Public-Private Partnership, Contracting Arrangements and Managerial Capacity to Strengthen RCH Programme Implementation

Strengthening management capacity and meeting the need for Reproductive and Child Health (RCH) services is a major challenge for the national RCH programme in India. Central and state governments are working through multiple options to meet this challenge, responding to the complexity of issues in RCH which cut across social, cultural and economic factors, as well as reflecting the immense geographical barriers to access for remote and rural populations. Other barriers are also being addressed, including lessening financial burdens and creating Public - Private Partnerships (PPP) to expand access. For example, the NRHM has been initiated with particular focus on rural population. However, there are a number constraints faced by departments of health in implementing these initiatives. In this paper we focus on one key area: the development of management capacity for working with the private sector. A synthesis of the learning from three case studies of public-private partnerships in the RCH area is discussed. Two case studies pertain to state level initiatives in Gujarat and Andhra Pradesh and third study focuses on the national level mother NGO scheme. The objective of these case studies was to investigate how management capacity was developed through the implementation of these three public-private partnerships initiatives and contracting out of RCH services. The case studies also focused on the partnership in service delivery setting by examining the structure and process of partnership experiences, understanding the management capacity and competency in make-up of various public-private partnership initiatives in RCH, and identify pathways towards developing management capacity of partners to address key challenges in implementation.

Tracking Global Fund HIV/AIDS resources used for sexual and reproductive health service integration: case study from Ethiopia

Objective/Background The Global Fund to Fight AIDS, Tuberculosis & Malaria (GF) strives for high value for money, encouraging countries to integrate synergistic services and systems strengthening to maximize investments. The GF needs to show how, and how much, its grants support more than just HIV/AIDS, TB and malaria. Sexual and Reproductive Health (SRH) has been part of HIV/AIDS grants since 2007. Previous studies showed the GF PBF system does not allow resource tracking for SRH integration within HIV/AIDS grants. We present findings from a resource tracking case study using primary data collected at country level. Methods Ethiopia was the study site. We reviewed data from four HIV/AIDS grants from January 2009-June 2011 and categorized SDAs and activities as directly, indirectly, or not related to SRH integration. Data included: GF PBF data; financial, performance, in-depth interview and facility observation data from Ethiopia. Results All HIV/AIDS grants in Ethiopia support SRH integration activities (12-100%). Using activities within SDAs, expenditures directly supporting SRH integration increased from 25% to 66% for the largest HIV/AIDS grant, and from 21% to 34% for the smaller PMTCT-focused grant. Using SDAs to categorize expenditures underestimated direct investments in SRH integration; activity-based categorization is more accurate. The important finding is that primary data collection could not resolve the limitations in using GF GPR data for resource tracking. The remedy is to require existing activity-based budgets and expenditure reports as part of PBF reporting requirements, and make them available in the grant portfolio database. The GF should do this quickly, as it is a serious shortfall in the GF guiding principle of transparency. Conclusions Showing high value for money is important for maximizing impact and replenishments. The Global Fund should routinely track HIV/AIDs grant expenditures to disease control, service integration, and overall health systems strengthening. The current PBF system will not allow this. Real-time expenditure analysis could be achieved by integrating existing activity-based financial data into the routine PBF system. The GF’s New Funding Model and the 2012-2016 strategy present good opportunities for over-hauling the PBF system to improve transparency and allow the GF to monitor and maximize value for money

Meeting women\u27s health care needs after abortion

Women who seek emergency treatment for abortion complications—bleeding, infection, and injuries to the reproductive tract system—should be a priority group for reproductive health care programs. These women often receive poor-quality services that do not address their multiple health needs. They may be discharged without counseling on postoperative recuperation, family planning (FP), or other reproductive health (RH) issues. Women who have had an induced abortion due to an unwanted pregnancy are likely to have a repeat abortion unless they receive appropriate FP counseling and services. Preventing repeat unsafe abortions is important for RH programs because it saves women\u27s lives, protects women’s health, and reduces the need for costly emergency services for abortion complications. At the 1994 International Conference on Population and Development, the world\u27s governments called for improvements in postabortion medical services. As part of the resulting international postabortion care initiative, the Population Council’s Operations Research and Technical Assistance projects worked collaboratively to conduct research on interventions to improve postabortion care. This brief summarizes the major findings of this research and relevant studies by other international organizations

Cómo satisfacer las necesidades de salud de la mujer después de un aborto

Las mujeres que buscan servicios de urgencia por complicaciones de un aborto (hemorragia, infección y lesiones del tracto reproductivo) deberían ser un grupo prioritario para los programas de salud reproductiva. Frecuentemente, estas mujeres reciben atención de mala calidad que no cubre sus múltiples necesidades de salud. En ocasiones se les da de alta sin haber recibido consejería en recuperación postoperatoria, planificación familiar y otros aspectos de salud reproductivahttp://www.popcouncil.org/pdfs/frontiers/pbriefs/Pbriefs_sp/PACPgmBrfSp.pd

Anti-trafficking programs in South Asia: Appropriate activities, indicators and evaluation methodologies

