Mainstreaming EC in Africa: The EC facilitative re-granting program—Final narrative report

Since 2006, ECafrique has been working to build the capacity of African nongovernmental organizations to design, implement, and evaluate successful emergency contraception (EC) mainstreaming projects. Through a process of “facilitative regranting,” ECafrique annually awarded nine grants ranging from $25,000 to$30,000 to organizations from across Anglophone and Francophone Africa. The program’s objectives were to increase access to EC across Africa by supporting projects intended to introduce, scale up, or mainstream the method, and build the capacity of African NGOs to design, implement, and evaluate successful EC mainstreaming projects. Each grantee participated in an international proposal development workshop and received individualized technical support throughout the life of their project. The nine projects supported under this program took place in Burkina Faso, Cameroon, Cote d’Ivoire, Ghana, Kenya, Nigeria, Senegal, and Uganda (two). This final narrative report details the accomplishments of each grantee, and highlights lessons learned regarding this approach to grant making

ECP Handbook: Introducing and Mainstreaming the Provision of Emergency Contraceptive Pills in Developing Countries

For many women, emergency contraceptive pills (ECPs) offer an opportunity to prevent unintended pregnancy following contraceptive method failure, rape, or unprotected sex. Access to this safe, effective option remains an essential element of women’s quality reproductive health care. However, ECPs remain inaccessible across much of the world, particularly in developing countries where limited commodity supplies, provider competency, public awareness, and misinformation routinely coalesce to restrict availability. While ECPs have been introduced on a pilot basis in many countries, their effective integration into both the public and private sectors has lagged. Successful interventions are guided by the principle that provision of ECPs is not exclusively the responsibility of government family planning programs, and so seek to mainstream delivery of ECPs by developing links with private sector providers and pharmacies, the HIV/AIDS sector, and sexual assault services. Successfully introducing ECPs into a country’s health-care system is a complex undertaking. This handbook provides comprehensive guidance to reproductive health program managers and policymakers on introducing and mainstreaming ECPs, including needs assessments and operations research, drug registration, training and logistics, and introduction of ECP scale-up

Guide pour les pilules de contraception d\u27urgence : Introduire et développer l\u27offre des pilules de contraception d\u27urgence dans les pays en voie de développement

Pendant plus d\u27une décennie, les défenseurs ont cherché à améliorer l\u27accès à la contraception d\u27urgence (CU) dans le monde. Ces efforts ont été couronnés de succès en Europe et en Amérique du Nord, ont suscité de nombreux débats en Amérique latine et commencent à prendre racine en Asie. En Afrique, cependant, le succès des programmes communautaires reste limité. Même dans les pays où l\u27environnement réglementaire est favorable, les contraintes de ressources au sein du secteur public limitent la capacité de fournir des services de CU cohérents et de qualité à faible coût. Dans un nombre croissant de pays africains, le secteur privé a émergé pour combler ces lacunes, augmentant l\u27accès principalement parmi les jeunes citadins aisés. Les faibles niveaux de connaissances de la population générale sapent en fin de compte l\u27impact de telles stratégies de prestation. L\u27initiative décrite dans ce rapport comprend des activités visant à améliorer la connaissance globale de la CU à travers le Kenya et à renforcer la qualité des services de la CU dans les secteurs public et privé. Il était destiné à servir de modèle pour d\u27autres pays intéressés à améliorer l\u27accès à la CU et à générer des connaissances approfondies sur les stratégies des programmes de la CU et les caractéristiques d\u27utilisation en Afrique subsaharienne. Ce rapport final du projet détaille les résultats de cette initiative. --- For more than a decade, advocates have sought to improve access to emergency contraception (EC) around the world. These efforts have been highly successful in Europe and North America, have generated much debate in Latin America, and are beginning to take hold in Asia. In Africa, however, the success of EC programs remains limited. Even in countries where the regulatory environment is favorable, resource constraints within the public sector limit the ability to provide consistent and quality EC services at low cost. In a growing number of African countries, the private sector has emerged to fill these gaps, increasing access primarily among young, affluent urbanites. Low knowledge levels among the general population ultimately undermine the impact of such provision strategies. The initiative described in this report includes activities aimed at improving overall awareness of EC across Kenya and strengthening the quality of EC services in the public and private sectors. It was intended to serve as a model for other countries interested in improving access to EC, and to generate in-depth knowledge on EC program strategies and utilization characteristics in sub-Saharan Africa. This final project report details the outcomes of this initiative

Affordability and Non-Perfectionism in Moral Action

One rationale policy-makers sometimes give for declining to fund a service or intervention is on the grounds that it would be ‘unaffordable’, which is to say, that the total cost of providing the service or intervention for all eligible recipients would exceed the budget limit. But does the mere fact that a service or intervention is unaffordable present a reason not to fund it? Thus far, the philosophical literature has remained largely silent on this issue. However, in this article, we consider this kind of thinking in depth. Albeit with certain important caveats, we argue that the use of affordability criteria in matters of public financing commits what Parfit might have called a ‘mistake in moral mathematics’. First, it fails to abide by what we term a principle of ‘non-perfectionism’ in moral action: the mere fact that it is practically impossible for you to do all the good that you have reason to do does not present a reason not to do whatever good you can do. And second, when used as a means of arbitrating between which services to fund, affordability criteria can lead to a kind of ‘numerical discrimination’. Various attendant issues around fairness and lotteries are also discussed

The UKC2 regional coupled environmental prediction system

It is hypothesized that more accurate prediction and warning of natural hazards, such as of the impacts of severe weather mediated through various components of the environment, require a more integrated Earth System approach to forecasting. This hypothesis can be explored using regional coupled prediction systems, in which the known interactions and feedbacks between different physical and biogeochemical components of the environment across sky, sea and land can be simulated. Such systems are becoming increasingly common research tools. This paper describes the development of the UKC2 regional coupled research system, which has been delivered under the UK Environmental Prediction Prototype project. This provides the first implementation of an atmosphere–land–ocean–wave modelling system focussed on the United Kingdom and surrounding seas at km-scale resolution. The UKC2 coupled system incorporates models of the atmosphere (Met Office Unified Model), land surface with river routing (JULES), shelf-sea ocean (NEMO) and ocean waves (WAVEWATCH III). These components are coupled, via OASIS3-MCT libraries, at unprecedentedly high resolution across the UK within a north-western European regional domain. A research framework has been established to explore the representation of feedback processes in coupled and uncoupled modes, providing a new research tool for UK environmental science. This paper documents the technical design and implementation of UKC2, along with the associated evaluation framework. An analysis of new results comparing the output of the coupled UKC2 system with relevant forced control simulations for six contrasting case studies of 5-day duration is presented. Results demonstrate that performance can be achieved with the UKC2 system that is at least comparable to its component control simulations. For some cases, improvements in air temperature, sea surface temperature, wind speed, significant wave height and mean wave period highlight the potential benefits of coupling between environmental model components. Results also illustrate that the coupling itself is not sufficient to address all known model issues. Priorities for future development of the UK Environmental Prediction framework and component systems are discussed