Global Health: Science and Practice最新文献

{"title":"Documenting Community Health Worker Compensation Schemes and Their Perceived Effectiveness in Seven sub-Saharan African Countries: A Qualitative Study.","authors":"Alyssa L Davis, Lola Flomen, Jehan Ahmed, Djibrilla Maiga Arouna, Amos Asiedu, Maman Bacharou Badamassi, Ousmane Badolo, Moumouni Bonkoungou, Ciro Franco, Zachariah Jezman, Victoria Kalota, Beh Kamate, Daniel Koko, John Munthali, Raphael Ntumy, Patrick Sichalwe, Oumar Yattara","doi":"10.9745/GHSP-D-24-00008","DOIUrl":"10.9745/GHSP-D-24-00008","url":null,"abstract":"<p><strong>Introduction: </strong>Community health worker (CHW) incentives and remuneration are core issues affecting the performance of CHWs and health programs. There is limited documentation on the implementation details of CHW financial compensation schemes used in sub-Saharan African countries, including their mechanisms of delivery and effectiveness. We aimed to document CHW financial compensation schemes and understand CHW, government, and other stakeholder perceptions of their effectiveness.</p><p><strong>Methods: </strong>A total of 68 semistructured interviews were conducted with a range of purposefully selected key informants in 7 countries: Benin, Burkina Faso, Ghana, Malawi, Mali, Niger, and Zambia. Thematic analysis of coded interview data was conducted, and relevant country documentation was reviewed, including any documents referenced by key informants, to provide contextual background for qualitative interpretation.</p><p><strong>Results: </strong>Key informants described compensation schemes as effective when payments are regular, distributions are consistent, and amounts are sufficient to support health worker performance and continuity of service delivery. CHW compensation schemes associated with an employed worker status and government payroll mechanisms were most often perceived as effective by stakeholders. Compensation schemes associated with a volunteer status were found to vary widely in their delivery mechanisms (e.g., cash or mobile phone distribution) and were perceived as less effective. Lessons learned in implementing CHW compensation schemes involved the need for government leadership, ministerial coordination, community engagement, partner harmonization, and realistic transitional financing plans.</p><p><strong>Conclusion: </strong>Policymakers should consider these findings in designing compensation schemes for CHWs engaged in routine, continuous health service delivery within the context of their country's health service delivery model. Systematic documentation of the tasks and time commitment of volunteer status CHWs could support more recognition of their health system contributions and better determination of commensurate compensation as recommended by the 2018 World Health Organization <i>Guidelines on Health Policy and System Support to Optimize Community Health Worker Programs.</i></p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":"12 3","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467486","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":"Budgeting and Advocacy to Improve Water, Sanitation, and Hygiene in Health Care Facilities: A Case Study in Nepal.","authors":"Laxman Kharal Chettry, Prakash Bohara, Ramesh C Bohara, Ramhari Rijal, Sarad Khadha, Hari Subedi, Debesh Giri, Sarbesh Sharma, Upendra Dhungana, Matteus van der Valen, John Brogan, Darcy M Anderson","doi":"10.9745/GHSP-D-23-00491","DOIUrl":"10.9745/GHSP-D-23-00491","url":null,"abstract":"<p><p>Barriers to achieving and sustaining access to water, sanitation, hygiene, cleaning, and waste management (WASH) in health care facilities include a lack of supportive policy environment and adequate funding. While guidelines exist for assessing needs and making initial infrastructure improvements, there is little guidance on how to develop budgets and policies to sustain WASH services. We conducted costing and advocacy activities in Thakurbaba municipality, Nepal, to develop a budget and operations and maintenance policy for WASH in health care facilities in partnership with the municipal government. Our objectives for this study were to (1) describe the process and methods used for costing and advocacy, (2) report the costs to achieve and maintain basic WASH services in the 8 health care facilities of Thakurbaba municipality, and (3) report the outcomes of advocacy activities and policy development. We applied bottom-up costing to enumerate the resources necessary to achieve and maintain basic WASH services and their costs. The annual costs to achieve, operate, and maintain basic access to WASH services ranged from US$4881-US$9695 per facility. Cost findings were used to prepare annual budgets recommended to achieve, operate, and maintain basic services, which were presented to the municipal government and incorporated into an operations and maintenance policy. To date, the municipality has adopted the policy and established a recovery fund of US$3831 for repair and maintenance of infrastructure and an additional US$153 per facility for discretionary WASH spending, which were to be replenished as they were spent. Advocacy at the national level for WASH in health care facilities is currently being championed by the municipality, and findings from this project have informed the development of a nationally costed plan for universal access. This study is intended to provide a roadmap for how cost data can be collected and applied to inform policy.