Health

  • February 21, 2013

    The evolution of implants

    Written by
    Laneta Dorflinger
    Markus Steiner
    Heather Vahdat

    2013 marks the 30th anniversary of the initial approval of Norplant®, the first long-lasting, reversible contraceptive implant. An innovation in contraception, the Norplant system consisted of six rods implanted in a woman’s upper arm that provided up to five years of pregnancy prevention – offering women the same discrete, highly effective, long-term, and reversible contraception offered by the IUD, without the need for a pelvic examination.

    Inserting and removing six rods proved cumbersome, however, so Norplant never gained much traction globally. In the 30 years since its introduction, contraceptive implant technology has continued to evolve. Norplant’s successor, Jadelle offers the same level of pregnancy prevention but only entails two silicone rods.

    Excitingly, Jadelle has played a pivotal role in bringing implants to the developing world after being approved by the (US) FDA in 2002. In 2006, another implant came onto the market. Implanon offers three years of pregnancy prevention in a single rod implant. Like Jadelle, Implanon has made an impact in the developing world. Because its delivery system is uniquely “preloaded”, health extension workers in developing countries are able to easily insert the implants.

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  • February 19, 2013

    The votes are in for injectable contraceptives

    Written by
    Laneta Dorflinger
    Kate Rademacher
    Vera Halpern

    Women in sub-Saharan Africa are voting with their feet. Or in the case of injectable contraceptives, they are voting with their arms.

    Injectable contraceptives — which are typically administered in the upper arm and provide protection from pregnancy for 1-3 months depending on the formulation — are the most commonly used family planning method in sub-Saharan Africa, with more than one-third of contraceptive users choosing this method, according to a United Nations report. Worldwide, over 40 million women use injectable contraceptives, mainly depot medroxyprogesterone acetate — commonly known as Depo-Provera or DMPA.

    Nineteen year old Masani* from Tanzania chose injectables because she wanted an effective method that was convenient and didn’t require daily action. When offered oral contraceptives at the clinic, she declined. “I will fail because I will forget,” she explained. Some women say that they appreciate injectable contraceptives because they do not require a more invasive medical procedure. For Masani, the familiarity of DMPA was appealing. “That one I can understand,” she said.

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  • January 31, 2013

    Family Planning, Injectable Contraceptives and the Community Health Worker

    Written by
    Liz Osborn, Media Relations Specialist, FHI 360

    Family planning can have remarkable effects on women, children and families. When women are able to decide how many children to have and when, they are more able to meet their own educational, health and economic goals. Planning the number and timing of pregnancies also allows women to plan their finances and invest in the children they have. Unfortunately, not every woman has access to the contraception necessary to decide when to have children and how many to have. Perhaps the answer lies in an expanded role for community-based health workers.

    Many governments and nongovernmental organizations have turned to community-based family planning programs to expand access to contraceptives.These distribution programs have been credited with advancing family planning endeavors in otherwise underserved areas in Africa, Asia and Latin America. Despite the progress made there is room for improvement. One challenge community health workers encounter is the fact that, while national policies in many countries permit community health workers to provide condoms and oral contraceptives, they are not allowed to administer injectable contraceptives. This is particularly problematic in sub-Saharan Africa, where injectable contraceptives are a preferred method of contraception for women.

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  • January 25, 2013

    Presidential campaigning and promoting healthy behaviors: What do they have in common?

    Written by
    Ann Jimerson, Senior Specialist in Behavior Change, Alive & Thrive, FHI 360

    FHI 360’s Alive & Thrive (A&T) project works to improve infant and young child nutrition in Bangladesh, Ethiopia and Vietnam by promoting behaviors such as exclusive breastfeeding and improved complementary feeding. Reflecting on President Obama’s inauguration, we found that running a presidential campaign and promoting healthy behaviors might have some things in common.

    Being precise about which behavior you need to promote

    Obama’s door-to-door canvassing effort during the recent presidential campaign was said to have a clear behavioral objective: Make sure that likely Democrat voters go to the polls and vote. Rather than knocking on all doors to persuade undecided voters to support Obama, canvassers contacted people who had already indicated they were pro-Obama.

    In an A&T TV spot in Vietnam, a “talking” baby shares the precise behavior that results in exclusive breastfeeding.

    We use a similar strategy to promote exclusive breastfeeding. In Vietnam, most mothers said they already knew that breastfeeding is the best feeding method. However, it didn’t occur to many mothers that when they give their babies water, those infants do not receive the benefit of exclusive breastfeeding in the first six months, as recommended by the World Health Organization. To increase the percentage of mothers practicing exclusive breastfeeding, one of our TV spots focuses on the specific behavior, “don’t give the baby water.”

