Evaluations & Reviews

Community-Based Distribution of Depo-Provera: Evidence of Success in the African Context

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.

Atlas: Nurses in Mental Health 2007

Mental health care is an essential but often forgotten component of health care. Nurses are core health-care providers and they need to be able to contribute effectively to mental health care. [This document] presents results of a global survey on the availability, education, training and role of nurses in mental health care. [from foreword]

Competence of Maternal and Child Health Clinic Workers in Detecting Malnutrition in Somalia

The MCH clinic workers in Somalia receive formal and in-service training to perform their professional duties. Their competence in the field was never examined. This study assessed their competencies in detecting malnourished children 5 years and below in Beledweyne. [from abstract]

Zanzibar Health Care Worker Productivity Study: Preliminary Study Findings

This report summarizes the findings and conclusions of [a baseline study and a three-day stakeholder workshop on productivity]. Specifically, we present the baseline study findings, identify areas where current productivity falls short of desired levels, consider the root causes of identified productivity gaps and offer practical recommendations for feasible management interventions to improve productivity. We conclude with a short-term action plan for moving forward with implementation activities. [from introduction]

Model of ODL to Address Educational Needs of Health Workers in Africa

Health workers attending overseas universities may be less likely to return home. One response is to improve course provision and professional updating opportunities in-country. Leeds Metropolitan University, with funding from the Commonwealth Scholarships Commission under their distance learning initiative, runs a tailor-made MSc Public Health (Environmental Health and Health Promotion) in Zambia, for nurse tutors, clinical officers and environmental health workers. Using locally relevant curricula, with community-based, student centred, problem-solving approaches, retention may be improved. This paper will discuss how the course is delivered in Zambia, how the partnership developed such as to enable effective delivery of the course, and how sustainable learning can be achieved in a developing country in partnership with a UK University. [from abstract]

Reducing Stigma and Discrimination in Hospitals: Positive Findings from India

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]

Getting Evidence into Practice: What Works in Developing Countries?

This article summarizes and comments on the available literature on the effectiveness of intrventions designed to change [health worker] professional behaviour in order to bring evidence into practice in developing countries. [from abstract]

Improving the Geographical Distribution of Health Professionals: What the Literature Tells Us

This Issues in Health Economics presents the main conclusions of an international literature review of policies designed to tackle geographical inequalities in the distribution of health professionals. [author’s description]

Expansion of the Role of Nurse Auxiliaries in the Delivery of Reproductive Health Services in Honduras

The nurse auxiliaries who work at the rural health centers (CESARs) of the Honduran Ministry of Health (MOH) are frequently the only source of reproductive health services in the communities they serve. In order to increase access to long-term family planning methods, the MOH and the Population Council’s INOPAL III Project conducted an operations research study from 1997 to 1998 to see if nurse auxiliaries could provide good quality IUD, Depo-Provera and vaginal cytology services without health risks for their clients.

Monitoring the Effect of the New Rural Allowance for Health Professionals

The aim of the project was to evaluate the effect of the new rural allowance on the short-term career choices of health professionals in rural areas. A longitudinal cohort study design was used, before and after the introduction of the new allowance.

Community Health Workers: What Do We Know About Them? The State of the Evidence on Programmes, Activities, Costs an Impact on Health Outcomes of Using Community Health Workers

This review paper revisits questions regarding the feasibility and effectiveness of community health worker programmes. This review aims to assess the presently existing evidence. It constitutes a desktop review, which draws together and assesses the evidence as it can be found in the published and selected grey literature since the late 1970s. [from executive summary]

Nurse Staffing and Quality of Patient Care

This review was designed to assess how nurse to patient ratios and nurse work hours were associated with patient outcomes in acute care hospitals, factors that influence nurse staffing policies, and nurse staffing strategies that improved patient outcomes. [from abstract]

Migration of Nurses from Sub-Saharan Africa: A Review of Issues and Challenges

This paper was commissioned to identify and review reports, documents and data relating to nursing workforce dynamics in sub-Saharan Africa with the objective of analyzing, synthesizing, and presenting key information on nurse migration in the region. It reviews trends and impact of nurse migration derived from previously published work by various groups and reports to the High Level Forum on the millennium development goals on the human resources crisis. [from abstract]

Initial Community Perspectives on the Health Service Extension Programme in Welkait, Ethiopia

The Health Service Extension Programme (HSEP) is an innovative approach to addressing the shortfall in health human resources in Ethiopia. It has developed a new cadre of Health Extension Workers (HEWs), who are charged with providing the health and hygiene promotion and some treatment services, which together constitute the bedrock of Ethiopia’s community health system. This study seeks to explore the experience of the HSEP from the perspective of the community who received the service. [from abstract]

Human Resources for Health: a Gender Analysis

In this paper I discuss gender issues manifested within health occupations and across them. In particular, I examine gender dynamics in medicine, nursing, community health workers and home carers. I also explore from a gender perspective issues concerning delegation, migration and violence, which cut across these categories of health workers. These occupational categories and themes reflect priorities identified by the terms of reference for this review paper and also the themes that emerged from the accessed literature. [from summary]

Family Planning - Integrated HIV Services: a Framework for Integrating Family Planning and Antiretroviral Therapy Services

This document focuses on FP integration with HIV services, more specifically with HIV care and treatment services. It encourages supervisors or planners, service providers, and community-based personnel to consider opportunities for operationalizing client-responsive integration of FP and HIV services.

