Global Health: Science and Practice最新文献

{"title":"Implementation of Maternal and Newborn Health Mobile Phone E-Cohorts to Track Longitudinal Care Quality in Low- and Middle-Income Countries.","authors":"Katherine Wright, Irene Mugenya, Emma Clarke-Deelder, Laura Baensch, Tefera Taddele, Anagaw Derseh Mebratie, Monica Chaudhry, Prashant Jarhyan, Nompumelelo Gloria Mfeka-Nkabinde, Jacinta Nzinga, Sailesh Mohan, Theodros Getachew, Margaret E Kruk, Catherine Arsenault","doi":"10.9745/GHSP-D-23-00506","DOIUrl":"10.9745/GHSP-D-23-00506","url":null,"abstract":"<p><strong>Background: </strong>The maternal and newborn health (MNH) eCohort is a new mixed-mode (in-person and phone) longitudinal survey aiming to provide data on novel and undermeasured dimensions of quality along the MNH continuum of care. We describe implementation experiences and lessons learned in Ethiopia, India, Kenya, and South Africa to inform future longitudinal mobile phone-based studies on health system quality.</p><p><strong>Methods: </strong>To document the implementation approach and lesson learned, we engaged numerous stakeholders and conducted data reviews, debriefs, and a workshop with participants from all collaborative research organizations.</p><p><strong>Results: </strong>The MNH eCohorts enrolled women during their first antenatal care visit in 2 sentinel sites in Ethiopia, India, Kenya, and South Africa. In India, a site with better health outcomes and a site with poorer outcomes were chosen. In the remaining countries, an urban site and a rural site were chosen. Enrollment facilities reflect care-seeking patterns according to local health information data across public and private facilities and primary and secondary levels. Data collectors had a range of educational and experience profiles, and phone data collection was completed by the same enumerators in some countries and outsourced to data collection firms in others. Adequate infrastructure (including Internet and mobile phone coverage) was essential to implementation. Although follow-up is ongoing in India and South Africa, the eCohort retained 89%-90% of participants throughout the entire pregnancy and 78%-81% until 3 months postpartum in Ethiopia and Kenya, respectively.</p><p><strong>Conclusions: </strong>The MNH eCohort is a complex and long survey. Careful and thoughtful implementation demonstrates that it is a useful tool to gather data on health system quality and continuity and on changes in user experience over the continuum of care. Findings from the eCohort related to care and system competence and user experience will be valuable to program managers and policymakers alike.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008667","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":"Presenting a Framework to Professionalize Health Supply Chain Management.","authors":"Andrew N Brown, Barry Chovitz, Richard Dos Santos, Michael Egharevba, Bridget McHenry, Erin Meier, Dominique Zwinkels","doi":"10.9745/GHSP-D-23-00119","DOIUrl":"https://doi.org/10.9745/GHSP-D-23-00119","url":null,"abstract":"<p><strong>Introduction: </strong>Many countries have an insufficient supply of adequately skilled supply chain workers to manage health commodities, and no global standards in education or experience exist for the supply chain management (SCM) workforce managing health products. We present a professionalization framework for the health SCM workforce that provides a systematic process that countries can use to standardize and elevate the health SCM profession.</p><p><strong>Methods: </strong>In 2019, semistructured interviews were conducted with individuals from 10 leading organizations supporting in-country public health supply chains to explore approaches for an SCM professionalization framework. Interview data were analyzed using direct thematic analysis. Findings were then validated through a validation workshop with 11 individuals from 8 leading SCM organizations.</p><p><strong>Results: </strong>Four associated components of this framework were developed: (1) The Library of Competencies and Designations contains management competencies grouped in 7 domains and supply chain technical competencies assigned to 5 professional designations; (2) The Collection of Roles and Job Descriptions contains 96 sample job descriptions; (3) The Mapping of Education displays the education offerings relevant to each competency across the 5 professional designations; and (4) The Implementation Approach for Health Supply Chains leads project teams to systematically apply these 3 tools in the supply chain context of a country.</p><p><strong>Conclusion: </strong>The SCM Professionalisation Framework provides a valuable tool to increase the supply of and demand for health SCM workers, increasing the recognition and use of SCM professionals within national health systems. Its utilization is a critical step in addressing the current workforce gap, particularly in low- and middle-income countries, and ensuring that the health SCM workforce possesses the right competencies, skills, and qualifications to fulfill its roles. The comprehensive framework can be used by governments, employers, and education institutions to define and align SCM professional standards, competencies, and curricula with job requirements.