Search

To analyze implementation of the maternal death surveillance and response (MDSR) strategy in Chad.Secondary data analysis of results from a cross-sectional study involving semistructured interviews with decision-makers at central, regional, and district levels, health providers, and technical and financial partners, and a document review. Data collection took place from June-July 2017.Maternal death reporting was incorporated into the Integrated Disease Surveillance and Response system but did not include neonatal deaths nor maternal and neonatal deaths in communities. Underreporting of maternal deaths owing to fear of repercussions was evident, likely associated with maternal deaths reported at monthly meetings held by the country's President with stakeholders in the health sector. Maternal death reviews were only undertaken between 2015 and 2016 in four regions of Chad and ceased in mid-August 2016. Reasons include the departure of foreign obstetricians, lack of motivation among health workers, weak accountability at all levels of the health system, organizational issues, and nonimplementation of review recommendations.Strong action is needed by the Ministry of Health to revive implementation of the MDSR system.

Background From May 2018 to the end of June 2022, the Democratic Republic of Congo (DRC) experienced six Ebola virus disease outbreaks within its borders. During the 10th EVD outbreak, the largest experienced in the DRC and the second largest and most prolonged EVD outbreak recorded globally, a WHO risk assessment identified nine countries bordering the DRC as moderate to high risk from cross border importation. Burundi, Rwanda, South Sudan and Uganda were classified as priority one countries while Angola, Central African Republic, Congo, Tanzania and Zambia as priority two. These countries implemented varying levels of Ebola virus disease preparedness interventions. This case study highlights the gains and shortfalls with the Ebola virus disease preparedness interventions against the background of a renewed and growing commitment for global epidemic preparedness highlighted during recent World Health Assembly events. Main text Several positive impacts from preparedness support to countries bordering the affected provinces in the DRC were identified, including development of sustained capacities which were leveraged upon to respond to the subsequent COVID-19 pandemic. Shortfalls such as lost opportunities in vertical approaches to response pillars such as surveillance, over dependence on external support and duplication of efforts especially in the areas of capacity building were also identified. A recurrent theme that emerged from this case study is the propensity towards implementing short-term interventions during Ebola virus disease outbreak preparedness and response rather than sustainable investment into strengthening systems for improved health security in alignment with IHR obligations and the Sustainable Development Goals. Conclusions Despite several international frameworks established at the global level for emergency preparedness, a shortfall exists between global policy and practice in countries at high risk of cross border transmission from persistent Ebola virus disease outbreaks in the Democratic Republic of Congo. With renewed global health commitment for country emergency preparedness resulting from the COVID-19 pandemic and cumulating in a resolution for a pandemic preparedness treaty, the time to review and address these gaps and provide recommendations for more sustainable approaches to emergency preparedness towards achieving global health security is now.

Background: Many policy makers deliberating on comprehensive sexual and reproductive health and rights services need reliable evidence to make choices that benefit women, adolescents, children and the wider society. While universal health coverage discourse provides an opportunity to expand access through evidence based interventions, many gaps exist. Research prioritization has proved to be very helpful in identifying relevant areas especially in constrained resource settings. The purpose of this paper is to present the results of the World Health Organization Africa Region research prioritization for sexual and reproductive health and rights. These priorities hope to guide the region for the next three years. Methods: We used the Child Health and Nutrition Research Initiative approach to identify priority questions among many potential areas for research prioritization on sexual and reproductive health and rights. The implementation process was organized in three phases. The first phase involved sending out an online survey to various experts with experience in sexual and reproductive health rights. These questions were received by a technical team from World Health Organization headquarters for review. 634 questions were identified for potential research and grouped into 12 themes. The second phase involved experts who reviewed the questions. The team merged questions with duplications, removed the questions that were out of scope and finally refined the wordings. In the final phase, experts worked in groups to score and rank top ten priority questions for each of the 12 thematic areas. Results: A list of 120 priority questions for sexual and reproductive health and rights were prioritized by 67 participants drawn from 16 organizations. Most of the priority research questions (45%) focused on the theme of gender-based violence, 35% prioritized services in sexual and reproductive health and rights in humanitarian settings while 15% prioritized preventing unsafe abortion. 5% of the participants prioritized cervical cancer prevalence, prevention and treatment as a thematic area out of the questions in the top 20 research priority questions. Conclusions: Key priority research questions in sexual and reproductive health and rights were identified around five themes. The priority list will be of significance to World Health Organization regional Office for Africa and her stakeholders for the next three years.

Background: There is an increasing emphasis on conducting research to identify gender based violence issues to enable development of appropriate programs and interventions. However, these efforts are mixed in quality and often raise ethical questions. The increased pressure on policy makers to move to a more evidence-based approach in addressing gender based issues creates the need for this research prioritization activity. Inadequate evaluative evidence in this area poses a challenge in the planning for responsive interventions especially in resource limited settings. The purpose of this paper is to present gender based violence research priority areas for the WHO Africa Region. Methods: We utilized a modified version of the Child Health and Nutrition Research Initiative approach to reach consensus on research priorities on the thematic area of gender based violence. In three phases, we first conducted an online survey with sexual and reproductive health and rights experts in academia, ministries of health, non-governmental organizations and other health actors with a wide range of experiences. These questions were consolidated by three experts from World Health Organization headquarters into themes. Secondly, experts were invited in a meeting in Cape Town South Africa to analyze and generate relevant areas of research based on the themes. Finally, a smaller group of experts prioritized research areas based on agreed criteria. Results: A list of 10 priority research questions for addressing gender based violence were scored and ranked. Four priority research questions scored 30 points out of the possible 30 points and were thus ranked as the highest priority. These included questions that “engage young adolescents in behavioral interventions to influence gender roles”, “determinants of gender based violence analysis”, “both long and short term complications of gender based violence on survivors” and “assessment of men’s involvement in addressing gender-based violence against women”. The second most highly ranked question was on the assessment of the extent and strategies to prevent gender-based violence in the context of humanitarian crises. Conclusions: Priority research questions for addressing gender based violence were identified. This exercise provides a three year investment case for research with high potential of effectively identifying interventions with high impact on addressing gender based violence.

