How can we improve the use of essential evidence-based interventions?

Between 250,000-280,000 women die worldwide during pregnancy and childbirth each year and children in low- and middle-income countries are 56 times more likely to die before the age of 5 than children in high-income countries. This Editorial discusses the publishing of a supplement within Reproductive Health titled Essential interventions for maternal, newborn and child health which aims to provide a scientific basis to the recommended interventions along with implementation strategies and proposed packages of care.Fil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Salaria, Natasha. BioMed Central; Reino UnidoFil: Valanzasca, Pilar. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Mbizvo, Michael. University of Zimbabwe; Zimbabu

Benchmark assessment of orphaned and vulnerable children in areas of the Zambia Family (ZAMFAM) Project—Brief

The US Agency for International Development and US President’s Emergency Plan for AIDS Relief (PEPFAR) are supporting the Zambia Family (ZAMFAM) project to strengthen comprehensive, integrated service delivery and support to children living with, affected by, or vulnerable to HIV/AIDS (OVC) in the Lusaka, Copperbelt, Southern, and Central Provinces of Zambia. To inform that effort, Project SOAR conducted a benchmark survey among beneficiaries in the four provinces of the ZAMFAM program. The benchmark survey measured the status and conditions of OVC and their families. This brief provides a summary of the findings outlined in the final report on the needs of OVC families and the gaps in service provision, as well as suggestions for strengthening care and support strategies for OVC in Zambia

Unsafe abortions and unwanted pregnancies contribute to maternal mortality in Zimbabwe

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Benchmark assessment of orphaned and vulnerable children in areas of the Zambia Family (ZAMFAM) Project

The US Agency for International Development and US President’s Emergency Plan for AIDS Relief (PEPFAR) are supporting the Zambia Family (ZAMFAM) project to strengthen comprehensive, integrated service delivery and support to children living with, affected by, or vulnerable to HIV/AIDS (OVC) in the Lusaka, Copperbelt, Southern, and Central Provinces of Zambia. To inform that effort, Project SOAR conducted a benchmark survey among beneficiaries in the four provinces of the ZAMFAM program. The benchmark survey measured the status and conditions of OVC and their families. The findings provide a deeper understanding of the needs of OVC families and the gaps in service provision, as well as suggestions for strengthening care and support strategies for OVC in Zambia

Practice-based learning: Integrating SGBV screening into health facilities in refugee contexts

Sexual and gender-based violence (SGBV) “screening” refers to the standardized assessment of clients for SGBV incidents, regardless of reasons for presenting at a health facility. This practice has been shown to be feasible and effective in various countries and contexts in the East and Southern African region, resulting in proactive identification of female survivors, and their successful referrals for comprehensive SGBV care. In the last decade, health facilities in the region have been increasingly eager to incorporate such screening within the normal protocols of their health-care providers. In collaboration with the Population Council-led Africa Regional SGBV Network, the UNHCR East, Horn of Africa, and Great Lakes (EHAGL) Africa Bureau has worked to integrate SGBV screening protocols within its country operations since 2017. Sauti/VOICE Program Brief 4 outlines practical lessons from training and implementation efforts in refugee settings

A new approach to assess the capability of health facilities to provide clinical care for sexual violence against women: a pilot study.

Several tools have been developed to collect information on health facility preparedness to provide sexual violence response services; however, little guidance exists on how this information can be used to better understand which functions a facility can perform. Our study therefore aims to propose a set of signal functions that provide a framework for monitoring the availability of clinical sexual violence services. To illustrate the potential insights that can be gained from using our proposed signal functions, we used the framework to analyse data from a health facility census conducted in Central Province, Zambia. We collected the geographic coordinates of health facilities and police stations to assess women's proximity to multi-sectoral sexual violence response services. We defined three key domains of clinical sexual violence response services, based on the timing of the visit to the health facility in relation to the most recent sexual assault: (1) core services, (2) immediate care, and (3) delayed and follow-up care. Combining information from all three domains, we estimate that just 3% of facilities were able to provide a comprehensive response to sexual violence, and only 16% could provide time-sensitive immediate care services such as HIV post-exposure prophylaxis and emergency contraception. Services were concentrated in hospitals, with few health centres and no health posts fulfilling the signal functions for any of the three domains. Only 23% of women lived within 15 km of comprehensive clinical sexual violence health services, and 38% lived within 15 km of immediate care. These findings point to a need to develop clear strategies for decentralizing sexual violence services to maximize coverage and ensure equity in access. Overall, our findings suggest that our proposed signal functions could be a simple and valuable approach for assessing the availability of clinical sexual violence response services, identifying areas for improvement and tracking improvements over time

Enhancing access to post-rape care for child survivors in the context of police and health services in Zambia: A feasibility assessment of a police response model

