South Asia

Although misconceptions about family planning and cultural factors such as son preference presented some obstacles to progress, [two MSH] projects found that religion in Afghanistan is not a barrier to expanding family planning services. It was critical to engage clinicians and communities in culturally sensitive ways. Emphasizing the use of birth spacing to protect the health of mothers and children was especially effective. Activities to empower women

Under the ENABLE Safe Motherhood Core Initiative, CEDPA/India collaborated with the Community Aid and Sponsorship Program on the Safe Motherhood Initiative to reduce maternal death by showing women, their families and their communities how to prepare for a safe delivery, to identify pregnancy-related complications at their onset, and to seek medical help immediately. [publisher’s description]

This paper discusses a collaborative effort between two universities in Sri Lanka and Canada to create a distance education program to train nurses in Sri Lanka.

Hospital managers who used a checklist to assess their facilities’ policies and practices took action to improve staff safety and reduce AIDS-related stigma. Findings suggest that the actions taken, including education, training, policy formulation, and involvement of AIDS NGOs, contributed to improved knowledge, attitudes, and practices among health workers. UNAIDS has recognized the intervention as a best practice, and NACO has endorsed the intervention’s tools and approaches. [author’s description]

This presentation is from PSP-One’s GHC Expert Panel - Expanding Health Service Access, Quality, and Equity in Developing Countries: The Role of the Private Sector. It presents franchise models for delivering family planning and reproductive health services by the private sector.

This paper describes the practice of international recruitment of Indian nurses in the model of a business process outsourcing of comprehensive training-cum-recruitment-cum-placement for popular destinations like the United Kingdom and United States through an agency system that has acquired growing intensity in India. [from abstract]

This PowerPoint was presented at the 2007 GHC expert panel “Making it Work: Private Sector Partnerships to Improve Women’s Health.” It discusses the challenges, costs and results of a program to use private practitioners for improving maternal and child survival.

While the availability and use of trained midwives can shape the quality of care received in pregnancy and childbirth, a number of other underlying health systems structures and processes are important. The management of health workforces, the mix of public and private provision and the impact of reforms affect quality of care across countries…[This study] examined how the structure and operation of a health system influences maternal health care provision and outcomes in Bangladesh, Russia, South Africa and Uganda. [author’s description]

The author focuses on a community health worker (CHW) intervention in India, where state-wide CHW programmes are under way as part of the National Rural Health Mission. The Mitanin programme of Chhattisgarh state in India highlights the many dilemmas and possibilities in the scaling-up of such programmes. [adapted from author]

The Centre for Health and Population Research, Dhaka, looked at the experiences of midwives attending homebirths in the rural region of Matlab. In Bangladesh, 91 percent of births still take place at home and only 13 percent are assisted by a doctor or midwife. In 1987, almost 20 years ago, a health initiative was introduced in Matlab to allow midwives to attend women in the home. Researchers conducted interviews and group discussions with 13 midwives in Matlab in 2003 and 2004 to learn what difficulties they faced during their work. [author’s description]

In 1996, the REWARD Project identified a need for effective interventions to increase women’s communication about reproductive health among themselves and with their husbands. Project staff formed women’s groups, called Communication Action Groups (CAGs), in three rural districts. The project provides group leaders with training on communication, leadership, group dynamics, condom use, condom negotiating skills, and HIV/AIDS and sexually transmitted infections (STIs).

This article assesses interventions aimed at improving family planning mechanisms and reviewing the problem-solving processes to build an effective monitoring system of the interventions at the local level of the overall system of the Ministry of Health and Family Welfare of the Government of Bangladesh. [adapted from author]

The objectives of this paper are to: lay out the facts on what we know about the HRH for EMR countries; generate and interpret evidence on the relationship between HRH and health status indicators for LMICs and middle and high income countries (MHICs) in the context of EMR; identify and analyze the information gaps and provide forward thinking by identifying priorities for research and policy. [abstract]

This document outlines the Programme for Development of Human Resources for Health (HRH) in the WHO South East Asia Region, whose overall aim is to collaborate with the Member Countries to correctly plan, effectively train, efficiently deploy and optimally utilize the types and numbers of health personnel that they require to meet the needs of their health systems. [from introduction]

Typically, provider–client interactions are brief, and providers often behave condescendingly toward clients. As a result, clients are unable to express their concerns or describe the limitations they face in trying to implement the providers’ suggested course of action. A training intervention was developed for providers that focused on addressing the problems inherent in this dynamic. This research was undertaken to assess whether providers in the experimental area delivered services in a different manner than they had prior to the training intervention. [adapted from author]

Despite the expanding literature on how reforms may affect health workers and which reactions they may provoke, little research has been conducted on the mechanisms of effect through which health sector reforms either promote or discourage health worker performance. This paper seeks to trace these mechanisms and examines the contextual framework of reform objectives in Uganda and Bangladesh, and health workers responses to the changes in their working environments by taking a realistic evaluation approach. [abstract]

This working paper evaluates th success of the Quality of Care Management Center in Nepal and highlights the fact that even in resource-poor settings, quality of care in health service delivery can be achieved. This model for a quality of care center that provides timely, appropriate, and ongoing support to clinical facilities may be especially useful in countries where centralized systems are in place for allocation of resources or where maintenance and supply capacity is limited to central locations.

