Health

  • Perspectives on how implementation science can improve global health

    What is implementation science, and what can it do for the field of global health?

    Earlier this month, FHI 360 brought together over 150 public health specialists, researchers, scholars and donors in Washington, DC, for a day-long symposium to wrestle with these questions.

    One clear conclusion emerged: There is no single definition for implementation science. Symposium speakers used definitions including: the scientific study of methods to promote the integration of research findings and evidence-based interventions into health care practice and policy (U.S. National Institutes of Health); the application of systematic learning, research and evaluation to improve health practice, policy and programs (U.S. Agency for International Development); and the study of methods to improve the uptake, implementation and translation of research findings into routine practices (U.S. President’s Emergency Plan for AIDS Relief).

    Despite the lack of consensus on definitions, symposium participants agreed that implementation science can make essential contributions to global health. Setting implementation science apart from other research disciplines is its focus on how to implement proven interventions in real-world contexts, delivered at scale. Noting that implementation occurs within complex systems, Greg Aarons of the University of California, San Diego, introduced participants to frameworks that help us consider the interaction of factors that affect the success of the implementation process. (View the symposium’s presentations and webcast.)

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  • Family planning: A look at the past, the present and the future

    In 1971, the world was a different place demographically. Our planet was mostly agrarian, family sizes were large and birth control was unavailable. That year, FHI 360’s heritage organization, the International Fertility Research Program, was created to perform clinical trials of emerging contraceptive technologies, such as oral hormonal contraception and intrauterine devices (IUDs). These studies helped jump-start global family planning programs, creating health services for women where none had previously existed.

    1994: Setting a new agenda

    Fast forward to 1994, the year of the International Conference on Population and Development (ICPD). This pivotal global event caused a seismic shift in family planning, from concern about population growth to a commitment to reproductive rights and justice. Women’s empowerment took center stage. Issues related to sexually transmitted infections, especially HIV, were folded into the sexual and reproductive health agenda.

    The ICPD also strengthened voluntary family planning as a fundamental human right. This enabled women and couples to determine the timing and spacing of their pregnancies. With control over their fertility, women improved both their personal health and their career aspirations. Family size preferences decreased, and the demand for more effective, longer-acting contraception increased.

    Family planning drives development

    Today, the shift from larger to smaller families represents one of the most important transformations in developing regions. This shift was made possible in large part by the increased availability of modern contraception. Demographers have traditionally defined “modern” as any method other than “traditional” (for example, natural family planning and withdrawal). During the past two decades, evidence has demonstrated the contributions that family planning can make to global health and development, including progress toward the Millennium Development Goals.

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  • Strengthening health systems: What the Ebola outbreak is teaching us

    I am deeply concerned for the wellbeing of people in West Africa confronting the rapid spread of the Ebola virus. We wish to pay our respect to the courageous health workers battling the disease, and who have paid a disproportionate price for their heroism, as well as to the faith-based organizations that have remained on the front lines. We are now faced with a crisis of historic proportions that threatens not just the health of tens of thousands of people, but the economic and social stability of the region. On behalf of FHI 360, I want to express our deepest sympathy for all those affected by this scourge and our solidarity with our staff, counterparts, and colleagues in the affected countries.

    This crisis will undoubtedly have broad consequences not only for West Africa, but for the wider world. If World Health Organization (WHO) officials are correct, the epidemic will take thousands more lives and we can expect an even deeper toll on already overwhelmed health systems. This is a crisis that requires the collective efforts of the international community.

    The Ebola virus outbreak has exposed the fragility of health systems in poor countries—and shown how vulnerable nations are when basic social systems are unable to respond to critical needs. The world is now witnessing the terrible consequences of the failure to equip health systems, connect patients to direct medical care in rural areas, educate medical staff and the general population to risk factors and prevention methods, provide laboratory testing, and track disease surveillance data to monitor the spread of the virus.

    By working to support WHO’s six building blocks of health systems, we can improve availability, use, and quality of health services delivered through both public and private facilities. We need to continue to develop and apply workable strategies to improve the quality of care and the performance of health systems, particularly in resource-constrained environments.

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  • Celebrating youth: Revisiting voices from the Interagency Youth Working Group

    Today, as we observe International Youth Day, we look back on the past eight years of FHI 360’s involvement with the U.S. Agency for International Development (USAID)’s Interagency Youth Working Group (IYWG), the only source of global information about preventing both unintended pregnancy and HIV among youth. Our work managing the technical content for the IYWG was conducted under USAID’s Preventive Technologies Agreement, which ends this month.

    During this time, we have made many contributions. The IYWG tools and resources have been used by thousands — more than 30,000 people from 199 countries have visited our website, over 6,000 have participated in our e-forum discussions, and more than 1,000 have attended our annual technical meetings. Since 2007, we have distributed InfoNet twice monthly to approximately 5,000 individuals and developed 21 issues of YouthLens; 1,219 users follow us on Twitter; and 2,444 people like our IYWG and Answer the Call Facebook pages.

    We are grateful to the many dedicated individuals who helped us produce, synthesize and disseminate evidence on youth sexual and reproductive health, and to our partners for sharing their work and supporting ours. To all who have helped us provide practical, evidence-based resources and tools in the service of improving the lives of young people around the world, thank you!

    To mark the end of the IYWG, we are featuring a few of our favorites from the IYWG blog, Half the World. Though we will not be providing any new content, the website and blog will continue to exist as a rich resource for information on youth reproductive health and HIV/AIDS.


  • Leadership in Family PlanningFamily planning is connected to all eight Millennium Development Goals (MDGs), whether ending poverty and hunger, providing universal education or fighting HIV and AIDS.

