IntraHealth International

BackgroundService integration is a strategy to reduce maternal and infant mortality rates. “We analyzed the extent to which maternal and child health, family planning, and nutrition policies support the integration of maternal and child health services in Burkina Faso, Côte d’Ivoire, and Niger.MethodsWe performed a document review of policy documents on nutrition, family planning and maternal and child health using the READ approach (Ready materials, Extract data, Analyze data, Distill). We conducted a systematic search for documents among key informants interviewed at the central level and health centers. The Ten Key Principles for Successful Health Systems Integration of Suter’s framework were used for data analysis.ResultsThe policy documents adopted a continuum of care approach and focused on mother, newborn, and child health (MNCH); family planning (FP); and nutritional needs throughout the course of life. However, in all three countries, most family planning and nutrition guidelines do not consider globality of care. These documents focus on the main themes of family planning and nutrition. None of the documents analyzed provided clear guidance on how providers should provide integrated MNCH, FP, and nutrition care to mother-child pairs in health centers.ConclusionPolicy documents serve as practical guides for the provision of care in health centers. It is time to update national policies by including a vision of integrated service delivery for maternal and child health, family planning, and nutritional services.

PurposeThis practice forum paper aims to present a theoretical framework to better develop the required supply chain management (SCM) competencies and the workforce needed for managing public health supply chains.Design/methodology/approachThis framework is driven by iterative systems thinking, a deeper consideration of the SCM labor market and a comprehensive mapping of human resource system requirements. The framework centers around three tools. A labor market analysis assesses factors influencing supply of and demand for health SCM workers in a country context. To improve supply of and demand for workers, the SCM Professionalisation Framework provides reference documents to establish health SCM as a recognized profession. The human resources for SCM Theory of Change explains and assesses the conditions required to achieve optimal workforce performance at the organizational level. The Ministry of Health in Rwanda applied these three tools sequentially to assess and improve the supply and performance of its health SCM workforce.FindingsThe authors describe this framework, how the tools were applied in Rwanda, and early impressions of the results.Practical implicationsPractitioners can apply this approach to improve SCM competence and promote the attractiveness of health SCM positions by formalizing their professional status. This could lead to a pool of individuals who seek SCM qualifications and, in time, overcome the current shortage of health SCM workers. Employers can apply this approach to structured roles and workforce needs to meet health SCM system requirements. This would lead to a greater demand for and use of appropriately trained personnel.Originality/valueThis paper presents a novel, iterative, systems-thinking approach to develop human resources in public health supply chains. Rwanda is the first country to apply all three tools using this framework.

A functional and reliable Health Information System (HIS) is vital for data-based decision-making in public health. Here we describe the assessment of data processes and general HIS principles by adapting a global approach to three cities. The assessments supported the data strategy of the CARDIO4cities initiative in each city aiming to improve urban population health by increasing the use of cardiovascular disease (CVD) data to inform decision-making. We aimed to explore data collection processes and entities, data availability and quality as well as data ownership and sharing regarding a set of identified key performance indicators (KPIs). KPIs were based on a global theory of change (ToC) and a global evaluation and indicator framework and were tailored to each location. By first assessing existing sources and processes regarding data, recommendations for changes and improvements are sure to build on current circumstances. To map the data, existing data collection, analysis and storage processes were investigated. A flow chart was created to visualize the data pathways and challenges for each system and findings were compared across cities to document differences and similarities. Data quality and interoperability of various separate systems were the most prominent challenges for all HISs. The observed dvata quality issues originated from incorrect, missing and incomplete data and were connected to the misunderstanding of indicators, incomplete data input forms or the lack of a systematic data routine in the workflow. Harmonization of the HISs to ensure interoperability can facilitate data collection and analysis of health data and can provide a solid basis for health management decision-making. Based on the presented HIS cases, we recommend to examine, map and verify current processes when conducting a HIS assessment, to visualize findings and to gauge the interest of government entities to ensure political support.

BackgroundInfection prevention and control (IPC) is important in ensuring patient safety, protecting healthcare workers, and reducing healthcare‐associated costs. The World Health Organization (WHO)‐validated Infection Prevention and Control Assessment Framework (IPCAF) was used to evaluate IPC practices in Rwandan healthcare facilities.MethodologyIn this cross‐sectional study, we assessed 25 health facilities across Rwanda, including district and referral hospitals. Using the IPCAF tool, we assessed eight core components (CCs) of IPC programs. We calculated median scores and interquartile ranges to determine the levels of implementation of IPC practices.FindingsAmong the 25 facilities, all showed some degree of IPCAF implementation, with an overall median IPCAF score of 545.0, reflecting an intermediate level. Three facilities (12%) were at a basic level, 16 (64%) at an intermediate level, and 6 (24%) at an advanced level of IPC practices. The presence of IPC guidelines scored the highest among CCs (median: 87.5). About 96% of facilities did not have a dedicated full‐time IPC staff, 64% of facilities did not offer IPC training to new staff, and 84% did not have protocols for multidrug‐resistant pathogens.ConclusionsThis initial IPCAF assessment in Rwanda reveals critical IPC strengths and gaps. These findings highlight the necessity for targeted interventions, such as appointing dedicated IPC staff, strengthening IPC committees, and enhancing IPC training and resources.