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  • January 18, 2013

    Vote for FHI 360 for Katerva’s People’s Choice Award

    Written by
    Matt Matassa, Manager, Visual & Digital Communications, FHI 360

    We are very excited that two projects we love, Sino-implant (II) and C-Change are finalists for the 2012 Katerva Awards. This year Katerva has added a People’s Choice Award, where you can help decide the winner!

    Help us support these programs by voting for Sino-implant (II) or C-Change for Katerva’s People’s Choice Award. Voting is taking place through January 29th at www.katerva.org/vote.

    Please take a few minutes to learn more about these projects by watching the videos below. Keep an eye out for the winners to be announced on January 30th!

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  • December 20, 2012

    New Video Highlights Benefits of Family Planning to Microfinance Clients in India

    Written by
    Sharmistha Basu, Senior Technical Specialist, Research, FHI 360
    Eva Canoutas, Associate Director, Research Utilization, FHI 360
    Rick Homan, Scientist, FHI 360

    FPquoteImagine millions of women who want to limit their family size or space their next birth, but can’t because they lack access to family planning. Imagine that many of these women have no knowledge of family planning at all. Hard to imagine after decades of national and global investments in health? This is the reality for many families around the world, particularly in developing countries, where approximately 222 million women have an unmet need for family planning.

    Innovative approaches to reach people with family planning information and services are critical. Under FHI 360’s PROGRESS (Program Research for Strengthening Services) project —a project funded by the U.S. Agency for International Development to improve family planning services among underserved populations in developing countries — a key strategy is to move beyond the health sector to reach women and men of reproductive age who need family planning but might not otherwise have access to it. As non-health development programs reach a large proportion of the world’s poor, PROGRESS builds on these networks to bring family planning information and services to communities. Family planning has been shown to contribute to the broader development goals of poverty reduction, enhanced education, environmental sustainability and gender equality, and therefore fits well with the goals of non-health development programs. Currently, PROGRESS supports several intervention-based studies on integrating family planning into non-health programs such as agriculture, environment and microfinance.

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  • December 19, 2012

    More mobile phones than toilets?

    Written by
    Laura Raney, Senior Technical Officer, FHI 360

    A version of this post originally appeared on K4Health’s Blog. Reposted with permission.

    Are there more mobile phones than toilets in some places? Yes, in some developing countries, that’s true. This was one of the take-aways from the mHealth Summit that took place last week in Washington, DC, where over 3,800 people gathered to hear about the fast-growing health-related mobile phone industry. The Summit featured for the first time this year a Global Health Track that focused solely on mobile health interventions and lessons learned from developing countries– lack of access to care, providers without the necessary knowledge or information to do their job properly, and stockouts of supplies and medicines.

    Patty Mechael, Executive Director of the mHealth Alliance, said in her introductory remarks on the first day of the conference that “more people in developing countries have access to mobile phones than clean water or bank accounts,” things we take for granted. What a possible game changer for health in developing countries if mobile phones can be used to leverage access to health care.

    The number of doctors in Africa is woefully low, and there exists a game-changing opportunity to use mobile phones with front line health workers to improve patient care. According Sandya Rao, Senior Advisor of Private Sector Partnerships in the Office of Health, Infectious Diseases and Nutrition at USAID, working with frontline health workers is the “most immediate and cost-effective way to save lives and improve health”, quoting the Frontline Health Workers Coalition. The challenges of frontline health workers include inadequate training, inadequate performance incentives and weak health systems. Many different approaches to using mobile phones with health workers exist and are working. The successful ones have benefited from stakeholder inclusion in design and taking a holistic systems approach. According to Alain Labrique, Director of the Johns Hopkins University Global mHealth Initiative, countries can “recognize the individual, support disconnected frontline health workers, engage the community, and make the invisible visible.”

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  • December 17, 2012

    From novel idea to catalyst

    Written by
    Cornelia Kip Lee, Instructional Design Associate, Global Research Services, FHI 360

    Photo via the Mobile for Reproductive Health (m4rh) project.In her keynote address at the 2012 mHealth Summit, which for the first time included a Global Health Track, mHealth Alliance executive director Patty Mechael said that mHealth has “transitioned from a novel idea to a strategy for global health.” She also said that 2013 would be the “year for scale,” to which I would add the ‘year of integration’, because mHealth is increasingly being applied as a game-changing approach for empowering individuals as well as strengthening health systems. There is an evolution along at least two dimensions: from initial pilots to programs with broad national or multi-regional reach, and from single-solution applications to multi-function catalysts of health system interventions.

