Global Health: Science and Practice最新文献

{"title":"The Cost and Intermediate Cost-Effectiveness of a Randomized Control Trial Delivering U=U Messaging to Increase HIV Testing Among South African Men.","authors":"P J Smith, D Joseph Davey, L Schmucker, L-G Bekker, A Medina-Marino, H Thirumurthy, A M Buttenheim, G Meyer-Rath","doi":"10.9745/GHSP-D-24-00143","DOIUrl":"10.9745/GHSP-D-24-00143","url":null,"abstract":"<p><strong>Background: </strong>South African men have lower HIV testing uptake than their female counterparts, leading to lower antiretroviral treatment (ART) uptake and higher HIV-related mortality. A recent cluster-randomized trial in a high HIV prevalence area in Cape Town showed that relaying the \"undetectable equals untransmittable\" (U=U) message to South African men increased their HIV testing uptake compared to issuing standard testing invitations. We conducted an economic analysis based on this trial to inform decision-making regarding implementing U=U messaging in routine public-sector HIV care.</p><p><strong>Methods: </strong>We analyzed the mean cost of the U=U intervention and its intermediate cost-effectiveness over the control arm. Costs were estimated from trial expenditure data in 2020 South African rand (ZAR), converted using March 2020 US$ exchange rates. Shared trial costs were allocated to each arm based on participant volume or days of operation; capital costs, including the creation of the U=U message via human-centered design workshops, were annualized over 8 years. In a second scenario, trial cost was adjusted for potential implementation in routine care.</p><p><strong>Results: </strong>Peer promoters delivered 504 U=U invitations to test for HIV over 7 intervention days and 544 standard invitations over 5 control days in March 2020. Compared with standard invitations, men who received U=U messaging had 60% increased odds of getting tested for HIV. The average trial cost was $5.40 per U=U message delivered ($2.35 after adjustment for routine implementation), $388.47 per person testing HIV-positive ($168.99 adjusted), and $906.44 per person initiating ART ($394.31 adjusted). Within trial costs, staff, overhead, and research costs were the largest allocations, with each accounting for 20% to 30% of total costs. After routine implementation adjustment, the costs of message creation via human-centered design workshops, personnel (peer promoters, research staff), and supplies were the largest allocations. Cost of U=U messaging per person confirmed HIV-positive and initiating ART was lower than conventional HIV testing messaging and at the lower end of cost ranges of HIV self-test distribution models targeted at men ($62 to $7,936 per person confirmed positive and $117 to $8,198 per person initiating ART) established in previous work.</p><p><strong>Conclusion: </strong>Delivering tailored U=U messaging can increase HIV testing and ART uptake among men while saving costs over standard untargeted HIV testing messaging and other HIV self-test distribution models.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":"14 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and Patterns in Wealth Index Assets: Observations From 68 Countries.","authors":"Andrew Corley, Claire Dunn, Yuen Wai Hung, Andrea Sprockett, Dominic Montagu, Nirali Chakraborty","doi":"10.9745/GHSP-D-24-00132","DOIUrl":"10.9745/GHSP-D-24-00132","url":null,"abstract":"","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring a Road Map to Achieving Tobacco Endgame in sub-Saharan Africa: A Qualitative Study Among Stakeholders From 12 Countries.","authors":"Catherine O Egbe, Senamile P Ngobese, Arshima Khan, Siphesihle Gwambe, Zinhle P Ngcobo, Stella A Bialous","doi":"10.9745/GHSP-D-24-00351","DOIUrl":"10.9745/GHSP-D-24-00351","url":null,"abstract":"<p><strong>Introduction: </strong>Tobacco endgame seeks to bring an end to tobacco use or drastically reduce prevalence to less than 5%. Discussions about tobacco endgame and the possible strategies to achieve this goal in sub-Saharan African are sparse. This study aimed to explore sub-Saharan African tobacco control stakeholders' perspectives about tobacco endgame and ascertain what strategies they perceive to be suitable for the region to achieve this goal.</p><p><strong>Methods: </strong>This qualitative study involved a purposive sample of 29 stakeholders interviewed via online platforms guided by a semi-structured interview schedule. Stakeholders were from academia, civil society, and government departments in 12 sub-Saharan African countries. Interviews were conducted in English or French, transcribed verbatim (those in French were then translated to English), and thematically analyzed with the aid of NVivo version 12 software.