RURAL Development and Land Reform Minister Gugile Nkwinti emphasised during his budget vote speech last week that stability and conformity with the constitution are central to government land reform policy. And as proof of its determination to press on with the process, which has fallen well short of the state’s self-imposed targets, he pointed to five pieces of draft legislation his department intends passing this year….more

Courtesy HIFA2015

(With thanks to HIFA Steering Group member John Liebhardt)

I was interested to read this article on the BBC Media Action website. The full article is freely available here:

http://www.bbc.co.uk/mediaaction/where_we_work/asia/india/india_sdp_overview_august_2012.html

As a personal comment, I am encouraged that the project will include ‘10,000 street theatre performances’ – this is a strong endorsement of the importance and continued relevance of traditional methods of health communication. Also, this combined approach to health communication (including traditional as well as new media) seems likely to be more effective than either approach used alone.

Are any HIFA members working with this project? If so, please do tell us more about it…

‘The Ananya programme, funded by the Bill & Melinda Gates Foundation, aims to reduce child mortality, improve maternal health and reduce infectious diseases in Bihar [India]. As a project partner, BBC Media Action has adopted a pioneering approach to improve the demand and uptake of life-saving family health behaviours amongst the population of 104 million.’

‘Reaching this enormous audience through traditional forms of media is difficult. Only 27% of young mothers have access to any traditional media (TV, radio, newspapers or cinema). But add mobile phones to the mix and access goes up dramatically to 90%.’

‘BBC Media Action has therefore adopted what has been called ‘a 360-degree approach’ ­ a combination of face-to-face communication, Information Communication Technology (ICT), mass media and community work ­ which is being implemented on an unprecedented scale[…]’

‘BBC Media Action has developed two innovative mobile phone services for CHWs: a training course called Mobile Academy, and an on-demand service called Mobile Kunji which is supported by a deck of cards illustrated with life-saving messages…’

‘10,000 street theatre performances and 6000 women’s listener clubs will further engage and inform families about critical family health issues. All these elements focus on the critical 33-month timeline from when a woman becomes pregnant until her child is two years old. The objective is to shift social norms and empower those who lack the information and power to make informed choices about their health.’

‘To implement this project called ?Shaping Demand and Practices, BBC Media Action leads a consortium that includes Pathfinder International, the GSMA Development Fund and Madison World. This consortium works in close partnership with the government of Bihar at all stages.’

Neil, HIFA2015

Thanks to HIFA member Irina Ibraghimova for the July 2014 issue of the AIHA Internet Resources Digest (American International Health Alliance)

This free newsletter contains descriptions of several “free and low-cost apps that help clinicians find evidence-based answers to their questions at a point-of-care”:

• – PubMed for Handhelds
• – LactMed App
• – Medscape
• – Evidence Central
• – 5-Minute Clinical Consult
• – ACP Clinical Guidelines from the American College of Physicians
• – QMDT (Quick Mobile Diagnosis & Treatment)
• – Guideline Central
• – EBM Rater
• – Evidence-based Medicine Toolkit
• – Qx Calculate
• For further details, see http://www.healthconnect-intl.org/resources.html

Which apps have you tried and which do you find most useful?

These apps are (I think) primarily aimed at health professionals in high-income countries. I would be very interested to learn from HIFA members about their applicability in low-resource settings.

Also, the newsletter points to an interesting related article ’10 mobile applications for evidence based medicine’:

“Evidence-based medicine has quickly moved from the background to the forefront as a determiner of treatment pathways, and the mobile health app marketplace has responded in kind. Dozens of EBM apps are available in Apple’s App-Store and Google’s Android Play for smartphones and tablets, many from major medical institutions and most of them free or for a nominal fee. …When doctors are overwhelmed with data points and don’t have the time or bandwidth to read through all the journals and abstracts, these programs can separate the signal from the noise and allow them to focus on the most relevant information, as well as making sure they answer the right questions.”

http://www.mhealthnews.com/slideshow/10-mobile-apps-evidence-based-medicine

Let’s build a future where people are no longer dying for lack of healthcare knowledge: Join HIFA www.hifa2015.org

I’m happy to share a new tool from Pathfinder International that may be of help to programs working in community- and facility-based contraceptive counseling and service provision: Cue Cards for Counseling Adults on Contraception: http://www.pathfinder.org/publications-tools/cue-cards-for-counseling-adults.html. The cue cards were developed to support a range of providers (such as facility-based providers, community health workers, pharmacists, outreach workers, counselors, and peer providers) in counseling adults on their contraceptive options. The cards can be adapted to meet local circumstances and contexts.

