Community and health systems barriers and enablers to family planning and contraceptive services provision and use in Kabwe District, Zambia.

BACKGROUND: Unmet need for contraception results in several health challenges such as unintended pregnancies, unwanted births and unsafe abortions. Most interventions have been unable to successfully address this unmet need due to various community and health system level factors. Identifying these inhibiting and enabling factors prior to implementation of interventions forms the basis for planning efforts to increase met needs. This qualitative study was part of the formative phase of a larger research project that aimed to develop an intervention to increase met needs for contraception through community and health system participation. The specific study component reported here explores barriers and enablers to family planning and contraceptive services provision and utilisation at community and health systems levels. METHODS: Twelve focus group discussions were conducted with community members (n = 114) and two with healthcare providers (n = 19). Ten in-depth interviews were held with key stakeholders. The study was conducted in Kabwe district, Zambia. Interviews/discussions were translated and transcribed verbatim. Data were coded and organised using NVivo 10 (QSR international), and were analysed using thematic analysis. RESULTS: Health systems barriers include long distances to healthcare facilities, stock-outs of preferred methods, lack of policies facilitating contraceptive provision in schools, and undesirable provider attitudes. Community level barriers comprise women's experience with contraceptive side effects, myths, rumours and misconceptions, societal stigma, and negative traditional and religious beliefs. On the other hand, health systems enablers consist of political will from government to expand contraceptive services access, integration of contraceptive services, provision of couples counselling, and availability of personnel to offer basic methods mix. Functional community health system structures, community desire to delay pregnancy, and knowledge of contraceptive services are enablers at a community level. CONCLUSIONS: These study findings highlight key community and health systems factors that should be considered by policy, program planners and implementers in the design and implementation of family planning and contraceptive services programmes, to ensure sustained uptake and increased met needs for contraceptive methods and services.

Combining Global Elimination Of Measles And Rubella With Strengthening Of Health Systems In Developing Countries.

Global efforts to eliminate measles and rubella can be combined with other actions to accelerate the strengthening of health systems in developing countries. However, there are several challenges standing in the way of successfully combining measles and rubella vaccination campaigns with health systems strengthening. Those challenges include the following: achieving universal vaccine coverage while integrating the initiative with other primary care strategies and developing the necessary health system resilience to confront emergencies, ensuring epidemiological and laboratory surveillance of vaccine-preventable diseases, developing the human resources needed to effectively manage and implement national strategies, increasing community demand for health services, and obtaining long-term political support. We describe lessons learned from the successful elimination of measles and rubella in the Americas and elsewhere that strive to strengthen national health systems to both improve vaccine uptake and confront emerging threats. The elimination of measles and rubella provides opportunities for nations to strengthen health systems and thus to both reduce inequities and ensure national health security.

Avaliação do Impacto do Programa Mãe Coruja Pernambucana nas taxas de mortalidade infantil e materna em Pernambuco / Evaluation of the Impact of the Mother Owl Program in the rates of infant and maternal mortality in Pernambuco

As taxas de mortalidade infantil e materna são indicadores em saúde pública utilizados em todo mundo. Como forma de diminuir a mortalidade em Pernambuco foi instituído o Programa Mãe Coruja Pernambucana (PMCP) a partir de 2007 em 102 municípios do estado, com proposta de redução das taxas de morbimortalidade materna e infantil. Apesar da importância desse programa, poucos estudos avaliaram o PMCP sobre o aspecto econométrico na redução dessas taxas. O presente estudo avaliou o impacto do PMCP na redução das taxas de mortalidade infantil e materna e no aumento da proporção de gestantes com consultas pré-natal no Estado de Pernambuco entre 2007-2012. Foram utilizados os dados de todas as unidades, com e sem o PMCP, com período de observação antes e depois da intervenção, calculando-se a diferença entre os períodos de tempo para cada unidade observada e a diferença entre as unidades para cada período de tempo. Esses dados foram analisados através do método diferenças-em-diferenças (DID). Os resultados encontrados mostraram que o PMCP teve um impacto positivo sobre as taxas de mortalidade infantil e a proporção de consultas pré-natal. Com o decorrer do tempo o efeito positivo sobre as taxas foi melhorando e no sexto ano de permanência no programa os municípios avaliados apresentaram uma queda de aproximadamente 23,32% na taxa de mortalidade infantil e aumento de 96,06% sobre a proporção de consultas pré-natal, quando comparados aos municípios sem o PMCP. Não houve impacto do PMCP sobre a redução da mortalidade materna nos municípios que fizeram adesão ao mesmo. Os resultados se mostraram robustos a um conjunto de hipóteses que poderiam influenciar o efeito estimado, sendo a interpretação de causalidade reforçada por este modelo. O PMCP contribuiu positivamente sobre as taxas de mortalidade infantil e na proporção de consultas pré-natal, nos municípios pernambucanos, sendo este o primeiro trabalho a analisar econometricamente os efeitos desse programa.(AU)

