Reproductive Health

This paper summarizes the importance of improving maternal and reproductive health, the progress made to date and lessons learned, and the major challenges confronting programs today. The paper highlights the progress that some countries, including very poor ones, have made in reducing maternal mortality, but cautions that progress in many countries remains slow. Relying on evidence from the most recent research and survey information, the paper also analyzes the key determinants and evidence on effective interventions for attaining the maternal health MDG. [from abstract]
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This training manual is designed to prepare trainers who already have skills as reproductive health trainers to proceed to a higher level of training implementation. This module prepares them to conduct a training needs assessment, develop detailed plans for training, develop and pilot test a training curriculum, conduct training using more advanced training techniques, conduct training follow up and evaluate training. [publisher's description]

Pathfinder has provided community-based family planning and reproductive health services to women and men throughout the developing world for over 50 years. Partnerships with local governments and Nongovernmental Organizations (NGOs) allow Pathfinder access into communities to provide information and services. These local organizations provide a solid, established network through which Pathfinder reaches people. Faith-Based Organizations (FBOs) are a vital extension of this network. [author's description]
This report provides information on: the process of building relationships; partn

This report presents the findings from an assessment of the contraceptive method mix in Myanmar focusing on birth spacing, the providers of birth spacing services (public, private, NGO) and the information needs of these health pracitioners. [adapted from publisher's summary]

To improve birth spacing services in Cambodia, the development of the communication and counselling skills of all providers is critical. A a large part of this issue focuses on these skills. [editor's description]

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—including a health-oriented literacy program—and increase the number of female community workers supported rapid scale-up of contraceptive use.

Contraceptive provision in many settings continues to be based on outdated medical information, unproven theoretical concerns, and provider biases. Studies have found that in some developing countries 25-50% of women seeking contraceptives are refused services until they are menstruating. Coupled with effective training, checklists can be important tools for health care workers at various levels to apply the latest WHO medical eligibility criteria and guidelines for contraceptive use. The pregnancy, combined oral contraceptive (COC), depot-medroxyprogesterone acetate (DMPA), and intrauterine device ( IUD) checklists allow health care workers to avoid medical barriers and better provide methods of contraception.

The guides in this toolkit are intented to be used to facilitate a broad discussion of the elements and conditions that underpin the concept of informed and voluntary decision making, help users assess the status of sexual reproductive health decision making in a given program by identifying the challenges and supporting factors at the individual/community, service-deliver, and policy levels, and to help users plan strategies to strengthen supports for clients’ reproductive health decision making.

This manual provides useful information to help the trainer conduct a training program in the client-centered approach to reproductive health. In addition to the modules covering the step-by-step activities that will help participants master different concepts, the information presented ranges from a practical listing of the tools required to short presentations on topics that the trainer will want to be familiar with during the training. [from introduction]

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 study was designed to evaluate the effectiveness of the CAG program so that achievements and problems could be identified and program activities strengthened.

Donor funds may be inadequate to support the growing demand for services provided by community-based distribution (CBD) programs. One solution may be to reduce the remuneration of CBD agents, but this approach may lower their productivity. Programs also need to consider reducing other costs, including those for supervision and training. The cost per agent visit—including costs associated with payments to agents and to supervisors and the costs of training—was calculated for three CBD programs in Tanzania. The output measure was visits in which contraceptives were provided or referrals made for family planning services.

In much of sub-Saharan Africa, a significant portion of the population lives in rural areas, leaving many women with limited access to clinic-based family planning services. Thus CBD of contraceptives remains an important service delivery mechanism in this region. The primary aim of this study was to assess the safety, quality, and feasibility of Depo-Provera provision by community reproductive health workers.

Nepal’s National Health Training Center (NHTC), the Family Health Division (FHD), USAID/Nepal, and JHPIEGO developed a Comprehensive Family Planning (COFP) course to provide comprehensive and effective training for family planning (FP) service providers in Nepal. Designed to increase training efficiency—by consolidating isolated courses into one complete, standardized course and by introducing competency-based, humanistic training approaches—the COFP course was intended to provide health workers with a complete range of essential FP information and skills necessary to provide quality services to clients. A number of agencies and individuals collaborated to adapt and develop these standardized training materials, and trainers were then specially prepared to deliver this course. [publisher's description]

This training manual is designed for use as part of the comprehensive family planning and reproductive health training of service providers. It is designed to be used to train physicians, nurses, and midwives. Sessions in this Training of Trainers (TOT) module include discussions, identification of trainer’s own learning style, training exercises, conducting training needs assessments, developing action plans, developing visual aids, and training practice sessions which are videotaped and critiqued. [from purpose]

The Population Council and The Pubcomm Group, Inc. have developed simple, inexpensive, user-friendly computerized job aids to assist supervisors in improving the quality of family planning, maternity care, and postabortion care services. The software is free to download. [publisher's description]

Government contracting of private organizations is an increasingly common tool to meet the growing demand for quality reproductive health care in developing nations. This guide brings together information about such contracting experiences in a way to serve the practical needs of World Bank staff and their government counterparts in developing countries interested in trying contracting. [introduction]

This primer introduces key aspects of contracting and summarizes key lessons from countries' experiences in contracting-out. In doing so, it is intended to serve the practical needs of contracting practicioners in developing countries that are considering contracting as a way to deliver RH/FP services. Intended users include country-level decision makers, contract operation managers, and mission officers and advisers from donor agencies. [publisher's description]

People caught in crisis situations have crucial reproductive health needs. The needs of pregnant women are most urgent. Complications of labor and delivery can be life-threatening when women lack adequate care. Risk for HIV/AIDS, other STIs, and unwanted pregnancy increases, particularly when disorder provides cover for rape and other sexual coercion. Health care providers understand people's needs and have experience meeting them, but few have worked in humanitarian relief. By learning more and being prepared, family planning providers and managers - whether at the community level or internationally-could help in several ways.

