RESUMEN
In 2015, a global learning agenda for the hormonal intrauterine device (IUD) was developed with priority research questions regarding use of the method in low- and middle-income countries. In addition, members of the Hormonal IUD Access Group aligned on a strategy to expand access in the context of volunteerism and contraceptive method choice. This article synthesizes evidence generated since then and describes steps taken to address demand- and supply-side barriers to access. Findings demonstrated high continuation rates and satisfaction among hormonal IUD users that are comparable to other long-acting reversible contraceptives (LARCs). Across studies, a sizable number of users reported they would have chosen a short-acting method or no method at all if the hormonal IUD were not an option, which suggests that women did not see the hormonal IUD as interchangeable with other LARC options and thus it may fill an important niche in the market. With several countries now poised to scale up the method, resource mobilization will be key. On the demand side, investments in implementation research will be critical to understanding how best to launch and scale the method, while ensuring the sustainability of multiple quality-assured suppliers with affordable public-sector pricing will be necessary on the supply side.
Asunto(s)
Anticonceptivos Femeninos , Prácticas Interdisciplinarias , Dispositivos Intrauterinos , Femenino , Humanos , Anticoncepción/métodosAsunto(s)
Anticonceptivos Femeninos , Accesibilidad a los Servicios de Salud/organización & administración , Internacionalidad , Dispositivos Intrauterinos Medicados , Aprendizaje , Levonorgestrel , Necesidades y Demandas de Servicios de Salud , Humanos , Dispositivos Intrauterinos Medicados/economíaAsunto(s)
Servicios de Salud Comunitaria/economía , Servicios de Planificación Familiar/economía , Servicios de Salud Materna/economía , Bienestar Social/economía , Servicios de Salud Comunitaria/organización & administración , Países en Desarrollo , Servicios de Planificación Familiar/organización & administración , Femenino , Educación en Salud , Accesibilidad a los Servicios de Salud/economía , Humanos , Masculino , Servicios de Salud Materna/organización & administración , Pobreza , Salud Reproductiva/economía , Bienestar Social/estadística & datos numéricosRESUMEN
Community case management (CCM) as applied to child survival is a strategy that enables trained community health workers or volunteers to assess, classify, treat and refer sick children who reside beyond the reach of fixed health facilities. The Nicaraguan Ministry of Health (MOH) and Save the Children trained and supported brigadistas (community health volunteers) in CCM to improve equitable access to treatment for pneumonia, diarrhoea and dysentery for children in remote areas. In this article, we examine the policy landscape and processes that influenced the adoption and implementation of CCM in Nicaragua. Contextual factors in the policy landscape that facilitated CCM included an international technical consensus supporting the strategy; the role of government in health care provision and commitment to reaching the poor; a history of community participation; the existence of community-based child survival strategies; the decentralization of implementation authority; internal MOH champions; and a credible catalyst organization. Challenges included scepticism about community-level cadres; resistance from health personnel; operational gaps in treatment norms and materials to support the strategy; resource constraints affecting service delivery; tensions around decentralization; and changes in administration. In order to capitalize on the opportunities and overcome the challenges that characterized the policy landscape, stakeholders pursued various efforts to support CCM including sparking interest, framing issues, monitoring and communicating results, ensuring support and cohesion among health personnel, supporting local adaptation, assuring credibility and ownership, joint problem solving, addressing sustainability and fostering learning. While delineated as separate efforts, these policy and implementation processes were dynamic and interactive in nature, balancing various tensions. Our qualitative analysis highlights the importance of supporting routine monitoring and documentation of these strategic operational policy and management issues vital for CCM success. We also demonstrate that while challenges to CCM adoption and implementation exist, they are not insurmountable.
Asunto(s)
Manejo de Caso , Difusión de Innovaciones , Servicios de Salud del Niño , Preescolar , Redes Comunitarias , Política de Salud , Accesibilidad a los Servicios de Salud , Experimentación Humana , Humanos , Lactante , Nicaragua , Desarrollo de ProgramaRESUMEN
It is well understood that undernutrition underpins much of child morbidity and mortality in less developed countries, but the causes of undernutrition are complex and interrelated, requiring a multipronged approach for intervention. This paper uses a subsample of 3853 children under age 5 from the most recent family health survey in El Salvador to examine the relationship between birth spacing and childhood undernutrition (stunting and underweight). While recent research and guidance suggest that birth spacing of three to five years contributes to lower levels of infant and childhood mortality, little attention has been given to the possibility that short birth intervals have longer-term effects on childhood nutrition status. The analysis controls for clustering effects arising from siblings being included in the subsample, as well as variables that are associated with household resources, household structure, reproductive history and outcomes, and household social environment. The results of the multiple regression analyses find that in comparison to intervals of 36-59 months, birth intervals of less than 24 months and intervals of 24-35 months significantly increase the odds of stunting (<24 months Odds Ratio (OR) = 1.52; 95% confidence interval (CI): 1.21-1.92; 25-36 months OR = 1.30; 95% CI: 1.05-1.64). Other factors related to stunting and underweight include standard of living index quintile, child's age, mother's education, low birthweight, use of prenatal care, and region of the country where the child lives. Policy and program implications include more effective use of health services and outreach programs to counsel mothers on family planning, breastfeeding, and well child care.