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining Public Sector Availability and Supply Chain Management Practices for Malaria Commodities: Findings From Northern Nigeria.","authors":"Kunle Rotimi, Ademola Joshua Itiola, Babatunde Ariyo Fagbemi, Jimmy Aiden, Taiwo Ibinaiye, Chrysantus Dabes, Andrew Okwulu, Daniel Oguche, Adaeze Aidenagbon, Umar Babuga Abubakar, Rose Tukura, Danladi Chonoko Mohammad, Christopher Bewa, Ahmad Muhammad Danzaki, Olusola Oresanya","doi":"10.9745/GHSP-D-22-00547","DOIUrl":"10.9745/GHSP-D-22-00547","url":null,"abstract":"<p><strong>Background: </strong>Nigeria accounts for substantial proportions of global malaria infections and deaths, with children aged younger than 5 years being the most affected group. This suggests that access to lifesaving malaria interventions could be suboptimal, especially at public health facilities where most rural dwellers seek health care. We conducted this study to ascertain if public health facilities have the commodities and the robust supply chain management (SCM) system required to deliver malaria interventions to children younger than 5 years.</p><p><strong>Method: </strong>We conducted a cross-sectional survey in 1,858 health facilities across 7 states in Nigeria. Using structured questionnaires, we assessed the availability of selected malaria commodities required by children aged younger than 5 years. We also interviewed health workers to evaluate other core SCM activities.</p><p><strong>Result: </strong>More than 50% of health facilities in 5 states were stocked out of malaria rapid diagnostic tests (mRDTs), and stock-out rates for artemisinin-based combination therapies (ACTs) were over 50% for almost all assessed ACTs across all states. The percentage of health facilities that received malaria commodities within the recommended lead time was below average across most states (71%). States with a higher percentage of health workers who were aware of and placed orders following the national reporting timeline and those that delivered commodities to the last mile predominantly through third-party logistics service providers tended to have higher availability of mRDTs and artemether/lumefantrine combinations. The top 2 logistics challenges were insecurity and inadequate funding.</p><p><strong>Conclusion: </strong>The availability of lifesaving malaria commodities across the health facilities visited was suboptimal, possibly due to several SCM challenges. The results from this study underscore the urgent need to implement effective interventions to address the observed gaps. This will contribute to reducing malaria morbidity and mortality among children aged younger than 5 years in Nigeria.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141316998","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":"An Effective Health System Approach to End TB: Implementing the Double X Strategy in Vietnam.","authors":"Anh L Innes, Victoria Lebrun, Gia Linh Hoang, Andres Martinez, Nhi Dinh, Thi Thuy Ha Nguyen, Tan Phat Huynh, Van Luong Quach, Thanh Binh Nguyen, Van Chinh Trieu, Nghi Do Bao Tran, Huy Minh Pham, Van Luong Dinh, Binh Hoa Nguyen, Thi Thanh Huyen Truong, Van Cu Nguyen, Viet Nhung Nguyen, Thu Hien Mai","doi":"10.9745/GHSP-D-24-00024","DOIUrl":"10.9745/GHSP-D-24-00024","url":null,"abstract":"<p><p>Countries that are high burden for TB must reverse the COVID-19 pandemic's devastating effects to accelerate progress toward ending TB. Vietnam's Double X (2X) strategy uses chest radiography (CXR) and GeneXpert (Xpert) rapid diagnostic testing to improve early detection of TB disease. Household contacts and vulnerable populations (e.g., individuals aged 60 years and older, smokers, diabetics, those with alcohol use disorders, and those previously treated for TB) with and without TB symptoms were screened in community campaigns using CXRs, followed by Xpert for those with a positive screen. In public non-TB district facilities, diabetics, respiratory outpatients, inpatients with lung disease, and other vulnerable populations underwent 2X evaluation. During COVID-19 restrictions in Vietnam, the 2X strategy improved access to TB services by decentralization to commune health stations, the lowest level of the health system, and enabling self-screening using a quick response mobile application. The number needed to screen (NNS) with CXRs to diagnose 1 person with TB disease was calculated for all 2X models and showed the highest yield among self-screeners (11 NNS with CXR), high yield for vulnerable populations in communities (60 NNS) and facilities (19 NNS), and moderately high yield for household contacts in community campaigns (154 NNS). Computer-aided diagnosis for CXRs was incorporated into community and facility implementation and improved physicians' CXR interpretations and Xpert referral decisions. Integration of TB infection and TB disease evaluation increased eligibility for TB preventive treatment among household contacts, a major challenge during implementation. The 2X strategy increased the rational use of Xpert, employing a health system-wide approach that reached vulnerable populations with and without TB symptoms in communities and facilities for early detection of TB disease. This strategy was effectively adapted to different levels of the health system during COVID-19 restrictions and contributed to post-pandemic TB recovery in Vietnam.