K4Health Blog

WHO Upholds Guidance on Hormonal Contraceptive Use and HIV Risk

sparrish — Fri, 17 Feb 2012 22:43:33 +0000

The World Health Organization (WHO) released a statement on February 16, 2012, upholding previous guidance indicating that women with HIV or at high risk of HIV can safely use hormonal contraceptives to prevent pregnancy. However, WHO has added new clarification instructing health care providers to strongly advise women with HIV or at high risk of HIV who decide to use progestin-only injectables, in particular, to also always use male or female condoms for protection against HIV.

The statement from WHO follows a technical consultation convened between 31 January and 1 February 2012, involving 75 experts in international family planning and HIV from 18 countries. The expert group met to review the evidence base on the risk of HIV with hormonal contraceptive use. In particular, a recent study published in The Lancet Infectious Diseases suggested that use of injectables may double the risk of uninfected women acquiring HIV and of HIV-infected women transmitting the virus to their uninfected partners (read previous K4Health blog for more details about the study). The expert group convened by WHO to review this and other evidence on HIV and hormonal contraception represented a wide range of disciplines—from clinicians, epidemiologists, researchers, reproductive biologists, and pharmacologists to program managers, policy makers, guideline methodologists, and HIV and women’s health advocates.

The group considered several factors, including systematic reviews of the evidence and presentations on biological and animal data, GRADE profile summaries on the strength of the epidemiologic evidence (GRADE is a system for grading the quality of evidence), and an analysis of the risks and benefits to country programs.

Due to serious limitations in the data, the body of evidence was given a GRADE rating of “low” on all counts—for the relationship of hormonal contraceptive use and HIV acquisition in women without the virus, transmission of the virus from HIV-positive women to HIV-negative men, and disease progression in HIV-positive women.

The group was most concerned about the risk of HIV acquisition in women using progestin-only injectables. After considering the entire evidence base, the expert group determined that current data neither established a direct cause-and-effect relationship between injectable use and HIV acquisition nor did the data definitively rule out the possibility of an effect. Thus, the group decided to uphold its previous guidance but to add clarification about using condoms with hormonal contraceptives to prevent HIV acquisition and transmission. This clarification also mentions the need for programs to expand contraceptive method mix to give women and couples access to a wide range of appropriate methods, and also the need for further research on this issue.

Register to join a global teleconference hosted by AVAC on Thursday, February 23, 2012, from 9-10 am ET to discuss WHO’s recommendations. Representatives from WHO, UNAIDS, international family planning programs, and civil society who participated in the WHO technical consultation will be on the call. Look for a summary of the teleconference afterward on the K4Health blog.

WHO Issues Statement on Hormonal Contraception and HIV

sparrish — Thu, 16 Feb 2012 23:02:53 +0000

Cover image of today's WHO statement

As covered in two K4Health Blog posts by Ruwaida Salem, a study was released in October 2011 suggesting a connection between injectable hormonal contraceptives and an increased risk of acquiring or transmitting HIV. The World Health Organization just released a statement in response to the study and the controversy that followed. A PDF version of the complete technical statement is available on the WHO website.

The statement notes:

Some studies suggest that women using progestogen-only injectable contraception may be at increased risk of HIV acquisition, other studies do not show this association. A WHO expert group reviewed all the available evidence and agreed that the data were not sufficiently conclusive to change current guidance. However, because of the inconclusive nature of the body of evidence on possible increased risk of HIV acquisition, women using progestogen-only injectable contraception should be strongly advised to also always use condoms, male or female, and other HIV preventive measures. Expansion of contraceptive method mix and further research on the relationship between hormonal contraception and HIV infection is essential. These recommendations will be continually reviewed in light of new evidence.

Look for more commentary on this issue on K4Health.org soon, or read our previous posts:

October 7, 2011: New Study Suggests HIV Risk with Hormonal Contraceptives: What It Means for Family Planning Policy and Programs
October 31, 2011: Global Teleconference Tackles Questions About Hormonal Contraceptives and HIV Risk

Saving Low Birth Weight Babies by Keeping Them Warm

sparrish — Fri, 10 Feb 2012 13:49:20 +0000

Every year, 20 million low birth weight (LBW) babies are born. One of the biggest problems these babies face is simply keeping warm: They are too small to maintain their body heat at normal room temperatures. Four million of them each year do not survive their first month. A new nonprofit organization, Embrace, is helping these infants survive with its innovative Infant Warmer. “These babies are so tiny they don’t have enough fat to regulate their own body temperature,” Jane Chen, Embrace’s Co-founder and CEO, told a recent ABC News program. Over the next five years, Embrace estimates it could save 100,000 babies and prevent illness in as many as 800,000.

The infant warmer looks like a miniature sleeping bag, with a separate sealed plastic pouch containing paraffin wax. An electric heater or a non-electric heating unit using hot water warms the pouch. Within 20 minutes, the pouch heats up to 37ºC (98.6ºF)—a temperature critical to a child’s survival. The heated pouch is placed into the sleeping bag warmer, and the baby placed inside the bag. The pouch remains warm for up to four hours, and can be reheated hundreds of times. The pouch’s “phase-change material” absorbs heat from the baby if the baby gets too hot, or releases heat if the baby gets too cold. The design complements the widely practiced technique of Kangaroo mother care, helping to promote and facilitate mother-baby bonding. The warmer is hypoallergenic, washable, and seamless to help prevent collection of bacteria. It can be used in clinics, hospitals, or as a transportation device.