    For example, in the category of client-centered mHealth, the Mobile Alliance for Maternal Action (MAMA) provides free or low-cost text (SMS) or voice messages for pregnant women related to each stage of pregnancy and a baby’s first year. In Bangladesh, MAMA is known as Aponjon, which means “close friend.” Aponjon service was launched in September 2011 in four districts with 1,000 subscribers. It started to scale nationally in August 2012, with the aim of reaching more than two million mothers by 2015.

    In “Health Workforce Capacity Development,” iHeed CEO Dr. Tom O Callaghan noted that each year, approximately 160,000 doctors are trained in Europe for a population of around 1 billion people, while in Sub-Saharan Africa for the same population size about 5,000 doctors are trained. Over the past 20 years, about 500,000 community health workers (CHWs) have been trained across Sub-Saharan Africa at a very high cost. Yet, there are 700 million mobile phones in Africa, about a billion people on Facebook, 300 million on Skype, and cheap tablets are increasingly available. “Aspirations to train another 1,000 or 10,000 CHWs seem very bland compared to the scale being achieved by other technology ventures,” O Callaghan said, suggesting that mHealth can aim much higher, training health workers and supporting their performance in innovative ways. In fact, emerging evidence indicates the potential of mHealth to positively impact multiple aspects of health systems, including adherence to treatment guidelines, supply chain management, and data collection and reporting.

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  • December 17, 2012

    Preventing mother-to-child transmission of HIV in Zambia: Replicating success

    Written by
    Elizabeth Doggett, Technical Officer, Research Utilization, FHI 360

    In 2010, around 390,000 children under age 15 became infected with HIV, mainly through mother-to-child transmission. However, with effective interventions, mother-to-child transmission can be virtually eliminated to save the lives of thousands of children every year. One effective, evidence-based intervention is the preventing mother-to-child transmission of HIV (PMTCT) component of FHI 360’s Zambia Prevention, Care and Treatment Partnership (ZPCT). This USAID-funded program, which ran from 2004–2009 —and was renewed through 2014 as ZPCT II— serves as a model for other countries.

    The ZPCT I program increased the percentage of pregnant women in antenatal clinics who accepted HIV tests and received test results from 45 to 99 percent. Among women who tested positive for HIV, the program increased the percentage of women who received a full course of antiretroviral prophylaxis from 29 to 100 percent. Most importantly, observational data from ZPCT sites showed an HIV acquisition rate of 6.5 percent among children ages 0 to 6 weeks where the mother and infant received interventions, compared with 20 percent where no intervention was given to either mother or baby. The fact that this highly effective intervention costs merely US$113–126 per mother makes a compelling case for replicating it in other contexts.

    To support program designers who wish to replicate this program, FHI 360 produced Preventing Mother-to-Child Transmission of HIV: Implementation Starter Kit. This starter kit describes and provides access to all programmatic materials and tools (such as training materials and job aids) used by ZPCT and provides basic guidance on replicating effective programs. We hope that such an effective and low-cost intervention will be reproduced in other country contexts and that it will generate the same life-saving results.

  • December 14, 2012

    Integrating gender into health projects – New collection of tools available

    Written by
    Laura Raney, Senior Technical Officer, FHI 360

    Are you a gender focal person in your organization looking to access programmatic evidence, tools for gender and health advocacy? Perhaps you are a program manager seeking to view guidance on integrating gender in HIV/AIDS, family planning, maternal health and youth programs or access gender training curricula and materials. Maybe you are a donor who wants to learn about key issues in gender mainstreaming and gender integration. Well, there is a new one-stop shop for you! The newly revised Interagency Gender Working Group (IGWG) Gender and Health Toolkit is now available.

    The Knowledge for Health (K4Health) project recently updated this electronic toolkit with input from leading gender experts. The result is a collection of carefully selected practical tools and instruments to help make programs and health systems more equitable and effective. Designed to move health practitioners, program mangers and policy makers from awareness and commitment to direct application and practice, the toolkit is a treasure trove of applied resources. This new IGWG Gender and Health Toolkit is a companion to the IGWG website and has the same goal: improvement of reproductive health/HIV/AIDS outcomes and sustainable development through the promotion of gender equity within population, health, and nutrition programs.