Valuing Health Systems: A framework for low and middle income countries
Collins, Charles and Andrew Green. New Delhi: Sage Publications, 2014.
In developing and middle-income countries, reforms of health care financing, governance, management and planning over the years too often have failed to result in real improvements in the health of the people, Collins and Green contend. They suggest that longer-term perspectives and consequent actions, reflecting the input of a wider array of system stakeholders, are far more likely to bring about the real change that health systems need.
Guest post by Bridgit Adamou, Research Associate for MEASURE Evaluation
The Triangle Global Health Consortium recently held its inaugural conference in Chapel Hill, NC. The theme of the conference, Innovation in Global Health: Bridging the Innovation Gap between Research and Implementation, brought together individuals representing the pharmaceutical and biotechnology industries, the international health development NGO community, and academia. It was inspiring to hear from such accomplished professionals working right here in the Triangle about their research and experiences studying and addressing current and emerging issues in infectious and non-communicable diseases.
I attended a morning session on innovations in research, strategy, and technology where presenters discussed the global burden of disease caused by diabetes, cardiovascular disease, and cancer, as well as the economic burden of global non-communicable diseases. I was struck by the statistic that by 2030, two thirds of all diabetes cases will occur in low- to middle-income countries, with over a 100% increase in diabetes prevalence in Africa. Globally, cancer takes more lives than malaria, AIDS, and tuberculosis combined, yet cancer prevention and treatment programs in developing countries continue to be largely neglected and underfunded.
In an afternoon session on innovations in implementation, execution and delivery in the context of HIV/AIDS and other infectious diseases, one speaker gave a thoughtful presentation on how stigma and discrimination continues to discount our HIV/AIDS investments by impeding HIV testing, eroding linkages and timely entry to care, compromises adherence to treatment protocols, undermines prevention efforts, weakens health systems, and impedes scientific discovery. Another speaker discussed biomedical HIV prevention research and its impact on HIV/AIDS priorities and programming.
There was a bit of serendipity that the conference was held just across the street from the MEASURE Evaluation office. But as a large project with a long legacy in addressing complex global health issues through research, innovation, and key partnerships, MEASURE Evaluation has demonstrated leadership in global health innovation in the Triangle, and strives to continue to build on that reputation in the next phase of the project.
This guide is part of a set of tools for measuring quantitative child outcomes and caregiver/household outcomes in programs for orphans and vulnerable children (OVC). The purpose of the guide is to standardize data management procedures; outline the steps for database design; describe best practices in data entry and data cleaning; identify where data-related missteps can occur; and highlight the importance of proactive data management.
The Mayer Hashi (MH) project covered 21 low-performing districts of Bangladesh to improve access, quality, and use of long-acting and permanent methods (LAPM) of contraception and selective maternal health services. This evaluation report focuses on the LAPM activities.
Under a “before-after and intervention-comparison” evaluation framework, six districts from the MH program districts and three otherwise comparable districts from non-program districts were selected. The evaluation design permits a difference-in-difference (DID) analysis of the project impact. Endline surveys were conducted among 5,864 currently married women of reproductive ages (CMWRA) and 627 service providers during February-May 2013. Baseline data on 32,018 CMWRA were taken from the 2010 Bangladesh Maternal Mortality Survey (BMMS) (conducted during January-August 2010) for the nine selected districts: Barisal, Patuakhali, Cox’s Bazar, Comilla, Moulovibazar, and Sunamganj are program districts; and Kishoreganj, Mymensingh, and Narsingdi are non-program districts.
This study investigated the distribution and determinants of HIV risks among married couples in North India. Gender inequality emerged as a potential driver of HIV risks in this region. Data collection took place in 2003 in a probability survey of 3385 couples living in India’s most populous state – Uttar Pradesh – and Uttaranchal.
Couples’ analyses utilizing generalized estimating equations showed that compared with husbands, wives were less knowledgeable about HIV (OR = 0.31, 95% CI = 0.27–0.36), more likely to consider themselves at risk for infection (OR = 6.86, 95% CI = 4.65–10.13), and less likely to feel that a wife had the right to refuse sex with her husband (OR = 0.50, 95% CI = 0.44–0.58). The proportion of husbands reporting non-marital sex in the past year was 7.1% and transactional sex in the past year, 2.2%. Among their wives, 73.4% were unaware of their husbands’ non-marital sexual behaviors and only 28.9% of husbands reported condom use during their last non-marital sexual encounter.
Logistic regression analyses showed that husbands’ alcohol use, husbands’ mobility, and urban residence were positively associated with husbands’ non-marital sexual behaviors adjusting for other covariates. The data demonstrate that HIV prevention programs among couples in North India should consider both sexual risks and gender inequalities which potentially fuel HIV spread in this region.
This study seeks to facilitate the improvement of voluntary counseling and testing (VCT) and other services for men who have sex with men (MSM) and transgender (TG) people through more efficient delivery of services, reducing duplication of efforts, and comprehensively addressing clients’ needs. The study aims to understand the extent to which organizations and actors providing VCT and other support and services to MSM and TG people in Chiang Mai, Thailand are aware of each other and the services they provide; and how these organizations coordinate, collaborate and/or share information, resources, and clients.
This evaluation was conducted as a mid-point assessment by MEASURE Evaluation and the University of Ghana School of Public Health, in collaboration with the Ghana AIDS Commission, in order to describe the achievements and challenges of the ongoing implementation of the National HIV Prevention Program for female sex workers (FSW) and men who have sex with men (MSM) in Ghana.
Study findings suggest that while some greater capacity building and standardization could improve data collection and reporting and standardize service availability, organizations are striving to adhere to the service package and to provide a high quality product. This effort has resulted in high demand for services and a positive reputation for respectful treatment and confidentiality among FSW and MSM. Overall, recommendations focus on the ways in which the program can continue to be strengthened and expanded to better meet demand for services without sacrificing the reputation for service quality upon which that demand is predicated.