Background: The use of mobile phones continues to rise rapidly in the provision of health related services. Many countries have adopted the use of mobiles to provide sexual and reproductive health and rights and especially among the adolescents where specific messages are tailored for various audiences with specific messages. The purpose of this paper is to present the results of a research priority setting exercise on mHealth and innovative strategies. Methods: We adapted Child Health and Nutrition Research Initiative methodology to identify and set research priorities on mHealth and innovative strategies that respond to sexual and reproductive health and rights services. General potential research questions were gathered online from multiple stakeholders in the region and sent for consolidation consolidated to technical experts in World Health Organization headquarters. The second phase involved a meeting with experts to review and thematically analyze the questions list of 33 questions producing a list of 22 research questions. The questions were scored against a six point criteria and ranked accordingly. Ten top priority research questions were identified. Results: Lists of 33 priority research questions for mHealth and innovative strategies were proposed for discussions by 67 stakeholders. The questions were reviewed, scored and ranked in a technical meeting by experts. The highest ranking questions at 87% include evaluation of mHealth for data management and sexual and reproductive health and rights decision making, assessment of innovative local financing techniques to support community based sexual reproductive health and rights and evaluation of the role of mobile technologies in referral and counter referral. Conclusions: Information and communication technology is developing drastically and has a great potential in improving health especially in sexual and reproductive health and rights service delivery. This potential must be demonstrated with more relevant and quality research on mHealth and innovative strategies priorities identified.

Background: Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive ages. It is classified as a main cause of maternal mortality and morbidity. This paper has considered questions that have the greatest potential to successfully reduce unsafe abortions in the resource poor settings. Methods: We adapted the Child Health and Nutrition Research Initiative (CHNRI) to identify and prioritize many competing sexual and reproductive health and rights research ideas that impact the health of the populations. The implementation was done in three phases which included generation and collection of research ideas from various experts virtually in August 2019 consolidation of the potential questions through thematic analysis conducted in September 2019. Finally, scoring and ranking of the research questions was done in a workshop of experts. Results: Out of a list of 45 priority research questions, two questions were ranked the highest scoring 28 out of the possible 30. The research priorities include: “The effectiveness of interventions (e.g. counseling or incentives or home visits) to increase post abortion uptake and continuance”, “Reducing repeat abortion on improving maternal health outcomes” and “Evaluation of community-based awareness programs to reduce unwanted pregnancies and encourage women to seek help early”. Conclusions: Ten key research priorities in preventing unsafe abortion were identified. The priority list covers areas of focus that could effectively impact preventing unsafe abortions while also acting as a knowledge base for researchers, policy makers and other interested stakeholders who would want to invest in this area.

Background: Despite increased recognition of the need for sexual and reproductive health and rights in humanitarian settings, evidence focusing on mainstreaming reproductive health services such as maternal, neonatal mortality, human immunodeficiency virus transmission and unsafe abortion still remains inadequate. The ability to understand the magnitude of the needs and highlight existing gaps is supported by improved data which is critical to informing effective policies, programming and funding decisions. The purpose of this report is to present the results of a research prioritization exercise on sexual and reproductive health and rights services in humanitarian settings for the WHO Africa region for the next three years. Methods: We adapted the Child Health and Nutrition Research Initiative method in three phases. Experts from the region participated in an online survey to identify key areas for research in sexual and reproductive health and rights. To identify potential areas for research, the experts ensured answerability, effectiveness, deliverability, equity and potential impact of the questions. The research areas they identified were reviewed by World Health Organization technical team from headquarters. In a meeting of 67 participants, the questions were subjected to further review and analysis. Using a modified for scoring criteria, the questions were scored and ranked to provide the top ten priority questions to address sexual and reproductive health and rights services in humanitarian settings. Results: A list of 21 priority research questions on sexual and reproductive health and rights services in humanitarian settings were scored and ranked. Top ten priorities research questions were identified. Those that scored highly by scoring 30 points out of the possible maximum of 30 include: “determining the prevalence and associated factors of unwanted pregnancies and abortions performed in emergency and humanitarian settings”, “evidence on gender-based violence in humanitarian situations and its associated factors” and “defining an optimal model for coordinating sexual and reproductive health and rights interventions and responses in crisis situations”. Conclusions: Top ten research priorities in sexual and reproductive health and rights services in humanitarian settings were identified. The priority research areas have the potential to identify the best areas for programming of services in humanitarian settings. It is our hope that the identified research areas will be prioritized to support programming of services in humanitarian settings based on scientific evidence.

Background: Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interventions that respond to sexual and reproductive health and rights services particularly in cervical cancer prevalence, prevention and treatment have not adequately taken into account research based evidence to respond appropriately. Methods: We adapted the Child Health and Nutrition Research Initiative method. A wide range of stakeholders identified potential research areas in an online survey. A technical working group comprising of 67 participants reviewed the questions for modification and removal of out scope questions. Finally, scoring and ranking was done to provide the top ten priorities questions. Results: “Cost-benefit analysis of systematic human papillomavirus vaccination compared to the current cost of cervical cancer in public health care systems” scored 27. This was followed by two research questions ranked at 24 points: “assessment of women’s and girls’ knowledge on the importance of early cervical cancer screening,” and “human papilloma virus vaccination and contributions of new technologies to the supply and storage of vaccines, including human papillomavirus vaccine”. Conclusion: The study identified 10 priority research questions that can guide the agenda for cervical cancer prevalence, prevention and treatment in the WHO Africa region. The identified priorities will be of use to policy makers, researchers and programmers and other stakeholders who can invest in areas that greatly affect cervical cancer prevalence, prevention and treatment.