The cue cards cover the following methods:

 *   Implants

 *   Male Sterilization

 *   Female Sterilization

 *   Intrauterine Device (IUD)

 *   Lactational Amenorrhea Method (LAM)

 *   DMPA (injectables)

 *   Combined Oral Contraceptives (COCs)

 *   Progestin-Only Pills (POPs)

 *   Standard Days Method (SDM)

 *   Male Condom

 *   Female Condom

 *   Emergency Contraceptive Pills (ECPs)

A French version of the cards will be available in the coming months. I’d also like to remind you that programs targeting adolescents can use Pathfinder’s Cue Cards for Counseling Adolescents on Contraception<http://www.pathfinder.org/publications-tools/cue-cards-for-counseling-adolescents-on-contraception.html> (available in English, French, and Portuguese).

Please share widely and feel free to email me with any questions.

Apologies for cross-posting!

Best,

Olivia

Olivia Moseley

Technical Advisor for Instructional Design, Technical Services Unit

omoseley@pathfinder.org<mailto:omoseley@pathfinder.org> | skype: pathfinder.olivia.moseley

Tel: +1.617.972.1361

‘Closure of the quality gap through the provision of effective care for all women and newborn babies delivering in facilities could prevent an estimated 113 000 maternal deaths, 531 000 stillbirths, and 1·325 million neonatal deaths annually by 2020 at an estimated running cost of US$4·5 billion per year (US$0·9 per person)’. This is one of the central messages of a 24-page paper in the Newborn Series in the current issue of The Lancet (26 July). Below is the citation and summary. The full text is freely available here (after free registration):

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60792-3/abstract

As a personal comment, it seems likely that many of the basic interventions listed by the authors are often locally available but are not provided in a timely manner for those who subsequently die. The reasons for failure to provide locally available interventions include deficits in basic healthcare knowledge among citizens and health workers. I would be interested to learn more about the gap between local availability of interventions and their actual implementation.

CITATION: Bhutta Z A et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? The Lancet, Volume 384, Issue 9940, Pages 347 – 370, 26 July 2014 doi:10.1016/S0140-6736(14)60792-3

SUMMARY: ‘Progress in newborn survival has been slow, and even more so for reductions in stillbirths. To meet Every Newborn targets of ten or fewer neonatal deaths and ten or fewer stillbirths per 1000 births in every country by 2035 will necessitate accelerated scale-up of the most effective care targeting major causes of newborn deaths. We have systematically reviewed interventions across the continuum of care and various delivery platforms, and then modelled the effect and cost of scale-up in the 75 high-burden Countdown countries. Closure of the quality gap through the provision of effective care for all women and newborn babies delivering in facilities could prevent an estimated 113 000 maternal deaths, 531 000 stillbirths, and 1·325 million neonatal deaths annually by 2020 at an estimated running cost of US$4·5 billion per year (US$0·9 per person). Increased coverage and quality of preconception, antenatal, intrapartum, and postnatal interventions by 2025 could avert 71% of neonatal deaths (1·9 million [range 1·6—2·1 million]), 33% of stillbirths (0·82 million [0·60—0·93 million]), and 54% of maternal deaths (0·16 million [0·14—0·17 million]) per year. These reductions can be achieved at an annual incremental running cost of US$5·65 billion (US$1·15 per person), which amounts to US$1928 for each life saved, including stillbirths, neonatal, and maternal deaths. Most (82%) of this effect is attributable to facility-based care which, although more expensive than community-based strategies, improves the likelihood of survival. Most of the running costs are also for facility-based care (US$3·66 billion or 64%), even without the cost of new hospitals and country-specific capital inputs being factored in. The maximum effect on neonatal deaths is through interventions delivered during labour and birth, including for obstetric complications (41%), followed by care of small and ill newborn babies (30%). To meet the unmet need for family planning with modern contraceptives would be synergistic, and would contribute to around a halving of births and therefore deaths. Our analysis also indicates that available interventions can reduce the three most common cause of neonatal mortality—preterm, intrapartum, and infection-related deaths—by 58%, 79%, and 84%, respectively.’

Neil, HIFA2015

Below are selected new WHO publications (with thanks to WHO Press). All are available for free download at the URLs shown.

WHO Guidelines for Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention

This guideline provides recommendations for strategies for a screen-and-treat programme. It is intended primarily for policy-makers, managers, programme officers, and other professionals in the health sector who have responsibility for choosing strategies for cervical cancer prevention, at country, regional and district levels.

http://apps.who.int/iris/bitstream/10665/94830/1/9789241548694_eng.pdf

WHO Recommendations for Augmentation of Labour

The goal of the present guideline is to consolidate the guidance for effective interventions that are needed to reduce the global burden of prolonged labour and its consequences. The primary target audience includes health professionals responsible for developing national and local health protocols and policies, as well as obstetricians, midwives, nurses, general medical practitioners, managers of maternal and child health programmes, and public health policy-makers in all settings.

http://whqlibdoc.who.int/publications/2011/9789241501156_eng.pdf

Clinical Practice Handbook for Safe Abortion

This handbook is oriented to providers who already have the requisite skills and training necessary to provide safe abortion and/or treat complications of unsafe abortion.