A traditional incubator costs $20,000—out of reach for many hospitals and clinics in lower-resourced areas. Desperate home-made methods for warming babies include wrapping hot water bottles around their bodies, placing them near ovens, or holding them under light bulbs. One rural Indian mother is quoted on the Embrace website as saying, “We didn’t have money for my baby to be put in an incubator, so I heated towels on a frying pan and wrapped those around her to keep her warm.”

An Embrace Infant Warmer costs less than $200.

Embrace is a sustainable social enterprise founded by a team of engineers, MBAs, and public policy graduate students at Stanford University and Harvard University. The team developed the warmer in India, which has one of the world’s highest rates of infant mortality. Development took two years and dozens of prototypes using feedback from rural mothers and doctors. Doctors in Bangalore have just completed the first round of tests, and mass production is scheduled to begin in March. “Doctors are literally lining up to place orders for the product,” Chen said in her ABC News interview. She added that in many villages in India, due to the high infant mortality rate, mothers don’t even name their babies for the first month.

http://embraceblog.org/2011/12/21/embrace-providing-hope-manjulas-story/

A recent Embrace blog post tells the story of Manjula, an Indian mother who lost her first two babies and was sadly blamed by her extended family and community for the loss. Manjula’s third baby weighed just under two pounds when she was born. Five days after being placed in the Embrace warmer she weighed over 2.5 pounds, a positive indication she will be healthy.

At the 2010 MDG Summit in New York, U.S. Secretary of State Hillary Clinton, U.K. Deputy Prime Minister Nick Clegg, Australia Minister for Foreign Affairs Kevin Rudd, and Melinda Gates, co-chair of the Bill & Melinda Gates Foundation, announced the formation of the Alliance for Reproductive, Maternal, and Newborn Health, a public/private global alliance to contribute to reducing the unmet need for family planning by 100 million women, expanding skilled birth attendance and facility-based deliveries, and increasing the numbers of women and “newborns receiving quality post-natal care by 2015.” There are indications that the Alliance may focus on the topic of keeping low birth weight babies warm, following a speech by Secretary of State Clinton in which she mentioned the Embrace product (at 8:28 of the linked video). This is an example of US-Indian collaboration that “hits close to home in an area I care deeply about,” she said.

With great collaboration from those the product directly affects—mothers, doctors, and skilled birth attendants—Embrace will be in a better position to succeed, and increase the likelihood of scale up worldwide.

Heard of something new and exciting in technology for global public health? Share it here! Contact blog@k4health.org.

Managing Through Sports: Some Thoughts on Leadership

sparrish — Thu, 09 Feb 2012 23:56:39 +0000

Everyone can learn from sports, especially managers and C-level executives [equivalent to program managers and agency directors in the government/NGO space - Ed.]. Have you ever noticed why one manager or executive may be better than another? In my experience, those managers or executives who were sportive and involved in team sports growing up are typically the better managers. Of course, I have no scientific evidence to prove this hypothesis, but based on my 30 years of experiential learning in different organizations, I strongly believe in this proposition.

Why do I say this? I feel that aside from the value of healthy exercise, sports (especially team sports) allow an individual to gain practice and expertise in many areas including the ability to work with others, experience with practical knowledge-sharing, the ability to delegate, a sense of community and belonging, the ability to handle pressure, the ability to multi-task and develop good time management skills, the ability to recognize others and allow them to succeed, and the ability to cope with both failure and success. Of course, there are cases where the manager may be the “ball hog” or a poor leader. But, by and large, team sports seem to hone one’s managerial skills for future use.

Let’s look at some examples. Many of the top consulting firms often hire individuals with a team athletics background. Part of the reason may be to stack their firm’s intramural teams, but I think the real essence for hiring those involved in team sports is for the reasons already cited. Certainly, consulting firms have time pressures with deliverables due, milestones to meet, and proposals to write. The ability to handle these pressures and perform proper time management without getting frazzled is an important trait for success in the consulting world. The ability to work with others, delegate, build strong bonding, and complement (and compliment) each other’s work are key elements for getting things done successfully.

How about the executive without prior involvement in team sports and possessing a kind of Napoleonic attitude? Everything and everyone must be conquered and in only the way that the executive feels. Whatever happened to team input, building esprit de corps, and working together? Without the ability to appreciate the value of team sports, the executive was later exiled similar to Napoleon.

So what can you do if you want to be an effective manager but maybe weren’t active in team sports growing up? First, you can surround yourself with those who are, in order to learn through osmosis in working collaboratively and collectively for team success. Second, think about the recognition and reward structure in your organization to encourage a “knowledge sharing is power” attitude versus a “knowledge is power” paradigm. Third, encourage others to succeed and meet their goals. And last, don’t be afraid to seek help from others, and treat everyone with the professional respect and trust that you would expect to be treated.

One caveat—if you were involved in individual sports or no sports at all, don’t worry. You can still be an effective leader as long as you think of others and not strictly yourself.

