Data-informed decision-making for life-saving commodities investments in Malawi: A qualitative case study

BackgroundDuring the last 15 years, Malawi has made remarkable progress in reducing child mortality. However, maternal and newborn mortality remains persistently high. To help address these entrenched challenges, the Reproductive, Maternal, Newborn and Child Health (RMNCH) Trust Fund provided short-term catalytic financing of $11.5 million (2013-2016) to support country plans to advance the RMNCH and commodity agenda. Objectives(1) To document how Malawi (ministries, partners, working groups) used evidence to inform decision-making and RMNCH investments, (2) To identify barriers to utilizing information and evidence in the planning and prioritization process at national and sub-national levels, and (3) To assess the utility of the RMNCH Landscape Synthesis, which uses existing information to review life-saving RMNCH commodities and services.MethodsThis was a qualitative case study utilizing a Rapid Appraisal (RA) approach, where semi-structured interviews were conducted with staff members from UN agencies, development partners and the Ministry of Health (MoH) at national and district level. The analysis enlists a framework approach for manual qualitative content analysis.ResultsLed by the MoH, the RMNCH Trust Fund grant proposal utilized an evidence-based and equity-focused process for prioritization of investments. Data-informed decision-making permeates similar commodity-focused working groups. However, common health information system (HIS) weaknesses, such as data quality and collection burden, persist and are more prevalent at district-level. The collation of evidence in the RMNCH Landscape Synthesis was a useful and sustainable tool to support planning.ConclusionsThe evidence-based, equity-focused decision-making process for the RMNCH Trust Fund proposal provides an effective model for inter-agency investment prioritization. Strengthening data-informed decision-making will require financial and political commitments to HIS and capacity building for data use, particularly at the district-level. New initiatives (e.g. Health Data Collaborative and QED Network to Improve Quality of Care) provide opportunities to further improve evidence-informed decision-making

Breaking the bttleneck: Understanding the intractable bottlenecks and data-informed decision-making to deliver life-saving commodities for women and children

Philosophiae Doctor - PhDAccess to life-saving commodities and related services for women and children is a fundamental component of universal health coverage. However, countries confront numerous intractable challenges, such as aligning regulatory practices, enhancing health workforce capacity, and effectively managing supply chains, to ensure essential reproductive, maternal, newborn and child health (RMNCH) commodities and services reach all communities. To address these entrenched obstacles, the UN Commission on Life Saving Commodities for Women and Children (UNCoLSC) in 2012 outlined a series of recommendations to improve access to 13 low-cost and high-impact commodities. This thesis explores the improvements and remaining barriers to accessing life-saving commodities for women and children in sub-Saharan Africa and Southeast Asia. In addition, this thesis showcases how effective data-informed decision-making can support prioritized RMNCH investments and equitycentered action

Contextual factors associated with contraceptive utilization and unmet need among sexually active unmarried women in Kenya: A multilevel regression analysis

Unmarried women who report less recent sexual intercourse (>30 days from survey enumeration) are largely excluded from global health monitoring and evaluation efforts. This study investigated level and contextual factors in modern contraceptive utilization and unmet need within this overlooked female subpopulation in Kenya from 2014 to 2019. This study analyzed data from the Performance Monitoring and Accountability (PMA) survey in Kenya, a nationally representative survey of female respondents, to understand the level and contextual factors for family planning utilization and unmet need within female subgroups including married, unmarried sexually active (defined as sexual intercourse within 30 days of survey enumeration), and unmarried with less recent sexual intercourse (defined as sexual intercourse 1–12 months prior to survey enumeration)

Effectiveness of sms technology on timely community health worker follow-up for childhood malnutrition: A retrospective cohort study in sub-Saharan Africa

The Millennium Villages Project facilitated technology-based health interventions in rural under-resourced areas of subSaharan Africa. Our study examined whether data entry using SMS compared with paper forms by community health workers (CHWs) led to higher proportion of timely follow-up visits for malnutrition screening in under-5 children in Ghana, Rwanda, Senegal, and Uganda.: Children under 5 years were screened for malnutrition every 90 days by CHWs using mid-upper arm circumference (MUAC) readings. CHWs used either SMS texts or paper forms to enter MUAC data. Reminder texts were sent at 15 days before follow-up was needed. Chi-square tests assessed proportion of timely follow-up visits within 90 days between SMS and paper groups. Logistic regression analysis was conducted in a step-wise multivariate model. Post-hoc power calculations were conducted to verify strength of associations

The UN Commission on Life Saving Commodities 3 years on: global progress update and results of a multicountry assessment

Background In September, 2012, the UN Commission on Life Saving Commodities (UNCoLSC) outlined a plan to expand availability and access to 13 life saving commodities. We profi le global and country progress against these recommendations between 2012 and 2015. Methods For 12 countries in sub-Saharan Africa that were off -track to achieve the Millennium Development Goals for maternal and child survival, we reviewed key documents and reference data, and conducted interviews with ministry staff and partners to assess the status of the UNCoLSC recommendations. The RMNCH fund provided short-term catalytic fi nancing to support country plans to advance the commodity agenda, with activities coded by UNCoLSC recommendation. Our network of technical resource teams identifi ed, addressed, and monitored progress against cross-cutting commodity-related challenges that needed coordinated global action. Findings In 2014 and 2015, child and maternal health commodities had fewer bottlenecks than reproductive and neonatal commodities. Common bottlenecks included regulatory challenges (ten of 12 countries); poor quality assurance (11 of 12 countries); insuffi cient staff training (more than half of facilities on average); and weak supply chains systems (11 of 12 countries), with stock-outs of priority commodities in about 40% of facilities on average. The RMNCH fund committed US$175·7 million to 19 countries to support strategies addressing crucial gaps.$68·2 million (39·0%) of the funds supported systems-strengthening interventions with the remainder split across reproductive, maternal, newborn, and child health. Health worker training ($88·6 million, 50·4 ($53·3 million, 30·0%), and demand generation ($21·1 million, 12·0%) were the major topics of focus. All priority commodities are now listed in the WHO Essential Medicines List; appropriate price reductions were secured; quality manufacturing was improved; a fast-track registration mechanism for prequalifi ed products was established; and methods were developed for advocacy, quantifi cation, demand generation, supply chain, and provider training. Slower progress was evident around regulatory harmonisation and quality assurance. Interpretation Much work is needed to achieve full implementation of the UNCoLSC recommendations. Coordinated eff orts to secure price reductions beyond the 13 commodities and improve regulatory effi ciency, quality, and supply chains are still needed alongside broader dissemination of work products

Underreported Threat of Multidrug-Resistant Tuberculosis in Africa

Identification of population-based factors should influence regional and national policy

Peer development as an alternative to peer observation: a tool to enhance professional development

Many Higher Education institutions worldwide require that all academic staff undergo a peer observation of teaching each academic year. Within one department in a university in the South of England, questions have arisen about the value and purpose of the traditional 'peer observation' process, and as a result a new voluntary system of 'peer development' has been introduced. This paper explains the rationale underpinning the new peer development process, and explores its worth and value to those who have participated in it as a mechanism for professional development. Reflections on the process are considered, along with what can be done to improve the new system