To evaluate the implementation of the maternal and neonatal death surveillance and response (MNDSR) system at county level in Liberia.Secondary analysis of data from a cross-sectional study carried out in March 2016, using both quantitative and qualitative methods to collect data in five counties based on set criteria. Three health facilities were selected in each county through the Health Management Information System (HMIS) by random sampling. The evaluation was also carried out in one catchment community per health facility and at the county referral hospital. Primary data were collected through individual interviews and a review of MNDSR tools and structure. Data were analyzed using thematic analysis.Implementation of the MNDSR system was very low in the five counties. Only two out of the five counties were currently conducting MNDSR. MNDSR guidelines and standard operating procedures were not available at the county level. Only 12 (23.5%) health facilities had a maternal and neonatal death review committee. Less than a quarter of the assessed community members could correctly give the definition of a maternal or neonatal death.The MNDSR system is weak in Liberia, at county, health facility, and community levels. Strong national commitment is needed in collaboration with diverse partners for successful implementation of the system.

Background: Contraception is an inexpensive and cost-effective intervention, but health workforce shortages and restrictive policies on the roles of mid and lower-level cadres limit access to effective contraceptive methods in many settings. Task sharing and task shifting are strategies that can be adopted to increase uptake of health services including family planning. Methods: We collected data through online survey, key informant interviews and focused grouped discussions with an intervention group and that implemented the task sharing and task shifting policy guidelines and a control group that did not implement the policy. A total of 434 questionnaires were filled by health workers’ in primary health care facilities to assess effectiveness of task sharing and task shifting on the uptake of family planning services including its strengths and challenges. The questionnaire was designed with the aim of getting data on services provided by the cadres on effectiveness (number of clients, increase in use of methods, access to services), how they perceive these tasks, the bottlenecks and facilitating factors associated with the practice of task sharing and task shifting. Results: We found out that the task sharing and task shifting can expand and increase access to services as stated by 95% of the respondents. Most community health workers provided more of the family planning services at 45% with only 5% of the services of family planning being provided by medical officers. 98% of family planning services were integrated with other services. Task shifting was beneficial to the health care providers as well as the clients and the success of task sharing and task shifting depended on training, supportive supervision and a regulated environment through policies. Conclusion: The study shows that formalized task sharing and task shifting can increase health service uptake especially when community health workers are involved to provide services in the community. This leads to increased service provision, equivalent health professional performance across cadres and patient outcomes in the provision of family planning services.

Background: The COVID-19 pandemic has had a major impact on the capacity of health systems to continue the delivery of essential health services. While health systems around the world are being challenged by increasing demand for care of COVID-19 patients, it is critical to all other services including sexual reproductive health services. Countries are expected to ensure optimal balance between fighting the COVID-19 pandemic and maintenance of essential health services like sexual reproductive health. The purpose of this report was to assess and document continuity of sexual and reproductive health services with a focus on safe abortion, post abortion care and family planning services during the COVID -19 pandemic in selected countries of the World Health Organization Africa Region.Methods: A descriptive survey using a simplified and user-friendly virtual web based rapid needs assessment through a questionnaire was filled in by key informants drawn from the ministries of health from 30 countries in July 2020. The questionnaires were filled in by the World Health Organization staff in charge of sexual reproductive health services in collaboration with their counterparts in the ministries of health and uploaded in excel data sheets and categorized in to thematic areas for analysis.Results: Responses were received from 17 countries out of the 30 countries that received the questionnaires. Of the 17 countries, only 2 (12%) countries reported that sexual and reproductive health services are not integrated in the essential health services package. All the sexual reproductive health elements-family planning/contraception and comprehensive abortion care, including post abortion care are integrated in the essential health services package in 12 (80%) of the 15 countries that have sexual reproductive health integrated. Also,14(82%) countries reporting having ongoing awareness raising campaigns/communication messages about family planning, comprehensive abortion care and post abortion care during the COVID pandemic. 9(59%) of the countries reported reduction in the use of family planning services, 6(35%) indicated no changes in the use of family planning services with only 2(12%) countries providing no response. Conclusion: The survey provides information on the weak health systems of the participating member states of the WHO Africa Region and the magnitude of disruptions of sexual reproductive health services in selected countries. Further, strategies adopted by countries to ensure continuity of sexual reproductive health services amidst COVID -19 like communications, Countries finally identified key areas that need to be supported in family planning/contraception, comprehensive abortion care and post abortion care during the COVID-19 pandemic.

WHO's normative guidance on self-care interventions for sexual and reproductive health and rights (SRHR) promotes comprehensive, integrated and people-centred approaches to health service delivery. Implementation of self-care interventions within the context of human rights, gender equality, and a life course approach, offers an underused opportunity to improve universal health coverage (UHC) for all. Results from an online global values and preferences survey provided lay persons' and healthcare providers' perspectives on access, acceptability, and implementation considerations. This analysis examines 326 qualitative responses to open-ended questions from healthcare providers (n = 242) and lay persons (n = 70) from 77 countries. Participants were mostly women (66.9%) and were from the Africa (34.5%), America (32.5%), South-East Asia (5.6%), European (19.8%), Eastern Mediterranean (4.8%), and Western Pacific regions (2.8%). Participants perceived multiple benefits of self-care interventions for SRHR, including: reduced exposure to stigma, discrimination and access barriers, increased confidentiality, empowerment, self-confidence, and informed decision-making. Concerns include insufficient knowledge, affordability, and possible side-effects. Implementation considerations highlighted the innovative approaches to linkages with health services. Introduction of self-care interventions is a paradigm shift in health care delivery bridging people and communities through primary health care to reach UHC. Self-care interventions can be leveraged by countries as gateways for reaching more people with quality, accessible and equitable services that is critical for achieving UHC. The survey results underscored the urgent need to reduce stigma and discrimination, increase access to and improve knowledge of self-care interventions for SRHR for laypersons and healthcare providers to advance SRHR.