</p><p><strong>Results: </strong>There is support for the adoption of tobacco endgame in sub-Saharan Africa by tobacco control stakeholders in the region due to the negative impact of tobacco on health, the environment, and economy. Proposed endgame approaches for the region were recommended to be Afrocentric and sensitive to cultural and regional dynamics. Stakeholders believed that the success of endgame strategies depends on political will, multisectoral collaboration, availability of resources, buy-in from the public, and monitoring of the tobacco industry. Suggested endgame strategies were categorized into 5 themes: (1) product-focused (less addictive tobacco and regulation of novel products); (2) user-focused (smoke-free generation, cessation support, and promotion of sports); (3) market/supply-focused (licensing of sellers, increase in taxes, control of illicit trade, and alternative income for farmers); (4) institutional structure-focused (tobacco industry monitoring and regulation); and (5) legislation implementation-focused (effective implementation of international treaties aimed at lowering tobacco use prevalence).</p><p><strong>Conclusion: </strong>There is support for a tobacco endgame in sub-Saharan Africa. Collaboration from various departments/ministries and support from government and the public would be needed to make tobacco endgame a reality in the region.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A User-Centered Approach to Achieving High Degree of Digital Health Technology Utilization for Community HIV Case Management and Data Collection in Ethiopia.","authors":"Legese A Mekuria, Getaneh Likasa, Temesgan Sintayehu, Leul Mekonen, Asayehegn Tekeste, Endris Seid, Wondwossen Asefa, Afework Negash, Abiy Shewarega, Mesfin Tilaye, Gizachew Eyassu, Kidist Belete, Mohamed Nur, Steven Neri, Adrienne Hayes, Emily Liddell, Sangeeta Mookherji, Dawit A Tsegaye","doi":"10.9745/GHSP-D-24-00353","DOIUrl":"10.9745/GHSP-D-24-00353","url":null,"abstract":"<p><p>Digital health technologies have untapped potential to transform community health systems, and they are underutilized for chronic HIV care and electronic data management in low- and middle-income countries. We describe the design, development, and use of a mobile health application in community-based HIV prevention, care, and treatment programs implemented in Ethiopia since 2017. Initially, these programs utilized aggregate data collection methods, which were fragmented, non-uniform, and largely paper-based, posing challenges to data quality and data use. Local software developers applied user-centered methods to build a Unified Data System (UDS), an innovative digital health solution aimed at standardizing case management and routine data collection procedures. Developers involved end-users, including frontline community health workers (CHWs) and program managers, in the design and development process. They also conducted field visits to understand and assess user activities and needs. Developers and program staff conducted field testing, and they made design changes iteratively to incorporate user feedback. Local implementing partners deployed 950 CHWs to use the UDS for HIV service delivery and client-level data collection offline. Data were stored centrally in the CommCare HQ web service backed by a local analytics server. The UDS was linked to Power BI for advanced data analytics and visualization. Data validation tests were performed prior to indicator computation and reporting to the next level. 1,766 mobile accounts were opened for CHWs, of which 1,628 (92.2%; 95% confidence interval [CI]=90.8%, 93.4%) have submitted data. An additional 368 of 392 web accounts (93.9%; 95% CI=91.0%, 96.0%) have been used by program managers and monitoring and evaluation experts to access the dashboard. The UDS has eliminated the tedious, manual, paper-based work associated with data (dis)aggregation and reporting by frontline CHWs and local implementing partners. Hence, the number of days to access client-level data by the local partners was reduced from 1 month to just 1 day, and the time to report on activity performance was shortened from 5 days to a half-day. Data completeness was nearly 100% and data validation tests demonstrated no invalid data elements or errors. Generally, there was a high degree of digital health technology utilization by frontline CHWs and local implementing partners for standardized HIV care, high-quality data collection, and making data-informed decisions. Lessons learned from the UDS implementation could be adapted not only to support community HIV programming but also to strengthen national electronic community health information systems.