Dr. Jay Liebowitz is the Orkand Endowed Chair in Management and Technology at the University of Maryland University College. He currently plays on a summer tennis team, and previously played most sports growing up as well as coaching youth tennis, basketball, and soccer.

After the Earthquake: Rebuilding In Haiti Through Maternal and Child Health

rashore — Fri, 03 Feb 2012 18:47:21 +0000

Two years ago, Haiti was hit with a massive earthquake. Even before this disaster, Haiti’s health system could not meet the needs of its nearly 10 million people. While some things had been improving (recent years had seen a decrease in HIV infection rates, more vaccinations, and improvements in the lives of children under 5), roughly 40% of the population had no access to basic health care. The widespread devastation of the earthquake was a severe blow to this already challenged system.

Today, recovery efforts in Haiti are evolving from emergency response to long-term improvement. This past Monday, January 30, as part of an audience of over 50 people, I listened to a panel discussion on “Addressing the Evolving Needs of Haiti’s Women and Children Two Years After the Earthquake” at the Woodrow Wilson International Center for Scholars in Washington, DC. The panel was led by Dr. Diane Silimperi, Vice President of Management Sciences for Health (MSH)’s Center for Health Services. Half of the panelists were from Haiti, and half were from United States Agency for International Development (USAID) and Population Services International (PSI). Both groups emphasized a need for improving infrastructure and for collaboration among partner organizations and the Haitian Ministry of Health (MOH) to make changes that would be sustainable and build capacity.

Monday’s panel focused on the role maternal and child health strategies have played in rebuilding after the earthquake. MSH, Population Services International (PSI), USAID, the United Nations Population Fund (UNFPA), and the Haitian MOH have worked together to use maternal and child health as a pathway toward broader improvements, including water and sanitation, reducing and responding to cholera outbreaks, reducing gender violence, building a university hospital system, and improving overall health infrastructure. The effectiveness of maternal and child health strategies in effecting broader change did not surprise me, given the high impact improving the lives of women and girls has on a family, culture, and society.

Kelly Saldana, Acting Deputy Director of the Office of Health Infectious Diseases and Nutrition at USAID, spoke of a main strategy to give Haiti the ability to manage and maintain its own infrastructure to improve maternal and child health. Prior to the earthquake, the United States Government (USG) had been providing access to health services for 50% of Haiti’s population. Immediately after the earthquake the USG focused on the crisis and emergency response. And now they are moving into a new strategy which works more as a partnership with the Haitian government and promotes sustainability by emphasizing country ownership and leadership. Some of the areas they are working in are better training to health care workers to address maternal, child and infant care, increased pre-natal visits, increased vaccinations, increased access to purified drinking water, and helping to build a large university hospital.

Many of the programs that were in place before the earthquake were improving the overall health services and health data of the country. However, without giving Haiti the power to improve its own infrastructure, many of these programs will not be sustainable without the large organizations backing them. With Haiti’s arduous history of colonialism and political unrest, there has been trouble maintaining autonomy and leadership over its health services without funding assistance from outside organizations and other countries. From Monday’s presentation, I have hope that with a strong focus on country ownership and leadership from Haiti’s government and the strong cooperation with other collaborating partners, Haiti will be empowered to sustain its own health services and infrastructure in the future.

More about Haiti on K4Health.org: In response to the need immediately after the earthquake, K4Health gathered experts to develop a Haiti Relief Toolkit that has been used by many different organizations working in Haiti and addressing the complexities of the problems there.

Mobile Data Collection: A Leapfrog Technology for Health Improvement

rashore — Thu, 26 Jan 2012 18:51:07 +0000

“For too long, the world’s information (and the world’s tools for collecting and understanding and using that information) was limited to the richer countries. Now the world has changed so much that a tool created in Kenya can benefit gorillas in Uganda, mothers in Central America, school children in Zambia, and a hospital in Washington DC. And all because of these common miracles—the Internet and the mobile phone that are binding us together as never before.” ~ Joel Selanikio, “Mobile Phones and the Power of Data Collection”

Many typical data collection methods such as telephone interviews and email or online surveys are not broadly feasible in lower-resourced countries, where landline infrastructure and Internet connectivity may be patchy or absent. Mobile technologies are creating a “leapfrog” effect—jumping over earlier stages of infrastructure and technology development completely, rather than waiting for them to catch up. For example, many health organizations around the world are using mobile phones to collect vital health information to design, evaluate, and make adjustments to their programs.

Health Workers using EpiSurveyor for antenatal care provision in Ethiopia, DigitalCampus.org

One of the leaders in the mobile data collection field is DataDyne’s EpiSurveyor. People are using this mobile phone-based service in more than 170 countries to collect and analyze essential data for health, agriculture, business, research, and conservation.

According to its website, “EpiSurveyor lets anyone create an account, design forms, download them to phones, and start collecting data in minutes, for free.” The free version provides 20 forms with up to 500 records per form, with a ceiling of 5,000 uploaded responses per year. Like many free services, EpiSurveyor also has paid premium versions.

