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We implemented a group randomized controlled trial in 24 reproductive and child health clinics in eight districts in Mbeya region. Three months pre-intervention, we identified 1924 and 1226 patients established on antiretroviral therapy for six months or more in intervention and control clinics, respectively, of whom 83.4% and 86.9% had one or more post-intervention visits. The unadjusted rate of missed visits declined from 36.5% to 34.4% in intervention clinics and increased from 38.9% to 45.5% in control clinics following the intervention. Interrupted time series analyses demonstrated a net decrease of 13.7% (95% CI [-15.4,-12.1]) for missed visits at six months post-intervention. Similar differential changes were observed for visits missed by 3, 7, 15, or 60 days. Appointment-tracking and community outreach significantly improved appointment-keeping for women on antiretroviral therapy. The facility staff controlled their workload better, identified missing patients rapidly, and worked with existing community organizations. There is now enough evidence to scale up this approach to all antiretroviral therapy and Option B+ reproductive and child health clinics in Tanzania as well as to evaluate the intervention in medical clinics that treat other chronic health conditions.

Uganda’s Ministry of Health in 2012 implemented a comprehensive strategy (SPARS) to build medicines management capacity in public sector health facilities. The approach includes supportive supervision. This structured observational study assesses supportive supervision competency among medicines management supervisors (MMS). The study used structured observations of two groups of five purposely selected MMS—one group supervising facilities with greater medicines management improvement during one year of SPARS and one group with less improvement, based on quantitative metrics. Our results suggest that MMS’ supportive supervision competency is positively related to the SPARS effectiveness scores of the facilities they supervise. We recommend strategies to strengthen supportive supervision behaviors and skills.

MSH has 10 TENs composed of approximately 600 members from 45 countries. Over two-thirds of members are based in field-based projects supported by MSH. Each TEN is focused on a technical area, such as reproductive, maternal, newborn, and child health, HIV/AIDS, and tuberculosis; a health systems function, such as leadership and governance, health care finance, and human resources for health; or cross-cutting topics, such as gender, youth, monitoring and evaluation, and country operations. A review of the literature, development of an operational framework, assessment, and analysis with case examples provide important insights into how the TENs can be used to collaborate with peers around the world and add value to the agency’s mission and vision. MSH now can identify which TENs are ready to be pushed to the next level of functionality to meet MSH’s evolving performance and learning priorities.

To upgrade from an older version of QuanTB download and read these instructions. QuanTB 4.1 QuanTB E-Course An e-course for health professionals on how to use QuanTB, a downloadable forecasting, quantification and early warning tool for TB medicines. Version 4.1 available as of August 24, 2017.

MSH authors have published a number of journal articles describing the accredited drug seller implementation experience and lessons learned in Tanzania—home of the flagship ADDO program. A new compendium reviews highlights ranging from robust multi-method quantitative to informative qualitative research. 

Managing Drug Supply (MDS) is the leading reference on how to manage essential medicines in developing countries. MDS was originally published in 1982. It was revised in 1997 with over 10,000 copies distributed in over 60 countries worldwide.

The Management of Medicines Benefit Programs in Low- and Middle-Income Settings manual serves as a primer for managers, government officials, or consultants who are tasked by a government, health insurance plan, or other institution with designing or implementing a medicines benefit program.

Lessons From a Quality Improvement Approach in Uganda

Due to its link to various complications during and after pregnancy, the prevention of malaria among pregnant women is regarded as an important strategy for reducing mortality and adverse maternal and neonatal health outcomes, such as maternal anemia, low birth weight, and perinatal deaths. 

Reducing the burden of malaria in Uganda is a priority for The National Malaria Control Program. While significant strides have been made, some components have not progressed to the same extent, including addressing malaria in pregnancy. This assessment was undertaken by the ASH project to examine facility-based factors that influence the coverage of IPTp among pregnant women.

Due to its link to various complications during and after pregnancy, the prevention of malaria among pregnant women is an important strategy for reducing mortality and adverse maternal and neonatal health outcomes, such as anemia, low birth weight, and newborn death.  

The Leadership Development Program Plus (LDP+) is the enhanced version of the Leadership Development Program (LDP) first delivered by Management Sciences for Health (MSH) in 2002.

A Conference on Epidemic Preparedness November 13, 2017 The Joseph B. Martin Conference Center I Harvard Medical School

Several recent studies have attempted to measure the prevalence of disrespect and abuse (D&A) of women during childbirth in health facilities. Variations in reported prevalence may be associated with differences in study instruments and data collection methods. This systematic review and comparative analysis of methods aims to aggregate and present lessons learned from published studies that quantified the prevalence of D&A during childbirth.

