Where there is no phone: The benefits and limitations of using intermediaries to extend the reach of mHealth to individuals without personal phones in Malawi

The purpose of this study is to identify the benefits and limitations associated with intermediaries to provide access to and increase utilization of an mHealth intervention amongst people without personal phones in Balaka District, Malawi. A mixed-methods approach was utilized including quantitative data on usage and focus groups and interviews with users and volunteers. Community volunteers equipped with mobile phones served as intermediaries and were critical access points to the service for users without personal phones. However, there were challenges maintaining phones and solar panels, sustaining volunteer motivation and understanding how to use the service. While these strategies had a number of limitations, the majority of users (more than 65%) were individuals without a personal phone, who may not have been able to access the service otherwise. Further research is needed to better understand the resources, strategies and effort needed to sustain access through intermediaries in the long-term

Identifying and Addressing Contemporary Issues in Central Coast Oak Woodlands

Recently, questions about the extent of thinning, the sustainability of forest management practices, and the compatibility with other uses were raised by the media, agency personnel, and environmental groups. In response, University of California Cooperative Extension and Cal Poly San Luis Obispo’s Natural Resources Management Department collaborated to address these issues. In March 2006, a questionnaire was mailed to landowners of properties greater than 100 acres in Santa Barbara, San Luis Obispo, and Monterey counties. A total of 2,786 questionnaires were mailed, with 450 completed and returned (16 percent). The respondents were highly educated, holding degrees in areas other than agriculture or natural resources. Most landowners earned degrees in biology, business, education, law, engineering, or medicine. Over 60 percent of respondents were opposed to any county ordinance. However, 71 percent of respondents said oaks are “important” for their aesthetic value, which indicates support for oak protection. Responding landowners feared the loss of private property rights, and felt that government should not interfere with management on private property. Nearly 73 percent of respondents to our survey make less than 25 percent of their income from their land. Landowners rated their knowledge of oak products marketing, laws and regulations (e.g., Forest Practices Act), forest health (e.g., Sudden Oak Death), and available consulting services as especially poor. A majority of landowners who responded to the survey did not know how to get more information on oak woodland management. The workshop presented on August 17, 2006, in San Luis Obispo, was designed to respond to issues and information needs identified by central coast landowners as well as to provide the latest scientific findings and policies regarding oak woodland management

Impact of pharmacy worker training and deployment on access to essential medicines for children under five in Malawi: a cluster quasi-experimental evaluation

Abstract Background Poor access to essential medicines is common in many low- and middle-income countries, partly due to an insufficient and inadequately trained workforce to manage the medicines supply chain. We conducted a prospective impact evaluation of the training and deployment of pharmacy assistants (PAs) to rural health centers in Malawi. Methods A quasi-experimental design was used to compare access to medicines in two districts where newly trained PAs were deployed to health centers (intervention) and two districts with no trained PAs at health centers (comparison). A baseline household survey and two annual post-intervention household surveys were conducted. We studied children under five years with a history of fever, cough and difficulty in breathing, and diarrhea in the previous two weeks. We collected data on access to antimalarials, antibiotics and oral rehydration salts (ORS) during the childrens’ symptomatic periods. We used difference-in-differences regression models to estimate the impact of PA training and deployment on access to medicines. Results We included 3974 children across the three rounds of annual surveys: 1840 (46%) in the districts with PAs deployed at health centers and 2096 (53%) in districts with no PAs deployed at health centers. Approximately 80% of children had a fever, nearly 30% had a cough, and 43% had diarrhea in the previous two weeks. In the first year of the program, the presence of a PA led to a significant 74% increase in the odds of access to any antimalarial, and a significant 49% increase in the odds of access to artemisinin combination therapies. This effect was restricted to the first year post-intervention. There was no effect of presence of a PA on access to antibiotics or ORS. Conclusion The training and deployment of pharmacy assistants to rural health centers in Malawi increased access to antimalarial medications over the first year, but the effect was attenuated over the second year. Pharmacy assistants training and deployment demonstrated no impact on access to antibiotics for pneumonia or oral rehydration salts for diarrhea