Tumaini Home-Based Care Program: a Case Study

This case study was conducted to impart a thorough understanding of the Tumaini Home-Based Care Program model and to document lessons learned that could be applied to other initiatives. While the Tumaini program addresses the needs of both people living with HIV and AIDS (PLHA) as well as OVC, the case study focuses particular attention on specific services and program impact for OVC. The program goals were to provide care and support to OVC; to provide care and support to PLHA; Tumaini: Home-Based Care and to build the capacity of local organizations to provide sustainable HBC services. [from

Improving the Use of Long-Term and Permanent Methods of Contraception in Guinea: a Performance Needs Assessment

This report describes a performance needs assessment of family planning and other health care providers in three regions of Guinea. Its purpose was to identify performance gaps or problems and determine the most appropriate interventions to improve providers’ performance and clients’ and communities’ access to and use of long-term and permanent methods of contraception (LTPMs)—specifically, male and female sterilization and the intrauterine device (IUD). [adapted from author]

Guatemala, Pro Redes Salud: Rapid Scale-Up of Primary Health Care Through NGOs

Before the project began, 300,000 remote rural inhabitants in the Mayan highlands lacked basic primary care, the NGO civil society in health lacked cohesion, and the MOH NGO granting program needed revising. From 2000 to 2004, the NGO Networks Project implemented a grants program that helped form networks of NGOs, strengthening health services and testing innovations in service delivery, and improved monitoring and evaluation.

Brain Drain of Health Professionals from Sub-Saharan Africa to Canada

Significant numbers of African-trained health workers migrate every year to developed countries including Canada. They leave severely crippled health systems in a region where life expectancy is only 50 years of age, 16 per cent of children die before their fifth birthday and the HIV/AIDS crisis continues to burgeon. The population of Sub-Saharan Africa totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. [from introduction]

Capacity Assessment of the Health Facilities and Community Based Associations

The overall objective of this study is to evaluate the capacity as well as the performance of the health facilities (HF) and community associations (community health workers associations (CHW), traditional birth attendant associations (TBA) and associations of people living with HIV (PLWHA), operating in the Gisagara (formerly Kibilizi) District. [from summary]

Nurse-Physician Relationships Solutions and Recommendations for Change

This report presents the findings of the Ministry of Health and Long Term Care (MOHLTC) directed research on the topic of nurse-physician relationships, and includes recommendations arising from the in depth literature review conducted and which are directed toward the Research Unit and Nursing Secretariat, at the MOHLTC.

Managing the Health Millennium Development Goals: the Challenge of Management Strengthening Lessons from Three Countries

Achieving the health Millennium Development Goals will require a significant scaling up of health service delivery in many countries. The number of competent managers will also have to be scaled up at the same time – managers are an essential resource for ensuring that priority needs are met and resources are used effectively. This study describes various management strengthening activities in 3 countries – South Africa, Togo and Uganda. [from executive summary]

Improving the Performance of Primary Providers in Family Planning and Reproductive Health: Results and Lessons Learned from the PRIME II Project, 1999-2004

A foundation of collaborative partnership, strong technical staff and field presence, and practical monitoring and evaluation anchored the PRIME II Project’s successful efforts to improve the performance of primary providers of family planning and reproductive health (FP/RH) services. PRIME II’s global achievements and lessons learned are summarized in the first section; an overview of project results in each technical leadership and focus area is presented in Chapter 2. [author’s description]

Indonesia: Resident Midwives Help Avert Maternal Deaths When Financial Barriers are Removed

In 1989, the government of Indonesia launched the Midwife in the Village programme. Its purpose was to reduce maternal death by assigning a resident midwife to each village in the country. By definition, she would live in the village and be part of the community she served. In 2005, Immpact examined the effect of the programme on the health and survival of mothers in two districts in Java. [from author’s description]

Romania, Reaching the Poor: Scaling Up Integrated Family Planning Services

This case study examines the scale up of family planning services in Romania through primary care providers. It disucces the process, the challenges, the successful results and the lessons learned.

Ophthalmology Human Resource Projections: Are We Heading for a Crisis in the Next 15 Years?

This manpower projection was undertaken by using the Canadian Medical Association Physician Resource Evaluation Template. This spreadsheet-based stock and flow model incorporates key parameters in estimating physician supply over the next 2 decades and enables planners to create various scenarios to test the effects on future supply. [author’s description]

Communication Action Groups: Promoting Broader Discussion of Reproductive Health

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).

Malawi Case Study: Choice, Not Chance: a Repositioning Family Planning Case Study

This report evaluates the success of a program to improve family planning services in Malawi. It discusses the importance of community-based distribution, i.e. mobile clinics and community health workers, to the success of family planning in the country since so much of the population is rural.

Lessons Learned from the Benin HIV/AIDS Prevention Program (BHAPP)

This report evaluates the BHAPP project including an analysis of its service and communication activities for outreach and capacity strengthening of personnel in 23 health centers to diagnose and treat STIs and use STI case management as a referral point for HIV testing. It also discusses the effectiveness of the project’s policy work at the central level.