Since its launch two years ago, EpiSurveyor has won over 6,000 users—its widespread adoption helped by its availability in multiple languages (at this writing: English, Spanish, Swahili, French, Portuguese, and Russian). Some examples of use include:

The International Federation of the Red Cross (IFRC) used volunteer interviewers equipped with mobile phones and EpiSurveyor software in the fight against malaria in Nigeria.
Internews recently completed an EpiSurveyor survey of information needs among refugees in the Dadaab refugee camps in Northern Kenya.
Data collectors in Peru used the software system for HIV analysis work among indigenous populations.
A Management Sciences for Health (MSH) team in Malawi piloted the free version of EpiSurveyor in a malaria supervision project. (A detailed report on MSH’s March 2010 pilot outlines some of the advantages and disadvantages of the free system.)

A team of programmers in Kenya developed the EpiSurveyor system, which can be used on major brands of phones including Nokia, Samsung, BlackBerry, and Sony Ericsson. The web site lists specific phone models which have been tested or are in beta testing. The site also features a 10-minute video on how to create a form and collect data using the system.

Dr. Joel Selanikio, formerly of the US Centers for Disease Control and Prevention (CDC), and technologist Rose Donna, formerly of the American Red Cross, founded DataDyne (the company that created EpiSurveyor) in 2003. The United Nations Foundation and the Vodafone Foundation provided initial funding for DataDyne.

Heard of something new and exciting in technology for global public health? Share it here! Contact blog@k4health.org.

Mapping High Impact Practices in Family Planning

rashore — Thu, 19 Jan 2012 16:22:31 +0000

When programming family planning interventions, why re-invent the wheel? It’s frustrating when efforts overlap and resources are wasted. Learning from the success and failures of others is critical to progress; however, it can be difficult with so many programs and no mechanism to track where and what High Impact Practices (HIPs) in family planning are being implemented worldwide. What if a program in Ghana is interested in expanding a community health worker intervention and wants some tips for implementation from other countries nearby? Where would program staff go to find that information?

Now, with the support of the Knowledge for Health (K4Health) Project, Implementing Best Practices (IBP) Initiative, and others, USAID has developed an online interactive map showing who, what, when, where, and how HIPs are being implemented in the field. This map will allow users—like our colleagues in Ghana—to quickly see what type of programs are being implemented (or have been implemented) in their region. The map will facilitate South-to-South learning and exchanges.

As a first step, the map will include information on the following four HIPs:

Providing family planning counseling and methods at the same time and location where women receive postabortion treatment.
Offering a wide range of family planning methods through mobile clinical outreach.
Offering family planning services during routine child immunization contacts.
Supporting Community Health Workers (CHWs) to provide a wide range of family planning methods.

The map taps the wealth of experiential knowledge among implementing partners, and is dependent on data voluntarily contributed by users around the world. If you are implementing a program involving one of the four HIPs cited above, please consider taking our brief survey. Responding to the survey will add your program to the online map, and build a basis for stronger learning between family planning and reproductive health programs worldwide. The more programs that respond, the more useful the map will be. Please note that this first map will include information on the four HIPs in 27 priority countries; we are unable to collect data on all countries at this time.

More: Learn more about HIPs | Go to the survey page

New Momentum for Frontline Health Workers

rashore — Thu, 19 Jan 2012 13:56:02 +0000

“The face of a country's health system.”
“The best investment for improved health.”
“The unsung heroes of public health.”

These were just a few of the phrases used at a special event last week to describe those who struggle every day to meet the vast majority of health issues around the world: frontline health workers. The forum for these accolades was the launch of the new Frontline Health Worker Coalition on January 11 at the Kaiser Family Foundation Conference Center in Washington, DC. A standing-room-only crowd listened to a panel discussion and learned more about the new initiative.

As a first step, the Coalition aims to spark new commitment from the US Government to support ways to add at least 250,000 new frontline health workers in lower-resourced countries by 2015. While this may seem like a large number, it's only a quarter of the estimated 1,000,000 new frontline health workers that the World Health Organization (WHO) has identified as being needed immediately. The meeting included founding members of the coalition as well as others such as the John Hopkins Bloomberg School of Public Health’s Center for Communication Programs and its Knowledge for Health (K4Health) Project. Both CCP and K4Health work to provide community health workers with the tools and information they need to serve their clients.

The panel discussion provided interesting and varied perspectives. Facilitated by former White House Press Secretary Dee Dee Myers, the panel included USAID’s Assistant Administrator for Global Health, Dr. Ariel Pablos-Méndez; former Chief of Staff to First Lady Laura Bush, Anita McBride; Dr. Peter Ngatia, Director of Capacity Building for AMREF; and Duncan Learmouth, Senior VP for Developing Countries and Market Access for GlaxoSmithKline (GSK).. While their perspectives were diverse, the panelists all agreed that there is a clear and present need for more and better trained frontline health workers, and that hiring and training more community-level workers is the most cost effective way to save lives, speed progress on global health threats, and promote US economic and strategic interests.

At K4Health, we produce tools, technology, and synthesized information to provide frontline health workers with the right information at the right time in the right format to improve their ability to serve their clients. This means, for example, developing and supporting appropriate technology tools such as Web-based toolkits, eLearning courses, and mHealth applications; distributing hundreds of thousands of copies of Family Planning: A Global Handbook for Providers; and working on the ground with Ministries of Health to build the capacity of their frontline health workers. That is why last’s week’s launch of the new Frontline Health Workers Coalition was such welcome news.

