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This study is a theory-driven analysis of the socio-demographic determinants of maternal care seeking in Kenya. Specifically, it examines predisposing, enabling, and need factors potentially associated with use of antenatal care (ANC), health facility delivery, and timely postnatal care (PNC).This s
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tudy uses data from the 2014 Kenya Demographic and Health Survey (KDHS) conducted among women age 15-49 with a live birth in the five years preceding the survey. It includes data from all 47 counties of Kenya, grouped contiguously into 12regions.We apply Andersen’s Behavioral Model of Health Services Use to examine socio-demographic predictors of health service use.We estimate logistic regression models for adequate use of ANC (defined as attending at least four ANC visits, starting in the first three months of pregnancy), delivery in a health facility, and PNC within 48 hours of delivery.
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The document is structured into five sections. The first presents the key experiences and challenges that justify a renewal of the EPHFs. The second section updates the groundwork for the exercise of public health and provides a framework to inform the exercise of the new essential functions. The th
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ird section proposes a new integrated approach for implementing the EPHFs. The fourth section presents a new list of 11 EPHFs related to each stage of this integrated approach. Finally, in the last section, considerations are put forth to guide EPHF implementation as a means of strengthening the health sector.
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Updated May 2021
Frontline health workers (FHWs) provide services directly to communities where they are most needed, especially in remote and rural areas. Many are community health workers and midwives, though they can also include local emergency responders/paramedics, pharmacists, nurses, and doctors who serve in
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community clinics.
The growing burden of non-communicable diseases (NCDs) on low- and middle-income countries threatens many health systems that are already weakened. In many countries, health systems—and health workers—are not prepared to address the complex nature of NCDs. Health systems are often fragmented, and designed to respond to single episodes of care or long-term prevention and control of infectious diseases.1 Many countries also continue to face shortages and distribution challenges of trained and supported health workers. As most NCDs are multifactorial in origin and are detected later in their evolution, health systems face significant challenges to provide early detection as well as affordable, effective, and timely treatment, particularly in underserved communities.
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This report provides the context, underlying evidence, content and process related to the
development of the draft global strategic directions for nursing and midwifery 2021–2025.
Background: Cervical cancer accounts for 23% of cancer incidence and 22% of cancer mortality among women in Burkina Faso. These proportions are more than 2 and 5 times higher than those of developed countries, respectively. Before 2010, cervical cancer prevention (CECAP) services in Burkina Faso wer
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e limited to temporary screening campaigns.
Program Description: Between September 2010 and August 2014, program implementers collaborated with the Ministry of Health and professional associations to implement a CECAP program focused on coupling visual inspection with acetic acid (VIA) for screening with same-day cryotherapy treatment for eligible women in 14 facilities. Women with larger lesions or lesions suspect for cancer were referred for loop electrosurgical excision procedure (LEEP). The program trained providers, raised awareness through demand generation activities, and strengthened monitoring capacity.
Methods: Data on program activities, service provision, and programmatic lessons were analyzed. Three data collection tools, an individual client form, a client registry, and a monthly summary sheet, were used to track 3 key CECAP service indicators: number of women screened using VIA, proportion of women who screened VIA positive, and proportion of women screening VIA positive who received same-day cryotherapy.
Results: Over 4 years, the program screened 13,999 women for cervical cancer using VIA; 8.9% screened positive; and 65.9% received cryotherapy in a single visit. The proportion receiving cryotherapy on the same day started at a high of 82% to 93% when services were provided free of charge, but dropped to 51% when a user fee of $10 was applied to cover the cost of supplies. After reducing the fee to $4 in November 2012, the proportion increased again to 78%. Implementation challenges included difficulties tracking referred patients, stock-outs of key supplies, difficulties with machine maintenance, and prohibitive user fees. Providers were trained to independently monitor services, identify gaps, and take corrective actions.
Conclusions: Following dissemination of the results that demonstrated the acceptability and feasibility of the CECAP program, the Burkina Faso Ministry of Health included CECAP services in its minimum service delivery package in 2016. Essential components for such programs include provider training on VIA, cryotherapy, and LEEP; provider and patient demand generation; local equipment maintenance; consistent supply stocks; referral system for LEEP; non-prohibitive fees; and a monitoring data collection system.
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The coronavirus disease 2019 (COVID-19) pandemic has created a global and gendered crisis that is compounding existing inequalities and disproportionately affecting girls and women. Emerging evidence from the COVID-19 crisis in 2020 shows school closures, disruptions in essential services and rising
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poverty contributed to girls’ increased risk of female genital mutilation (FGM). School closures limited the monitoring and reporting of cases of FGM. Rising household monetary poverty may have contributed to families adopting negative coping mechanisms, including having girls undergo FGM as a precursor to marriage to reduce household costs. A report from the United Nations Population Fund (UNFPA) estimates 2 million additional cases of FGM by 2030 due to the pandemic.
