Family Planning Counseling in Your Pocket: A Mobile Job Aid for Community Health Workers in Tanzania.

To address low contraceptive use in Tanzania, a pilot intervention using a mobile job aid was developed to guide community health workers (CHWs) to deliver integrated counseling on family planning, HIV, and other sexually transmitted infections (STIs). In this article, we describe the process of developing the family planning algorithms and implementation of the mobile job aid, discuss how the job aid supported collection of real-time data for decision making, and present the cost of the overall system based on an evaluation of the pilot. The family planning algorithm was developed, beginning in June 2011, in partnership with the Tanzania Ministry of Health and Social Welfare based on a combination of evidence-based tools such as the Balanced Counseling Strategy Plus Toolkit. The pilot intervention and study was implemented with 25 CHWs in 3 wards in Ilala district in Dar es Salaam between January 2013 and July 2013. A total of 710 family planning users (455 continuing users and 255 new users) were registered and counseled using the mobile job aid over the 6-month intervention period. All users were screened for current pregnancy, questioned on partner support for contraceptive use, counseled on a range of contraceptives, and screened for HIV/STI risk. Most new and continuing family planning users chose pills and male condoms (59% and 73%, respectively). Pills and condoms were provided by the CHW at the community level. Referrals were made to the health facility for pregnancy confirmation, injectable contraceptives, long-acting reversible contraceptives and HIV/STI testing. Follow-up visits with clients were planned to confirm completion of the health facility referral. The financial cost of implementing this intervention with 25 CHWs and 3 supervisors are estimated to be US$26,000 for the first year. For subsequent years, the financial costs are estimated to be 73% lower at $7,100. Challenges such as limited client follow-up by CHWs and use of data by supervisors identified during the pilot are currently being addressed during the scale-up phase by developing accountability and incentive mechanisms for CHWs and dashboards for data access and use.

An evaluation of a family planning mobile job aid for community health workers in Tanzania.

OBJECTIVES: The global rapid growth in mobile technology provides unique opportunities to support community health workers (CHWs) in providing family planning (FP) services. FHI 360, Pathfinder International and D-tree International developed an evidence-based mobile job aid to support CHW counseling, screening, service provision and referrals, with mobile forms for client and service data, and text-message reporting and reminders. The purpose of this study is to evaluate the acceptability and potential benefits to service quality from the perspective of CHWs and their clients. STUDY DESIGN: The mobile job aid was piloted in Dar es Salaam, Tanzania. Data collection tools included a demographic survey of all 25 CHWs trained to use the mobile job aid, in-depth interviews with 20 of the CHWs after 3 months and a survey of 176 clients who received FP services from a CHW using the mobile job aid after 6 months. RESULTS: Both CHWs and their clients reported that the mobile job aid was a highly acceptable FP support tool. CHWs perceived benefits to service quality, including timelier and more convenient care; better quality of information; increased method choice; and improved privacy, confidentiality and trust with clients. Most clients discussed multiple FP methods with CHWs; only 1 in 10 clients reported discussion of all 9 methods. CONCLUSIONS: This research suggests that mobile phones can be effective tools to support CHWs with FP counseling, screening and referrals, data collection and reporting, and communication. Challenges remain to support informed contraceptive choice. Future research should focus on implementation, including scale-up and sustainability. IMPLICATIONS: Mobile job aids can uniquely enhance FP service provision at the community level through adherence to standard protocols, real-time feedback and technical assistance, and provision of confidential care. This study can inform future efforts to support and expand the role of CHWs in increasing FP access and informed contraceptive choice.

Children of the sug: a study of the daily lives of street children in Khartoum, Sudan, with intervention recommendations.

OBJECTIVES: The study examines street children's daily lives in Khartoum, Sudan to recommend ways to improve their conditions and to successfully assist them off the streets. METHODS: In 2000-2001, eight researchers conducted participant observation for 7 weeks; 20 groups of children engaged in role-plays and drawing activities; over 500 children participated in qualitative group and individual interviews; and 872 current and former street children were surveyed. RESULTS: Approximately half of children were 14 years old or younger. Daily life focused on eating, sucking glue-soaked rags, obtaining money, and sometimes movies or games; many children valued their freedom and relatively abundant food on the streets. Boys engaged in odd jobs, and sometimes theft, begging, or sex work. Girls had fewer work opportunities and primarily obtained money through begging and sex work. Almost half of children saw their families weekly. Children belonged to same-sex groups of common geographic origin, which shared food, shelter, and care when sick; boys' group leaders could be both protectors and aggressors. Most girls had a boyfriend who financially assisted and protected her. Girls frequently were raped by street boys, police, or other men. Children feared routine capture, beating and incarceration by authorities. Former street children were housed in large camps where abuse was common, or costly small residencies. CONCLUSIONS: Street-based services to improve children's health and safety are urgently needed. Re-integration programs may help large numbers of children voluntarily and permanently leave the streets. Advocacy campaigns and collaborative efforts with the police, judiciary and legislature should be intensified. PRACTICE IMPLICATIONS: The paper highlights important challenges facing street children in Khartoum, and provides specific recommendations for how they might be better assisted while on the streets and successfully helped off of the streets through community re-integration, rather than current (1) large-scale beating and incarceration by government authorities, or (2) small-scale and costly residential housing by NGOs. The findings have already been used in a sustained advocacy campaign that has resulted in a number of positive legislative changes for street children, such as parliamentary endorsement of a new bill that improves street children's legal status.