    As the MDGs come to a close and the world prepares for the post-2015 development agenda, a recent editorial in the Bulletin of the World Health Organization written by family planning experts from FHI 360 summarizes the growing evidence that continues to confirm the relevance of family planning to each of the MDGs. The editorial also explores why family planning is critical to the success of the new post-2015 global development goals.

    Authors Tricia Petruney, Technical Advisor; Lucy Wilson, Monitoring and Evaluation Advisor; John Stanback, Scientist; and Ward Cates, Distinguished Scientist and President Emeritus show how family planning, an area of work traditionally found only within the health sector, is actually intricately intertwined with many other areas of development.

    Read the editorial to learn more about how the integration of family planning across the development sphere is, as stated by the authors, “a best buy for development.”

  • And the award goes to …

    They’re not as well known as the Academy Awards, but in the public health realm, the Web Health Awards pack a punch.

    That’s why FHI 360’s Social Marketing and Communication (SMC) video team is pleased to announce that three of the “Making the Business Case for Prevention” videos we produced on behalf of the U.S. Centers for Disease Control and Prevention (CDC) Division of Community Health recently won a Web Health Awards Recognition-of-Merit Award. It is the 16th year of this prestigious competition that receives thousands of submissions and selects the best in digital health resources for consumers and health professionals.

    Our winning, documentary-style vignettes feature real-life, business-success stories that demonstrate how good health is good business. The vignettes were created to build support for community health within the business sector and to encourage similar public health initiatives nationwide.

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  • UNDP reportThe United Nations Development Programme (UNDP)’s 2014 Human Development Report, entitled Sustaining Human Progress: Reducing Vulnerabilities and Building Resilience, calls attention to the persistent vulnerability that threatens human development. According to the recently released report, 2.2 billion people are poor or near-poor, and unless policies and social norms systematically address their vulnerabilities, development will fail to be equitable or sustainable.

    The report proposes multiple ways to strengthen resilience, such as the provision of basic social services and stronger policies for social protection and full employment.

    “By addressing vulnerabilities, all people may share in development progress, and human development will become increasingly equitable and sustainable,” said UNDP Administrator Helen Clark. Read the report.

  • Research on key populations leads Botswana to smarter HIV prevention

    At approximately 18 percent, the prevalence of HIV in Botswana’s general population is one of the highest in the world. As a result, national HIV prevention efforts have focused more intensively on the general population than on other populations. Little is known about key populations, such as female sex workers and men who have sex with men, whose behaviors are both stigmatized and illegal in Botswana.

    In 2012, the Botswana Ministry of Health used an integrated behavioral and biological surveillance survey to estimate population sizes and prevalence of HIV and sexually transmitted infections (STIs) among female sex workers and men who have sex with men. The study was historic. For the first time, it showed the HIV and STI burden among these two key populations and raised awareness about how they might have contributed to the generalized HIV epidemic.

    The survey, carried out with technical assistance from FHI 360 through the Preventive Technologies Agreement (funded by the U.S. Agency for International Development), uncovered a population of more than 4,000 female sex workers in the three districts where the survey was conducted. Among these female sex workers, HIV prevalence was 61.9 percent, and the prevalence of gonorrhea and chlamydia were both higher than 10 percent. The female sex workers had a mean of more than seven partners per week, and condom failure, which includes condom breakage and being paid or forced not to use condoms, was common.

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  • Improving HIV testing in targeted populations in India

    At the 20th International AIDS Conference (AIDS 2014) in Melbourne, Australia, staff from FHI 360’s India office will present a poster on a study that shows improved HIV testing among clients of female sex workers. The study contributes to evidence about what works to strengthen HIV prevention.

    Why focus research on the clients of female sex workers?

    Recent studies from India suggest that the purchase of sex from female sex workers is most predominant in higher HIV-prevalence states, such as Andhra Pradesh, Maharashtra and Tamil Nadu. In India, there is a growing recognition of the importance of considering clients when looking to stop HIV transmission, and a number of prevention efforts under the national program have targeted these clients, most of whom are men.

    Conducting surveys among clients of sex workers is challenging, because clients do not like to be identified. There is also little evidence that establishes clients’ risk of contracting HIV in India. To bridge this gap and to provide invaluable information on HIV trends and risk behavior, FHI 360 designed and managed the largest integrated biological and behavioral assessment (IBBA) for most-at-risk populations in India.

    Collecting evidence to inform HIV programming

    Conducted in 2006 and 2009, this cross-sectional survey interviewed approximately 10,000 clients of sex workers as part of Avahan (the India AIDS initiative). This program, funded by the Bill & Melinda Gates Foundation, gathered evidence to inform future HIV prevention programs in India. The IBBA survey was implemented by the institutes of the Indian Council of Medical Research, and technical support was provided by FHI 360.

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  • Focusing on key populations affected by HIV: A smart investment for greater impact

    In an era of limited resources, HIV prevention, care and treatment efforts need to focus on the smartest investments. This means investing in programs that can have the greatest impact in halting HIV transmission and turning back the epidemic. From a public health perspective, the effective use of resources requires focusing on key populations who have the highest level of HIV infection and tackling the barriers that discourage and prevent them from accessing health systems and services. These populations are broadly defined as sex workers, men who have sex with men, transgender persons and persons who inject drugs.

    As the world gathers at the 20th International AIDS Conference (AIDS 2014) in Melbourne, Australia, July 20–25, 2014, we have an excellent opportunity to share how investing in evidence-based strategies can change the trajectory of the epidemic once and for all.

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