Presbyterian Church of East Africa (PCEA) Chogoria Hospital is a faith based non-governmental organization providing a wide range of healthcare services. The organization faces a number of challenges related to sustainability: declining donor support (especially for reproductive health services), low cost recovery levels, and increasing poverty levels among its clientele. In response to these concerns, a team from Chogoria Hospital attended a one-week workshop held in Ghana on financial sustainability and developed a small scale operations research project to determine the cost of providing a selected number of reproductive health (RH) services and to evaluate their cost recovery levels.

This cost analysis is based on QAP research on the effectiveness of two interventions (self-assessment and peer review) in sustaining or increasing the effectiveness of interpersonal communications training that midwives had taken. The research had measured the effectiveness of the interventions in terms of the number of utterances midwives made during family planning consultations, and this case study followed on, measuring the cost of each intervention in terms of the number of utterances generated. Activities/tools: Sample provider self-assessment form, sources of costs, evaluation of marginal benefit.

This research brief presents results from a cost analysis of an adolescent reproductive health intervention that found that using community health workers was less expensive than using doctors for provision of reproductive health services to young women. [from publisher]

The Christian Health Association of Ghana (CHAG) is a large faith-based NGO which currently serves an estimated 35 percent of the Ghanaian population, mainly in remote rural areas. CHAG’s financial sustainability is threatened due to declining donations from missionary groups and donor agencies, uncertain support from government, and low cost recovery in member facilities. Although knowledge of costs is essential to program management, CHAG members had no information on the costs of the services they provided. Thus, CHAG had no economic benchmarks for evaluating efforts to control costs, no denominator for calculating cost recovery for different services, and no empirical data on service costs that could be used to approach donors and the Ghanaian government with requests for funding.

Contraceptive security requires comprehensive and integrated approaches that go beyond the public sector. Private sector involvement is critical not only in helping respond to growing market demand but also in ensuring equity in the contraceptive market. Redirecting well-off clients to the private sector will free up scarce donor and public resources for those most vulnerable and in need. Governments and donors cannot mandate private sector expansion and roles; however, they can create favorable conditions that induce private providers to enter the FP/RH market. [author's description]

This issue of The Family Planning Manager will help you to asses both the opportunities and the risks inherent in decentralizing your program. It will help you identify the new relationships that must exist between the central and local level managers, and the types of skills that local level managers must have in order for decentralization to have a positive impact. [author's description]

The competency-based approach used in JHPIEGO-supported training improves performance by ensuring that trainees go back to their worksites with the knowledge and skills required to provide FP services. Once back at the workplace, however, participants often face constraints that limit their ability to provide quality services. Factors that can affect the performance of the healthcare provider include: job expectations, performance feedback, supplies and equipment, motivation, possessing the knowledge and skills to provide services, and supervision. For these participants—and their colleagues in clinical settings—to perform well, it is essential that they have regular and supportive personal contact from supervisors... JHPIEGO proposes to address training-related supervision problems through the development of a supervision learning package. Before embarking on the development of the supervision learning package, JHPIEGO carried out a performance analysis that focused on reproductive health (RH) supervisors. [publisher's description]

Under the USAID AIDS, Population and Health Integrated Assistance project, JHPIEGO has been working since 1995 with the Division of Primary Health Care (DPHC), the Nursing Council of Kenya (NCK) and the Division of Nursing (DON) to pioneer the development of an integrated clinical training system used for both preservice and inservice family planning (FP) training. JHPIEGO and its partners have strengthened both inservice training and preservice education systems cost-effectively by developing a core group of trainers, tutors and preceptors. In addition, training materials, for both student and participant use, have been supplied to a limited number of clinical facilities. [publisher's description]

This assessment evalutes the RACHA program in Cambodia which was intended to strengthen the capacity and sustainability of the public and private sectors to deliver quality reproductive health and child survival services. The five technical intervention areas were birth spacing, STD/HIV prevention, safe motherhood, childhood diarrhoeal diseases and micronutrient deficiences. One of the key intermediate results identified within these areas was inproved human resource capacity to address these issues. [adapted from author]

This report presents the child mortality impact of a trial of primary healthcare service delivery strategies in rural Ghana. After adjustment for sociodemographic factors, underfive mortality in areas with village-based community-nurse services fell by 16 percent during the five years of program implementation compared with mortality before the intervention. [from abstract]

In both Senegal and Mali, JHPIEGO used a "jumpstart" training approach that combines both basic and intermediate training to ensure that participants are not only competent but are also confident in the skills or procedures acquired during training. High caseloads are needed so that trainers can have enough practice to achieve both competency and confidence in method provision skills—insertion and removal. The Klinik Raden Saleh (KRS), in Indonesia, was selected as the jumpstart training center for the Senegalese and Malian clinical teams because of its large Norplant implants clinical caseload, extensive clinical training, programmatic and research experience, large number of master trainers and clinical coaches, and extensive use of midwives as trainers and service providers. [publisher's description]

This reference manual, part of a learning package developed through a collaboration between the World Health Organization and JHPIEGO, contains 12 modules on topics such as facilitating group learning, managing clinical practice, and preparing and using knowledge and skills assessments. The modules include examples related to maternal, reproductive and child health.