| 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. March 2018 | Volume 6 | Number 1 Read the March 2018 issue of GHSP to find answers to these questions and more. View a list of all articles by article type below or online. Visit the 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 The Coming-of-Age of Subcutaneous Injectable Contraception DMPA-SC is a contraceptive injectable formulation that provides women and couples another important voluntary family planning option. It offers characteristics that many women like, including cost and time savings, and has the potential to be delivered by a range of health care cadres in a variety of service delivery channels. Kimberly Cole, Abdulmumin Saad Human Resources for Health: The Best Learning, the Best Skill Mix, and the Most Impact Acting in a difficult environment, constructive efforts to improve medical education in Zimbabwe included revised curricula, investing in faculty and improved teaching skills, competency-based learning, and modern technology. But an ideal approach to health systems strengthening would put more emphasis on primary care and prevention, equity, and the many other vital health cadres besides physicians. James D Shelton COMMENTARIES A New World Health Era Unprecedented economic progress and demands for social protection have engendered an economic transition in health in many low- and middle-income countries, characterized by major increases in domestic health spending and growing national autonomy. At the global level, development assistance is refocusing on fragile states, the poorest communities, and cooperation on global public goods like health security, technical norms, and innovation. Intergovernmental organizations like WHO need the wherewithal and support to provide leadership and to properly advance this new world health era. Ariel Pablos-Méndez, Mario C Raviglione PROGRAMMATIC REVIEWS AND ANALYSES Liftoff: The Blossoming of Contraceptive Implant Use in Africa Contraceptive implant use is rising rapidly, substantially, and equitably in many sub-Saharan African countries, across almost all sociodemographic categories. Gains in implant use have exceeded combined gains for IUDs, pills, and injectables. Key contributing factors include sizeable reductions in commodity cost, much increased commodity supply, greater government commitment to expanded method choice, and wider adoption of high-impact service delivery practices that broaden access and better reach underserved populations. Continued progress in meeting women's reproductive intentions with implants calls for further investment in quality services for both insertion and removal, and for addressing issues of financing and sustainability. Roy Jacobstein Family Planning in the Democratic Republic of the Congo: Encouraging Momentum, Formidable Challenges Formidable challenges: uncertain political situation, cultural norms favoring high fertility, a thin patchwork of service delivery institutions, logistical issues in a vast country with weak infrastructure, and low capacity of the population to pay for contraceptive services. Encouraging progress: increasing government and donor support, openness to progressive service delivery policies, innovative programming including robust social marketing and initiatives with nursing schools and the military, strong collaboration among stakeholders, high unmet need suggesting strong latent demand for family planning, and an increasingly balanced method mix including long-acting methods. Dieudonné Kwete, Arsene Binanga, Thibaut Mukaba, Théophile Nemuandjare, Muanda Fidele Mbadu, Marie-Thérèse Kyungu, Perri Sutton, Jane T Bertrand ORIGINAL ARTICLES Expanding Access to Injectable Contraception: Results From Pilot Introduction of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) in 4 African Countries Nearly half a million doses of DMPA-SC were administered over 2 years in Burkina Faso, Niger, Senegal, and Uganda, with 29% of doses provided to first-time family planning users and 44% (in 3 countries) to adolescent girls and young women under age 25. Switching from intramuscular DMPA (DMPA-IM) was not widespread and generally decreased over time. Community health workers provided a higher proportion of DMPA-SC than DMPA-IM injections. Stock-outs in 2 countries hindered product uptake, highlighting the need to strengthen logistics systems when introducing a new method. Anna Stout, Siri Wood, George Barigye, Alain Kaboré, Daouda Siddo, Ida Ndione Rapid Uptake of the Subcutaneous Injectable