| Global Health: Science and Practice (GHSP), a no-fee, peer-reviewed, open-access journal, is targeted to global health professionals, particularly program implementers, to validate their experiences and program results by peer reviewers and to share them with the greater global health community. September 2017 | Volume 5 | Number 3 Read the September issue of GHSP to find answers to these questions and more. View a list of all articles by article type below or online. With this issue, we are pleased to announce our newly redesigned website. In addition to a fresh, modern look, it has several important new features including mobile-responsive design, downloadable figures in PowerPoint, and metrics on each article. Visit the new GHSP website to read and comment on the articles, and subscribe to receive alerts when new articles and issues are published. Table of Contents EDITORIALS Maternal Death Surveillance and Response: A Tall Order for Effectiveness in Resource-Poor Settings Most countries with high maternal (and newborn) mortality have very limited resources, overstretched health workers, and relatively weak systems and governance. To make important progress in reducing mortality, therefore, they need to carefully prioritize where to invest effort and funds. Given the demanding requirements to effectively implement the maternal death surveillance and response (MDSR) approach, in many settings it makes more sense to focus effort on the known drivers of high mortality, e.g., reducing geographic, financial, and systems barriers to lifesaving maternal and newborn care. Marge Koblinsky Routine Health Facility and Community Information Systems: Creating an Information Use Culture Substantial progress has been made to strengthen health information systems, with most efforts focusing on digitization, improving data quality and analysis, and identifying problems. But the ultimate goal is using information to solve problems, which requires building an information use culture over time. How? Human-centered design, role modeling by senior managers in use of data, and incentive-based systems hold consider Theo Lippeveld COMMENTARIES Seeking Synchrony Between Family Planning and Immunization: A Week-10 DMPA Start Option for Breastfeeding Mothers Many mothers initiate DMPA injectables at 6 weeks postpartum, at the time of their baby's first immunization visit. Offering an optional delayed DMPA start at the next (10-week) immunization visit has potential advantages including a reduced follow-up schedule with DMPA visits synchronized with other immunization visits, and, possibly, improved contraceptive and immunization outcomes. John Stanback ORIGINAL ARTICLES Implementing Maternal Death Surveillance and Response in Kenya: Incremental Progress and Lessons Learned A national coordinating structure was established but encountered significant challenges including: (1) a low number of estimated maternal deaths identified that only included some occurring within facilities, (2) only half of those identified were reviewed, (3) reviewers had difficulties assessing the cause of death largely because of limited documentation in clinical records; and (4) resulting actions were limited. Successful implementation will require addressing many issues, including building support for the process lower down in the health system. Helen Smith, Charles Ameh, Pamela Godia, Judith Maua, Kigen Bartilol, Patrick Amoth, Matthews Mathai, Nynke van den Broek Using Data to Improve Programs: Assessment of a Data Quality and Use Intervention Package for Integrated Community Case Management in Malawi Use of simple wall charts by community and facility health workers to collect and visualize data helped inform data-based decision making for community health education activities, tracking stock-outs, staffing decisions, and other programming issues. Since scale-up of the intervention, however, use of the wall chart has dropped, demonstrating need for continued investment in supportive supervision. Elizabeth Hazel, Emmanuel Chimbalanga, Tiyese Chimuna, Humphreys Nsona, Angella Mtimuni, Ernest Kaludzu, Kate Gilroy, Tanya Guenther National Assessment of Data Quality and Associated Systems-Level Factors in Malawi Nearly all facility registers were available and complete. But accuracy varied, with antenatal care and HIV testing and counseling performing the best and family planning and acute respiratory infections data less well. Most facilities visibly displayed routine health data and most hospitals and district health offices had staff trained in health management information systems, but training was lacking at the facility