Discussion of climate change typically involves natural phenomena: raging wildfires, record flooding, ruinous drought. Less frequently examined, but equally important, is the effect of our warming planet on a child’s right to education.
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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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Why do we need civil society?
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What is civil society? My children always ask me that. Think of what makes a good school. A good school has good teachers, a good curriculum, a good principal, and good buildings and classrooms. It also has extracurricular activities, including student government and clubs where kids can pursue their interests, voice their views and connect with other kids whom they might not meet otherwise.
Civil society is similar to those extracurricular activities. Usually, a country’s government takes care of the basics, such as defense, education and health care. But it doesn’t provide citizens with a way to organize themselves to do what is important to them or express their views. That’s where civil society comes into play. It is the groups that people form to advocate for the things they believe in and to solve problems in their communities. Societies that do not allow people to connect with one another to solve problems or monitor their governments are less effective, less democratic and less resilient than those that do.
In very poor schools, kids often stop believing they can succeed. They no longer try to start clubs. Similarly, in societies that have been torn apart by war or authoritarian rule, people often lose faith in their ability to improve their situation. The goal of our work is reigniting that confidence and reactivating people’s capacity to solve their own problems. One key is finding change agents — organizations or individuals who can help rebuild people’s confidence. We try to identify change agents, train them and help them organize to improve schools, the government, the environment or whatever their communities need.
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In the international development community, the dominant technology discussion is currently about mobile phones, applications and services. According to the International Telecommunications Union, there are now 6 billion mobile phone subscriptions globally.1 Most of the subscriber growth is in the developing world, where prices are falling rapidly and expanding connectivity is catalyzing the growth of entire economies.2But, with the rapidly expanding availability of mobile phones, it is easy to forget about the potential of older technologies, such as radio. In much of the world, radio remains the most pervasive communicator of information. In sub-Saharan Africa, for example, an estimated 80 percent to 90 percent of households have access to a working radio, while only 15 percent have access to the Internet.3,4
Rather than making radio irrelevant, mobile technologies have made radio potentially more powerful than ever. Individuals in rural communities with access to mobile phones can interact with broadcasters. Farmers in their fields can access experts on radio call-in programs. Radio stations can send listeners recaps of programs via SMS. Interactive voice-response systems allow farmers to listen to programs on demand. Sophisticated surveys of audience feedback and behavior change campaigns can be conducted with new precision and efficacy. The list goes on, and not just for agricultural issues. The benefits of radio also reach into health, education, civil society and other development areas.
Integrating effective interactive radio into development projects requires careful planning. To help organizations unlock radio’s new potential, FHI 360 has developed Interactive Radio for Agricultural Development Projects: A Toolkit for Practitioners under the Fostering Agriculture Competitiveness Employing Information Communication Technologies (FACET) project, funded by the U.S. Agency for International Development (USAID).
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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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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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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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January 3, 2013
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Imagine 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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More mobile phones than toilets?
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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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From novel idea to catalyst
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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.