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The MILEPOST Framework for Integrating mHealth Into Community-Driven Interventions: Lessons Learned From a Human-Centered Design Approach in Rural Uganda.","authors":"Josephine Schwab, Jonas Wachinger, Maxencia Nabiryo, Juliette Cazier, Juliet Wanyana, Kizito Mayombwe, Ezekiel Okou, Dennis Oloka, John Bosco Ntambara, Richard Munana, Ivan Weswa, Isaac Sekitoleko, Andrew Basenero, Rebecca Ingenhoff, Caterina Favaretti, Vasanthi Subramonia Pillai, Till Bärnighausen, Nikkil Sudharsanan, Robert Kalyesubula, Christine Nalwadda, Shannon A McMahon","doi":"10.9745/GHSP-D-24-00061","DOIUrl":"10.9745/GHSP-D-24-00061","url":null,"abstract":"<p><p>Participatory design approaches to develop global health interventions have gained traction in recent years. However, while broad frameworks for the application of design approaches exist, literature outlining concrete experiences of and guidance for navigating specific design challenges remains limited. This article proposes a design framework based on our own experiences when applying human-centered design principles to bolster sustainable hypertension medication financing in rural Uganda. In our case study, we embedded an mHealth platform within a community-led health intervention aiming to fund blood pressure medication through a shared financial pooling system. Over the course of this project and in close collaboration with intervention end-users, we developed a design framework that outlines challenges, decision-making processes, and design solutions. We iteratively refined the framework between November 2021 and April 2023 over two phases of extensive formative research and one phase of structured qualitative data collection, consisting of 55 in-depth interviews and 4 focus group discussions with clients with hypertension, health care providers, and key intervention stakeholders. The resulting MILEPOST framework consists of 7 domains to consider amid mHealth intervention co-development: medical (e.g., health challenge scope and management); interpersonal (e.g., communication, decision-making, and trust within and across communities); logistical (e.g., current processes and sustainable implementation pathways); ethical (e.g., research and implementation ethics); political (e.g., stakeholder buy-in and long-term support); scientific (e.g., rigorous and feasible approaches for data collection, management, and analysis); and technical (e.g., mHealth component development, refinement, and implementation). We define each domain, provide examples of design challenges and derived solutions as they emerged in our work, and outline starting points for operationalizing each domain in other contexts or studies. We discuss how MILEPOST can provide guidance to researchers and implementors by contributing specific and actionable insights for participatory health intervention design efforts.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":"14 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns and Drivers of Packaged (Fortified) Maize Flour Purchase in Urban and Peri-Urban Kenya.","authors":"Semeni Ngozi, Ayala Wineman, Mywish K Maredia, David Tschirley, Ian Fisher, Nahian Bin Khaled","doi":"10.9745/GHSP-D-24-00240","DOIUrl":"10.9745/GHSP-D-24-00240","url":null,"abstract":"<p><strong>Background: </strong>Large-scale food fortification is a widely applied strategy to address micronutrient deficiencies, and in Kenya, all industrially processed and packaged maize flour is mandated to be fortified with micronutrients. However, policymakers lack information regarding the population's readiness to procure fortified foods. This study aims to measure the purchase rate of packaged (and presumably fortified) maize flour among households in two Kenyan cities and assess how food environment, household characteristics, and individual shopper perceptions influence consumption of this product.</p><p><strong>Methods: </strong>We conducted a survey of 1,507 households in urban and peri-urban Kisumu and Nairobi from May to June 2022 to gather information on food purchases, food-shopping behavior, awareness of fortification, and household demographics and socioeconomic status. Between June and August 2022, we conducted a census of food outlets to characterize the households' home food environment. To analyze the data, we first conducted a descriptive analysis with statistics disaggregated by study-region, household poverty status, and/or status as a consumer of packaged maize flour. We then used a probit regression to determine the differential influence of various factors on the households' likelihood of purchasing packaged (presumably fortified) maize flour.