This study used hospital records from two time periods to understand the implication of COVID-19 on hospital-based deaths in Burundi. The place of COVID-19 symptoms was sought among deaths that occurred from January to May 2020 (during the pandemic) vs. January to May 2019 (before the pandemic). First, death proportions were tested to seize differences between mortality rates for each month in 2020 vs. 2019. In the second time, we compared mean time-to-death between the two periods using the Kaplan-Meier survival curve. Finally, a logistic regression was fitted to assess the likelihood of dying from COVID-19 symptoms between the two periods. We found statistical evidence of a higher death rate in May 2020 as compared to May 2019. Moreover, death occurred faster in 2020 (mean = 6.7 days, s.d. = 8.9) than in 2019 (mean = 7.8 days, s.d. = 10.9). Unlike in 2019, being a male was significantly associated with a much lower likelihood of dying with one or more COVID-19 symptom(s) in 2020 (odds ratio 0.35, 95% confidence interval 0.14-0.87). This study yielded some evidence for a possible COVID-19-related hospital-based mortality trend for May 2020. However, considering the time-constraint of the study, further similar studies over a longer period of time need to be conducted to trace a clearer picture on COVID-19 implication on hospital-based deaths in Burundi.

Expanding access and use of effective contraception is important in achieving universal access to reproductive healthcare services, especially in low- and middle-income countries (LMICs), such as those in sub-Saharan Africa (SSA). Shortage of trained healthcare providers is an important contributor to increased unmet need for contraception in SSA. The World Health Organization (WHO) recommends task sharing as an important strategy to improve access to sexual and reproductive healthcare services by addressing shortage of healthcare providers. This study explores the status, successes, challenges and impacts of the implementation of task sharing for family planning in five SSA countries. This evidence is aimed at promoting the implementation and scale-up of task sharing programmes in SSA countries by WHO.We employed a rapid programme review (RPR) methodology to generate evidence on task sharing for family planning programmes from five SSA countries namely, Burkina Faso, Cote d'Ivoire, Ethiopia, Ghana, and Nigeria. This involved a desk review of country task sharing policy documents, implementation plans and guidelines, annual sexual and reproductive health programme reports, WHO regional meeting reports on task sharing for family planning; and information from key informants on country background, intervention packages, impact, enablers, challenges and ways forward on task sharing for family planning. The findings indicate mainly the involvement of community health workers, midwives and nurses in the task sharing programmes with training in provision of contraceptive pills and long-acting reversible contraceptives (LARC). Results indicate an increase in family planning indicators during the task shifting implementation period. For instance, injectable contraceptive use increased more than threefold within six months in Burkina Faso; contraceptive prevalence rate doubled with declines in total fertility and unmet need for contraception in Ethiopia; and uptake of LARC increased in Ghana and Nigeria. Some barriers to successful implementation include poor retention of lower cadre providers, inadequate documentation, and poor data systems.Task sharing plays a role in increasing contraceptive uptake and holds promise in promoting universal access to family planning in the SSA region. Evidence from this RPR is helpful in elaborating country policies and scale-up of task sharing for family planning programmes.INTRODUCTION: L'élargissement de l'accès et de l'utilisation d’une contraception efficace est important pour parvenir à l'accès universel aux services de santé reproductive, en particulier dans les pays à revenu faible et intermédiaire, comme ceux de l'Afrique subsaharienne. L’insuffisance de prestataires de soins de santé qualifiés est un facteur important de l'augmentation des besoins non satisfaits en matière de contraception en Afrique subsaharienne. L'Organisation mondiale de la Santé (OMS) recommande le partage des tâches comme stratégie importante pour améliorer l'accès aux services de santé sexuelle et reproductive en s’attaquant à la pénurie des prestataires de soins de santé. Cette étude explore l'état des lieux, les réussites, les défis et les impacts de la mise en œuvre du partage des tâches pour la planification familiale dans cinq pays d'Afrique subsaharienne. Ces données factuelles visent à promouvoir la mise en œuvre et l'extension des programmes de partage des tâches dans les pays d'Afrique sub-saharienne par l'OMS. MéTHODOLOGIE ET RéSULTATS: Nous avons utilisé la méthodologie de la revue rapide des programmes (RPR) pour générer des données sur le partage des tâches pour les programmes de planification familiale de cinq pays d'Afrique subsaharienne, à savoir le Burkina Faso, la Côte d'Ivoire, l'Éthiopie, le Ghana et le Nigéria. Cela impliquait la revue documentaire des documents de politique nationale de partage des tâches, des plans de mise en œuvre et des directives, des rapports annuels sur les programmes de santé sexuelle et reproductive, des rapports des réunions régionales de l'OMS sur le partage des tâches pour la planification familiale; et des informations provenant des informateurs clés sur le contexte du pays, les programmes d'intervention, l'impact, les catalyseurs, les défis et les voies à suivre pour le partage des tâches pour la planification familiale. Les résultats indiquent principalement l'implication des agents de santé communautaires, des sages-femmes et des infirmières dans les programmes de partage des tâches avec une formation liée à l’approvisionnement de pilules contraceptives et de contraceptifs réversibles à longue durée d’action (LARC). Les résultats indiquent une augmentation des indicateurs de planification familiale pendant la période de mise en œuvre du partage des tâches. Par exemple, l'utilisation des contraceptifs injectables a plus que triplé en six mois au Burkina Faso; le taux de prévalence de la contraception a doublé avec une baisse de la fécondité totale et des besoins non satisfaits en matière de contraception en Éthiopie; et l'adoption du LARC a augmenté au Ghana et au Nigéria. Certains obstacles à la réussite de la mise en œuvre comprennent une faible rétention des prestataires de niveau inférieur, une documentation inadéquate et des systèmes peu performants de gestion des données.Le partage des tâches joue un rôle important dans l'augmentation de l'utilisation de la contraception et dans la promotion de l'accès universel à la planification familiale dans la région Afrique subsaharienne. Les données de ce RPR sont utiles pour l'élaboration des politiques nationales et l'intensification du partage des tâches pour les programmes de planification familiale. Correct and consistent use of contraceptives has been shown to reduce pregnancy and childbirth related maternal deaths and generally improve reproductive health. However, statistics show that many women of reproductive age in SSA who ought to be using contraceptives are not using them. As a result, high rates of maternal deaths from pregnancy or childbirth-related complications have been recorded in the region. One of the key barriers to accessing family planning in SSA is the shortage of healthcare providers. To address this problem, WHO recommends task sharing as an intervention to improve access and use of sexual and reproductive health services including family planning. While task sharing guidelines have been developed and disseminated in many SSA countries, limited evidence exists on their adoption, implementation and outcomes to promote scale-up. This study undertook a rapid programme review of evidence from policy documents, implementation plans and guidelines, annual sexual and reproductive health programme reports, regional meeting reports and key stakeholder reports on task sharing to explore the status, successes, challenges and impacts of the implementation of task sharing for family planning in five SSA countries: Burkina Faso, Cote d’Ivoire, Ethiopia, Ghana, and Nigeria. We found that task sharing programmes mainly involved community health workers, midwives and nurses. The intervention led to increased modern contraception access and use and general improvement in family planning indicators during the implementation periods. Some barriers to successful implementation of task sharing include poor retention of lower cadre providers, inadequate documentation, and poor data systems.

