R4D Pakistan

Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost?

Tue, 15 May 2012 02:24 GMT

Document Type: Journal Article
Creator: Shah, N.M.; Wang WenJuan; Bishai, D.M.

Production Year: 2011

Citation: Shah, N.M.; Wang WenJuan; Bishai, D.M. Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost? Health Policy and Planning (2011) 26 (Suppl. 1) i63-i71. [DOI: 10.1093/heapol/czr027]

Summary: Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing (1) independent private sector providers; (2) social franchises of private providers; (3) non-government organization (NGO) providers; and (4) government providers on these three factors. Franchised private clinics have higher quality than non-franchised private clinics in both countries. In Pakistan, the costs per client and the proportion of poorest clients showed no differences between franchised and non-franchised private clinics, whereas in Ethiopia, franchised clinics had higher costs and fewer clients from the poorest quintile. Our results highlight that there are trade-offs between access, cost and quality of care that must be balanced as competing priorities. The relative programme performance of various service arrangements on each metric will be context specific.

Bridging the gaps among research, policy and practice in ten low- and middle-income countries: development and testing of a questionnaire for health-care providers

Fri, 11 May 2012 05:02 GMT

Document Type: Journal Article
Creator: Guindon, G.E.; Lavis, J.N.; Boupha, B.; Shi, G.; Sidibe, M.; Turdaliyeva, B.

Production Year: 2010

Citation: Guindon, G.E.; Lavis, J.N.; Boupha, B.; Shi, G.; Sidibe, M.; Turdaliyeva, B. Bridging the gaps among research, policy and practice in ten low- and middle-income countries: development and testing of a questionnaire for health-care providers. Health Research Policy and Systems (2010) 8 (1) 3. [DOI: 10.1186/1478-4505-8-3]

Summary: Background: The reliability and validity of instruments used to survey health-care providers' views about and experiences with research evidence have seldom been examined. Methods: Country teams from ten low- and middle-income countries (China, Ghana, India, Iran, Kazakhstan, Laos, Mexico, Pakistan, Senegal and Tanzania) participated in the development, translation, pilot-testing and administration of a questionnaire designed to measure health-care providers’ views and activities related to improving their clinical practice and their awareness of, access to and use of research evidence, as well as changes in their clinical practice that they attribute to particular sources of research evidence that they have used. We use internal consistency as a measure of the questionnaire’s reliability and, whenever possible, we use explanatory factor analyses to assess the degree to which questions that pertain to a single domain actually address common themes. We assess the questionnaire’s face validity and content validity and, to a lesser extent, we also explore its criterion validity. Results: The questionnaire has high internal consistency, with Cronbach's alphas between 0.7 and 0.9 for 16 of 20 domains and sub-domains (identified by factor analyses). Cronbach's alphas are greater than 0.9 for two domains, suggesting some item redundancy. Pre- and post-field work assessments indicate the questionnaire has good face validity and content validity. Our limited assessment of criterion validity shows weak but statistically significant associations between the general influence of research evidence among providers and more specific measures of providers' change in approach to preventing or treating a clinical condition. Conclusion: Our analysis points to a number of strengths of the questionnaire - high internal consistency (reliability) and good face and content validity - but also to areas where it can be shortened without losing important conceptual domains.

Bridging the gaps among research, policy and practice in ten low- and middle-income countries: development and testing of a questionnaire for researchers

Fri, 11 May 2012 04:30 GMT

Document Type: Journal Article
Creator: Cameron, D.; Lavis, J.N.; Guindon, E.; Akhtar, T.; Posada, F.B.; Ndossi, G.D.; Boupha, B.

Production Year: 2010

Citation: Cameron, D.; Lavis, J.N.; Guindon, E.; Akhtar, T.; Posada, F.B.; Ndossi, G.D.; Boupha, B. Bridging the gaps among research, policy and practice in ten low- and middle-income countries: development and testing of a questionnaire for researchers. Health Research Policy and Systems (2010) 8 (1) 4. [DOI: 10.1186/1478-4505-8-4]