We look forward to following the progress of this Coalition and contributing however we can. To learn more about the Frontline Health Workers Coalition and how you can participate, visit their website at http://frontlinehealthworkers.org/.

Six Years of Learning: Online Discussion Forum Monitoring & Evaluation

rashore — Tue, 17 Jan 2012 13:33:39 +0000

In recent years, online discussion forums have gained importance in sharing public health information among policy makers and practitioners in both developed and developing countries. Since 2005, the World Health Organization Department of Reproductive Health and Research (WHO/RHR) and the Knowledge for Health (K4Health) Project have supported more than 50 virtual discussion forums on the Implementing Best Practices Knowledge Gateway (IBP KG).

K4Health has collected survey data on 26 forums hosted by WHO/RHR and JHU∙CCP. However, until recently, we had not systematically analyzed the impact of these forums on knowledge exchange and adaptation. “Six Years of Lessons Learned in Monitoring and Evaluating Online Discussion Forums”, published in the Knowledge Management & E-Learning: An International Journal in December 2011, offers one of the first looks at empirical data from virtual discussion forums in public health.

I am a co-author of the paper, along with Megan Avila, Catherine Richey and Lisa Mwaikambo. Our work was guided by the “Conceptual Framework for Monitoring and Evaluating Health Information Products,” published as part of the Guide to Monitoring and Evaluating Health Information Products and Services. Relatively few other monitoring and evaluation guidelines exist for virtual discussions in general. In public health specifically, little research has been conducted to determine links between online discussion and health outcomes.

On IBP KG, virtual discussion forums are moderated, time-bound discussions, which typically last from 1-6 weeks. Participants can choose to participate either online or by email. All contributions are collected; expert commentary is added, and the resulting digest is emailed to all registrants.

We embarked on a study to determine value of how the exchange of evidence-based information and practices from the forums has informed the policy environment, enhanced programs and practices, and facilitated collaboration and capacity building. To do so, we evaluated quantitative data from 26 forums as well as synthesized qualitative results from in-depth interviews from two forums, using the parameters of “reach,” “usefulness,” and “use”

Evaluation findings include:

On average, discussions had 109 participant postings. More than half (61%) of the postings came from forum participants working in less developed countries. The discussion with the most contributions was the two-week Patient Safety Virtual Global Discussion Forum (2010) with 437 postings.
Most respondents (34%) worked at local and international non-governmental organizations/private volunteer organizations, 24% at academic/research institutions, and 19% worked at medical/health organizations. Other groups included government ministry (8%), reproductive health/family planning service provider (7%), private sector (5%), USAID (3%), United Nations agency (3%), and faith-based organizations (1%).
The forums reached an average of 532 registrants per forum that joined from an average of 61 countries.
Just over half (51%) of respondents had forwarded forum postings to other people and had already downloaded resources shared during the discussion forum.
Over half (64%) of respondents were satisfied or very satisfied with the discussion content. Most (54%) felt that the forums definitely met their specific goals, while 38% felt that they somewhat met their goals.

We wanted to look beyond the numbers, so in our next phase of evaluation we conducted 17 in-depth interviews from two forums. Participants commented on the usefulness of learning about experiences in other countries. One respondent from the 2009 “Access to Reproductive Health Essential Medicines and Contraceptives Forum: Why is it so Difficult to Achieve?” forum said, “As we continue to support the MOH [Ministry of Health] and highlight these issues both at local and national level, I now have other successful models which we could try to use tailoring it to the needs of this country.” However, respondents also reminded us that there are still barriers to access, including poor Internet connectivity as indicated by requests for paper and/or CD-ROM resources from past discussions.

Online discussion forums contribute to global learning and collaboration among international public health professionals by addressing the “knowledge to practice gap.” The forums also provide a low-cost opportunity for geographically dispersed public health professionals to share knowledge that in turn, can inform program design and management, ultimately improving health outcomes.

In conducting this evaluation, we learned that we had more success in measuring reach and usefulness, and have more work to do in capturing use. We hope that this study will spur additional research on evaluation of online discussion forums. The complete paper can be accessed as part of the December 2011 special issue on “Creating, Supporting, Sustaining and Evaluating Virtual Learning Communities” in the Knowledge Management & E-Learning: An International Journal (KM&EL).

New Couple Years of Protection (CYP) Conversion Factors Reflect Advances in Family Planning

rashore — Thu, 12 Jan 2012 21:56:25 +0000

According to USAID, one Jadelle® implant provides 3.8 “couple years of protection”(CYP). But what exactly does this mean? CYP is an indicator used by USAID and a number of other donors and international agencies to monitor the progress of family planning programs and to estimate family planning coverage. CYP refers to the estimated protection provided by contraceptive methods during a one-year period, based on the volume of all contraceptives sold or dispensed free of charge to clients during that period. In essence, CYP indicates the amount of time a couple will be protected against an unwanted pregnancy based on the contraceptive method used.

CYP is a commonly-used indicator of effectiveness because it can be easily calculated from data that programs routinely collect. CYP is calculated by multiplying the quantity of each contraceptive method distributed to clients by the conversion factor, which yields an estimate of the duration of contraceptive protection provided per unit of that method. This provides programs with an easy way to compare contraceptive coverage provided by different methods, estimate total CYP provided by all methods, monitor program results over time, compare regions within a country, or calculate cost-effectiveness of a method.