In Burkina Faso, the coverage of services for family planning is low due to shortage of qualified health staff and limited access to services.Following the launch of the Ouagadougou Partnership, an alliance to catalyse the expansion of family planning services, the health ministry created a consortium of family planning stakeholders in 2011. The consortium adopted a collaborative framework to implement a pilot project for task sharing in family planning at community and primary health-care centre levels in two rural districts. Stakeholders were responsible for their areas of expertise. These areas included advocacy; monitoring and evaluation; and capacity development of community health workers (CHWs) to offer oral and injectable contraceptives to new users and of auxiliary nurses and auxiliary midwives to provide implants and intrauterine devices. The health ministry implemented supportive supervision cascades involving relevant planning and service levels.In Burkina Faso, only 15% (2563/17 087) of married women used modern contraceptives in 2010.Adoption of new policies and clinical care standards expanded task sharing roles in family planning. The consortium trained a total of 79 CHWs and 124 auxiliary nurses and midwives. Between January 2017 and December 2018, CHWs provided injectables to 3698 new users, and auxiliary nurses or midwives provided 726 intrauterine devices and 2574 implants to new users. No safety issues were reported.The pilot project was feasible and safe, however, financial constraints are hindering scale-up efforts. Supportive supervision cascades were critical in ensuring success.Au Burkina Faso, la couverture des services de planification familiale est faible, en raison de la pénurie de personnel de santé qualifié et de l'accès limité à ces services.Suite au lancement du Partenariat de Ouagadougou, alliance destinée à accélérer l'expansion des services de planification familiale, le ministère de la Santé a créé en 2011 un consortium d'acteurs de la planification familiale. Ce consortium a adopté un cadre collaboratif pour mettre en œuvre un projet pilote visant à partager les tâches de planification familiale, aux niveaux de la communauté et des centres de soins primaires, dans deux districts ruraux. Les différents acteurs étaient responsables de leurs domaines d'expertise, parmi lesquels la sensibilisation, le suivi et l'évaluation, ainsi que le renforcement des compétences des agents de santé communautaires, afin de proposer des contraceptifs oraux et injectables à de nouvelles utilisatrices, et des aides-soignants et sages-femmes auxiliaires, dans le but de poser des implants et des dispositifs intra-utérins. Le ministère de la Santé a mis en place des structures d'encadrement faisant intervenir les niveaux concernés de planification et de services.Au Burkina Faso, seules 15% (2563/17 087) des femmes mariées utilisaient des contraceptifs modernes en 2010.L'adoption de nouvelles politiques et de nouveaux standards de soins a élargi les rôles de partage des tâches en matière de planification familiale. Le consortium a formé un total de 79 agents de santé communautaires et de 124 aides-soignants et sages-femmes auxiliaires. Entre janvier 2017 et décembre 2018, les agents de santé communautaires ont délivré des contraceptifs injectables à 3698 nouvelles utilisatrices, et les aides-soignants et sages-femmes auxiliaires ont posé 726 dispositifs intra-utérins et 2574 implants à de nouvelles utilisatrices. Aucun problème de sécurité n'a été signalé.Ce projet pilote était réalisable et sûr; cependant, des contraintes financières entravent les efforts d'évolution. Les structures d'encadrement ont été essentielles à la réussite de ce projet.En Burkina Faso, la cobertura de los servicios de planificación familiar es baja debido a la escasez de personal sanitario cualificado y al acceso limitado a los servicios.Tras la puesta en marcha de Ouagadougou Partnership (la Asociación de Uagadugú), una alianza para promover la expansión de los servicios de planificación familiar, el Ministerio de Salud creó en 2011 un consorcio de interesados en la planificación familiar. El consorcio adoptó un marco de colaboración para ejecutar un proyecto piloto de distribución de tareas en materia de planificación familiar a nivel comunitario y de centros de atención primaria de la salud en dos distritos rurales. Las partes interesadas eran responsables de sus áreas de especialización. Estas áreas incluían la promoción, la vigilancia y la evaluación, y el desarrollo de la capacidad de los trabajadores sanitarios de la comunidad (community health workers, CHW) para ofrecer anticonceptivos orales e inyectables a los nuevos usuarios, así como de los enfermeros auxiliares y las parteras auxiliares para proporcionar implantes y dispositivos intrauterinos. El Ministerio de Salud implementó cascadas de supervisión de apoyo que involucran niveles relevantes de