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":"12 3","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467485","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":"Accelerating COVID-19 Vaccination Among People Living With HIV and Health Care Workers in Tanzania: A Case Study.","authors":"Mohamed F Jalloh, Florian Tinuga, Mohamed Dahoma, Anath Rwebembera, Ntuli A Kapologwe, Daniel Magesa, Kokuhabwa Mukurasi, Oscar Ernest Rwabiyago, Jaiving Kazitanga, Angela Miller, David Sando, Haruka Maruyama, Redempta Mbatia, Florence Temu, Eva Matiko, Kokuhumbya Kazaura, Prosper Njau, Jennifer Imaa, Tara Pinto, Sophia A Nur, Nicolas Schaad, Augustine Malero, Damian Damian, Jonathan Grund, George S Mgomella, Alison Johnson, Gbolahan Cole, Eunice Mmari, Wangeci Gatei, Mahesh Swaminathan","doi":"10.9745/GHSP-D-23-00281","DOIUrl":"10.9745/GHSP-D-23-00281","url":null,"abstract":"<p><strong>Background: </strong>There is limited evidence on COVID-19 vaccination uptake among people living with HIV (PLHIV) and health care workers (HCWs), with the current evidence concentrated in high-income countries. There is also limited documentation in the published literature regarding the feasibility and lessons from implementing targeted vaccination strategies to reach PLHIV and HCWs in low- and middle-income countries.</p><p><strong>Program development, piloting, and implementation: </strong>We designed and implemented multifaceted strategies to scale up targeted COVID-19 vaccination among PLHIV and HCWs in 11 administrative regions on the mainland of Tanzania plus Zanzibar. An initial 6-week intensification strategy was implemented using a diverse partnership model comprising key stakeholders at the national- and subnational levels. A layered package of strategies included expanding the number of certified vaccinators, creating vaccination points within HIV clinics, engaging HCWs to address their concerns, and building the capacity of HCWs as \"champions\" to promote and facilitate vaccination. We then closely monitored COVID-19 vaccination uptake in 562 high-volume HIV clinics. Between September 2021 and September 2022, the proportion of fully vaccinated adult PLHIV increased from <1% to 97% and fully vaccinated HCWs increased from 23% to 80%.</p><p><strong>Lessons and implications: </strong>Our intra-action review highlighted the importance of leveraging a strong foundation of existing partnerships and platforms, integrating COVID-19 vaccination points within HIV clinics, and refining strategies to increase vaccination demand while ensuring continuity of vaccine supply to meet the increased demand. Lessons from Tanzania can inform targeted vaccination of vulnerable groups in future health emergencies.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141161849","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":"Integration of Acute Malnutrition Treatment Into Integrated Community Case Management in Three Districts in Southern Mali: An Economic Evaluation.","authors":"Bernardette Cichon, Noemí López-Ejeda, Magloire Bunkembo Mampindu, Aliou Bagayoko, Mahamadou Samake, Pilar Charle Cuellar","doi":"10.9745/GHSP-D-23-00431","DOIUrl":"10.9745/GHSP-D-23-00431","url":null,"abstract":"<p><strong>Background: </strong>Enabling community health workers (CHWs) to treat acute malnutrition improves treatment access and coverage. However, data on the cost and cost-effectiveness of this approach is limited. We aimed to cost the treatment at scale and determine the cost-effectiveness of different levels of supervision and technical support.</p><p><strong>Methods: </strong>This economic evaluation was part of a prospective nonrandomized community intervention study in 3 districts in Mali examining the impact of different levels of CHW and health center supervision and support on treatment outcomes for children with severe acute malnutrition. Treatment admission and outcome data were extracted from the records of 120 participating health centers and 169 CHW sites. Cost data were collected from accountancy records and through key informant interviews. Results were presented as cost per child treated and cured. Modeled scenario sensitivity analyses were conducted to determine how cost-efficiency and cost-effectiveness estimates change in an equal scale scenario and/or if the supervision had been done by government staff.</p><p><strong>Results: </strong>In the observed scenario, with an unequal number of children, the average cost per child treated was US$203.40 in Bafoulabé where a basic level of supervision and support was provided, US$279.90 in Kayes with a medium level of supervision, and US$253.9 in Kita with the highest level of supervision. Costs per child cured were US$303.90 in Bafoulabé, US$324.90 in Kayes, and US$311.80 in Kita, with overlapping uncertainty ranges.</p><p><strong>Conclusion: </strong>Additional supervision has the potential to be a cost-effective strategy if supervision costs are reduced without compromising the quality of supervision. Further research should aim to better adapt the supervision model and associated tools to the context and investigate where efficiencies can be made in its delivery.