Here's an example: Imagine a community-based contraceptive distribution (CBD) program in which community health workers (CHWs) provide contraceptives to patients and clients. Last year, the CHWs distributed 6,000 cycles’ worth of pills, 2,000 doses of DMPA, and 75,000 condoms. This year, they distributed 4,000 cycles of pills, 3,000 doses of DMPA, and 100,000 condoms. Does this mean the program provided more contraceptive coverage, or less?

To answer this question, we can calculate the CYP provided each year using the conversion factors for pills (15 cycles per CYP), DMPA (4 doses per CYP), and condoms (120 units per CYP). The formula looks like this:

CYP for each Contraceptive = # of Contraceptives ÷ Conversion Factor
Total CYP for the CBD = Sum of all Contraceptive CYPs
Year 1: Oral Contraceptives (Pills) (CYP = 6,000÷15 = 400) + DPMA (CYP = 2,000÷4 = 500) + Condoms (CYP = 75,000÷120 = 625); Total Program CYP = 1,525
Year 2: Oral Contraceptive Pills (CYP = 4,000÷15 = 267) + DPMA (CYP = 3,000÷4 = 750) + Condoms (CYP = 100,000÷120 = 833); Total Program CYP = 1,850

The answer? The program provided 1,525 CYP last year and 1,850 CYP this year. Good news! The program’s performance has improved.

In December 2011, USAID collaborated with The RESPOND Project to update the CYP conversion factors to reflect the advances in contraceptive technology—both improvements in existing contraceptive methods and development of new methods such as Jadelle®, Implanon®, and Sino Implant (II)® —that occurred since the factors were last updated in 2000. CYP conversion factors are based on how a method is used, failure rates, wastage, and the number of units of the method typically needed to provide one year of contraceptive protection for a couple. The factors account for incorrect use, as in the case of condoms or oral contraceptives, and early discontinuation, as in the case of IUDs or implants. The new CYP conversion factors are a culmination of an extensive literature review and several expert meetings attended by representatives of donor organizations, multilaterals, and cooperating agencies.

The updated CYP conversion factors are available on USAID’s web site.

The Forgotten 3 Billion

rashore — Wed, 11 Jan 2012 16:24:42 +0000

Question: What human behavior causes two million premature deaths a year--twice as many deaths as malaria--and nearly 50% of pneumonia deaths among children under five?

Hint: Almost 42% of people around the world, mostly in low-income developing countries, practice it.

Answer: Cooking and heating homes using open fires and leaky stoves which burn biomass (wood, animal dung, and crop waste) and coal.

http://www.stoveteam.org/solution

Around 3 billion people still cook and heat their homes using solid fuels in open fires and leaky stoves. According to a 2011 WHO Fact Sheet, open fires and common indoor stoves “produce high levels of indoor air pollution with a range of health-damaging pollutants, including small soot particles that penetrate deep into the lungs. In poorly ventilated dwellings, indoor smoke can be 100 times higher than acceptable levels for small particles. Exposure is particularly high among women and young children, who spend the most time near the domestic hearth.”. WHO reports that women and men exposed to heavy indoor smoke are 2-3 times more likely to develop chronic obstructive respiratory disease (COPD), which kills over 1 million people a year.

The Fact Sheet points out that use of polluting fuels also poses a major burden on development:

Fuel gathering consumes considerable time for women and children, limiting other productive activities and taking children away from school.
Non-renewable harvesting of biomass contributes to deforestation and thus climate change.

Solution: The United Nations Foundation’s new Global Alliance for Clean Cookstoves is a public-private initiative to save lives, improve livelihoods, empower women, and combat climate change by creating a thriving global market for clean and efficient household cooking solutions. One such cooking solution, developed by Stove Team International--a Global Alliance implementing partner-- is The Ecocina portable stove. The stove is economical to build and operate, saves up to 60% of the wood used by a traditional fire, and reduces particulate matter and carbon emissions by over 70%. It produces almost no smoke and, apart from the cooking surface, is cool to the touch.

http://www.stoveteam.org/solution

Made from readily available local materials requiring only limited tools and training to manufacture, the Ecocina is small and portable, enabling it to be easily transported.

Stove Team International has established local factories in Guatemala, El Salvador, Honduras, Mexico, and Nicaragua. The Ecocina stove has replaced the traditional open cooking fire in more than 15,000 homes across Central America, reaching more than 90,000 people. The stoves are distributed with training from local women. In this way, Stove Team hopes that the fuel-efficient stoves will become culturally acceptable and be part of each country's developing economy.

Nancy Sanford Hughes, 68, from Eugene, Oregon founded Stove Team International four years ago. In November 2011, she won a $100,000 Purpose Prize award for making an extraordinary impact in an encore career. She developed the stove after a medical mission to Guatemala where she met an 18-year-old indigenous woman who was a patient at the clinic. The patient’s hands had been burned shut at age 2 when she fell into the family cooking fire. Hughes returned home and collaborated with rocket stove inventor Larry Winiarski to develop the Ecocina.

Tackling indoor air pollution will help achieve many of the Millennium Development Goals (MDGs), in particular MDG 4 (reduce child mortality) and MDG 5 (improve maternal health) according to the WHO fact sheet. It will also contribute to gender equality (MDG 3) as well as freeing women's time for income generation that helps eradicate extreme poverty and hunger (MDG 1). Finally, clean household energy can help ensure environmental sustainability (MDG 7).

