Quality of care in family planning service delivery in Kenya: Clients\u27 and providers\u27 perspectives

In recent years, the increasing number of organizations that have studied quality of care in international family planning (FP) programs demonstrates the importance the topic has acquired. To define quality of care in FP, the Bruce–Jain framework of six elements of care (choice of methods, information given to clients, technical competence, interpersonal relations, continuity and follow up, and appropriate constellation of services) have been used as the standard. However, what has been overlooked in this approach is the clients\u27 perspectives of service quality. This study sought to narrow the gap in knowledge about the comparability and consistency in views between clients, providers, and researchers. Thus, this study’s main objective was to define the laypersons\u27 and providers\u27 dimensions of quality of care and compare them with the Bruce-Jain elements. The study was conducted in Kenya between July and September 1994. It was the first part of the Kenyan National Situation Analysis Study (conducted in 1995), and results will provide a guide in the methodology and formulation of the study instruments

Exploring current practices in pediatric ARV rollout and integration with early childhood programs in South Africa: A rapid situation analysis

This Horizons program report describes the status of pediatric HIV treatment in selected sites in South Africa, identifies gaps in service delivery, and proposes recommendations for strengthening services and expanding children’s access to treatment. The study provides much needed information on critical issues of pediatric HIV care, especially regarding health service and contextual issues surrounding the expansion of access to treatment for HIV-infected children, and key factors that facilitate sustainability of treatment by young children. The aims of the study were to identify successful program strategies in pediatric HIV treatment in South Africa and to determine priority knowledge gaps to be addressed by operations research. The demonstrated model of collaboration between government and NGOs, though not an easy relationship to manage, can be very successful at scaling up and ensuring sustainability

An assessment of the Zimbabwe family planning programme: Results from the 1996 Situation Analysis Study

Within the past ten years, the Zimbabwe National Family Planning Council (ZNFPC) has conducted two major studies for assessing the availability and quality of reproductive health services. The two studies, generally referred to as Situation Analysis studies, were conducted in 1991 and 1996. The 1996 survey collected data from 192 health facilities spread throughout Zimbabwe. During this exercise, an inventory of physical facilities, equipment, and educational materials was taken. In addition, 758 provider–client interactions of new and revisit clients were observed. Exit interviews were conducted with service providers, and with family planning and maternal and child health clients. In this report, wherever possible findings from the 1996 study are compared to those of 1991 in which 181 health facilities were visited. However, the evolution of the Situation Analysis methodology since 1991 limits the degree to which comparisons can be made between the two studies

Reproductive health services in KwaZulu Natal, South Africa: A situation analysis study focusing on HIV/AIDS services

This Horizons report examines the readiness of reproductive health services in South Africa, which are primarily geared to women, to deliver HIV and AIDS treatment, care, and prevention services. The goal of the study was to obtain information from a representative sample of provincial health care facilities offering reproductive health services in KwaZulu Natal to meet the growing demand for HIV/AIDS-related services. Ninety-eight hospitals, community health centers, and clinics participated in the situation analysis that identified gaps in service delivery and determined priorities for service integration. Results of the study were presented to a large audience of Department of Health, NGO, and donor agency staff with the hope that this workshop would set a trend for feedback and the use of research for service improvement

Strengthening the evaluation and research unit of the Zimbabwe Family Planning Council (1995–1998)

The Evaluation and Research Unit (ERU) plays a crucial role in supporting the research activities of the Zimbabwe National Family Planning Council (ZNFPC). Research activities are conducted in addition to analysis of service statistics and compilation of quarterly and annual reports. With a staff capacity of five and inadequate research skills existing in other units, the ERU finds it difficult to manage and monitor the diverse activities of the organization. To address these problems, a buy-in was signed between the Zimbabwe Government and USAID in May 1995. The objectives were to assist the ZNFPC in conducting operations research studies and strengthening the ERU’s research capacity. The ERU’s traditional role of implementing research had to be revised to research management. The ZNFPC requested that the Population Council’s Africa OR/TA II Project provide technical assistance to implement this new role. The ZNFPC convened a meeting of cooperating agencies, donors, government, and municipal departments to explore ways of improving the coordination and implementation of population activities in Zimbabwe. As noted in this document, recommendations from the meeting were developed and the Africa OR/TA Project used these as guidelines for designing future programs for strengthening the ERU’s research capacity