planificación y servicio.En Burkina Faso, solamente el 15 % (2 563/17 087) de las mujeres casadas utilizaron anticonceptivos modernos en 2010.La adopción de nuevas políticas y estándares de atención clínica expandió la distribución de tareas en la planificación familiar. El consorcio capacitó a un total de 79 CHW y 124 enfermeros y parteras auxiliares. Entre enero de 2017 y diciembre de 2018, los CHW administraron inyectables a 3 698 nuevas usuarias, y los enfermeros auxiliares o parteras suministraron 726 dispositivos intrauterinos y 2 574 implantes a las nuevas usuarias. No se informó de ningún problema de seguridad.El proyecto piloto era viable y seguro; sin embargo, las limitaciones financieras están obstaculizando los esfuerzos de ampliación. Las cascadas de supervisión de apoyo fueron fundamentales para garantizar el éxito.انخفاض تغطية خدمات تنظيم الأسرة بسبب نقص العاملين الصحيين المؤهلين ومحدودية الوصول إلى الخدمات.عقب إطلاق شراكة واغادوغو وهو تحالف لتحفيز توسع خدمات تنظيم الأسرة، شكلت وزارة الصحة ائتلافًا من أصحاب المصلحة في تنظيم الأسرة في عام 2011. اعتمد الائتلاف إطارًا تعاونيًا لتنفيذ مشروع تجريبي خاص بمشاركة المهام المتعلقة بتنظيم الأسرة على مستوى مراكز الرعاية الصحية الأولية والمجتمع في منطقتين ريفيتين. وكان أصحاب المصلحة مسؤولين عن مجالات خبراتهم. وشملت هذه المجالات: التأييد؛ والمراقبة والتقييم؛ وتطوير قدرات العاملين في مجال الصحة المجتمعية (CHW) لتقديم موانع الحمل التي يتم تعاطيها عن طريق الفم، والقابلة للحقن إلى مستخدمين جدد؛ بالإضافة إلى تطوير قدرات الممرضات المساعدات والقابلات المساعدات لتوفير أدوات زرع داخل الرحم وأجهزة رحمية لمنع الحمل. نفذت وزارة الصحة سلاسل إشراف داعمة تتضمن مستويات التخطيط والخدمات ذات الصلة.استخدمت 15% فقط (2563/17087) من النساء المتزوجات في بوركينا فاسو وسائل منع حمل حديثة في عام 2010.أدى اعتماد سياسات جديدة ومعايير الرعاية السريرية إلى توسيع أدوار مشاركة المهام المتعلقة بتنظيم الأسرة. ودرب الائتلاف إجمالي 79 عاملاً في مجال الصحة المجتمعية (CHW)، و124 ممرضة مساعدة وقابلة مساعدة. في الفترة ما بين يناير/كانون ثاني 2017 وديسمبر/كانون أول 2018، قدم العاملون في مجال الصحة المجتمعية (CHW) وسائلَا قابلة للحقن إلى 3698 مستخدمًا جديدًا، وقدمت الممرضات المساعدات والقابلات المساعدات 726 جهازًا رحمياً و2574 أداة للزرع داخل الرحم للمستخدمين الجدد. ولم يتم الإبلاغ عن أي مشاكل متعلقة بالسلامة.كان المشروع التجريبي عمليًا وآمنًا، ومع ذلك، كانت القيود المالية تعيق جهود التوسع. كانت سلاسل الإشراف الداعمة حاسمة في ضمان النجاح.在布吉纳法索，由于缺乏合格的医务人员以及获得服务的途径有限，计划生育服务的覆盖率很低。.在瓦加杜古伙伴关系（旨在促进推广计划生育服务的联盟）启动之后，卫生部于 2011 年成立了一个计划生育利益相关者联盟。该联盟采用协作架构以实施试点项目，从而在两个农村地区的社区和初级医疗保健中心实现计划生育任务分担。利益相关者对其专业领域负责。这些领域包括加大宣传、监测与评估，培养社区卫生工作者 (CHW) 向新用户提供口服型和注射型避孕药的能力，以及由助理护士和助理助产士提供植入型避孕措施和宫内节育器的能力。卫生部实施了支持性联动监督，涉及相关的计划和服务层面。.2010 年，布吉纳法索仅有 15% （即 2563/17087）的已婚妇女使用现代避孕措施。.新的政策和临床护理标准的采用扩大了任务分担在计划生育中的作用。联盟共培训了 79 名社区卫生工作者以及 124 名助理护士和助产士。2017 年 1 月至 2018 年 12 月间，社区卫生工作者向 3698 名新用户提供了注射型避孕药物，助理护士或助产士向新用户提供了 726 个宫内节育器和 2574 个植入型避孕措施。目前尚未出现任何安全问题报告。.试点项目可行且安全，但是，财政拮据影响了其规模的进一步扩大。支持性联动监督是成功的关键。.В Буркина-Фасо наблюдается низкий уровень охвата услугами по планированию семьи по причине нехватки квалифицированного медицинского персонала и ограниченного доступа к услугам.После запуска программы «Партнерство Уагадугу» (союза, в задачи которого входит ускорение расширения охвата услугами по планированию семьи) Министерство здравоохранения в 2011 году создало консорциум партнеров по данному вопросу. Консорциум определил рамки сотрудничества для осуществления пилотного проекта по разделению функций в оказании услуг по планированию семьи на уровне общин и центров первичного медико-санитарного обслуживания в двух сельских регионах. Каждый из партнеров отвечал за свою область знаний. Эти области знаний включали информационно-разъяснительную работу, мониторинг и оценку, а также обучение общинных медико-санитарных работников (ОМСР) тому, чтобы они могли предлагать пероральные и инъекционные контрацептивы новым пользователям, а также обучение младших медсестер и акушерок процедуре установки имплантатов и внутриматочных устройств. Министерство здравоохранения также внедрило ступенчатую систему надзора и поддержки, в которую вошли соответствующие уровни планирования и оказания услуг.В 2010 году только 15% замужних женщин в Буркина-Фасо (2563 из 17 087) использовали современные контрацептивы.Принятие новых правил и стандартов клинического ухода расширило возможности разделения функций в услугах планирования семьи. Консорциум обучил в общей сложности 79 ОМСР и 124 младшие медсестры и акушерки. В период с января 2017 года по декабрь 2018 года ОМСР выдали инъекционные контрацептивы 3698 новым пользователям, а младшие медсестры и акушерки установили 726 внутриматочных устройств и 2574 имплантата. Проблем с безопасностью при этом не было зарегистрировано.Пилотный проект оказался осуществимым и безопасным, однако финансовые ограничения препятствуют расширению его масштабов. Критическим звеном в обеспечении успешности проекта оказалась ступенчатая система надзора и поддержки.