</p><p><strong>Results: </strong>Across Kisumu and Nairobi, 67% of households purchased packaged maize flour, with higher rates seen in urban and peri-urban Nairobi (68% and 70%, respectively) and lower rates seen in urban and peri-urban Kisumu (50% and 34%, respectively). While almost 100% of households had some access to packaged maize flour in their home food environment, the density of outlets that sell this product varied from 12/km² in peri-urban Kisumu to 54/km² in urban Nairobi. Moreover, households that purchased packaged maize flour resided in neighborhoods with approximately 11 more outlets/km², on average, than other households. The local price premium charged for packaged maize flour compared to unpackaged maize flour was a negative and statistically significant driver of the purchase decision.</p><p><strong>Conclusions: </strong>If the goal is to enhance the population's uptake of fortified maize meal, the government should encourage the private sector to invest more in food outlets that sell packaged maize flour; reduce the retail cost of packaged maize flour; raise awareness of the benefits of fortification (particularly in peri-urban Kisumu); and make relevant technologies available at the scale of smaller mills.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stakeholder Perceptions on Innovative Private Pharmacy Distribution Channels and Implications for Medicine Quality in Zambia: A Qualitative Study.","authors":"Scott Kaba Matafwali, Virginia Bond, Sian E Clarke, Harparkash Kaur","doi":"10.9745/GHSP-D-24-00248","DOIUrl":"10.9745/GHSP-D-24-00248","url":null,"abstract":"<p><strong>Introduction: </strong>Innovative private pharmacy distribution channels, including delivery services, telepharmacy, and e-pharmacies, have emerged as potential solutions to improve access to quality-assured medicine and pharmacy services in Zambia, but limited evidence exists regarding their impact on medicine quality and safety. This qualitative study provides the first comprehensive investigation of stakeholder perspectives on these channels, examining their implications for pharmaceutical quality assurance and distribution in Zambia's health care system.</p><p><strong>Methods: </strong>A purposive sample of 15 stakeholders participated in the study, selected to represent key sectors of the pharmaceutical supply chain, including wholesalers, innovators, retailers, national medicine supply agencies, national medicine regulators, professional pharmacy bodies, and supply chain experts. Semi-structured interviews were conducted until data saturation was achieved. Interviews were recorded and transcribed, and a bottom-up thematic analysis was employed to derive themes directly from the data.</p><p><strong>Results: </strong>Themes that emerged from the analysis fell into 4 interconnected categories of issues: (1) current challenges in the pharmaceutical supply chain (including affordability barriers, transportation limitations, and regulatory constraints) affecting both traditional and innovative pharmacy services, (2) potential benefits of the innovative pharmacy approaches (such as enhanced traceability and improved quality assurance), (3) limitations and shortcomings (including technical and behavioral challenges), and (4) recommendations for improvement. Stakeholder perspectives varied notably by role, with regulators emphasizing quality control and innovators focusing on accessibility and efficiency.</p><p><strong>Conclusion: </strong>The findings suggest that innovative pharmacy distribution approaches will be constrained by some of the same regulatory and structural issues faced by traditional pharmacy systems, and thus cannot fully circumvent existing challenges of access to quality pharmacy services and medicines in Zambia and other countries. To successfully realize the potential of pharmacy innovations to improve accessibility to good-quality medicines, balanced attention is required to technological advancement, regulatory compliance, and the local context. These insights offer actionable guidance for policymakers and stakeholders seeking to strengthen medicine distribution systems, enriching the broader narrative of health care delivery in resource-limited settings.