level as were routine data quality checks and regular supervision. Richael O'Hagan, Melissa A Marx, Karen E Finnegan, Patrick Naphini, Kumbukani Ng'ambi, Kingsley Laija, Emily Wilson, Lois Park, Sautso Wachepa, Joseph Smith, Lewis Gombwa, Amos Misomali, Tiope Mleme, Simeon Yosefe Family Planning in the Context of Latin America's Universal Health Coverage Agenda Latin American countries have expanded family planning along with universal health coverage (UHC). Leveraging UHC-oriented schemes to increase family planning program coverage, equity, and financing requires: (1) Prioritizing poor and indigenous populations; (2) Including family planning services in all benefits packages; (3) Ensuring sufficient supply of commodities and human resources to avoid stock-outs and implicit rationing; (4) Reducing nonfinancial barriers to access Thomas Fagan, Arin Dutta, James Rosen, Agathe Olivetti, Kate Klein Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects Investments in a national logistics management unit and electronic logistics management information system resulted in better data use and improvements in some, but not all, management practices. After 1 year, key improvements included reduced stock-out rates, stock-out duration, and expiry rates. Although the upgraded systems were not inexpensive, they contributed to greater system efficiency and generated modest savings that defrayed much of the investment and maintenance costs. Marasi Mwencha, James E Rosen, Cary Spisak, Noel Watson, Noela Kisoka, Happiness Mberesero Large-Scale Evaluation of Quality of Care in 6 Countries of Eastern Europe and Central Asia Using Clinical Performance and Value Vignettes When providers in 6 different countries were asked how they would care for the same patient, there was wide variation within and between countries. Nevertheless, 11% of the physicians scored over 80%, suggesting good quality of care is possible even with resource constraints. Use of validated clinical vignettes, which can be applied affordably at scale, could help improve quality of services in low- and middle-income countries. John W Peabody, Lisa DeMaria, Owen Smith, Angela Hoth, Edmond Dragoti, Jeff Luck Geographic Access Modeling of Emergency Obstetric and Neonatal Care in Kigoma Region, Tanzania: Transportation Schemes and Programmatic Implications 32% of estimated live births in the region may not be able to reach emergency obstetric and neonatal care (EmONC) services within 2 hours in dry season, regardless of the type of transportation available. However, bicycles, motorcycles, and cars provide a significant increase in geographic accessibility in some areas. Achieving good access may require upgrading non-EmONC facilities to EmONC facilities in some districts while incorporating bicycles and motorcycles into the health transportation strategy in others. Yi No Chen,* Michelle M Schmitz,* Florina Serbanescu, Michelle M Dynes, Godson Maro, Michael R Kramer Increasing Contraceptive Access for Hard-to-Reach Populations With Vouchers and Social Franchising in Uganda Between 2011 and 2014, the program provided more than 330,000 family planning services, mostly to rural women in the informal sector with little or no education. 70% of the voucher clients chose an implant and 25% an intrauterine device. Benjamin Bellows, Anna Mackay, Antonia Dingle, Richard Tuyiragize, William Nnyombi, Aisha Dasgupta Overcoming Operational Challenges to Ebola Case Investigation in Sierra Leone Deficiencies in transportation and communication, low frontline staff morale, and mistrust among communities, among other operational challenges, greatly limited Ebola case investigation in Sierra Leone. Recommendations for future outbreaks: (1) timely compensation for frontline staff, (2) context-appropriate transportation and communication resources, (3) systematic data collection, storage, and retrieval systems, (4) sound linkages between frontline staff and communities, (5) daily meetings between frontline staff and epidemiologists, (6) clear and appropriate operational chain of command, and (7) political and funding support to operational agencies. Samuel T Boland, Erin Polich, Allison Connolly, Adam Hoar, Tom Sesay, Anh-Minh A Tran From Albania to Zimbabwe: Surveying 10 Years of Summer Field Experiences at the Rollins School of Public Health Since 1985, students from the Rollins School of Public Health have worked for more than 300 organizations in 84 countries. The students indicated key benefits of applying public health course work in real-world settings and gaining skills, including cultural competency, leadership, teamwork, communication, and