Improving women’s reproductive health in India by educating men and families

This repository item contains a single issue of Issues in Brief, a series of policy briefs that began publishing in 2008 by the Boston University Frederick S. Pardee Center for the Study of the Longer-Range Future.In this Issues in Brief, 2015 Pardee Graduate Summer Fellow Maanasa Venkatesh argues that reproductive health care for women – as well as men – would improve in India if health care providers included men and marital family members in discussions and education about women’s reproductive health issues. She cites research that has shown that effective reproductive health programs consider cultural decision-making norms and include the partners and other family members who are directly involved in decisions about seeking reproductive health care. She writes “There is discomfort acknowledging that the role of traditional social norms and decision-making dynamics don’t fit with widely-held perceptions of modern female agency. Yet public health efforts have been found to be most effective with they understand and work with existing social structures to achieve change through education and dialogue.” Maanasa Venkatesh was a 2015 Graduate Summer Fellow at the Frederick S. Pardee Center for the Study of the Longer-Range Future. She completed her MBBS in India and earned a master’s degree in Public Health at the Boston University School of Public Health in 2016. She is presently working as a junior resident doctor in Chennai, India. Her research interests include women’s health and equity in international health

Community Health Worker Use of Smart Devices for Health Promotion: Scoping Review

BACKGROUND: Community health workers (CHWs) have become essential to the promotion of healthy behaviors, yet their work is complicated by challenges both within and beyond their control. These challenges include resistance to the change of existing behaviors, disbelief of health messages, limited community health literacy, insufficient CHW communication skills and knowledge, lack of community interest and respect for CHWs, and CHWs' lack of adequate supplies. The rising penetration of "smart" technology (eg, smartphones and tablets) in low- and middle-income countries facilitates the use of portable electronic devices in the field. OBJECTIVE: This scoping review examines to what extent mobile health in the form of smart devices may enhance the delivery of public health messages in CHW-client interactions, thereby addressing the aforementioned challenges and inducing client behavior change. METHODS: We conducted a structured search of the PubMed and LILACS databases using subject heading terms in 4 categories: technology user, technology device, use of technology, and outcome. Eligibility criteria included publication since January 2007, CHWs delivering a health message aided by a smart device, and face-to-face communication between CHWs and clients. Eligible studies were analyzed qualitatively using a modified version of the Partners in Health conceptual framework. RESULTS: We identified 12 eligible studies, 10 (83%) of which used qualitative or mixed methods approaches. We found that smart devices mitigate challenges encountered by CHWs by improving their knowledge, motivation, and creativity (eg, through self-made videos); their status within the community; and the credibility of their health messages. The technology stimulated interest in both CHWs and clients-and sometimes even in bystanders and neighbors. Media content produced locally or reflecting local customs was strongly embraced. Yet, the effect of smart devices on the quality of CHW-client interactions was inconclusive. Interactions suffered as CHWs were tempted to replace educational conversations with clients by passively watching video content. Furthermore, a series of technical difficulties experienced especially by older and less educated CHWs compromised some of the advantages brought about by mobile devices. Adequate CHW training ameliorated these difficulties. Only 1 study (8%) considered client health behavior change as an end point, thus revealing a major research gap. CONCLUSIONS: Smart mobile devices may augment CHWs' field performance and enhance face-to-face interactions with clients, yet they also generate new challenges. The available evidence is scarce, mostly qualitative, and focused on a limited range of health outcomes. Future research should include larger-scale interventions across a wide range of health outcomes and feature client health behavior change as an end point

Healthcare information and the rural primary care doctor

Health inequity and improper dispensing of social justice is a huge topic of which one aspect is healthcare information and access to it. Access to health information is a ‘prerequisite for meeting the Millennium Development Goals’, and lack of knowledge and information, especially in resource-poor settings, impedes the delivery of quality healthcare and contributes to many preventable deaths worldwide. Three out of four doctors responsible for care of children in district hospitals in seven less developed countries reported inadequate knowledge in managing common childhood illnesses such as childhood pneumonia, severe malnutrition and sepsis. A review concluded that information deficiency exists ‘right across the health workforce’ and can be associated with provision of suboptimal care

e-ESAS: Evolution of a Participatory Design-based Solution for Breast Cancer (BC) Patients in Rural Bangladesh

Healthcare facility is scarce for rural women in the developing world. The situation is worse for patients who are suffering from diseases that require long-term feedback-oriented monitoring such as breast cancer. Lack of motivation to go to the health centers on patients’ side due to sociocultural barriers, financial restrictions and transportation hazards results in inadequate data for proper assessment. Fortunately, mobile phones have penetrated the masses even in rural communities of the developing countries. In this scenario, a mobile phone-based remote symptom monitoring system (RSMS) with inspirational videos can serve the purpose of both patients and doctors. Here, we present the findings of our field study conducted on 39 breast cancer patients in rural Bangladesh. Based on the results of extensive field studies, we have categorized the challenges faced by patients in different phases of the treatment process. As a solution, we have designed, developed and deployed e-ESAS—the first mobile-based RSMS in rural context. Along with the detail need assessment of such a system, we describe the evolution of e-ESAS and the deployment results. We have included the unique and useful design lessons that we learned as e-ESAS evolved through participatory design process. The findings show how e-ESAS addresses several challenges faced by patients and doctors and positively impact their lives