Expanding pediatric access to antiretroviral therapy in South Africa

In sub-Saharan Africa, AIDS has become one of the leading causes of death among children under the age of five years. Yet, despite increased availability of antiretroviral therapy (ART), children have been largely ignored or excluded from treatment initiatives. While efforts to get more children on treatment are increasing, important information is lacking to guide program and policy implementation. To address these gaps, the Horizons Program and the University of Cape Town conducted a rapid situational analysis in 2005 of pediatric HIV treatment sites in South Africa. In 2003, the South African government approved a plan for a national HIV treatment program with the goal of at least one service delivery point in each district providing treatment. The government guidelines emphasized providing treatment for both adults and children and the initial effort resulted in a significant number of children initiating treatment. This research summary details what is happening on the ground to understand how children have been affected by the ART rollout and what can be done to reach the thousands more that should be on treatment

The Situation Analysis Approach to Assessing Family Planning and Reproductive Health Services: A Handbook

Good family planning service delivery emphasizing both access and quality is key to the related goals of satisfying individual needs and achieving programmatic success. Situation Analysis (SA) provides a needed link between the manager and the client he or she is trying to serve. The data marshaled for SA offer a representative picture of how subsystems are working and provide a way to “see” the client’s experience. Situation Analyses assist managers in achieving the broadest management goal—that of efficient administration of a vital health care service while keeping in view the ultimate goal—providing good care for those who seek it. “The Situation Analysis Approach to Assessing Family Planning and Reproductive Health Services” handbook is a tool to help implement SA studies. Some of the sections are more valuable for policymakers and program planners, others for researchers, and still others for field interviewers. The handbook consists of four chapters: The Situation Analysis Study Methodology; Conducting the Study; Instruments and Question-by-Question Guides; and Data Analysis and Reporting

An assessment of clinic based family planning services in Kenya: Results from the 1995 situation analysis study

This study’s objective was to assist the Kenya Ministry of Health (MOH), the National Council for Population and Development (NCPD), NGOs, and donor agencies in planning the expansion and improvement of family planning (FP) and other reproductive health (RH) services provided in Kenya. Data on the functioning of program subsystems and the quality of care provided were collected in May 1995 from 254 maternal and child health/family planning (MCH/FP) facilities throughout the country using a situation analysis approach. The study sample included a representative sample of facilities from the MOH and NGO sectors. It also included a census of all facilities operated by the Nairobi City Council so that comparisons could be made with the situation analysis study undertaken in 1991. Data were collected through an inventory of facility infrastructure and equipment, staff interviews, observations of FP client-provider consultations, and exit interviews with FP and MCH staff. This is the second time that a national situation analysis study was undertaken in Kenya, and a comparison was made with the results from the first study, which was undertaken in 1989

Reducing the transmission of HIV and sexually transmitted infections in a mining community: Findings from the Carletonville Mothusimpilo intervention project: 1998 to 2001

The Horizons program, in collaboration with the Center for Scientific and Industrial Research, the South African Institute for Medical Research, and the London School of Economics, conducted an intervention study in the mining town of Carletonville, South Africa to examine the social determinants of the HIV epidemic, and to assess the impact of a targeted program of HIV and STI prevention and service delivery. The project did not reduce STI prevalence or HIV prevalence, as changing sexual behavior is far more complex than educating individuals about HIV. The report recommends interventions to support behavioral change education, STI treatment, the role of social organizations, and stakeholder participation and community mobilization. The project provided important information on the challenges of implementing interventions in high prevalence communities and on the obstacles facing multi-stakeholder management of projects

Genetic Manipulation of Schistosoma haematobium, the Neglected Schistosome

More people are infected with Schistosoma haematobium than other major human schistosomes yet it has been less studied because of difficulty in maintaining the life cycle in the laboratory. S. haematobium might be considered the ‘neglected schistosome’ since minimal information on the genome and proteome of S. haematobium is available, in marked contrast to the other major schistosomes. In this report we describe tools and protocols to investigate the genome and genetics of this neglected schistosome. We cultured developmental stages of S. haematobium, and investigated the utility of introducing gene probes into the parasites to silence two model genes. One of these, firefly luciferase, was a reporter gene whereas the second was a schistosome gene encoding a surface protein, termed Sh-tsp-2. We observed that both genes could be silenced – a phenomenon known as experimental RNA interference (RNAi). These findings indicated that the genome of S. haematobium will be amenable to genetic manipulation investigations designed to determine the function and importance of genes of this schistosome and to investigate for novel anti-parasite treatments