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467484","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":"Acceptability of an Incentivized Peer Referral Intervention to Address COVID-19 Vaccine Hesitancy Among Adults in Yopougon-Est, Côte d'Ivoire.","authors":"Katherine Thanel, Brian Pedersen, Yao Kouakou Albert, Mariame Louise Ouattara, Dorgeles Gbeke, Virupax Ranebennur, Holly M Burke","doi":"10.9745/GHSP-D-23-00468","DOIUrl":"10.9745/GHSP-D-23-00468","url":null,"abstract":"<p><strong>Introduction: </strong>Vaccine hesitancy persists as a barrier to vaccine uptake among adults across geographies. We pilot-tested an incentivized peer referral intervention in Yopougon-Est, Côte d'Ivoire, to encourage adults who recently received COVID-19 vaccination to discuss their experiences and motivate family and friends to seek vaccination.<b>Implementation:</b> From May through June 2023, the intervention operated at 2 vaccination sites, where staff approached individuals immediately after receiving COVID-19 vaccination. Interested vaccine recipients received up to 9 referral coupons to distribute among their social circles, with a small financial incentive (approximately US$3) offered for each person they referred who returned to 1 of the 2 sites for COVID-19 vaccination.</p><p><strong>Methods: </strong>We collected data on numbers of people vaccinated and coupons returned. Qualitative interviews were conducted with 40 referred vaccine recipients and 7 public health officials.</p><p><strong>Results: </strong>During the 6-week intervention, 450 newly vaccinated individuals were offered the opportunity to enroll, with 197 opting to distribute coupons. Nearly half (45%) of these peer mobilizers who distributed coupons referred at least 1 person who subsequently came in for vaccination, and most of this subset had 2 or more completed referrals. Qualitative findings revealed that coupons served as effective reminders, sparking discussions within social networks and prompting vaccine-seeking behavior. According to the referred vaccine recipients, hearing about their peers' vaccination experience influenced uptake. Vaccine recipients and public health officials found the small referral incentive acceptable. Officials noted the intervention's potential utility and cost effectiveness, suggesting possible sustainability.</p><p><strong>Conclusion: </strong>This incentivized peer referral intervention, capitalizing on peer networks and social norms, holds promise for increasing vaccine uptake in Yopougon-Est and potentially in other vaccination contexts globally. Practitioners can leverage the implementation guide and training materials we developed to replicate the intervention at larger scale and assess impact on vaccination trends.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897173","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 in and Correlates of Short-Acting Contraceptive Stock-Outs: Multicountry Analysis of Performance Monitoring for Action Agile Platform Data.","authors":"Alain K Koffi, Pierre Muhoza, Saifuddin Ahmed, Philip Anglewicz, Funmilola OlaOlorun, Elizabeth Omoluabi, Mary Thiongo, Peter Gichangi, Georges Guiella, Pierre Akilimali, P R Sodani, Amy Tsui, Scott Radloff","doi":"10.9745/GHSP-D-23-00411","DOIUrl":"10.9745/GHSP-D-23-00411","url":null,"abstract":"<p><p>Understanding trends in contraceptive stock-outs, as well as their structural and demand-side correlates, is critical for policymakers and program managers to identify strategies to further anticipate, reduce, and prevent stock-outs. We analyzed trends as well as supply- and demand-side correlates of short-acting contraceptive method stock-outs by using data from multiple rounds of Performance Monitoring for Action Agile surveys. These data longitudinally measured contraceptive availability over 2 years (between November 2017 and January 2020) across 2,134 public and private service delivery points (SDPs) from urban areas of 5 countries (Burkina Faso, Democratic Republic of the Congo [DRC], India, Kenya, and Nigeria). For each country, we analyzed the trends and used multilevel mixed-effect logistic regression to model the odds of short-acting contraceptive stock-outs, adjusting for key structural and demand-side factors of the SDPs. Stock-outs in short-acting contraceptive methods were common in health facilities and varied markedly, ranging from as low as 2.9% (95% confidence interval [CI]=1.7%, 5.1%) in India to 51.0% (95% CIs=46.8%, 56.0%) in Kenya. During the observation period, stock-out rates decreased by 28% in the SDP samples in India (aOR=0.72, <i>P</i><.001) and 8% in Nigeria (aOR=0.92, <i>P</i><.001) but increased by 15% in DRC (aOR=1.15; <i>P=</i>036) and 5% in Kenya (aOR=1.05, <i>P=</i>003) with each round of data collection. Correlates of stock-out rates included the facility managerial authority (private versus public), whether the facility was rated high quality, whether the facility was at an advanced tier, and whether there was high demand for short-acting contraceptives. In conclusion, stock-outs of short-acting contraceptives are still common in many settings. Measuring and monitoring contraceptive stock-outs is crucial for identifying and addressing issues related to the availability and supply of short-acting contraceptives.