Child and maternal mortality rates are public health indicators used in worldwide. As a way to reduce mortality was instituted in 2007 the Pernambuco Mother Owl Program (PMOP) in 102 municipalities of the state, with a proposal to reduce maternal and child morbidity and mortality rates. Despite the importance of this program, few studies have evaluated PMOP by econometric aspect aiming reducing these rates. The present study evaluated the PMOP impact to reduce the child and maternal mortality rates and pregnant women proportion with antenatal care in Pernambuco between 2007-2012. Data from all units, with and without PMOP, before and after the intervention, were used to calculate the difference between time periods for each unit observed and difference between the units for each time period. These data were analyzed using the differences-in-differences (DID) method. The results demonstred that PMOP had a positive impact on childt mortality rates and antenatal care proportion. Positive effect on rates was improving over time and on year six of program, the municipalities evaluated presented a drop of approximately 23.32% in the infant mortality rate and 96.06% increase in the antenatal care proportion, when compared to municipalities without PMOP. There was no impact of PMOP on maternal mortality in municipalities that adhered to it. The results were robust to a set of hypotheses that could influence the estimated effect, being causality interpretation reinforced by this model. PMOP contributed positively to child mortality rates and antenatal care proportion on Pernambuco municipalities, which is the first study to analyze econometrically the effects of PMOP.(AU)

What can volunteer co-providers contribute to health systems? The role of people living with HIV in the Thai paediatric HIV programme.

In Thailand people living with HIV (PLHIV) have played a major role in shaping policy and practice. They have acted as volunteer co-providers, although their potential in terms of paediatric service provision has seldom been explored from a health systems perspective. We describe the Thai paediatric HIV care system and use both demand- and supply-side perspectives to explore the impact, opportunities and challenges of PLHIV acting as volunteer co-providers. We employed qualitative methods to assess experiences and perceptions and triangulate stakeholder perspectives. Data were collected in Khon Kaen province, in the poorest Northeastern region of Thailand: three focus group discussions and two workshops (total participants n = 31) with co-providers and hospital staff; interviews with ART service-users (n = 35). Nationally, key informant interviews were conducted with policy actors (n = 20). Volunteer co-providers were found to be ideally placed to broker the link between clinic and communities for HIV infected children and played an important part in the vital psychosocial support component of HIV care. As co-providers they were recognized as having multiple roles linking and delivering services in clinics and communities. Clear emerging needs include strengthened coordination and training as well as strategies to support funding. Using motivated volunteers with a shared HIV status as co-providers for specific clinical services can contribute to strengthening health systems in Asia; they are critical players in delivering care (supply side) and being responsive to service-users needs (demand side). Co-providers blur the boundaries between these two spheres. Sustaining and optimising co-providers' contribution to health systems strengthening requires a health systems approach. Our findings help to guide policy makers and service providers on how to balance clinical priorities with psycho-social responsiveness and on how best to integrate the views and experience of volunteers into a holistic model of care.

Is something better than nothing? An evaluation of early childhood programs in Cambodia.

This study evaluated the relative effectiveness of home-based, community-based, and state-run early childhood programs across Cambodia. A total of 880 five-year-olds (55% girls) from 6 rural provinces in Cambodia attending State Preschools, Community Preschools, Home-Based Programs, or no programs were assessed twice using the Cambodian Developmental Assessment Test. Controlling for baseline differences, children who participated in any early childhood programs performed significantly better in posttest than those of children who did not participate in any programs. Children in State Preschools scored significantly higher than those in either Community Preschools or Home-Based Programs; scores did not differ as a function of attending Community Preschools or Home-Based Programs. The results indicate that some preschool experience is better than none at all.