Throughout South Asia, men, women, boys, and girls are trafficked within their own countries and across international borders against their wills in what is essentially a clandestine slave trade. The Congressional Research Service and the U.S. State Department estimate that between 1 to 2 million people are trafficked each year worldwide with the majority originating in Asia. Root causes include extreme disparities of wealth, increased awareness of job opportunities far from home, pervasive inequality due to caste, class, and gender bias, lack of transparency in regulations governing labor migration, poor enforcement of internationally agreed-upon human rights standards, and the enormous profitability for traffickers. The Population Council, UNIFEM, and PATH led a participatory approach to explore activities that address the problem of human trafficking in South Asia. A meeting was held in Kathmandu, Nepal, September 11– 13, 2001 to discuss these issues. Approximately 50 representatives from South Asian institutions, United Nations agencies, and international and local NGOs attended. This report summarizes the principal points from each paper presented and captures important discussion points that emerged from each panel presentation

Advances and challenges in postabortion care operations research: Summary report of a global meeting

The Global Meeting on Postabortion Care: Advances and Challenges in Operations Research was held at the Population Council’s New York office on January 19–21, 1998, to review progress made by three regional operations research (OR) projects in improving delivery of postabortion care. The resources of the three OR contracts were pooled, and, in collaboration with Ipas and the Ebert Program, approximately 65 researchers, senior program managers, and government officials from Africa, Latin America, the Middle East, and Southeast Asia were convened. Three objectives guided the planning of the meeting: review progress in the development of OR methodologies pertaining to postabortion care, identify elements in the design of new postabortion care services, and suggest future areas for postabortion care OR. The meeting was organized around the presentation of 20 papers distributed to all participants several weeks earlier. Discussants presented critical syntheses of the papers and indicated directions for future OR studies. This report presents a summary overview of the principal themes and key points drawn from the papers and discussions, organized according to the theme of each session

Quality at the centre of universal health coverage

The last decade of the MDG era witnessed substantial focus on reaching the bottom economic quintiles in low and middle income countries. However, the inordinate focus on reducing financial risk burden and increasing coverage without sufficient focus on expanding quality of services may account for slow progress of the MDGs in many countries. Human Resources for Health underlie quality and service delivery improvements, yet remains under-addressed in many national strategies to achieve Universal Health Coverage. Without adequate investments in improving and expanding health professional education, making and sustaining gains will be unlikely. The transition from the Millennium Development Goals (MDG) to the Sustainable Development Goals (SDG), with exciting new financing initiatives such as the Global Financing Facility brings the potential to enact substantial gains in the quality of services delivered and upgrading human health resources. This focus should ensure effective methodologies to improve health worker competencies and change practice are employed and ineffective and harmful ones eliminated (including undue influence of commercial interests)

Experience with clinical training in postabortion care in Egypt: Improving medical and interpersonal skills

The Population Council’s Asia and Near East Operations Research and Technical Assistance (ANE OR/TA) Project is collaborating with AVSC International to incorporate the addition of improved postabortion care procedures into the ongoing Safe Reproductive Health Care project. An element in the next phase of the program’s evolution was a two-day seminar held in Alexandria, Egypt. This seminar provided an opportunity for staff from ten hospitals that participated in the 1996–97 expansion program to present their own experience and impressions of the postabortion case-management procedures, and to discuss their strengths and weaknesses. This report presents an overview of this meeting’s presentations and discussions

Integrating issues of sexuality into Egyptian family planning counseling

The Population Council studied the acceptability of including sexuality issues in family planning (FP) in Egypt, a conservative society with social restrictions around discussions of sex. The study results showed that sexuality counseling is acceptable to family planning clients in Egypt; in fact, sexuality-related problems and concerns were found to be very common in the study group. Similarly, training family planning service providers on issues of sexuality is both feasible and acceptable to providers. The report offers recommendations for refining existing FP training programs and services including: integrating issues of sexuality into FP counseling, training FP service providers on the management of basic sexual problems, offering health education messages that encourage the public to bring their sexuality-related questions or concerns to FP providers, and establishing linkages between clinics and hospitals for referral of cases with more complex problems

The effect of a livelihoods intervention in an urban slum in India: Do vocational counseling and training alter the attitudes and behavior of adolescent girls?

This Population Council working paper examines whether an experimental intervention for girls aged 14–19 that provided reproductive health information, vocational counseling and training, and assistance with opening savings accounts in slum areas of Allahabad in Uttar Pradesh, India had an effect on their attitudes and behaviors. Although the livelihoods program was acceptable to parents and feasible to implement, the project had only a minimal impact on the behavior and attitudes of adolescent girls in the experimental slums. The greatest changes between the baseline and the endline surveys were found in those outcomes that most closely reflected the content of the intervention. Girls exposed to the intervention were significantly more likely to have knowledge of safe spaces, be a member of a group, score higher on the social skills index, be informed about reproductive health, and spend time on leisure activities than were the matched control respondents. No effect was found on gender-role attitudes, mobility, self-esteem, work expectations, or on number of hours visiting friends, performing domestic chores, or engaging in labor-market work