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431800","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":"Performance of Pit Latrines and Their Herd Protection Against Diarrhea: A Longitudinal Cohort Study in Rural Ethiopia.","authors":"Seungman Cha, Sunghoon Jung, Tadesse Abera, Ermias Tadesse Beyene, Wolf-Peter Schmidt, Ian Ross, Yan Jin, Dawit Belew Bizuneh","doi":"10.9745/GHSP-D-22-00541","DOIUrl":"10.9745/GHSP-D-22-00541","url":null,"abstract":"<p><p>In sanitation policies, \"improved sanitation\" is often broadly described as a goal with little rationale for the minimum standard required. We conducted a secondary analysis of data collected as part of a cluster randomized controlled trial in rural Ethiopia. We compared the performance of well-constructed and poorly constructed pit latrines in reducing child diarrhea. In addition, we explored whether having a well-constructed household latrine provides indirect protection to neighbors if cluster-level coverage reaches a certain threshold. We followed up children aged younger than 5 years (U5C) of 906 households in rural areas of the Gurage zone, Ethiopia, for 10 months after community-led total sanitation interventions. A study-improved latrine was defined as having all the following: pit of ≥2 m depth, slab of any material, drop-hole cover, wall, roof, door, and handwashing facilities (water and soap observed). U5C in households with a study-improved latrine had 54% lower odds of contracting diarrhea than those living in households with a latrine missing 1 or more of the characteristics (adjusted odds ratio [aOR]=0.46; 95% confidence interval [CI]=0.27, 0.81; <i>P</i>=.006). Analyses were adjusted for child age and sex, presence of improved water for drinking, and self-reported handwashing at 4 critical times. The odds of having diarrhea among those with an improved latrine based on the World Health Organization/UNICEF Joint Monitoring Program (JMP) definition (i.e., pit latrines with slabs) were not substantially different from those with a JMP-unimproved latrine (aOR=0.99; 95% CI=0.56, 1.79; <i>P</i>=.99). Of U5C living in households without a latrine or with a study-unimproved latrine, those in the high-coverage villages were less likely to contract diarrhea than those in low-coverage villages (aOR=0.55; 95% CI=0.35, 0.86; <i>P</i>=.008). We recommend that academic studies and routine program monitoring and evaluation should measure more latrine characteristics and evaluate multiple latrine categories instead of making binary comparisons only.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247872","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":"Journey From a Digital Innovation to a Sustainable Health Worker Capacity-Building App in India: Experiences, Challenges, and Lessons Learned.","authors":"Rebecca Chase, Sohini Sanyal, Preksha Singh, Sharda Sharda, Anita Bhargava, Pramod Raturi, Gopal Krishna Soni, Parthasarathi Ganguly","doi":"10.9745/GHSP-D-24-00006","DOIUrl":"10.9745/GHSP-D-24-00006","url":null,"abstract":"<p><p>Health workers, especially auxiliary nurse midwives (ANMs), are among the most critical resources in improving the quality of immunization services and reducing vaccine hesitancy under the Universal Immunization Programme (UIP) in India. To improve health worker immunization skills, UIP trainings in India are primarily conducted through instructor-led classroom, cascade trainings. However, a 2018 capacity-building need assessment revealed several challenges involved in traditional classroom training, such as a single-time exposure to new guidelines, complicated logistics arrangements, a lack of refresher training, and varying quality of training. These complexities make it difficult to meet the timely knowledge and skill needs of every health worker effectively and uniformly in a rapidly changing scenario of UIP. To meet health worker capacity-building needs and address these challenges, Rapid Immunization Skill Enhancement (RISE), a learning management system (LMS) application, was conceptualized. The RISE LMS application was developed as a human-centered, interactive, continuous, and adaptable knowledge and skill-building platform for health workers engaged in the UIP. RISE complements existing classroom-based cascade training for health workers by leveraging digital technologies for faster, easier, and more effective knowledge transfer to accommodate the fast-changing needs of a dynamic health program like UIP. In this article, we share the challenges and strategic solutions to digital training applications, lessons learned, sustainability of the application, and the impact RISE has made in India, all of which stemmed from leadership, coordinated efforts from a team of skilled professionals, government acceptance, detailed planning, and continued stakeholder engagement.