http://apps.who.int/iris/bitstream/10665/97415/1/9789241548717_eng.pdf

Psychological First Aid: Facilitator’s Manual for Orienting Field Workers

The instructions and materials in this manual are for a half-day orientation (4 hours excluding breaks) to prepare helpers to support people recently affected by very stressful events. This facilitator’s manual is to be used together with the Psychological First Aid: Guide for Field Workers.

http://apps.who.int/iris/bitstream/10665/102380/1/9789241548618_eng.pdf

eHealth and innovation in women’s and children’s health: a baseline review

This report shows how, on a daily basis, eHealth innovations are improving access to care and assisting women to take control of their own health. Advances such as these are providing pregnant women, mothers and young children with better health care services and advice.

http://www.who.int/goe/publications/baseline/en/

Atlas of eHealth Country Profiles 2013: eHealth and Innovation in Women’s and Children’s Health

This publication is based on the 2013 WHO/ITU joint survey that explored the use of eHealth for women’s and children’s health in countries that are covered by the Commission on Information and Accountability for Women’s and Children’s Health (CoIA).

http://www.who.int/goe/publications/atlas_2013/en/

Best wishes,

Neil

An account controlled by a senior provincial health department official reflects payments that were clearly made for election-related items…..1 2 3

About 100 protestors took to the streets yesterday to demand the expansion of Daveyton Main Clinic and an end to recurring HIV drug stock outs. The protest is the second in two years….more

SOUTH Africa’s biggest generic drug manufacturer, Aspen Pharmacare, is sitting with millions of packs of unsold AIDS drugs as provinces drag their heels in ordering the new three-in-one pills the government switched to last April….more

South African scientists may be en route to developing shorter, better tuberculosis (TB) treatment, according to research released at the International AIDS Conference in Melbourne, Australia. Researchers from the universities of Cape Town, Stellenbosch and the Free State were part of the international team that recently discovered that a new combination of drugs was able to kill more TB bacteria more quickly than standard treatment…..more

Xolela Mangcu has a plan to transform SA’s professoriate. Universities are arguably the most influential institutions in any society. Governments, businesses, newspapers, television and radio networks are run by university graduates. Universities produce the theories, ideas, technologies and products upon which the modern world is built…..more

DA Parliamentary leader Mmusi Maimane has dared President Jacob Zuma to show leadership or step aside. In a speech marked by loud howls and heckling from ANC benches, Maimane advised Zuma to take the lead on critical issues facing the country such as labour unrest, the crisis at the SABC, unemployment and to encourage respect for institutions of state such as the Public Protector and the National Prosecuting Authority….1 2

The BNF is actually available for free online in HINARI countries [*] BNF.org provides free access for users in the UK and the HINARI group of developing nations to the British National Formulary and BNF for Children on Medicines Complete http://www.bnf.org/bnf/org_450070.htm

A new paper in Health Policy and Planning seeks to evaluate the quality of VCT services and reveals ‘serious underperformance in counselling about key risk-reduction methods’. ‘In a generalized HIV epidemic where multiple concurrent sexual partners are a significant problem for transmitting the disease, risk-reduction methods and discussion should be a main focus of pre-test and post-test counselling.’ CITATION: Levey IR & Wang W. Unravelling the quality of HIV counselling and testing services in the private and public sectors in Zambia. Health Policy Plan. (2014) 29 (suppl 1): i30-i37. doi: 10.1093/heapol/czt036

ABSTRACT

Background: Despite the substantial investment for providing HIV counselling and testing (VCT) services in Zambia, there has been little effort to systematically evaluate the quality of VCT services provided by various types of health providers. This study, conducted in 2009, examines VCT in the public and private sectors including private for-profit and NGO/faith-based sectors in Copperbelt and Luapula.

Methods: The study used five primary data collection methods to gauge quality of VCT services: closed-ended client interviews with clients exiting VCT sites; open-ended client interviews; interviews with facility managers; review of service statistics; and an observation of the physical environment for VCT by site. Over 400 clients and 87 facility managers were interviewed from almost 90 facilities. Sites were randomly selected and results are generalizable at the provincial level.

Results: The study shows concerning levels of underperformance in VCT services across the sectors. It reveals serious underperformance in counselling about key risk-reduction methods. Less than one-third of clients received counselling on reducing number of sexual partners and only approximately 5% of clients received counselling about disclosing test results to partners. In terms of client profiles, the NGO sector attracts the most educated clients and less educated Zambians seek VCT services at very low rates (7%). The private for-profit performs equally or sometimes better than other sectors even though this sector is not adequately integrated into the Zambian national response to HIV.

Conclusion: The private for-profit sector provides VCT services on par in quality with the other sectors. Most clients did not receive counselling on partner reduction or disclosure of HIV test results to partners. In a generalized HIV epidemic where multiple concurrent sexual partners are a significant problem for transmitting the disease, risk-reduction methods and discussion should be a main focus of pre-test and post-test counselling.

Best wishes, Neil