The equine antitoxins supply system for biological poisons in Japan.

Recently, the equine antitoxin supply in Japan has sharply decreased; then it is apparent that a stable supply produced solely by private industry cannot be relied upon. The Ministry of Health, Labor and Welfare (MHLW), therefore, purchases vaccines and equine antitoxins from manufacturers who could not otherwise independently provide an adequate antitoxin supply to hospitals. This supply system is called the 'Kokuyu vaccine system.' Under this system, MHLW purchases, stores and distributes vaccines and antitoxins to hospitals. This system has worked efficiently and effectively so far and may be a good model for establishing a stable antitoxin supply system in other countries.

[Determinations in the applications for a medical rehabilitation--screening of blue color workers in the statutory pension insurance in Schleswig-Holstein]. / Determinanten der Antragstellung auf eine medizinische Rehabilitation--Ergebnisse einer Befragung von Versicherten der LVA Schleswig-Holstein.

During the first 6 months of 1997 the number of applications for medical rehabilitation measures dropped markedly by 50% compared with the number in the previous year. To clarify the reasons for this decline the regional statutory pension fund of blue collar workers in Schleswig-Holstein (LVA) and the Institute for Social Medicine, Medical University Lübeck initiated a survey among 4400 blue collar workers (2% of the LVA population aged of 40-59 years). Between November 1997 and January 1998 a postal survey inquired of the perceived need for rehabilitation and various criteria influencing the decision to apply for such a measure. After two months the response rate was 64%. A quarter of the workers answering considered themselves in need of rehabilitation. Of those 41% intended to file an application, 34% intended not to do so and 25% were undecided. The main reasons for supporting an application were encouragement by the GP and family members as well as the hope to improve working capacity. The decision against applying for rehabilitation was evoked by consequences of the recent legislation (WFG), job uncertainty and the public debate about the rehabilitation system in Germany.

Feast or famine? Supplemental food programs and their impacts on two American Indian communities in California.

This article examines the use of supplemental food programs by two Native American populations and assesses some of the health and cultural impacts of these programs. A cross-sectional survey of 80 American Indian families, 40 families residing on the Round Valley Indian Reservation and 40 in Sacramento, California was conducted to determine access, use and appropriateness of supplemental feeding programs. Respondents at both the rural and urban geographic location showed considerable familiarity with available supplemental feeding programs. USDA Food Commodities were utilized most at Round Valley, raising the concern that provided staples which were highly processed and contained significant amounts of sodium, sucrose, and fat, could contribute to the problems of obesity and diabetes. Native Americans in Sacramento used food banks and food closets as their primary source of supplemental foods, and some expressed concern that the foods provided were highly sweetened and high in fat. While some nutrition advising was available at both geographical localities, access was inadequate. The study found that the foods provided by the supplemental food programs varied considerably in their nutritional quality and healthier foods such as fresh fruits, vegetables, and meats were either completely lacking or in short supply. In addition, culturally sensitive nutritional counseling and the development of education modules to instruct program recipients in the preparation of healthy meals and how to manage obesity and diabetes were needed and requested within the California Native American communities surveyed.

The role of the aedes aegypti surveillance and control in relation to the epidemiology, prevention and control of Dengue Fever in Jamaica