Summary: Background: A questionnaire could assist researchers, policymakers, and healthcare providers to describe and monitor changes in efforts to bridge the gaps among research, policy and practice. No questionnaire focused on researchers' engagement in bridging activities related to high-priority topics (or the potential correlates of their engagement) has been developed and tested in a range of low- and middle-income countries (LMICs). Methods: Country teams from ten LMICs (China, Ghana, India, Iran, Kazakhstan, Laos, Mexico, Pakistan, Senegal, and Tanzania) participated in the development and testing of a questionnaire. To assess reliability we calculated the internal consistency of items within each of the ten conceptual domains related to bridging activities (specifically Cronbach’s alpha). To assess face and content validity we convened several teleconferences and a workshop. To assess construct validity we calculated the correlation between scales and counts (i.e., criterion measures) for the three countries that employed both and we calculated the correlation between different but theoretically related (i. e., convergent) measures for all countries. Results: Internal consistency (Cronbach’s alpha) for sets of related items was very high, ranging from 0.89 (0.86- 0.91) to 0.96 (0.95-0.97), suggesting some item redundancy. Both face and content validity were determined to be high. Assessments of construct validity using criterion-related measures showed statistically significant associations for related measures (with gammas ranging from 0.36 to 0.73). Assessments using convergent measures also showed significant associations (with gammas ranging from 0.30 to 0.50). Conclusions: While no direct comparison can be made to a comparable questionnaire, our findings do suggest a number of strengths of the questionnaire but also the need to reduce item redundancy and to test its capacity to monitor changes over time.

Tuberculosis patient adherence to direct observation: results of a social study in Pakistan

Tue, 24 Apr 2012 04:20 GMT

Document Type: Journal Article
Creator: Khan, M.A.; Walley, J.D.; Witter, S.N.; Shah, S.K.; Javeed, S.

Production Year: 2005

Citation: Khan, M.A.; Walley, J.D.; Witter, S.N.; Shah, S.K.; Javeed, S. Tuberculosis patient adherence to direct observation: results of a social study in Pakistan. Health Policy and Planning (2005) 20 (6) 354-365. [DOI: 10.1093/heapol/czi047]

Summary: A randomized controlled trial was carried out in Pakistan in 1999 to establish the effectiveness of the direct observation component of DOTS programmes. It found no significant differences in cure rates for patients directly observed by health facility workers, community health workers or by family members, as compared with the control group who had self-administered treatment. This paper reports on the social studies which were carried out during and after this trial, to explain these results. They consisted of a survey of all patients (64% response rate); in-depth interviews with a smaller sample of different types of patients; and focus group discussions with patients and providers. One finding was that of the 32 in-depth interview patients, 13 (mainly from the health facility observation group) failed to comply with their allocated DOT approach during the trial, citing the inconvenience of the method of observation. Another finding was that while patients found the overall TB care approach efficient and economical in general, they faced numerous barriers to regular attendance for the direct observation of drug-taking (most especially, time, travel costs, ill health and need to pursue their occupation). This may be one of the reasons why there was no overall benefit from direct observation in the trial. Provider attitudes were also poor: health facility workers expressed cynical and uncaring views; community health workers were more positive, but still arranged direct observation to suit their, rather than patients’, schedules. The article concludes that direct observation, if used, should be flexible and convenient, whether at a health facility close to the patient's home or in the community. The emphasis should shift in practice from tablet watching towards treatment support, together with education and other adherence measures.

Religions and development in India, Pakistan, Nigeria and Tazinia: inspirational or inhibiting? Policy Brief 21.

Tue, 17 Apr 2012 06:58 GMT

Document Type: Briefing

Production Year: 2011

Citation: Anon. Religions and development in India, Pakistan, Nigeria and Tazinia: inspirational or inhibiting? Policy Brief 21. Religions and Development Research Programme, University of Birmingham, Birmingham, UK (2011) 8 pp. [Policy Brief No. 21, Religions and Development Research Programme]

Dilemmas of Pride and Pain: Sectarian Conflict and Conflict Transformation in Pakistan

Tue, 17 Apr 2012 06:44 GMT

Document Type: Working Paper
Creator: Mohammad Waseem

Production Year: 2010

Citation: Mohammad Waseem. Dilemmas of Pride and Pain: Sectarian Conflict and Conflict Transformation in Pakistan. Religions and Development Research Programme, University of Birmingham, Birmingham, UK (2010) 116 pp. ISBN 978-0-7044-2789-1 [Working Paper No. 48, Religions and Development Research Programme]

Summary: This study is about Shia-Sunni confict and the postconflict restoration of peace in Pakistan. It sets case studies of the 'contested cities' of Jhang and Gilgit within a wider national and international framework, examining the historical roots of sectarian conflict, the trajectory and nature of the violence, and the restoration of relative calm. It argues that unless peacebuilding tackles the underlying dynamics of intra-religious conflict, it results in negative peace rather than conflict transformation.

The Impact of Franchised Family Planning Clinics in Poor Urban Areas of Pakistan

Tue, 10 Apr 2012 08:19 GMT

Document Type: Journal Article
Creator: Hennink, M.; Clements, S.