This IUD assessment tool provides performance standards for IUD provision based on type of visit-new client or revisit. It may be used as part of a programmatic performance improvement initiative, by the site or individual providers to self-assess or by external evaluators to assess achievement of the standards. Often, performance standards are used to affect change at multiple sites. [author’s description]

The objective of this article was to compare the cost-effectiveness of the tuberculosis programm run by the Bangladesh Rural Advancement Committee, which uses community health workers (CHWs), with that of the government program which does not use CHWs. [adapted from author]

The purpose of this study is to estimate the cost implications of implementing the newly proposed Integrated Management of Childhood Illnesses algorithm in first-level health care facilities in rural areas of Bangladesh. Bangladesh policymakers need to know the cost of IMCI prior to its implementation so that they allocate adequate resources, particularly personnel and drugs, and the associated financial resources to health facilities. [from author]

Women health workers have been vital in improving the health of women and children in Pakistan. Inspired by its neighbor’s experience, Afghanistan is embarking on a similar program to encourage women to work in the health sector. [author’s description]

The authors argue that health for all is not achievable in most countries without health sector reform that incorporates a process of coordinated health and human resources development. They examine the situation in countries in the Eastern Mediterranean Region of the World Health Organization.

In an effort to improve the health gain that might be achieved from allocated resources, a sector wide framework has been developed for planning, choosing priorities, and committing funds in accordance with agreed priorities. [from summary]

AIDS-related stigma and discrimination is a pervasive problem worldwide. People living with HIV/AIDS (PLHA) in India, as elsewhere, face stigma and discrimination in a variety of contexts, including the household, community, workplace, and health care setting. Research in India has shown that stigma and discrimination against HIV-positive people and those perceived to be infected are common in hospitals and act as barriers to seeking and receiving critical treatment and care services (UNAIDS 2001). Recognizing the need to move beyond documentation of the problem, three New Delhi hospitals; SHARAN, an Indian NGO; and the Horizons Program, with support from the National AIDS Control Organisation (NACO), carried out an operations research project to develop and test responses to hospital-based stigma and discrimination against people living with HIV/AIDS.

The handbook is a resource collection of information sheets and participatory activities for NGOs working on HIV/AIDS who want to work towards a greater involvement of people living with HIV (GIPA) in their work. It aims at sensitising NGOs, building individual skills and organisational capacities so that NGO management, staff and volunteers can discuss and plan together in a participatory way how to meaningfully involve people living with HIV in their organisation. [from introduction]

The objective of this document is to implement and evaluate a public–private partnership to deliver the internationally recommended strategy DOTS for the control of tuberculosis (TB) in Lalitpur municipality, Nepal, where it is estimated that 50% of patients with TB are managed in the private sector. [author’s description]

This paper is a desk study which looks at experiences of integrating vertical health programmes into national delivery systems where government and donors have adopted a sector wide approach (SWAp) to supporting health sector reform. It was commissioned to facilitate decision making in SDC regarding future possible integration of the Tanzania Tuberculosis and Leprosy Programme into national delivery systems and the SWAp process.[author’s description]

The goal of this paper is to describe the establishment of a self-sustaining Student Learning Center (SLC) employing humanistic anatomical models to aid in the teaching of family planning and reproductive health clinical skills to nursing students in Nepal.

This presentation was part of the International Conference on Global Health session, “Expanding Emergency Obstetric Care: Overcoming Challenges in Training and Service Delivery.” It discusses the first planned effort by the the largest association of ob/gyns and its academic wing to help build human resource capacity in India to develop EmOC in rural areas. It also presents the specifics of the training EmOC certification course they have developed to address the issue.

This paper describes the experiences of three types of programs (government, reproductive health NGO, and women’s health NGO) in Kenya, India, and Guatemala that integrate gender in their work and examines how they integrate gender into programs that improve quality of care and access to care. It should be emphasized that this report does not document whether gender integration results in higher quality and access, but rather documents how gender integration can take place. [author’s description]