program implementation. They also experienced challenges related to health, safety, and support. Evelyn L Howatt, Roger W Rochat, Deborah McFarland, Carlos del Rio Field Action Reports The Tobacco-Free Village Program: Helping Rural Areas Implement and Achieve Goals of Tobacco Control Policies in India Tobacco control and prevention in rural areas are possible as demonstrated by a community-driven tobacco-free village program in India. Success factors included community ownership with supportive program guidance, motivated and committed local leaders, collaboration with grassroots organizations, rewards and sanctions to establish new social norms, and provision of other income-generating options for vendors who sell tobacco. While the program required time and dedicated effort and was not successful in all villages, it holds promise for helping to achieve the goals of tobacco control policies, especially in resource-scarce settings. Nilesh Chatterjee, Deepak Patil, Rajashree Kadam, Genevie Fernandes A Mobile-Based Community Health Management Information System for Community Health Workers and Their Supervisors in 2 Districts of Zambia Using simple-feature mobile phones, CHWs sent weekly reports on disease caseloads and commodities consumed, ordered drugs and supplies, and sent pre-referral notices to health centers. Supervisors provided feedback to CHWs on referred patient outcomes and received monthly SMS reminders to set up mentoring sessions with the CHWs. Scale-up limitations include: (1) staff shortages at health centers to supervise the CHWs, (2) need for ongoing technical support to troubleshoot challenges with mobile phones and software, and (3) recurring costs for data bundles. Godfrey Biemba, Boniface Chiluba, Kojo Yeboah-Antwi, Vichaels Silavwe, Karsten Lunze, Rodgers K Mwale, Scott Russpatrick, Davidson H Hamer Community-Based Noncommunicable Disease Care for Syrian Refugees in Lebanon The high prevalence of noncommunicable diseases (NCDs) among Syrian refugees in Lebanon required a shift in the humanitarian response, from direct care provided through mobile medical clinics to community-based primary health care and health promotion provided through trained refugee outreach volunteers (ROVs). During the first 2 months after training, these ROVs conducted 753 blood pressure monitoring visits and 657 blood glucose checks; monitored medication adherence among 387 patients with NCDs; referred 293 refugees to the local primary health care facility for additional care; and provided 346 targeted health education messages. Stephen Sethi, Rebecka Jonsson, Rony Skaff, Frank Tyler Infant Feeding Policy and Programming During the 2014–2015 Ebola Virus Disease Outbreak in Sierra Leone Policies on breastfeeding and possible mother-to-child transmission of Ebola Virus Disease (EVD) during the outbreak evolved depending on public health priorities and the evidence available at that particular time. To improve responses to future outbreaks, research on vertical transmission of EVD should be prioritized; infant and young child feeding experts should be integrated into the outbreak response; and a digital repository of national policies and associated messages should be created. Amelia Brandt, Oscar Serrano Oria, Mustapha Kallon, Alessandra N Bazzano Short Reports Migration Experiences and Reported Sexual Behavior Among Young, Unmarried Female Migrants in Changzhou, China 30% reported being sexually experienced, but only 38% reported using contraception at first sex and 58% consistently over the past year, leading to many unintended pregnancies and abortions. These findings document an unmet need for reproductive health education and services for young, unmarried female migrants in urban China. Zhanhong Zong, Wenjian Yang, Xiaoming Sun, Jingshu Mao, Xingyu Shu, Norman Hearst LETTERS to the Editor The Collapse of the Price of Oil and the Importance of Fair Market Competition and Optimizing Public and Private Resources: Assessing Angola's Contraceptive Market Landscape Denise L Harrison Putting Consumers at the Center in a Context of Limited Choice and Availability of Modern Contraception in Luanda, Angola. Authors' Response to "Assessing Angola's Contraceptive Market Landscape" Benjamin Nieto-Andrade, Eva Fidel, Rebecca Simmons, Dana Sievers, Anya Fedorova, Suzanne Bell, Karen Weidert, Ndola Prata GHSP is supported by the U.S. Agency for International Development and published by the Knowledge for Health project at the Johns Hopkins Center for Communication Programs. Learn more about GHSP on its website: www.ghspjournal.org. | 
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