to patients with a CD4 cell count below 150/mm3. However, many patients in Zimbabwe cannot access these medications continuously because they cannot afford the monthly costs of obtaining the ARV’s: bus fare to the disbursing clinic and the consultation fee required to pick up the medications. This policy brief suggests three new policies that could increase access and adherence to ARV’s, thereby reducing HIV prevalence in Zimbabwe: subsidize bus fares to government clinics for HIV patients; waive the consultation fee for HIV patients obtaining their monthly medications; and eventually distribute 3 months’ supplies of ARV’s to patients at one time. These policies would reduce the costs to patients of obtaining their ARV, which would increase their continuous adherence to the life-saving medications. Key Words: Antiretrovirals, medication access, financial barriers, Zimbabwe