Asunto(s)
Intervalo entre Nacimientos , Trastornos de la Nutrición del Niño/epidemiología , Fenómenos Fisiológicos Nutricionales Infantiles/fisiología , Servicios de Planificación Familiar/organización & administración , Encuestas Epidemiológicas , Antropometría , Lactancia Materna , Niño , Mortalidad del Niño , Trastornos de la Nutrición del Niño/etiología , Trastornos de la Nutrición del Niño/prevención & control , Protección a la Infancia , Preescolar , El Salvador/epidemiología , Femenino , Promoción de la Salud/métodos , Indicadores de Salud , Humanos , Lactante , Mortalidad Infantil , Trastornos de la Nutrición del Lactante/epidemiología , Trastornos de la Nutrición del Lactante/etiología , Trastornos de la Nutrición del Lactante/prevención & control , Fenómenos Fisiológicos Nutricionales del Lactante/fisiología , Recién Nacido , Masculino , Estado Nutricional , Oportunidad Relativa , Embarazo , Factores de Riesgo , Factores Socioeconómicos , Factores de TiempoRESUMEN
While social factors broadly determine health outcomes, strategic health workforce innovations such as community case management (CCM) can redress social inequalities in access to health care. Community case management enables trained health workers to assess children, diagnose common childhood infections, administer medicines, and monitor life-saving treatment in the poor, remote communities where they reside. This article reports on research that combined focus group discussions and key informant interviews to examine the perceptions of multiple stakeholders, with monitoring data, in order to assess programmatic results, limitations, and lessons learned in implementing CCM in Nicaragua. We found that CCM increases the use of curative services by poor children with pneumonia, diarrhea, or dysentery by five to six-fold over facility-based services. Apart from dramatically increasing geographic access to treatment for underserved groups, our qualitative research suggests that Nicaragua's CCM model also addresses the managerial challenges and social relations that underpin good quality of care, care-giver knowledge and awareness, and community mobilization, all health system-strengthening factors that are central to equitably and effectively improving child health. While our findings are promising, we suggest areas for further operational research to strengthen CCM program learning and functioning.
Asunto(s)
Manejo de Caso/organización & administración , Servicios de Salud del Niño/organización & administración , Servicios de Salud Comunitaria/organización & administración , Área sin Atención Médica , Servicios de Salud Rural/organización & administración , Actitud Frente a la Salud , Servicios de Salud del Niño/estadística & datos numéricos , Preescolar , Femenino , Grupos Focales , Accesibilidad a los Servicios de Salud , Humanos , Lactante , Entrevistas como Asunto , Masculino , Nicaragua , Cooperación del Paciente , Investigación CualitativaAsunto(s)
Anticoncepción/economía , Política de Planificación Familiar , Servicios de Planificación Familiar , Pobreza , Administración en Salud Pública/métodos , Anticoncepción/estadística & datos numéricos , Política de Planificación Familiar/historia , Política de Planificación Familiar/tendencias , Servicios de Planificación Familiar/legislación & jurisprudencia , Servicios de Planificación Familiar/organización & administración , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Perú , Sector Privado/economía , Práctica de Salud Pública , Servicios de Salud RuralRESUMEN
Periconceptional intake of folic acid is known to reduce the risk for neural tube defects (NTDs). To inform southeast Michigan Latina women of childbearing age about the benefits of food and supplemental sources of the micronutrient in the prevention of NTDs, Spanish-English bilingual health educators carried out 20 education events in supermarkets and community organizations serving Latina women. One hundred and sixty Latina women ages 19 to 50 years indicated their current folic acid awareness and stated their future intentions regarding folic acid. Of 160 women surveyed, 114 (71%) had heard of folic acid, 84 (74%) knew that folic acid prevents birth defects, 63 (55%) knew the critical time to take folic acid, and 76 (67%) identified at least one source of folic acid. After participating in the education events, 136 women (85%) reported planning to eat more folate and/or folic acid-rich foods. Although general folic acid awareness is fairly high, health promotion efforts must be coordinated at community locations serving Latina women to share folic acid's specific protective effects in the prevention of NTDs, the critical timing of intake, and its food and supplement sources.