in Burkina Faso: Evidence From PMA2020 Cross-Sectional Surveys Availability and use of the subcutaneous injectable increased rapidly during national scale-up in 2016. Substantial increases were found in rural areas, where unmet need for family planning is higher. Since the method is amenable to community-based distribution, a new pilot is testing provision by community health workers to further improve access. Georges Guiella, Shani Turke, Hamadou Coulibaly, Scott Radloff, Yoonjoung Choi Medical Education Partnership Initiative (MEPI) in Zimbabwe: Outcomes and Challenges The 5-year medical education and research strengthening initiative in Zimbabwe increased faculty retention and student enrollment, improved information technology infrastructure, provided mentoring for postgraduates and clinical training in specialty areas, instituted a competency-based curriculum reform process, and created new departments and centers to institutionalize health education and research implementation. A comprehensive review of the curriculum is still underway and uptake of technology-assisted teaching has been slower than expected. James G Hakim, Midion MChidzonga, Margaret Z Borok, Kusum J Nathoo, Jonathan Matenga, Edward Havranek, Frances Cowan, Melanie Abas, Eva Aagaard, Susan Connors, Sanele Nkomani, Chiratidzo E Ndhlovu, Antony Matsika, Michele Barry, Thomas B Campbell Can Family Planning Service Statistics Be Used to Track Population-Level Outcomes? Estimates of the modern contraceptive prevalence rate (mCPR), a population-level indicator, that are derived directly from family planning service statistics lack sufficient accuracy to serve as stand-alone substitutes for survey-based estimates. However, data on contraceptive commodities distributed to clients, family planning service visits, and current users tend to track trends in mCPR fairly accurately and, when combined with survey data in new tools, can be used to approximate the annual mCPR in the absence of annual surveys. Robert J Magnani, John Ross, Jessica Williamson, Michelle Weinberger Community-Based Management of Acute Malnutrition to Reduce Wasting in Urban Informal Settlements of Mumbai, India: A Mixed-Methods Evaluation Under the NGO–government partnership, wasting among children under age 3 decreased by 28% in intervention areas and by only 5% in comparison areas. Success factors included persuading and engaging with communities including delivery of tailored information, close presence and supervision of field staff, and holistic management of other issues beyond acute malnutrition. This intensive approach may be challenging for the government to adapt effectively at large scale. Neena Shah More, Anagha Waingankar, Sudha Ramani, Sheila Chanani, Vanessa D'Souza, Shanti Pantvaidya, Armida Fernandez, Anuja Jayaraman Building Support for Adolescent Sexuality and Reproductive Health Education and Responding to Resistance in Conservative Contexts: Cases From Pakistan While there is no one-size-fits-all approach to building community support for such programs, key strategies in Pakistan included: (1) sensitizing and engaging key stakeholders, including religious groups, schools, health and education government officials, parents, and adolescents themselves; (2) tactfully designing and framing the curricula with careful consideration of context and sensitive topics; (3) institutionalizing the programs within the school system; (4) showcasing school programs to increase transparency; and (5) engaging the media to build positive public perceptions. Venkatraman Chandra-Mouli, Marina Plesons, Sheena Hadi, Qadeer Baig, Iliana Lang Evolution and Resistance to Sexuality Education in Mexico Mexico's efforts at sexuality education have progressively evolved, from a biological focus in the socialist era in the 1930s, to adding a demographically concerned family planning component in the 1970s and including a wider reproductive health perspective in the 1990s, and finally shifting to a broader sociological context in the early 21st century. Opposition to sexuality education rose steadily in the time period considered, with a growing range of more organized and well-financed actors. Despite this opposition, alliances between academic, government, civil society, and NGO champions have helped ensure sustainability. Venkatraman Chandra-Mouli, Lucia Gómez Garbero, Marina Plesons, Iliana Lang, Esther Corona Vargas Let's Stop Trying to Quantify Household Vulnerability: The Problem With Simple Scales for Targeting and Evaluating