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":"12 3","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467487","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":"Boosting Contraceptive Uptake in Urban Uganda: Older Women Benefit When Layering Adolescent and Youth Interventions Onto Existing Family Planning Programming.","authors":"Albert Bwire, Denis Joel Sama, Jessica Mirano, Paul Nyachae, Kenneth Owino, Josephine Nabukeera, Juliet Tumuhairwe, Maheen Malik, Ian Salas, Vanessa Mitchell, Krishna Bose","doi":"10.9745/GHSP-D-22-00308","DOIUrl":"10.9745/GHSP-D-22-00308","url":null,"abstract":"<p><strong>Introduction: </strong>Uganda has a large young population with a high unmet need for family planning (FP). Although there have been many efforts to improve access to and uptake of contraception, improvements have been slow. The Ministry of Health Uganda partnered with The Challenge Initiative (TCI) to implement a novel multipronged approach layering adolescent and youth sexual reproductive health (AYSRH) onto a functioning general FP program for women of reproductive age in 3 local governments of Buikwe, Mukono, and Iganga. We describe the approach and aim to determine whether layering AYSRH interventions onto an existing program resulted in increased contraceptive uptake among adolescents and youth aged 10-24 years and among women aged 25-49 years.</p><p><strong>Methods: </strong>We analyzed service statistics from the Uganda Health Management Information System to assess contraceptive uptake for adolescents and youth (aged 10-24 years) and older women (aged 25-49 years) before and after the implementation of the AYSRH approach in 3 areas (Buikwe, Iganga, and Mukono) compared to 11 areas where only the general FP program was implemented and the Uganda country total.</p><p><strong>Results: </strong>This analysis showed that before the start of TCI's support, levels of contraceptive uptake were similar in all local governments. However, after implementation, there was an increase in uptake for general FP program only areas (1.7-point advantage over country total) and an even greater increase in general FP+AYSRH areas (2.4-point advantage over FP only programming). This was observed in both adolescents and youth aged 10-24 years and among women aged 25-49 years.</p><p><strong>Conclusion: </strong>The layering of TCI's AYSRH interventions onto a well-functioning FP platform not only increased contraceptive uptake among adolescents and youth aged 10-24 years but also boosted uptake among women older than age 25 years.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11111102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874587","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":"Increasing Contraceptive Use Through Free Family Planning Special Days in Poor Urban Areas in Francophone West Africa.","authors":"Mamadou Kandji, Hawa Talla, René Jean Firmin Nakoulma, Sujata Naik Bijou, Cheikh Ibrahima Diop, Josephat Avoce, Fatoumata Bamba, Fatimata Sow","doi":"10.9745/GHSP-D-22-00227","DOIUrl":"10.9745/GHSP-D-22-00227","url":null,"abstract":"<p><strong>Introduction: </strong>In francophone West Africa (FWA), contraceptive uptake remains limited, often due to geographic, economic, and social barriers. With technical support from The Challenge Initiative (TCI), municipalities and health systems implemented Family Planning Special Days (FPSDs) to improve family planning (FP) uptake and reduce high unmet need. The FPSD intervention consisted of organizing free FP services on a monthly or quarterly basis over 2 to 5 consecutive days within health facilities or sites close to the population. These events helped to educate, inform, and mobilize the community around FP and improve geographic and financial access to FP services. We describe the process of implementing FPSDs in FWA countries and analyze the results.</p><p><strong>Methods: </strong>We used several techniques and data sources in our descriptive analysis, including document review of activity reports, analysis of health management information system data, and retrospective data collection on the profile of FPSD users and implementation costs.</p><p><strong>Results: </strong>Between July 2020 and June 2021, municipalities and health systems collaborated to hold 1,046 FPSDs in 452 health facilities in 10 FWA cities. This collaboration was made possible through the establishment of city-level management and coordination units composed of municipal, health system, and TCI focal points. In the 10 FWA cities, 181,792 people were made aware of the FPSDs and 71,669 contraceptive users were served. The overall cost of organizing the FPSDs was about 145382501 Central African CFA francs (US$252839), 35% of which came from the municipalities' local financial contribution.</p><p><strong>Discussion: </strong>Results from our analysis showed that, with appropriate financial support from municipalities, the health system could offer high-quality free FP services. Nonetheless, there are still challenges to the sustainability of conducting FPSDs, including the availability of contraceptive products and continued financing of the strategy during system shocks such as the COVID-19 pandemic.