Asunto(s)
Concienciación , Ácido Fólico/uso terapéutico , Promoción de la Salud/métodos , Hispánicos o Latinos/psicología , Madres/psicología , Defectos del Tubo Neural/prevención & control , Atención Preconceptiva/métodos , Adulto , Distribución de Chi-Cuadrado , Femenino , Humanos , Michigan , Persona de Mediana Edad , EmbarazoRESUMEN
The countries of Latin America and the Caribbean are facing the gradual phase-out of international-donor support of contraceptive commodities and technical and management assistance, as well as an increased reliance on limited public sector resources and a limited private sector role in providing contraceptives to the public. Therefore, those nations must develop multisectoral strategies to achieve contraceptive security. The countries need to consider information about the market for family planning commodities and services in order to define and promote complementary roles for the public sector, the commercial sector, and the nongovernmental-organization sector, as well as to better identify which segments of the population each of those sectors should serve. While it is unable to mandate private sector participation, the public sector can create conditions that support and promote a greater role for the private sector in meeting the growing needs of family planning users. Taking steps to actively involve and expand the private sector's market share is a critical strategy for achieving a more equitable distribution of available resources, addressing unmet need, and creating a more sustainable future for family planning commodities and services. This paper also discusses in detail the experiences of two countries, Paraguay and Peru. Paraguay's family planning market illustrates a vibrant private sector, but with limited access to family planning commodities and services for those who cannot afford private sector prices. In Peru a 1995 policy change that sought to increase family planning coverage had the effect of restricting access for the poor and leaving the Ministry of Health unable to pay for the growing need for family planning commodities and services.
Asunto(s)
Actitud/etnología , Conducta Anticonceptiva/etnología , Servicios de Planificación Familiar/estadística & datos numéricos , Sector Privado , Adulto , Femenino , Humanos , América Latina/epidemiología , MasculinoRESUMEN
The countries of Latin America and the Caribbean are facing the gradual phaseout of international-donor support of contraceptive commodities and technical and management assistance, as well as an increased reliance on limited public sector resources and a limited private sector role in providing contraceptives to the public. Therefore, those nations must develop multisectoral strategies to achieve contraceptive security. The countries need to consider information about the market for family planning commodities and services in order to define and promote complementary roles for the public sector, as well as to better identify which segments of the population each of those sectors should serve. While it is unable to mandate private sector participation, the poublic sector can create conditions that suport and promote a greater role for the private sector in meeting growing needs of family planning users. Taking steps to actively involve and expand the private sector's market share is a critical strategy for achieving a more equitable distribution of available resources, addressing unmet need, and creating a more sustainable future for family planning commodities and services (AU)
Asunto(s)
Humanos , Anticoncepción/estadística & datos numéricos , Anticoncepción/tendencias , América Latina/epidemiología , Atención a la Salud/estadística & datos numéricos , Atención a la Salud/tendencias , Servicios de Planificación Familiar , Accesibilidad a los Servicios de Salud , Comercialización de los Servicios de Salud , Mercadeo Social , Región del Caribe/epidemiologíaRESUMEN
Los países de América Latina y el Caribe enfrentan el cese gradual del apoyo y de la ayuda técnica y administrativa brindados por donantes internacionales a los proveedores de productos anticonceptivos, por lo que dependen cada vez más de los limitados recursos del sector público y del papel menguante del sector privado para la provisión de anticonceptivos al público en general. Así las cosas, dichos países tendrán que crear estrategias multisectoriales para lograr la provisión segura de anticonceptivos. Deberán, asimismo, tener en cuenta la situación del mercado de los productos y servicios de planificación familiar a fin de poder definir y promover los papeles complementarios que han de desempeñar el sector público, el sector comercial y el sector de las organizaciones no gubernamentales, así como determinar con más exactitud a qué grupos de la población debe servir cada uno de estos sectores. Si bien es cierto que el sector público no puede exigirle al sector privado su participación, sí le es posible crear las condiciones propicias para que este asuma un papel más destacado en la satisfacción de las necesidades cada vez mayores de quienes usan métodos de planificación familiar. Tomar medidas para incrementar la participación del sector privado en el mercado es una estrategia esencial si se ha de lograr una distribución más equitativa de los recursos existentes, satisfacer necesidades insatisfechas y crear un futuro sustentable para los proveedores de productos y servicios de planificación familiar. En este trabajo también se examinan en detalle las experiencias de dos países, Paraguay y Perú. El mercado de servicios de planificación familiar en Paraguay es ejemplo de la vigorosa participación del sector privado, aunque el acceso a los servicios de planificación familiar es limitado para quienes no pueden afrontar los costos de dicho sector. En Perú tuvo lugar en 1995 un cambio de políticas orientado a aumentar la cobertura de los servicios de planificación familiar que redundó en un acceso restringido para los pobres y dejó al Ministerio de Salud sin poder sufragar la necesidad creciente de productos y servicios de planificación familiar.