Economic Strengthening Programs Simple scales developed to measure broad constructs of household economic vulnerability in 3 countries did not accurately measure susceptibility to negative economic outcomes or generate valid classifications of economic status to use for targeting and monitoring and evaluation. We recommend designing tailored monitoring and evaluation instruments to capture narrower definitions of economic vulnerability based on characteristics that economic strengthening programs intend to affect and using separate tools for client targeting based on presence of context-specific "red flag" indicators. Whitney M Moret Using Program Data to Improve Access to Family Planning and Enhance the Method Mix in Conflict-Affected Areas of the Democratic Republic of the Congo Analysis of program data and a formative assessment informed several program changes, including improved coaching and supportive supervision, introduction of postpartum IUDs and the levonorgestrel-releasing intrauterine system, and enhanced behavior change communication. These changes substantially increased family planning adoption, from a monthly average of 14 adopters per facility to 37 per facility. Implants continued to be the most popular method, but the percentage of adopters choosing the IUD increased from 2% in 2012 to 13% in 2016, and it was the most popular method among post abortion care clients. Lara S Ho, Erin Wheeler Effective Collaboration for Scaling Up Health Technologies: A Case Study of the Chlorhexidine for Umbilical Cord Care Experience Facilitating factors for the Chlorhexidine Working Group: (1) strong, transparent leadership by a neutral broker, promoting shared ownership among all members; (2) reliable internal and external communication; (3) well-defined terms of reference building on common interest around a simple, effective health intervention; (4) clear benefits of participation, including access to evidence and technical assistance; and (5) adequate resources to support the secretariat functions. Patricia S Coffey, Steve Hodgins, Amie Bishop FIELD ACTION REPORTS Positive Influence of Behavior Change Communication on Knowledge, Attitudes, and Practices for Visceral Leishmaniasis/Kala-azar in India After 8 months of behavior change communication activities, largely using group and interpersonal communication, refusal of indoor residual spraying to prevent visceral leishmaniasis was significantly lower among households in intervention villages (8%) than control villages (25%). Knowledge and attitudes were also better among the households in the intervention villages than control villages. Raghavan Srinivasan, Tanwir Ahmad, Vidya Raghavan, Manisha Kaushik, Ramakant Pathak STUDENT ARTICLES-UNDERGRADUATE Palm Oil in Myanmar: A Spatiotemporal Analysis of the Effects of Industrial Farming on Biodiversity Loss Satellite imagery analysis reveals a progressive shift from smallholder farming to industrial oil palm plantations in rural Myanmar, concomitant with biodiversity loss. Although industrial palm oil cultivation may help the local economy flourish, rural communities assume the dual burden of ecosystem instability from deforestation and potential health risks from increased palm oil consumption. Khristopher Nicholas, Jessica Fanzo, Kytt MacManus LETTERS TO THE EDITOR Yazidi Women: Healing the Invisible Wounds Global health cannot be improved without addressing the plight of the survivors and victims of brutal armed conflicts, especially minorities and marginalized people. Dilshad Jaff UPDATES Update of: Marx Delaney et al., Improving Adherence to Essential Birth Practices Using the WHO Safe Childbirth Checklist With Peer Coaching: Experience From 60 Public Health Facilities in Uttar Pradesh, India Megan Marx Delaney, Pinki Maji, Tapan Kalita, Nabihah Kara, Darpan Rana, Krishan Kumar, Jenny Masoinneuve, Simon Cousens, Atul A Gawande, Vishwajeet Kumar, Bhala Kodkany, Narender Sharma, Rajiv Saurastri, Vinay Pratap Singh, Lisa R Hirschhorn, Katherine EA Semrau, Rebecca Firestone Update of: Kara et al., The BetterBirth Program: Pursuing Effective Adoption and Sustained Use of the WHO Safe Childbirth Checklist Through Coaching-Based Implementation in Uttar Pradesh, India Nabihah Kara, Rebecca Firestone, Tapan Kalita, Atul A Gawande, Vishwajeet Kumar, Bhala Kodkany, Rajiv Saurastri, Vinay Pratap Singh, Pinki Maji, Ami Karlage, Lisa R Hirschhorn, Katherine EA Semrau; on behalf of the BetterBirth Trial Group 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. | 
Posts
