Interventions linking gender relations and violence with reproductive health and HIV: Rationale, effectiveness and gaps

The past decade has witnessed much attention on the interrelationship between accepted gender norms and reproductive health (RH) outcomes in the context of HIV/AIDS. After decades of ignoring men in RH programmes, attention is now focusing on actively involving men in interrogating gender norms underpinning gender-based violence (GBV) in the context of RH and HIV/AIDS prevention, care and support activities. However, there are challenges in addressing gender norms and in male involvement. The purpose of this article is to highlight existing evidence-based efforts to challenge gender norms and promote constructive male involvement, with a special focus on South Africa; to present findings on effectiveness of gender and male-focused RH programmes; and to identify knowledge and programme design-related gaps. | This article argues that addressing biased gender norms and masculinities in an RH/HIV policy and programme context will contribute to the improvement of the health and rights of women and children, as well as of men. However, achievement of these goals will be limited by a failure to address broader structural factors such as poverty and unemployment that shape gender relations and RH/HIV outcomes. This will require getting RH/HIV interventions ‘out of the health box’ and into the arena of socio-economic development in collaboration with agencies working in these areas

Dual protection in an integrated community-based program: A case study of Tanzania Family Health/Ministry of Health Project in Mbeya

One of the most pressing challenges for health programs in most sub-Saharan African countries is effectively addressing the increasing prevalence of HIV/AIDS. Recent evidence suggests that controlling sexually transmitted diseases (STDs) through undertaking preventive measures, early diagnosis, and treatment significantly slows the spread of HIV/AIDS. In regard to STI/HIV, Maternal and Child Health (MCH) and Family Planning (FP) clients are described as “low risk” groups. However, in a number of sub-Saharan African countries, the reported levels of STDs are significantly high enough to justify use of limited resources to target this group for STD services. MCH/FP programs have begun to get more involved in prevention of STDs/HIV among MCH and FP clients through providing integrated programs and integrated services. This move toward integration is gaining momentum, however it presents immense challenges for reproductive health (RH) programs in the region. The issue of the best cost-effective strategy to provide quality integrated MCH/FP/STD/HIV services in the context of scarce financial, laboratory, and technical resources is still unsettled, according to this report, including the technical challenge of altering existing MCH/FP services to simultaneously meet contraceptive and disease-control goals

An assessment of community-based family planning programs in Kenya

Kenya has a long history of using community-based distribution (CBD) as an integral part of its family planning (FP) program. The purpose of this study was to assess the role of CBD programs in terms of providing information and services, to learn more about the determinants of program effectiveness, and to attempt to compare the programs’ cost-effectiveness. Fieldwork was undertaken in mid-1995 when data were collected from seven of the major CBD programs in Kenya. Four rural and three urban programs were included, as were programs that remunerated their agents and those that did not, and programs that had full-time agents and those that had part-time agents. Data on the programs themselves were collected from records and from interviews with managers and staff, as well as from a sample of CBD agents. Data were also collected from representative samples of the population living in the agents’ catchment areas. Key findings and programmatic recommendations are provided in this report

Testing the effectiveness of integrating community-based approaches for encouraging abandonment of female genital cutting into CARE\u27s reproductive health programs in Ethiopia and Kenya

CARE International, with technical support from the Frontiers in Reproductive Health Program completed a study in Ethiopia and Kenya designed to test the effectiveness of education activities using behavior change communication (BCC) approaches and advocacy activities by religious and other key leaders to abandon female genital cutting (FGC). In Ethiopia, the increased knowledge of harmful FGC effects and human rights issues translated to a positive attitude in support of FGC abandonment and an intention not to cut their daughters in the future. In Kenya, the analysis indicated mixed results in attitude and intended behavior change

Nursing staff dynamics and implications for maternal health provision in public health facilities in the context of HIV/AIDS

This study, carried out in Limpopo, KwaZulu-Natal, and Mpumalanga provinces in South Africa, aimed to document nursing staff dynamics in maternal health services, and to explore the factors associated with these dynamics. The study found that a high percentage of nursing staff working in public facilities were demotivated, burnt out, and were considering leaving the facility where they were working. A range of factors, both financial and nonfinancial, were associated with nurses considering going overseas: inadequate pay, poor promotion, feeling unsupported by management, and having bad relationships at work were all associated with lack of organizational commitment. As a result of high numbers of nurses feeling demoralized, there is not a conducive environment for policy interventions. Policymakers need to pay more attention to how policies are implemented and the impact of policies on the relationships between nurses, and nurses and managers in facilities

