Potential for cost recovery: women's willingness to pay for injectable contraceptives in Tigray, Ethiopia.

ObjectiveTo investigate factors associated with a woman's willingness to pay (WTP) for injectable contraceptives in Tigray, Ethiopia.MethodsWe used a multistage random sampling design to generate a representative sample of reproductive age women from the Central Zone of Tigray, Ethiopia to participate in a survey (N = 1490). Respondents who had ever used injectable contraceptives or who were interested in using them were asked whether they would be willing to pay, and if so, how much. Logistic regression odds ratios (ORs) with 95% confidence intervals (CIs) and p-values were used to assess which factors were associated with WTP in our final model.FindingsOn average, respondents were willing to pay 11 birr ($0.65 USD) per injection. Being married, completing any amount of education, having given birth, and having visited a health facility in the last 12 months (whether received family planning information or not) were associated with statistically significantly increased odds of WTP. Having initiated sexual activity and having 1-2 children (compared to 0 children) were associated with statistically significantly decreased odds of WTP. We also detected two significant interactions. Among women who prefer injectable contraceptives, their odds of WTP for injectable contraceptives vary across length of time they have used them. And among women who work for pay, their odds of WTP for injectable contraceptives vary by whether they agree with their husband/partner about the ideal number of children.ConclusionIn a sector that continually struggles with funding, cost recovery for contraceptive services may offer a means of improved financial sustainability while increasing rural access to injectable contraceptives. Results indicate there are opportunities for cost recovery in rural Tigray, Ethiopia and highlight factors that could be leveraged to increase WTP for injectable contraceptives

‘Living well’ as a path to social, ecological and economic sustainability

© 2017 by the author. While there is wide agreement on the need to move towards fairer and more sustainable societies, how to best achieve this is still the source of some debate. In particular, there are tensions between more market-based/technological approaches and more redistributive/social approaches. Living Well, a strategy which falls into the latter category, has been proposed as a path to social, ecological and economic sustainability by several state governments of the Global South. This paper examines the Living Well paradigm as implemented in Bolivia through the lens of the recently agreed Sustainable Development Goals (SDGs). The article is based on a 3 year, ESRC funded project on transitions to sustainability and reports the findings of documentary, policy and secondary data analysis, participant observations and semi-structured interviews with local stakeholders. The work indicates that, despite constraints and set-backs, in just a decade, Living Well has achieved a major shift towards social, economic and ecological sustainability in Bolivia. This seems to be primarily a result of the emphasis on redistributive policies, an intention to live in harmony with nature, respect for traditional values and practices, local control of natural resources, and participative decision-making. It is, therefore, argued that other nations might achieve more success in transitioning to sustainability by focusing on these factors, rather than continuing to emphasise the technological/growth/market approaches which are currently dominating global sustainability debates and activities

Green economy or living well? Assessing divergent paradigms for equitable eco-social transition in South Korea and Bolivia

'Green Economy' and 'Living Well ('Vivir Bien)' have emerged as contending macro-policies in the search for a future direction that meets human needs whilst respecting environmental limits. There are a number of different interpretations of each concept but the dominant discourses in relation to each are distinct. Green Economy is presented as a fundamentally technological, managerial and market-based approach, whilst Living Well is considered to imply redistribution of wealth, inter-personal and inter-species reciprocity and eco-socialist development in harmony with nature. Contributing to the debate on the most effective strategic direction to take to achieve equitable and effective eco-social transition, this article examines the processes, politics and early impacts of attempts to implement these macro-policies in South Korea, a global Green Economy leader, and Bolivia, at the forefront of promoting the Living Well approach

Community Health Workers as Social Marketers of Injectable Contraceptives: A Case Study from Ethiopia.

Ethiopia has made notable progress in increasing awareness and knowledge of family planning and is considered a success story among funders and program planners. Yet unmet need among rural women (28.6%) is almost double that of urban women (15.5%), with a wide gap in total fertility rate depending on urban (2.6) or rural (5.5) residence. This study investigates the impact of a service delivery model that combines community-based distribution (CBD) of contraception with social marketing in Tigray, Ethiopia, to create a more sustainable approach to CBD. Between September 2011 and October 2013, 626 volunteer CHWs were recruited and trained to administer depot medroxyprogesterone acetate (DMPA) injections and provide counseling and referrals to the health post for other methods; the project implementation period ended in June 2014. The CHWs received a supply of DMPA injections in the form of a microloan from a drug revolving fund; the CHWs charged women a minimal fee (5 birr, or US$0.29), determined based on willingness-to-pay data, for each DMPA injection; and the CHWs returned part of the fee (3 birr) to the drug revolving fund while keeping the remaining portion (2 birr). The CHWs also promoted demand for family planning through door-to-door outreach and community meetings. Existing health extension workers (HEWs) provided regular supervision of the CHWs, supplemented by in-depth supervision visits from study coordinators. Baseline and endline representative surveys of women of reproductive age, as well as of participating CHWs, were conducted. In addition, DMPA provision data from the CHWs were collected. Between October 2011 and June 2014, the CHWs served in total 8,604 women and administered an estimated 15,410 DMPA injections, equivalent to providing 3,853 couple-years of protection. There was a 25% significant increase in contraceptive use among surveyed women, from 30.1% at baseline to 37.7% at endline, with DMPA use largely responsible for this increase. Changes in quality of family planning markers from baseline suggested services improved between baseline and endline: nearly 50% more women reported being told about side effects and what to do if they experience side effects, and 25% more women said they were told about other methods of contraception. The results from household surveys at baseline and endline suggest that CHWs in this model made a significant contribution to family planning in the region

Managing Burnout in Nursing

Burnout is a widespread phenomenon characterized by a reduction in energy that manifests in exhaustion, lack of inspiration, and feelings of frustration which may lead to reduced work efficacy and multiple absences. In the nursing profession, long hours, the pressure of quick decision-making, and the stress of caring for patients who may have poor outcomes may contribute to burnout. This integrative review was conducted to identify variables that contribute to nurse burnout and discover strategies organizations can implement to reduce or prevent nurse burnout