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140921869","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":"Empowerment Among Adolescent Girls in Nepal: A Concept Mapping Exploratory Study.","authors":"Jessica G Burke, Sara Baumann, Jennifer Jones, Niva Joshi, Pema Lhaki","doi":"10.9745/GHSP-D-23-00010","DOIUrl":"10.9745/GHSP-D-23-00010","url":null,"abstract":"<p><strong>Background: </strong>The concept of empowerment is challenging to operationalize and measure; it is multidimensional, the outcomes are not always directly observable, and meanings of empowerment are highly contextual and socially and culturally situated. This study aimed to explore perspectives of empowerment among adolescent girls in Nepal to identify statements for inclusion in a context-specific empowerment measure.</p><p><strong>Methods: </strong>We used a participatory and mixed method research method called concept mapping in 3 districts in Nepal. Three sequential concept mapping sessions were used to solicit, organize, and process how participants responded to the prompt: \"The life of an adolescent girl improves when she has/can…\" The Concept Systems Global software was used to manage and analyze the concept mapping brainstorming, sorting, and rating data using established tools, such as multidimensional scaling and cluster analysis.</p><p><strong>Results: </strong>Concept mapping was conducted with 113 participants, including national experts, program staff, adolescents, and their mothers. They identified 105 items that fall into a 4-cluster solution: education and knowledge, decision-making, supports and skills, and physical infrastructure. Rating data uncovered there was some overlap between the top 10 most important items between the national-level experts and other stakeholder groups; however, several components associated with empowerment differed by stakeholder group in terms of importance.</p><p><strong>Conclusion: </strong>This research represents a critical step in exploring definitions of empowerment among adolescent girls in the Nepal context and with expert input. These results led to the development of a contextually specific definition of empowerment. Researchers and practitioners interested in developing context-specific understandings of complex topics that incorporate community voices and perspectives could use a similar concept mapping approach in other countries to explore various topics with diverse populations.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141184050","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":"Learnings From the Implementation of an Electronic Human Resource Management System for the Health Workforce in Uttar Pradesh, India.","authors":"Sushant Jain, Vasanthakumar Namasivayam, Shivalingappa Halli, Shajy Isac, Marissa Becker, Mushahid Ali Khan, Vikas Gothalwal, James Blanchard, Pooja Pandey, Awadhesh Kumar Rawat, Ravi Prakash","doi":"10.9745/GHSP-D-23-00312","DOIUrl":"10.9745/GHSP-D-23-00312","url":null,"abstract":"<p><p>The state of Uttar Pradesh (UP), India, has one of the largest single public health systems globally, serving about 235 million people through more than 30,000 public health facilities with approximately 160,000 health personnel. Yet, the UP health system has a shortfall of public health facilities to meet the population's needs, a shortage of clinical and nonclinical health personnel, inequitable distribution of existing health personnel, and low utilization of public health facilities. A robust and effective electronic human resource management system (eHRMS) that provides real-time information about the lifecycle of all health professionals in UP may aid in improving the health workforce, resulting in better health services and improved health outcomes. The Government of UP rolled out Manav Sampada, a comprehensive eHRMS that complied with global norms and requirements. We describe the implementation of Manav Sampada at scale and elaborate on key learnings and adoption strategies. Manav Sampada was based on key principles of integration and data-sharing with other digital systems, included functional components, a minimum dataset, used a lifecycle-based approach, and a workflow-based system, all of which acted to improve human resource data quality. The eHRMS emerged as a valuable tool for key stakeholders in reviewing worker performance, identifying skill-building needs, and allocating resources for training, leading to improved availability and equity in the distribution of a few critical cadres. The eHRMS in UP is well positioned to become an integral part of the Ayushman Bharat Digital Mission, the backbone of India's integrated digital health infrastructure. Linking eHRMS to a planned beneficiary-centric unitized health service delivery system (capturing information at the individual level rather than the aggregate level) will enable the measurement of service delivery and quality, leading to improved workforce management.