A multi-sectoral approach to providing reproductive health information and services to young people in Western Kenya: The Kenya adolescent reproductive health project

Informing adolescents about appropriate and acceptable behaviors, and ways to protect themselves against unwanted and unprotected sex, has proved problematic in Kenya. Education programs for in- and out-of-school adolescents are lacking, there is controversy about providing services to sexually active adolescents, and a pervasive concern that sexuality education and contraceptive services leads to promiscuity. Unbiased and accurate information and services are needed if adolescents are to delay becoming sexually active, to resist pressures to engage in nonconsensual sex, and to protect themselves against unwanted pregnancies and infections if they do have sex. Moreover, strategies for providing such information and services need to be acceptable to the community and sustainable over time. The Population Council’s Frontiers in Reproductive Health Program and the Program for Appropriate Technology in Health Kenya office collaborated with three government of Kenya ministries to design and implement a multisectoral project to improve knowledge about reproductive health and encourage a responsible and healthy attitude toward sexuality among adolescents, delay the onset of sexual activity among younger adolescents, and decrease risky behaviors among sexually active adolescents. Three interventions were implemented and evaluated in two districts in Western Province and this report presents findings that directly evaluate and cost the interventions

Comprehensive care and HIV prophylaxis after sexual assault in rural South Africa: the Refentse intervention study.

PROBLEM: Although international guidelines specify the central role of the health sector in providing comprehensive care, including HIV post-exposure prophylaxis (PEP), after sexual assault, in both industrialised and developing countries there are many challenges to providing timely and comprehensive services. DESIGN: A nurse driven model of post-rape care was integrated into existing hospital services; the before and after study design evaluated impacts on quality of care, reviewing 334 hospital charts and conducting interviews with 16 service providers and 109 patients. SETTING: 450 bed district hospital in rural South Africa. KEY MEASURES FOR IMPROVEMENT: Quality of care after rape (forensic history and examination, provision of emergency contraception, prophylaxis for sexually transmitted infections, referrals); provision of HIV counselling and testing and provision and completion of full 28 day course of PEP; and service utilisation (number of service providers seen on first visit and number of rape cases presenting to hospital per month). STRATEGIES FOR CHANGE: After completing baseline research, we introduced a five part intervention model, consisting of a sexual violence advisory committee, hospital rape management policy, training workshop for service providers, designated examining room, and community awareness campaigns. Effect of change Existing services were fragmented and of poor quality. After the intervention, there were considerable improvements in clinical history and examination, pregnancy testing, emergency contraception, prophylaxis for sexually transmitted infections; HIV counselling and testing, PEP, trauma counselling, and referrals. Completion of the 28 day course of PEP drugs increased from 20% to 58%. LESSONS LEARNT: It is possible to improve the quality of care after sexual assault, including HIV prophylaxis, within a rural South African hospital at modest cost, using existing staff. With additional training, nurses can become the primary providers of this care

Association of Mother’s Handwashing Practices and Pediatric Diarrhea: Evidence from a Multi-Country Study on Community Oriented Interventions

IntroductionImproved hand hygiene in contexts with high levels of diarrheal diseases has shown to reduce diarrheal episodes in children under five years. A quasi-experimental multi-country study with matched comparisons was conducted in four rural districts/sub districts in Cambodia, Guatemala, Kenya and Zambia.MethodsCommunity oriented interventions including health promotion for appropriate hand washing was implemented in the intervention sites, through community health workers (CHW) and social accountability mechanisms. Community councils were strengthened/established in all study sites. Using household surveys, information on mother’s handwashing practices and diarrhea incidence of children 2 weeks preceding the study was obtained.   Results and ConclusionAccess to safe drinking water was reportedly higher for communities in Guatemala and Zambia (>80%), than those in Cambodia and Kenya (<63%), with significantly higher levels in intervention sites for Guatemala and Kenya. Improved sanitation was low (<10%), for Kenya and Zambia, compared to Cambodia and Guatemala (>40%); intervention sites reporting significantly higher levels, except for Zambia. Hand washing index; hand washing before food preparation, after defecation, attending to a child after defecation, and before feeding children was significantly higher for intervention sites in Cambodia, Guatemala and Kenya (Cambodia, 2.4 vs 2.2, p<0.001, Guatemala, 3.0 vs 2.5, p<0.001, Kenya, 2.6 vs 2.3, p<0.001). Factors significantly associated with lower odds of diarrhea were; mother’s marital status, higher educational status, one or more handwashing practices, wealthier quintiles, older (>24m), and female children. The findings suggest that caretaker handwashing with soap or ash has a protective effect on prevalence of diarrhea in children.