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reaching Men and Women Through a Decentralized Mobile Service Delivery Model for HIV Prevention and Pre-Exposure Prophylaxis Services in South Africa.","authors":"Pelisa Nongena, Catherine E Martin, Lorrein S Muhwava, Fatima A Cholo, Glory Chidumwa, Maserame V Mojapele, Vusile Butler, Saiqa Mullick","doi":"10.9745/GHSP-D-24-00258","DOIUrl":"10.9745/GHSP-D-24-00258","url":null,"abstract":"<p><strong>Introduction: </strong>Structural and service delivery barriers such as long waiting times, health care provider attitudes, and distance from services prevent access to HIV prevention and pre-exposure prophylaxis (PrEP) services, particularly for young people. The World Health Organization recommends differentiated service delivery models for HIV prevention and treatment services, including through mobile outreach. Mobile health clinics offer an opportunity to overcome barriers to service access by bringing services closer to places of work or study, improving convenience, minimizing stigma, and expanding the choice of service delivery locations and types.</p><p><strong>Methods: </strong>We conducted a mixed-methods study describing a mobile service delivery model for HIV prevention and PrEP services in 3 provinces in South Africa. The study used routine program monitoring and evaluation data from 35,375 men and women aged ≥15 years accessing services at project fixed facility and mobile clinic sites between January 2019 and October 2022, in addition to data from 74 in-depth interviews with a purposively selected sample of adolescent girls and young women aged 15-24 years and men aged ≥15 years enrolled in a nested study cohort.</p><p><strong>Results: </strong>Overall, 11,687 people were reached through mobile clinics between January 2019 and October 2022, of whom the majority were female (89.3%) and between 15-24 years (82.8%). Nearly all (96.0%) mobile clinic clients received an HIV test and 80.8% initiated oral PrEP, similar to HIV testing and PrEP initiation rates at the fixed facilities. Health care users demonstrated a high level of satisfaction with mobile health services, with benefits including a reduction in trips to fixed facilities, improved privacy, and reduced waiting times. However, some participants noted challenges with mobile services, including inconsistent schedules.</p><p><strong>Conclusion: </strong>Mobile health services with youth-friendly staff have the potential to reach young people in need of HIV prevention services and are feasible and acceptable in the South African setting. Mobile health services offered benefits such as convenience, privacy, and reduced need to travel to clinics, although they could be enhanced through improved consistency of services.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMPACT: A Structured Human-Centered Design Process for Integrating Community Health Worker Insights Into Program Policy in Pakistan.","authors":"Svea Closser, Marium Sultan, Erin Finley, Sue Gerber, Muhammad Shafique, Saeed Ahmed, Imtiaz Ali Shah, Naveed Khurshid, Farah Naz, Sadaf Nayyab, Celena Fei, Ali Sohail","doi":"10.9745/GHSP-D-24-00050","DOIUrl":"10.9745/GHSP-D-24-00050","url":null,"abstract":"<p><strong>Background: </strong>Community health workers (CHWs), most of whom are women, are the bedrock of primary health care provision in much of the world. CHWs are often employed at the bottom of health hierarchies where they have little voice; in state programs and vertical initiatives, accountability has generally flowed downwards. Yet many programs might function better if CHWs' needs and ideas were considered in program design.</p><p><strong>Methods: </strong>From 2020-2022, we implemented a human-centered design process called IMPACT with CHWs working on polio vaccination in one district of Pakistan. The name IMPACT draws from the steps in the process: Identify problems and brainstorm innovations; Make and refine ideas; Present and evaluate ideas; and ACT to disseminate and implement. We held a facilitated competition for teams of CHWs, all of whom were women, to propose policy improvements to polio vaccination. In total, 417 CHWs participated in the design process facilitated by our team, and more than 500 additional CHWs participated in sessions facilitated by local supervisors. We worked with local policymakers to short-list the best ideas. Teams of CHWs presented the short-listed ideas to a panel of provincial and national-level policymakers, who selected ideas for implementation. We conducted interviews with CHWs and policymakers throughout the process to understand their experiences (n=82).