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":"1 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11111110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78875981","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":"Improving Contraceptive Service Quality and Accessibility for Adolescents and Youth Through Proprietary Patent Medicine Vendors in Four Nigerian States.","authors":"Dorcas Akila, Oluwasegun Akinola, Olukunle Omotoso, Saori Ohkubo, Adewale Adefila, Philemon Yohanna, Nwanne Ikodiya Kalu, Adebusola Oyeyemi, Olubunmi Ojelade, Aisha Waziri, Winifred Kwaknat, Olusola Solanke, Bernard Emonena, Oluwafemi Rotimi, Lisa Mwaikambo, Victor Igharo, Lekan Ajijola, Krishna Bose","doi":"10.9745/GHSP-D-22-00225","DOIUrl":"10.9745/GHSP-D-22-00225","url":null,"abstract":"<p><strong>Introduction: </strong>In Nigeria, health care services and commodities have increasingly been accessed through private sector entities, including retail pharmacies and drug shops (also called proprietary patent medicine vendors [PPMVs]). However, PPMVs cannot provide long-acting or permanent methods, and concerns have been raised about their quality of services and their need to better comply with government regulations. This article describes how The Challenge Initiative's (TCI) family planning program supported 4 state governments in Nigeria to develop a model to strengthen public-private partnerships between PPMVs and primary health centers (PHCs) to leverage PPMVs to provide adolescents and youth with high-quality contraceptive information, services, and referrals to PHCs.</p><p><strong>Program description: </strong>The intervention implemented a hub-spoke model by strengthening the linkages between neighboring PPMVs and large PHCs for delivering contraceptive services to adolescents and youth. The steps in the implementation process included: (1) introducing the intervention to state governments, (2) selecting PPMVs as spokes and high-volume PHCs as hubs, (3) conducting whole-site orientations jointly with PPMV and PHC staff, (4) strengthening referral links between PPMVs and PHCs, (5) implementing supportive supervision and coaching, and (6) strengthening client data management. TCI worked with the state and local ministry of health to improve PPMV operators' knowledge, attitudes, and skills to deliver adolescent- and youth-friendly services.</p><p><strong>Lessons learned and recommendations: </strong>Implementing the PPMV intervention with state governments and PHCs strengthened the public-private partnership. A functional referral system in Plateau State demonstrated significant success, enabling increased contraceptive choice and adherence to regulations for adolescents and youth. We recommend that the government strengthen the working relationship between PPMVs and PHCs, incorporate PPMVs into the routine supportive supervision of the state health system, and incorporate a referral linkage with PHCs into the design and implementation of PPMV programs.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11111103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140174239","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":"Engaging Community Health Workers to Enhance Modern Contraceptive Uptake Among Young First-Time Parents in Five Cities of Uttar Pradesh.","authors":"Mukesh Kumar Sharma, Emily Das, Hitesh Sahni, Jessica Mirano, Kate Graham, Abhishek Kumar, Clea Finkle","doi":"10.9745/GHSP-D-22-00170","DOIUrl":"10.9745/GHSP-D-22-00170","url":null,"abstract":"<p><strong>Introduction: </strong>Young newly married women and first-time parents (FTPs), particularly those living in slum settlements, have a high unmet need for modern contraceptive methods to limit and space births. We describe an intervention in which adolescents and youth sexual and reproductive health (AYSRH) services tailored to FTPs were incorporated into the government's existing family planning (FP) program in 5 cities of Uttar Pradesh. We examined the effect of this intervention on modern contraceptive use among FTPs aged 15-24 years.</p><p><strong>Methods: </strong>To assess the effect of this pilot, in 2019, 1 year after the implementation of the program, we analyzed community-based output tracking survey data on 549 married women who are FTPs in the pilot cities. These FTPs were compared with 253 women who were FTPs from other cities where the program was implemented without a specific focus on FTPs. Descriptive statistics and multivariate logistic regression analysis were applied to understand the association between exposure to FP information, either through accredited social health activists or through service delivery points, and use of modern contraceptives.</p><p><strong>Results: </strong>Use of modern contraceptives was higher among FTPs in the 5 pilot cities than non-pilot cities (39% vs. 32%; <i>P</i><.05). The interaction effect of city type and exposure to the information showed a positive association between modern contraceptive use and program exposure, greater in pilot cities than non-pilot cities.</p><p><strong>Conclusions: </strong>Higher uptake of modern contraceptives among young women may be achieved when an FTP-focused intervention is layered on the government's existing FP programs. Future studies with a longer duration of implementation, in a wider geography, and with longitudinal design are recommended to provide more robust measures of high impact intervention/practices in urban areas.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11111106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862577","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}