Disease surveillance and patient care in remote regions: an exploratory study of collaboration among healthcare professionals in Amazonia

The development and deployment of information technology, particularly mobile tools, to support collaboration between different groups of healthcare professionals has been viewed as a promising way to improve disease surveillance and patient care in remote regions. The effects of global climate change combined with rapid changes to land cover and use in Amazonia are believed to be contributing to the spread of vector-borne emerging and neglected diseases. This makes empowering and providing support for local healthcare providers all the more important. We investigate the use of information technology in this context to support professionals whose activities range from diagnosing diseases and monitoring their spread to developing policies to deal with outbreaks. An analysis of stakeholders, their roles and requirements, is presented which encompasses results of fieldwork and of a process of design and prototyping complemented by questionnaires and targeted interviews. Findings are analysed with respect to the tasks of diagnosis, training of local healthcare professionals, and gathering, sharing and visualisation of data for purposes of epidemiological research and disease surveillance. Methodological issues regarding the elicitation of cooperation and collaboration requirements are discussed and implications are drawn with respect to the use of technology in tackling emerging and neglected diseases

The usefulness of nutrition and health videos displayed on mobile phones in rural Uganda : Experiences of community health workers and mothers

Improvements in community health workers' (CHWs) knowledge and practices in low-income countries increasingly involve mobile phones and videos. However, little data exists on CHWs' and mothers' experiences of using such phones and videos. In this study, educational videos on nutrition, health and hygiene were downloaded onto mobile phones, which were given to 12 CHWs in rural Uganda. In 2018, these CHWs used the videos for a period of 3 months to support their work during their visits with families. We subsequently conducted individual interviews with eight CHWs and held four focus group discussions with 16 mothers. From the inductively analysed data, we identified four key themes: impact, competence, meaningfulness and choice, which are also dimensions of the Intrinsic Task Motivation Model. The model describes the motivation of workers and has previously been used in connection with CHWs. In our study, CHWs and mothers considered that the videos had more strongly impacted their learning than traditional teaching methods, and they felt the videos improved the child feeding and caring competence of both CHWs and mothers. Furthermore, the CHWs found that the videos enhanced the meaningfulness of their work, as they felt more greatly appreciated and necessary. In addition, they experienced more freedom of choice in their ability to influence their working routines. This study shows that educational videos are well received among CHWs and mothers. Educational videos are a promising method to maintain and improve the motivation of voluntary CHWs and influence correct child feeding and hygiene practices in Uganda.Peer reviewe

Using mobile phones to improve community health workers performance in low-and-middle-income countries

Background: In low-and-middle-income countries community health workers are the core component of the PHC system as they act as a liaison between the communities and the healthcare facilities. Evidence suggests that the services offered by these workers have helped in the decline of maternal and child morbidity and mortality rates and the burden of communicable and non-communicable diseases. However, the coverage and the overall progress towards achieving the SDG targets is very sluggish. The recent consensus concerning this current pace of progress, is that it relates to financial and human resources constraints. CHWs are overburdened as they are expected to accomplish more although they may not obtain the required support to perform their duties. The health systems of LMICs, have given very little attention to the work environment of CHWs; which has negatively affected CHWs productivity, and quality of services. This debate is intended to explore the potential of mobile phone technology in LMICs for improving CHWs performance and effectiveness.Discussion: To improve CHWs productivity, some studies involved the use of mobile phones for data collection and reporting, while other studies used mobile technology for patient to provider communication, patient education, CHWs supervision, and monitoring and evaluation. A wide range of benefits exists for using mobile phones including reduction in CHWs workload, improvement in data collection, reporting and monitoring, provision of quality healthcare services, supportive supervision, better organization of CHWs tasks and improvement in community health outcomes. However, a number of studies suggests that CHWs encounter unique challenges when adopting and using mobile health solutions for health service delivery such as, lack of CHWs training on new mHealth solutions, weak technical support, issues of internet connectivity and other administrative challenges. Future research efforts should be directed to explore health system readiness for adopting sustainable mHealth solutions to improve CHWs workflows in LMICs.Conclusion: Future research efforts and policy dialogue should be directed to explore health system readiness for adopting sustainable mHealth solutions to improve CHWs workflows in LMICs

Achieving urban food and nutrition security in the developing world:

CONTENTS: Brief 1. Overview / James L. Garrett Brief 2. An urbanizing world / Martin Brockerhoff Brief 3. Rural-urban interdependence / Ceclia Tacoli Brief 4. Urban livelihoods and labor markets / Arjan de Haan Brief 5. Feeding the cities: food supply and distribution / Olivio Argenti Brief 6. The hidden significance of urban agriculture / Luc J.A. Mougeot Brief 7. Urbanization and the nutrition transition / Barry M. Popkin Brief 8. Urban women: balancing work and childcare / Patrice L. Engle Brief 9. Threats to urban health / Carolyn Stephens Brief 10. Programming for urban food and nutrition security / Timothy R. Frankenberger, James L. Garrett, and Jeanne Downen.Food supply, food security, Livelihoods, Urban programming,