Emergencies can often directly impact health systems of an affected region or country, especially in resource-constrained areas. Health system recovery following an emergency is a complex and dynamic process. Health system recovery efforts have often been structured around the World Health Organization’s health systems building blocks as demonstrated by the Post-Disaster Needs Assessment. Although this structure is valuable and well known, it can overlook the intricacies of public health systems. We retrospectively examine public health systems recovery, a subset of the larger health system, following the 2010 Haiti earthquake and cholera outbreak, through the lens of the 10 essential public health services. This framework illustrates the comprehensive nature of and helps categorize the activities necessary for a well-functioning public health system and can complement other assessments. Outlining the features of a public health system for recovery in structured manner can also help lay the foundation for sustainable long-term development leading to a more robust and resilient health system.

The objective of this study is to explore selected pharmacies' readiness to serve women seeking emergency contraception (EC). This study used a mystery client (MC) methodology to visit 73 pharmacies in Kinshasa, Democratic Republic of Congo (DRC). Findings indicate that more than two-thirds of EC providers were knowledgeable about EC dosage, timeframe, and side effects, and 90% were deemed helpful towards novice EC users. Rare but glaring misconceptions about EC timeframe (20% of providers) and long-term side effects (4% of providers), as well as frequent stock-out (22%) and cost issues highlight priorities for programmatic improvements. As new service delivery strategies are explored to complement the uneven network of health structures in DRC, this study suggests that, given proper training and integration in FP programming, private-sector pharmacies have the potential to meet specific contraceptive needs for women living in Kinshasa.

The objective of this study was to understand motives for contraceptive implant discontinuation in Luanda and Huambo, Angola. We conducted 45 in-depth interviews and six focus groups amongst former and current contraceptive implant clients and family planning nurses in eight clinics. Motives for discontinuation reflect findings from other studies in similar settings, in particular the influence of adverse side effects and desire for pregnancy as motivating factors. We contextualize these findings in the Angolan setting to tease out the relationship between cultural norms of ideal family size and the perceived role of women in regards to fertility and child-bearing. We suggest that programs enter into dialog with communities to address these concerns, rather than working exclusively on improving service delivery and quality.

The objective of the NSP is to improve network effectiveness to meet their member’s needs and enhance their long-term sustainability. The content of the program includes: membership and benefits, distributed leadership, network governance, financial systems and sustainability, and communications for resource mobilization.

The Pre-service Integration Guide is designed to assist heads of departments and faculty in pre-service health training institutions that train medical, nursing, pharmacy, laboratory and other allied health professionals to successfully introduce practical and action-oriented leadership and management modules into pre-service curricula for their students.

This guide was developed as an abbreviated companion to the longer Management Sciences for Health publication Leaders Who Govern, with two main goals: To facilitate finding practical information about specific aspects of good governance

FinMAT helps managers assess their organizations’ financial management capacity, identify areas for improvement, make specific action plans to address shortcomings, and monitor for improvement The heart of FinMAT is an instrument for collecting and summarizing technical information about an organization’s financial management systems and practices.

Antimicrobial resistance (AMR) is one of the world’s most pressing and urgent global health threats —one that could erode gains against tuberculosis (TB), malaria, HIV/AIDS, and many other infectious diseases. While AMR has emerged as a critical issue at the global level, current efforts to address AMR are insufficient to curb its spread.

In Gavi-eligible countries partnerships are dynamic networks of immunization actors who work together to support all stages and aspects of Gavi support. This paper describes a conceptual framework--the partnership framework--and analytic approach for evaluating the perceptions of partnerships’ value as well as the results from an application to one case in Uganda. We used a mixed-methods case study design embedded in the Gavi Full Country Evaluations to test the partnership framework on Uganda’s human papillomavirus vaccine application partnership. The partnership was not perceived to have increased the efficiency of the process, perhaps as a result of unclear or absent guidelines around roles and responsibilities. We concluded that the health and functioning of global health partnerships can be evaluated using the framework and approach presented here. Network theory and methods added value to the conceptual and analytic processes, and we recommend applying this approach to other global health partnerships to ensure that they are meeting the complex challenges they were designed to address.

Kobe Refugee camp hosts roughly 39,000 refugees displaced from Somalia during the 2011–2012 Horn of Africa Crisis. Sexual and reproductive health (SRH) issues, as well as the greater issues of health and well-being for adolescents displaced from this crisis, remain largely unknown and neglected. In 2013, the Women’s Refugee Commission, Johns Hopkins University, and International Medical Corps in Ethiopia implemented qualitative and quantitative research to explore the factors and risks that impact the health of very young adolescents (VYAs), those 10–14 years of age, in this setting. This research identified several factors that were found to influence the health and well-being of VYAs in Kobe refugee camp, including newfound access to education and security, combined with gender divisions and parental communication around early SRH and puberty that remained intact from traditional Somali culture. Girls were found to face an additional risk of child marriage and early pregnancy since displacement, which significantly limited their ability to access education and achieve future aspirations.

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