Following the publication of the original article [1], the authors identified that the subheading was incorrect. The correct subheading is given below. The correct subheading is: Step 5: Projecting the principal outcomes through country experiences The original article [1] has been corrected. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

To compare contraceptive provision to women with and without intellectual and developmental disabilities enrolled in North Carolina Medicaid. Our retrospective cohort study used 2019 North Carolina Medicaid claims to identify women aged 15-44 years with and without intellectual and developmental disabilities at risk for pregnancy who were continuously enrolled during 2019 or had Family Planning Medicaid with at least one claim. We calculated the proportion in each cohort who received 1) most or moderately effective contraception, 2) long-acting reversible contraception, 3) short-acting contraception, and 4) individual methods. We classified contraceptive receipt by procedure type and disaggregated across sociodemographic characteristics. Adjusting for age, race, ethnicity, and urban or rural setting, we constructed logistic regression models to estimate most or moderately effective contraceptive provision odds by intellectual and developmental disability status and by level or type of intellectual and developmental disability. We performed subanalyses to estimate co-occurrence of provision and menstrual disorders. Among 9,508 women with intellectual and developmental disabilities and 299,978 without, a significantly smaller proportion with intellectual and developmental disabilities received most or moderately effective contraception (30.1% vs 36.3%, P <.001). With the exception of injectable contraception, this trend was consistent across all measures and remained statistically significant after controlling for race, ethnicity, age, and urban or rural status (adjusted odds ratio 0.75, 95% CI 0.72-0.79; P <.001). Among those who received most or moderately effective contraception, a significantly greater proportion of women with intellectual and developmental disabilities had co-occurring menstrual disorders (31.3% vs 24.3%, P <.001). These findings suggest disparities in contraceptive provision and potential differences in clinical indication by intellectual and developmental disability status. Future studies should investigate reasons for and barriers to contraceptive use among women with intellectual and developmental disabilities.

This panel will focus on the emerging area of Learning Engineering. Learning Engineering is a transdisciplinary area focusing on the systematic application of evidence-based principles from science of learning disciplines to create effective learning experiences, addressing the challenges of learners. During the panel, examples of Learning Engineering will be presented of interest to anyone within human factors and ergonomics with interest in education, training, or usability/design science. The panel will represent experience from both academia and industry. The goal of this panel is to foster dialog between the IEEE Industry Connections Industry Consortium on Learning Engineering (ICICLE) and HFES members in the hope of increasing knowledge of Learning Engineering and creating ties between the two organizations.

Cite this article as: Jacobstein R, Radloff S, Khan F, et al. Author's response to letter on "Down but not out: vasectomy is faring poorly almost everywhere-we can do better to make it a true method option."

This commentary brings together theory, evidence and lessons from 15 years of gender and HRH analyses conducted in health systems in six WHO regions to address selected data-related aspects of WHO’s 2016 Global HRH Strategy and 2022 Working for Health Action Plan. It considers useful theoretical lenses, multi-country evidence and implications for implementation and HRH policy. Systemic, structural gender discrimination and inequality encompass widespread but often masked or invisible patterns of gendered practices, interactions, relations and the social, economic or cultural background conditions that are entrenched in the processes and structures of health systems (such as health education and employment institutions) that can create or perpetuate disadvantage for some members of a marginalized group relative to other groups in society or organizations. Context-specific sex- and age-disaggregated and gender-descriptive data on HRH systems’ dysfunctions are needed to enable HRH policy planners and managers to anticipate bottlenecks to health workforce entry, flows and exit or retention. Multi-method approaches using ethnographic techniques reveal rich contextual detail. Accountability requires that gender and HRH analyses measure SDGs 3, 4, 5 and 8 targets and indicators. To achieve gender equality in paid work, women also need to achieve equality in unpaid work, underscoring the importance of SDG target 5.4. HRH policies based on principles of substantive equality and nondiscrimination are effective in countering gender discrimination and inequality. HRH leaders and managers can make the use of gender and HRH evidence a priority in developing transformational policy that changes the actual conditions and terms of health workers’ lives and work for the better. Knowledge translation and intersectoral coalition-building are also critical to effectiveness and accountability. These will contribute to social progress, equity and the realization of human rights, and expand the health care workforce. Global HRH strategy objectives and UHC and SDG goals will more likely be realized.