More information is available in the Peace Corps Improved Stoves and Ovens Toolkit on K4Health.org.

Heard of something new and exciting in technology for global public health? Contact blog@k4health.org.

USAID Reminds Us Why We Should Invest In Women

rashore — Tue, 10 Jan 2012 03:08:06 +0000

In writing the blog series “Women of the World,” I have covered many different aspects of women’s equality. This is a topic I feel strongly about, not just because I’m a woman, but because I know how important women’s rights and equality are to social change for everyone. In the developing world, a focus on improving the status and equality of women leads to stronger societies and increased development across many sectors, including agriculture, banking, health, politics, and education. A new infographic came out recently from the United States Agency for International Development (USAID): “Why Invest in Women?” which depicts several statistics on how investing in women has far-reaching effects. The quote at the top states:

Aid programs that provide women opportunities to better their health, education, and well-being have effects far beyond a single individual. A woman multiples the impact of an investment made in her future by extending benefits to the world around her, creating a better life for her family and building a strong community.

The infographic offers several problems faced by women in developing countries, alongside solutions that could bring strong positive change. For example, women make up 43% of the agriculture labor force, but most often do not own their own land or own less land when they do. Where women own the same amount of land as men, there is a 10% increase in crop yields. Increasing equality in this case literally yields more food production, which equals fewer hungry people and more economic growth for the farmer and her family. Another statistic is that 1 in 7 girls in the developing world marry before they are 15. Such early marriage can increase the likelihood of pregnancy complications, increases the risk of violence against women, and limits the girls' access to education. However, girls who stay in school for seven or more years marry later and have fewer children. Education for women is paramount to individual growth, but it is also one of the most effective ways to reduce poverty and can have ripple effects within the family and across generations.

Over the fifty years USAID has been funding development projects all over the world, there has been a huge increase in the breadth of knowledge about women’s rights, equality, and empowerment in the developing world. Agencies working in the international development sector are taking more notice of the root societal and cultural influences on social and economic problems, instead of just putting a band aid on one issue. Women’s inequality is one such root cause: helping to empower women and increase equality has a tremendous effect on many other issues. The “Why Invest in Women?” graphic makes me even more excited to see what the next 50 years of USAID programs will bring. I believe investing in women will be the primary catalyst for change that the world needs, and I hope it does not take another fifty years to see that real progress.

Learning from Others in Knowledge Management: A New Year’s Resolution

sparrish — Wed, 04 Jan 2012 16:40:23 +0000

The heart of knowledge management is sharing your knowledge and learning from others. This is also essentially the main tenet of public health. Better informing the world through capturing, sharing, applying, disseminating, and generating knowledge is what the public health and knowledge management fields have in common. But are we (the knowledge management community) truly learning from others in various related disciplines and applying our knowledge for the common good?

Let’s look at our knowledge management discipline. This field draws from multi-disciplines, such as cognitive psychology, information technology, computer science, business and management, library and information science, human resources and organizational behavior, sociology, education, and other fields. One would expect that knowledge management practitioners should be able to apply, combine, and adapt from these other disciplines in order to maximize their effectiveness in knowledge management.

This is a Wordle Simone made out of the words in a post about knowledge management.

For example, the field of artificial intelligence (or intelligent systems) offers many techniques that the knowledge management practitioner could apply. Expert systems or knowledge engineering have focused on techniques used in knowledge acquisition or knowledge representation over many years. The resulting knowledge-based system is essentially an online way of storing and retrieving knowledge from an expert with inferencing mechanisms built-in. The more advanced version of intelligent agents or “know-bots” also can be used to look at ways to provide synergy among various types of knowledge and functions. Data or text mining, a derivative of the artificial intelligence field, can be used to look for hidden patterns or relationships in large masses of data or text. In this way, various associations can be determined which may contribute to a knowledge management system.

I’m not sure if we are truly capitalizing on borrowing techniques from other disciplines in order to further improve our knowledge management field. Certainly, in using social network analysis to map knowledge flows and knowledge gaps in organizations, we are borrowing from the sociology and education fields. Additionally, we have looked at the software engineering and human resources management fields to help us develop system, output, and outcome metrics for knowledge management.

However, there are still open areas where we could better borrow from existing disciplines to improve the current state-of-the-art of knowledge management. Knowledge taxonomies and ontologies are derived from the database management, library science, and knowledge representation fields—yet I’m not sure how well we have applied these concepts to the knowledge management field. We certainly haven’t taken full advantage of coupling AI (artificial intelligence) techniques with knowledge management. We also haven’t used extensive testing and evaluation techniques found in such fields as public health, medicine, and education for improving knowledge management metrics. And we also need to look at the change management field to see how we can best change an organizational culture to “sharing knowledge” versus “hoarding knowledge.”

My new year’s resolution for 2012 is to be more thoughtful in learning from other disciplines to apply to our knowledge management field. In this way, synergy can take place in creating a stronger whole for knowledge management instead of piecing together its component parts.