This study builds on previous interventions by the Population Council and the Zambia Police Service to mitigate unintended pregnancy and HIV among survivors of sexual violence by involving trained police in task-sharing interventions. These previous efforts have involved police providing emergency contraceptive pills and HIV post-exposure prophylaxis to survivors reporting to police stations, in addition to referrals to health facilities. The objective of the current study was to assess the feasibility of implementing a transportation intervention within police stations, coupled with training and sensitization for police officers to perform their government-mandated roles in post-rape care. This intervention was developed as a means of enhancing children’s access to comprehensive post-rape care in Zambia. The study concluded that this package of interventions enhances child survivors’ access to comprehensive services, however, post-rape care service delivery in health facilities must be strengthened for greater efficiency. A series of recommendations, described in the report, were generated to help support the operationalization and sustainability of the package of interventions to strengthen the capacity of police officers to provide post-rape care

Storytelling and policy change in Africa\u27s Great Lakes Region

In April 2019, the International Conference on the Great Lakes Region’s Regional Training Facility (ICGLR-RTF) organized a regional meeting entitled “Sensitization Meeting for Police Chiefs and National Reproductive Health Heads in the Great Lakes Region.” Held in Kigo, Uganda, the meeting brought together chiefs of police and heads of reproductive health departments (Ministries of Health) from nine ICGLR member states, namely: Burundi, Central African Republic, Democratic Republic of Congo, Kenya, Republic of Congo, South Sudan, Sudan, Uganda, and Zambia. The meeting was sponsored by the Population Council, Kenya. Sauti/VOICE Program Brief 2 describes the preamble to ICGLR-RTF’s meeting resolutions and the ten resolutions made. Regional resolutions will be employed as an advocacy tool by ICGLR-RTF and its partners (including the Council) to promote utilization of the police emergency contraception provision model in the region, including in refugee contexts

Linking sexual and reproductive health and HIV interventions: a systematic review

<p>Abstract</p> <p>Background</p> <p>The international community agrees that the Millennium Development Goals will not be achieved without ensuring universal access to both sexual and reproductive health (SRH) services and HIV/AIDS prevention, treatment, care and support. Recently, there has been increasing awareness and discussion of the possible benefits of linkages between SRH and HIV programmes at the policy, systems and service delivery levels. However, the evidence for the efficacy of these linkages has not been systematically assessed.</p> <p>Methods</p> <p>We conducted a systematic review of the evidence for interventions linking SRH and HIV. Structured methods were employed for searching, screening and data extraction. Studies from 1990 to 2007 reporting pre-post or multi-arm evaluation data from SRH-HIV linkage interventions were included. Study design rigour was scored on a nine-point scale. Unpublished programme reports were gathered as "promising practices".</p> <p>Results</p> <p>Of more than 50,000 citations identified, 185 studies were included in the review and 35 were analyzed. These studies had heterogeneous interventions, populations, objectives, study designs, rigour and measured outcomes. SRH-HIV linkage interventions were generally considered beneficial and feasible. The majority of studies showed improvements in all outcomes measured. While there were some mixed results, there were very few negative findings. Generally, positive effects were shown for key outcomes, including HIV incidence, sexually transmitted infection incidence, condom use, contraceptive use, uptake of HIV testing and quality of services. Promising practices (n = 23) tended to evaluate more recent and more comprehensive programmes. Factors promoting effective linkages included stakeholder involvement, capacity building, positive staff attitudes, non-stigmatizing services, and engagement of key populations.</p> <p>Conclusions</p> <p>Existing evidence provides support for linkages, although significant gaps in the literature remain. Policy makers, programme managers and researchers should continue to advocate for, support, implement and rigorously evaluate SRH and HIV linkages at the policy, systems and service levels.</p

Practice-based learning: Establishing simple monitoring systems to support SGBV programming in refugee settings

Implementers of sexual and gender-based violence programs in refugee settings are typically eager to learn about the extent to which their programs are making a difference in the lives of those they serve. Basic monitoring information can help address this imperative without unduly burdening program implementers with time-consuming evaluations. The Sauti/VOICE project is guiding adaptation and implementation of evidence-based SGBV interventions in refugee contexts. These interventions are implemented by UNHCR partners in eight countries in the East, Horn, and Great Lakes region of Africa. Although Sauti/VOICE is primarily focused on integrating tested SGBV interventions into refugee contexts, monitoring the implementation of these new interventions is an important project component. While rigorous evaluations of SGBV interventions are necessary, in the context of emergencies or other pressing need, such evaluations may not always be possible. It is possible, however, to establish relatively simple monitoring systems that will provide necessary and important information. This program brief documents the process employed by the Sauti/VOICE project to implement simple monitoring systems that record service progress, reveal issues that need to be resolved, and provide evidence of how well interventions are working