</p><p><strong>Results: </strong>We received 181 idea submissions over two rounds of the process; 9 ideas were chosen for implementation. CHWs valued the process enormously; most said it was the first time their insights had been considered, and they wanted more opportunities for such input. The second round of the process was more effective than the first, with workers generating more complex ideas and program staff running workshops themselves. We heard, across management levels, that the process had positively impacted CHW motivation and confidence. Overall, the innovations selected for implementation were in the form of adjustments rather than major programmatic changes. Yet CHWs reported that the changes made were helpful and that it was very meaningful to have contributed to program policy.</p><p><strong>Conclusion: </strong>IMPACT facilitated substantive engagement and collaboration from both male supervisors and frontline female workers in a highly gender-stratified setting. Structured processes can allow the least powerful actors in global health interventions to draw on their frontline experience to suggest policy innovations.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Service Quality and Empowerment in Government Clinics Through Continuous Quality Improvement of Community Score Cards: A Case Study From the Dominican Republic.","authors":"Erin Morse, Mary Mukomba, Jose Eduardo Rodriguez, Kristen Mallory, Christian Taco, Cesar Jacome Castro, Enmanuel Díaz Santiago, Anne K Sebert Kuhlmann","doi":"10.9745/GHSP-D-24-00171","DOIUrl":"10.9745/GHSP-D-24-00171","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The Dominican Republic offers universal, government-run health care through primary, secondary, and tertiary levels. Reliability and confidence in care have lower user satisfaction than other dimensions. Thus, the government aims to enhance relationships between service users and providers as a key health systems strengthening priority to improve primary care services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Program description: &lt;/strong&gt;From 2018 to 2023, a global nonprofit organization implemented social accountability, using an adapted Community Score Card (CSC) process, in 10 government-run clinic sites in the Dominican Republic. Each site implemented multiple CSC cycles, which involved a facilitated dialogue process among service users, providers, and community leaders, prioritization, action planning, and implementation. We developed a comprehensive monitoring and evaluation toolkit to facilitate ongoing analysis and use of data for continuous quality improvement of the social accountability approach and sharing of the results with stakeholders. The toolkit includes components that span all steps in the CSC process, including tracking participation of key stakeholder groups, assessing CSC facilitation quality, scoring clinics on 4 defined global indicators (quality of care, availability of medical staff, availability of medicines, and community participation), tracking progress on action plans, tracking participants' level of empowerment over time, and assessing how interventions impacted change through periodic use of the Most Significant Change monitoring and evaluation technique.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Process improvements: &lt;/strong&gt;The data generated from the toolkit supported process improvements in the CSC approach, including the importance of youth leadership in social accountability and of achieving concrete change early on to drive the capacity for more complex change requiring vertical support. These iterative improvements to the CSC process resulted in empowerment and engagement of community members to drive change in government-run primary health clinics and improved perceptions of service quality. Case study data from the Dominican Republic show ongoing stakeholder participation, improvement across the 4 global indicators, and community empowerment, which collectively contribute to strengthening local health care services. The comprehensive toolkit supports efforts for continuous quality improvement while producing evidence locally, nationally, and globally for health systems strengthening and demonstrating the effectiveness of the CSC approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Three key lessons emerged from the development of a CSC monitoring toolkit. First, a comprehensive toolkit centralizes data in one place and pulls together evidence from multiple sources. Second, a standardized toolkit allows for analysis at multiple levels. Finally, ensuring data are actionable locally is central to gathering complete, accurate data for","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147473362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}