Emergency obstetric and newborn care (EmONC) can be life-saving in managing well-known complications during childbirth. However, suboptimal availability, accessibility, quality and utilisation of EmONC services hampered meeting Millennium Development Goal target 5A. Evaluation and modelling tools of health system performance and future potential can help countries to optimise their strategies towards reaching Sustainable Development Goal (SDG) 3: ensure healthy lives and promote well-being for all at all ages. The standard set of indicators for monitoring EmONC has been found useful for assessing quality and utilisation but does not account for travel time required to physically access health services. The increased use of geographical information systems, availability of free geographical modelling tools such as AccessMod and the quality of geographical data provide opportunities to complement the existing EmONC indicators by adding geographically explicit measurements. This paper proposes three additional EmONC indicators to the standard set for monitoring EmONC; two consider physical accessibility and a third addresses referral time from basic to comprehensive EmONC services. We provide examples to illustrate how the AccessMod tool can be used to measure these indicators, analyse service utilisation and propose options for the scaling-up of EmONC services. The additional indicators and analysis methods can supplement traditional EmONC assessments by informing approaches to improve timely access to achieve Universal Health Coverage and reach SDG 3.

In April 2016, the Population Council, in partnership with the World Health Organization (WHO) and the International Consortium for Emergency Contraception, convened a regional meeting in Lusaka, Zambia, geared toward supporting countries in East and Southern Africa in meeting their obligations under the Maputo Protocol. These obligations include expanding access to women’s reproductive health services – especially women survivors of sexual violence. Government and civil society representatives from six countries participated: Botswana, Ethiopia, Kenya, Malawi, Rwanda, and Zambia. Countries were selected based on to their being priority settings for the projects that sponsored the meeting, coupled with the fact that they were each far enough along in addressing post-rape care to be able to develop concrete policy, programming, and/or legal action plans by the end of the meeting. The meeting was the first activity in a joint project of technical assistance by the conveners, aimed at strengthening access to comprehensive post-rape care for survivors of sexual violence. It aimed to sensitize Member States to their obligations under the Maputo Protocol to expand women’s access to emergency contraception (EC) and safe abortion services, and to inspire them to do so by providing information, research evidence, and a platform for discussion. The meeting deliberations fostered a better understanding of opportunities to broaden access to EC and safe abortion for survivors in the region. Discussions on EC in this regard centered on strengthening EC delivery in the clinical context, decentralizing EC services, increasing community awareness, and overcoming policy barriers. Safe abortion discussions focused primarily on legislation, policy, and integrating these services into existing services for sexual violence survivors. Country-specific action plans were developed to address gaps and weaknesses. The regional technical meeting concluded with a discussion of practical steps that participants could take to facilitate legal, policy, and program reform with respect to pregnancy prevention and safe abortion in their respective countries. The steps revolved around three mainly areas, namely: establishing an evidence base to inform action; creating forums for discussing the issues; and drafting action points to carry the momentum from the meeting forward. This paper details the proceedings from this regional technical meeting – proceedings that are of interest to the field of sexual and gender-based violence (and reproductive health, more broadly) as challenges faced by countries in implementing the Maputo Protocol are outlined, and evidence-informed and practice-based strategies for addressing these challenges are provided.

Background In-country research capacity is key to creating improvements in local implementation of health programs and can help prioritize health issues in a landscape of limited funding. Research prioritization has shown to be particularly useful to help answer strategic and programmatic issues in health care, including sexual and reproductive health (SRH). The purpose of this paper is to present the results of a priority setting exercise that brought together researchers and program managers from the WHO Africa and Eastern Mediterranean regions to identify key SRH issues. Methods In June 2015, researchers and program managers from the WHO Africa and Eastern Mediterranean regions met for a three-day meeting to discuss strategies to strengthen research capacity in the regions. A prioritization exercise was carried out to identify key priority areas for research in SRH. The process included five criteria: answerability, effectiveness, deliverability and acceptability, potential impact of the intervention/program to improve reproductive, maternal and newborn health substantially, and equity. Results The six main priorities identified include: creation and investment in multipurpose prevention technologies, addressing adolescent violence and early pregnancy (especially in the context of early marriage), improved maternal and newborn emergency care, increased evaluation and improvement of adolescent health interventions including contraception, further focus on family planning uptake and barriers, and improving care for mothers and children during childbirth. Conclusion The setting of priorities is the first step in a dynamic process to identify where research funding should be focused to maximize health benefits. The key elements identified in this exercise provides guidance for decision makers to focus action on identified research priorities and goals. Prioritization and identifying/acting on research gaps can have great impact across multiple sectors in the regions for improved reproductive, maternal and children health.