Change is Coming to K4Health.org (Part 1)

sparrish — Wed, 21 Dec 2011 11:58:00 +0000

You might (we hope!) have noticed some changes around here. Our new-and-improved blog platform is part of an ongoing series of enhancements to K4Health’s web products portfolio. These changes are based on feedback from the people who collaborate on and use our products—website visitors, blog readers, Toolkit builders, Photoshare devotees, POPLINE researchers, and eLearning students.

I’m Simone Parrish, K4Health’s Web Products Manager (I joined the project at the end of August). I’ll be your guide to what’s coming next on K4Health.org.

K4Health is fundamentally a knowledge management project. We are focusing some of our expertise inward, and finding new ways to apply knowledge management practices to our web-based products. This means making structures simpler to navigate, content easier to find, and the overall experience smoother and more productive.

Already in Place: Photoshare | Happening Now: Blog | What’s Next

The first of K4Health’s web products to be polished up was Photoshare (www.photoshare.org). The enhancements were unveiled on September 15 at an Society for International Development-Washington meeting hosted by the Bread for the World Institute. The meeting focused on “Cool Tools for Sharing, Communicating, and Coordinating in International Development.” K4Health’s David Alexander presented the new Photoshare to the group.

It wasn’t Photoshare’s content that needed enhancing—there are nearly 20,000 images available in this amazing collection, with more on the way. Rather, the enhancements were to the visual design of the Photoshare site, and to the submission, search, and request systems. The changes make it easier for photographers to share their photos, for people in the field to request photos, and for K4Health staff to manage requests. Details are available on Photoshare’s blog.

Since September, we have been gathering feedback on the new site. We have just begun prioritizing fixes and features for the next phase of Photoshare’s development. Feel free to visit Photoshare and let us know what you think.

Already in Place: Photoshare | Happening Now: Blog | What’s Next

The new look for K4Health’s blog isn’t just a pretty face—it has been revised to better meet the needs of readers, contributors, and K4Health staff.

Readers now have options for sorting and viewing K4Health’s blog posts—by date, topic, series, etc. —so you can quickly get to the content you care about most.
We have shifted the tone of the blog slightly over the past few months, to better highlight the personal voices and insights of staff and guest contributors. This reflects K4Health’s commitment to providing reliable information from a breadth of perspectives, and in formats that a variety of people will find useful.
Speaking of guest contributors: K4Health doesn’t want the last word. We want to facilitate conversation. We’ll be bringing you posts from partner organizations (like FHI 360 and MSH) and other experts who have insight into K4Health’s core topics, such as Dr. Jay Liebowitz on knowledge management. (Email blog [at] k4health [dot] org if you are interested in contributing.)
Finally, we’re excited about how much easier it is for us to upload new blog posts and manage our content.

We are still tweaking some items (like uploading contributors' photos, marking old posts with new topic areas, finding a few images that got lost, etc.), but we would love to hear what you think of the new platform, or if you run into any problems.

Already in Place: Photoshare | Happening Now: Blog | What’s Next

Between now and the summer of 2012, we plan to roll out enhancements to the main K4Health.org website, Toolkits, POPLINE, and our Affiliate Sites platform. I will be posting here about each set of improvements as the release date for each one becomes more solid.

Do let me know if you have questions, concerns, or feedback as this process unfolds—you can contact me directly, sparrish [at] jhuccp [dot] org, or contact the blog team, blog [at] k4health [dot] org.

We hope you like what you see.

Solar Suitcase Saves Mothers’ Lives

sparrish — Tue, 20 Dec 2011 15:02:19 +0000

In health clinics and hospitals in many low-income countries, midwives and surgeons are often forced to work in near-darkness or with candles and kerosene lanterns. “Lack of a regular and reliable power supply severely impairs the ability to deliver care at an estimated 300,000 health facilities around the world,” according to Dr. Laura Stachel, a Berkeley OB/GYN.

During a 2008 trip to Zaria in northern Nigeria, Dr. Stachel discovered that health clinics and even hospitals didn’t have a regular power supply for a large part of the day. She saw midwives delivering babies by kerosene lanterns. "I was seeing the sickest patients I'd ever seen in rooms not as well equipped as an American garage," she said in a recent interview with the San Francisco Chronicle. "I would be there at night and think, 'I'm just here to watch these women die.'"

Nigeria has 2 percent of the world’s population, but a disproportionate 10 percent of maternal deaths, according the World Health Organization (WHO). Dr. Stachel returned home and worked with her husband, a renewable energy expert, to develop the Solar Suitcase.

Image showing the inner workings of the Solar Suitcase; http://wecaresolar.org/solutions/solar-suitcase/

“Using solar technology to power LED lights, mobile communications, blood bank refrigerators and other medical devices means women can deliver babies more safely and hospitals need not turn people away at night,” adds Dr. Stachel, founder of We Care Solar (Women’s Emergency Communication and Reliable Electricity). The obstetric Solar Suitcase includes medical quality lighting, fetal monitors, power for charging cell phones and small devices, and headlamps with rechargeable batteries. The suitcase only costs about $1,500 and is a durable waterproof case that doubles as a cabinet that can be mounted on the wall. The award winning Solar Suitcases will be in operation in 14 countries, including Nigeria, Liberia, and Haiti, by the end of the year.

Heard of something new and exciting in technology for global public health? Contact blog@k4health.org.