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This is the sixth of our 11-paper supplement entitled “Community Health Workers at the Dawn of New Era”. Expectations of community health workers (CHWs) have expanded in recent years to encompass a wider array
of services to numerous subpopulations, engage communities to collaborate with and to
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assist health systems in responding to complex and sometimes intensive threats. In this paper, we explore a set of key considerations for training of CHWs in response to their enhanced and changing roles and provide actionable recommendations based on
current evidence and case examples for health systems leaders and other stakeholders to utilize.
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This is the ninth paper in our series, “Community Health Workers at the Dawn of a New Era”. Community health workers (CHWs) are in an intermediary position between the health system and the community. While this position provides CHWs with a good platform to improve community health, a major cha
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llenge in large-scale CHW programmes is the need for CHWs to establish and maintain benefcial relationships with both sets of actors, who may have diferent expectations and needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system and with communities.
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Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV, syphilis and hepatitis B virus
EMTCT Global Validation Advisory Committee, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes
World Health Organization WHO
(2021)
C_WHO
Validation of elimination of mother-to-child transmission, or vertical transmission, of HIV, syphilis and hepatitis B virus (HBV), is an attestation that a country has successfully met standard criteria for elimination, or for being at 1 of the 3 levels of achievement on the ‘Path to Elimination
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while delivering quality services for women, girls and their children, through the life-course, respecting human rights and ensuring gender equality and community engagement.
This document, the third version, adds on EMTCT of hepatitis B virus (HBV), bringing together a package of interventions and metrics to support integrated management and monitoring of vertical transmission across a wide range of epidemiological and programmatic contexts.
This document, the third version, adds on EMTCT of hepatitis B virus (HBV), bringing together a package of interventions and metrics to support integrated management and monitoring of vertical transmission across a wide range of epidemiological and programmatic contexts.
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This publication provides managers with guidance on how to create basic HIV prevention cascades as a starting point to enhance their ability to monitor and improve their programming and to facilitate comparisons of programme effectiveness across sites.
This document is the national level companion to a broader document on health care facility level developed by the WHO Health Emergencies Programme for national level stakeholders
The Essential Nutrition Actions and Essential Hygiene Actions Training Guide: Community Workers strengthens the capacity of community workers to deliver and promote the essential nutrition and hygiene actions. It introduces technical content within hands-on sessions to practice counseling and negoti
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ation, using role plays and field practice. It guides community workers in understanding why and how to integrate messages on nutrition and hygiene into their different program platforms using a life cycle approach to deliver the right message to right person at the right time.
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RESULTS: Between 76 and 97% of the PHCS offered RMCAH services before the lockdown. Except in antenatal, delivery and adolescent care, there was a decline of between 2 and 6% in all the services during the lockdown and up to 10% decline after the lockdown with variation across and within States. Dur
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ing the lockdown. Full-service delivery was reported by 75.2% whereas 24.8% delivered partial services. There was a significant reduction in clients' utilization of the services during the lockdown, and the difference between States before the pandemic, during, and after the lockdown. Reported difficulties during the lockdown included stock-out of drugs (25.7%), stock-out of contraceptives (25.1%), harassment by the law enforcement agents (76.9%), and transportation difficulties (55.8%). Only 2% of the PHCs reported the availability of gowns, 18% had gloves, 90.1% had hand sanitizers, and a temperature checker was available in 94.1%. Slightly above 10% identified clients with symptoms of COVID-19.
CONCLUSIONS: The large proportion of PHCs who provided RMCAH services despite the lockdown demonstrates resilience. Considering the several difficulties reported, and the limited provision of primary protective equipment more effort by the government and non-governmental agencies is recommended to strengthen delivery of sexual and reproductive health in primary health centres in Nigeria during the pandemic.
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To support countries in adapting their response to different COVID-19 scenarios, the World Health Organization (WHO) Department of Maternal, Newborn, Child and Adolescent Health and Ageing commissioned this scoping review of published and grey literature. The objective was to identify interventions
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implemented to maintain the provision and use of essential services for MNCAAH during disruptive events and to summarize lessons learned during these interventions. The review included outbreaks of Ebola virus disease (EVD), severe acute respiratory syndrome (SARS), Zika virus disease (ZVD), the ongoing COVID-19 pandemic, and natural disasters and humanitarian emergencies that caused disruption to services, transport and other activities.
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Low- and middle-income countries (LMICs) experience a high disease burden for epilepsy, a chronic neurological condition.The authors evaluate the cost-effectiveness of community health workers (CHWs) to improve adherence to medication for epilepsy in South Africa. They found that utilizing CHWs to i
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mprove medication adherence was cost-effective.
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Mohamed et al. BMC Public Health 2018, 18(Suppl 3):1215
https://doi.org/10.1186/s12889-018-6053-xpre-
One of the many gender inequities in the health and care workforce that COVID-19 has exposed is around the fit and design of Personal Protective Equipment (PPE). The rapid onset and scale of COVID-19 led to shortages of PPE in most countries, causing preventable infection and mortality among healthc
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are workers and others on the front lines. Even though most health workers are women, manufacturing specifications for medical PPE are usually drawn up based on the male body and there have been many reports of PPE not designed for women's bodies.
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