The control of dengue fever depends on the level of Aedes aegypti infestation and thus relies heavily on the measures for controlling the vector. Quite recently, despite the implementation of mosquito control measures, the Aedes aegypti population has still escalated. The vector apparently has adapted to or resisted most of the control methods. The failure of Aedes aegypti control programmes has been blamed on the vector's biological features fostering the development of species resistance to chemical control or environmental factors favouring the increase of the Aedes aegypti' population at a faster rate than the control methods can reduce them. Nevertheless, many Aedes aegypti control programmes are improperly planned and implemented or the control measures are often used as reactive methods of controlling dengue fever outbreaks, rather than as continuous proactive strategies preventing disease. Aedes aegypti breeding is basically a problem of domestic sanitation and therefore communities have an essential role to play in source reduction activities. The activities of some governmental departments, non governmental organizations and the private sector may encourage the increase of Aedes aegypti mosquitoes or play a positive role in vector control. Consequently, intra sectoral and intersectoral in vector control are very important. This study examined the control measures applied by the Jamaican Ministry of Health, Vector Control Department and the community for Aedes aegypti surveillance and control, and determined the effectiveness of and obstacles to the mosquito control activities presently being applied. The aim of the study was achieved through the execution of an entomology survey, an environmental survey, an insecticide susceptibility test, key informant interviews with vector control staff from the Ministry of Health and the administration of a Knowledge-Attitude-pracitce survey. The research results showed that the environmental conditions in the study area were conducive to Aedes aegypti breeding and proliferation, especially during the months of July to October. Aedes aegypti mosquitoes were present throughout the study area, with a higher density of Aedes aegypti larvae in Tavern and Gordon Town. Aedes aegypti larvae collected from Mona and Hermitage were highly susceptible to a 1 percent abate larvicide.(Au)

Aplicaçäo de métodos odontológicos preventivos e curativos nas crianças de faixa etária de 6 a 12 anos, residentes e domiciliadas na área rural do município de Cansançäo - Bahia / Use of preventives and curative oral methods in 6 to 12 years old children residing and living in rural area in Cansançäo municipality Bahia

A preservaçäo da saúde bucal da populaçäo brasileira, particularmente daqueles indivíduos de baixo poder aquisitivo, residentes nas áreas rurais e nas periferias dos grandes centros urbanos, em que pese ser um dever do Estado, em realidade os encaminhamentos de soluçöes passam por açöoes conjuntas envolvendo o governo federal, estadual e municipal, os setores organizados da populaçäo e os cidadäos em geral. A implementaçäo de programas de prevençäo odontológica, onde säo destacados os hábitos de higiene bucal e uso do flúor säo extremamente eficazes e de baixo custo, entretanto, o êxito maior é atingido, se estes programas estiverem inseridos dentro de uma proposta de valorizaçäo de cidadania fundamentada numa metodologia participativa. Estes säo os princípios norteadores do projeto em tela denominado: " Aplicaçäo de métodos odontológicos preventivos e curativos nas crianças de faixa etária de 6 a 12 anos, residentes e domiciliadas na área rural do município de Cansançäo, Bahia", resultante do convênio estabelecido entre o Governo do Estado da Bahia/SESAB, através do Projeto Nordeste e a UFBA. As açöes preventivas realizadas ao longo de 21 meses concomitantemente às açöes reparadoras desencadeadas durante 9 meses, aliadas à educaçäo sanitária revelaram-se extremamente valiosas para as crianças e os familiares destas, envolvidos com o projeto, direta ou indiretamente, devido ao significativo alcance social desta proposta, revelado tanto na formaçäo da consciência crítica observada, quanto pelo quantitativo de eventos implementados. Assumindo as suas obrigaçöes enquanto instituiçäo produtora e transmissora do conhecimento científico, a Universidade Federal da Bahia, através do grupo de trabalho executor do projeto em pauta, coloca os resultados desta proposta alternativa à disposiçäo dos setores organizados da comunidade, em particular o Estado, responsável que é pelo SUS, visando contribuir metodologicamente para a preservaçäo da saúde pública bucal, fundamentados em bases acadêmicas, no baixo custeio e na formaçäo de cidadäos representados, tanto pelo público atingido pelas açöes odontológicas desencadeadas, como também pelos acadêmicos de odontologia integrados ao projeto. Há que se considerar que o tempo de realizaçäo do projeto - 21 meses - näo foi suficiente para executar os tratamentos reparadores ...

Municipalizaçäo da saúde: Casa Branca - SP / Health municipalization: Casa Branca city (Säo Paulo)

Discorre sobre a questäo da municipalizaçäo. Avalia os ganhos sociais conseguidos, no Estado de Säo Paulo, com a descentralizaçäo e a hierarquizaçäo dos serviços de saúde onde cita a humanizaçäo e a universalizaççäo do atendimento médico ambulatorial, hospitalar e laboratorial à populaçäo carente do Estado. Traz dados sobre o SUDS/R-55. Apresenta e detalha o Programa de Saúde Bucal, no município de Casa Branca (Säo Paulo). (NMPM)