Production Year: 2005

Citation: Hennink, M.; Clements, S. The Impact of Franchised Family Planning Clinics in Poor Urban Areas of Pakistan. Studies in Family Planning (2005) 36 (1) 33-44. [DOI: 10.1111/j.1728-4465.2005.00039.x]

Summary: This study uses a quasi-experimental design to determine the impact of new family planning clinics on knowledge, contraceptive use, and unmet need for family planning among married women in poor urban areas of six secondary cities of Pakistan. Baseline (n = 5,338) and end line (n = 5,502) population surveys were conducted during 1999–2000 and 2001–02 in four study sites and two control sites. Exit interviews with clients identified the socio demographic and geographic characteristics of clinic users. The results show that the clinics contributed to a 5 percent increase in overall knowledge of family planning methods and an increase in knowledge of female sterilization and the IUD of 15 percent and 7 percent, respectively. Distinct effects were found on contraceptive uptake, including an 8 percent increase in female sterilization and a 7 percent decline in condom use. Unmet need for family planning declined in two sites, whereas impacts on the other sites were variable. Although the new clinics are located within poor urban communities, users of the services were not the urban poor, but rather were select subgroups of the local population.

Protifolon Issue 3. Disaster Risk Management and Climate Change Adaptation in South Asia

Wed, 04 Apr 2012 07:29 GMT

Document Type: Briefing
Creator: Atiq Rahman, A.; Fatema Rajabali; Mafruha Alam; Md. Masum Billah; Shah Md. Ashraful Amin (Editors)

Production Year: 2010

Citation: Atiq Rahman, A.; Fatema Rajabali; Mafruha Alam; Md. Masum Billah; Shah Md. Ashraful Amin (Editors). Protifolon Issue 3. Disaster Risk Management and Climate Change Adaptation in South Asia. D.Net, Dhaka, Bangladesh (2010) 8 pp.

Summary: This issue focuses on how local communities in six countries in south-east Asia are managing risk; how they are coping with and preparing for possible disaster in their villages; how people living on the flood plains of the Brahmaputra-Jamuna river in Bangladesh are coping with annual flooding; and how rice farmers in Hambantota district, Sri Lanka are dealing with increasing soil salinity.

An Assessment of Crop Water Productivity in the Indus and Ganges River Basins: Current Status and Scope for Improvement

Thu, 15 Mar 2012 03:56 GMT

Document Type: Report
Creator: Cai XueLiang; Sharma, B.R.; Matin, M.A.; Devesh Sharma; Sarath Gunasinghe

Production Year: 2010

Citation: Cai XueLiang; Sharma, B.R.; Matin, M.A.; Devesh Sharma; Sarath Gunasinghe. An Assessment of Crop Water Productivity in the Indus and Ganges River Basins: Current Status and Scope for Improvement. International Water Management Institute, Colombo, Sri Lanka (2010) 34 pp. ISBN 978-92-9090-735-0 [DOI: 10.5337/2010.232] IWMI Research Report 140

Summary: This research study was initiated as part of the “Basin Focal Project for the Indus and the Ganges River Basins (BFP-IGB)” (PN 60) of the CGIAR Challenge Program on Water and Food (CPWF). It formed part of the wider network of the “Basin Focal Projects.”

As part of the ‘Basin Focal Project for the IGB’ supported by the CGIAR Challenge Program on Water and Food (CPWF), a study has been carried out to assess the basin agricultural water management performance to reveal the implications for food security while securing sustainable development of the basin. This research report assesses the agricultural WP of the basin with focus on the predominant rice and wheat cropping system. The report presents a new approach to integrate remotely sensed imagery, meteorological data, ground survey, and national crop and land use census to assess crop water productivity at basin scale. The causes for its variations and potential for improvement were also analyzed. The section, The Study Area, briefly describes the characteristics of the study area. The section, Data and Method of Analysis, details the data sources and method of analysis. We present the detailed results of basin crop yield, ET and water productivity and the related maps in the section, Basin Crop Yield, ET and Water Productivity, followed by the causes for variation and scope for improvement of water productivity in the section, Causes for Variation and Scope for Improvement. Major conclusions, recommendations and suggestions are presented in the section, Conclusions.

Lady health workers and social change in Pakistan

Fri, 09 Mar 2012 09:42 GMT

Document Type: Journal Article
Creator: Khan, A.

Production Year: 2011

Citation: Khan, A. Lady health workers and social change in Pakistan. Economic & Political Weekly (2011) XLVI (30) 28-31.

Summary: Pakistan's Lady Health Workers' programme has trained over 100,000 women to provide community health services in rural areas. Not only has the programme revitalised the primary health care system, it has also helped overcome the gendered division of public and private space that is a major obstacle to women's access to basic services, including education, and employment opportunities. However, there are a number of shortcomings that need government intervention to ensure that it fulfils its aims.