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141184095","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":"Using Vignettes to Gain Insights Into Social Norms Related to Voluntary Family Planning and Gender-Based Violence in South Sudan.","authors":"Paul Bukuluki, Moses Okwii, Kamden Hoffmann, Melinda Pavin","doi":"10.9745/GHSP-D-23-00489","DOIUrl":"10.9745/GHSP-D-23-00489","url":null,"abstract":"<p><p>Social norms are the shared expectations about behaviors that are held within collective groups. These differ from attitudes and beliefs, which are individually held. In South Sudan, social norms can affect the use of voluntary family planning and reproductive health (FP/RH); some of these norms even present risks for women seeking FP/RH care and their FP/RH providers. This cross-sectional, descriptive study conducted in 5 counties in South Sudan used vignettes as a qualitative method to explore social norms related to FP/RH and decisions related to contraceptive use and gender-based violence. Participants were asked to respond to vignettes about a fictional couple during various life stages of care-seeking. Vignettes allow respondents to share their opinions and feelings without directly speaking about their own experiences. Respondents included community members, FP/RH providers, and key influencers (e.g., religious leaders, traditional leaders, elders). The study identified restrictive social norms related to FP/RH, including entrenched, dominant gender roles (i.e., requiring male consent to use contraceptives) and risk for the woman and her provider if she accesses FP/RH services. Of note, supportive social norms are gaining acceptance regarding women's voice and agency; it was found that some women can negotiate their reproductive choice with their partners and participate in planning their families, which has not always been a widely accepted norm. The use of vignettes can lead to a better understanding of the challenges and provide insights on effective implementation approaches. It is essential for programs working to promote the use of FP/RH services in South Sudan to consider the challenges presented by social norms. Findings from this study were shared with stakeholders and communities to codesign interventions aimed at increasing the use of FP/RH services. Additionally, the dialogue stimulated by this study should lead to an organic transformation toward supportive social norms through collective agency.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436764","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":"Lessons From the Design and Rollout of an Electronic Medical Record System for Cervical Cancer Screening in Rwanda.","authors":"Nang'andu Chizyuka, Emily Crawford, Katharine Schilling Hebert, Sylvie Gaju, Inga Mumukunde, Jean Marie Vianney Dusengimana, Marc Hagenimana","doi":"10.9745/GHSP-D-23-00469","DOIUrl":"10.9745/GHSP-D-23-00469","url":null,"abstract":"<p><strong>Background: </strong>In its commitment to delivering comprehensive women's cancer early detection services, the Rwanda Ministry of Health rolled out a new cervical cancer screening program. The paper-based medical record system that tracked clients at different points in the continuum of cervical cancer care had challenges with storing data, accessing client information for follow-up visits, and fragmenting information on individual clients. To support the rollout of the new cervical cancer screening program, a new electronic medical record system was designed and implemented to ensure clients were followed along the complete continuum of care. We document the development and implementation of the electronic medical record system and highlight challenges and lessons learned during implementation.</p><p><strong>Methods: </strong>Implementation took a participatory approach to ensure that the electronic medical record system was efficient in tracking clients along the continuum of care. At every stage, a wide range of stakeholders were engaged, including clinicians, program managers, and software developers. Health facility visits and conversations were conducted with health care providers and data managers to review the existing system and ensure that the design and development of the electronic record system were suitable for the context in which it would be used.</p><p><strong>Results: </strong>Cervical cancer screening sites are currently using the electronic medical record system to document client information and track women along the continuum of care to reduce loss to follow-up. The system has been rolled out to all newly activated screening sites as part of national scale-up.</p><p><strong>Conclusion: </strong>Planning, collaboration, and adaptability were the key factors in this system's successful rollout and should be the foundation of future data systems development.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854733","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}