Background Benzathine penicillin G (BPG) is the only recommended treatment to prevent mother-to-child transmission of syphilis. Due to recent reports of country-level shortages of BPG, an evaluation was undertaken to quantify countries that have experienced shortages in the past 2 years and to describe factors contributing to these shortages. Methods and findings Country-level data about BPG shortages were collected using 3 survey approaches. First, a survey designed by the WHO Department of Reproductive Health and Research was distributed to 41 countries and territories in the Americas and 41 more in Africa. Second, WHO conducted an email survey of 28 US Centers for Disease Control and Prevention country directors. An additional 13 countries were in contact with WHO for related congenital syphilis prevention activities and also reported on BPG shortages. Third, the Clinton Health Access Initiative (CHAI) collected data from 14 countries (where it has active operations) to understand the extent of stock-outs, in-country purchasing, usage behavior, and breadth of available purchasing options to identify stock-outs worldwide. CHAI also conducted in-person interviews in the same 14 countries to understand the extent of stock-outs, in-country purchasing and usage behavior, and available purchasing options. CHAI also completed a desk review of 10 additional high-income countries, which were also included. BPG shortages were attributable to shortfalls in supply, demand, and procurement in the countries assessed. This assessment should not be considered globally representative as countries not surveyed may also have experienced BPG shortages. Country contacts may not have been aware of BPG shortages when surveyed or may have underreported medication substitutions due to desirability bias. Funding for the purchase of BPG by countries was not evaluated. In all, 114 countries and territories were approached to provide information on BPG shortages occurring during 2014–2016. Of unique countries and territories, 95 (83%) responded or had information evaluable from public records. Of these 95 countries and territories, 39 (41%) reported a BPG shortage, and 56 (59%) reported no BPG shortage; 10 (12%) countries with and without BPG shortages reported use of antibiotic alternatives to BPG for treatment of maternal syphilis. Market exits, inflexible production cycles, and minimum order quantities affect BPG supply. On the demand side, inaccurate forecasts and sole sourcing lead to under-procurement. Clinicians may also incorrectly prescribe BPG substitutes due to misperceptions of quality or of the likelihood of adverse outcomes. Conclusions Targets for improvement include drug forecasting and procurement, and addressing provider reluctance to use BPG. Opportunities to improve global supply, demand, and use of BPG should be prioritized alongside congenital syphilis elimination efforts., Using country-level surveys and stakeholder interviews, Stephen Nurse-Findlay and colleagues investigate the global frequency of benzathine penicillin shortages and uncover commonly noted causes., Author summary Why was this study done? A single dose of low-cost benzathine penicillin G (BPG) ends syphilis infectivity in adults with no documented risk of antibiotic resistance. In spite of this, syphilis continues to infect millions globally. Pregnant women with syphilis are particularly vulnerable, as fetal transmission of the infection can cause stillbirth. The only recommended treatment for syphilis in pregnant women is BPG. Congenital syphilis remains a significant contributor to early infant mortality, particularly in low- and middle-income countries. There are several reasons for this, but one of the most important is a global shortage of BPG. In 2015, WHO began to receive anecdotal country reports of BPG stock-outs. WHO decided to assess these shortages, describe global supply and demand drivers, and propose viable policy solutions. What did the researchers do and find? The team completed 3 surveys to assess global BPG shortages occurring during 2014–2016. The first was distributed to 41 countries and territories in the Americas and 41 African countries. The second was emailed to 28 US Centers for Disease Control and Prevention country directors. The third was used in in-person interviews in 14 countries by the Clinton Health Access Initiative. In all, 95 of 114 unique countries and territories responded to the surveys. Of these, 39 reported a BPG shortage and 56 reported no BPG shortage. The team discovered 3 major issues. First, countries often obtain their product from a single wholesaler, which often obtains its products from a single final dose formulator, which often obtains its active ingredient from a single manufacturer. This “sole sourcing,” combined with a highly consolidated market, makes alternative supply difficult if there are production, quality, regulatory, or specification changes within a country’s supply chain. Second, as an off-patent medication, BPG commands a market price of pennies per dose. However, as a sterile injectable, it is also expensive to manufacture. These economics have led manufacturers to either abandon BPG production or implement stringent ordering protocols that compromise supply for low- and middle-income countries. Third, inaccurate country forecasts, weak procurement systems, and clinical knowledge gaps about syphilis treatment have compromised demand for and procurement of BPG. What do these findings mean? Widespread BPG shortages compromise treatment of adult syphilis, prevention of congenital syphilis, and treatment of other BPG-indicated conditions (including rheumatic heart disease). An uninterrupted supply of quality-assured active pharmaceutical ingredient and final formulated product will simplify BPG procurement for high-burden countries. Countries must strengthen their supply chain, purchasing, forecasting, and procurement infrastructure to mitigate shortage risk and reduce demand-side stock-outs. Countries must also strengthen testing for and treatment of maternal syphilis (and prevention of congenital syphilis) with BPG.

Objective To analyze and compare the availability, utilization, and quality of services for maternal and neonatal health in 2010 and 2014 in Burkina Faso. Methods A cross-sectional study of emergency obstetric and neonatal care services (EmONC) in all public and private health facilities in Burkina Faso in 2010 and a sample of 812 health facilities in 2014. The generic tools developed by the Averting Maternal Death and Disability (AMDD) program were used as the basic tools for evaluation. Results In 2010, 25 health facilities were considered as EmONC health facilities and there were 23 in 2014. In 2010 and 2014, the proportion of births in EmONC health facilities was low (4.5%). The cesarean delivery rate also remained very low, at 0.9% in 2010 and 1.13% in 2014. The proportion of obstetric complications supported in health facilities was 12.3% in 2010 and 17.1% in 2014. The direct complication case fatality rate in EmONC health facilities was 1.6% in 2010 and 1.3% in 2014. Conclusion The two surveys did not show a significant improvement in the availability, utilization, and quality of maternal and neonatal healthcare services between 2010 and 2014.

Background: Maternal mortality has declined by nearly half since 1990, but over a quarter million women still die every year of causes related to pregnancy and childbirth. Maternal-health related targets are falling short of the 2015 Millennium Development Goals and a post-2015 Development Agenda is emerging. In connection with this, setting global research priorities for the next decade is now required.\ud Methods. We adapted the methods of the Child Health and Nutrition Research Initiative (CHNRI) to identify and set global research priorities for maternal and perinatal health for the period 2015 to 2025. Priority research questions were received from various international stakeholders constituting a large reference group, and consolidated into a final list of research questions by a technical working group. Questions on this list were then scored by the reference working group according to five independent and equally weighted criteria. Normalized research priority scores (NRPS) were calculated, and research priority questions were ranked accordingly. Results: A list of 190 priority research questions for improving maternal and perinatal health was scored by 140 stakeholders. Most priority research questions (89%) were concerned with the evaluation of implementation and delivery of existing interventions, with research subthemes frequently concerned with training and/or awareness interventions (11%), and access to interventions and/or services (14%). Twenty-one questions (11%) involved the discovery of new interventions or technologies. Conclusions: Key research priorities in maternal and perinatal health were identified. The resulting ranked list of research questions provides a valuable resource for health research investors, researchers and other stakeholders. We are hopeful that this exercise will inform the post-2015 Development Agenda and assist donors, research-policy decision makers and researchers to invest in research that will ultimately make the most significant difference in the lives of mothers and babies.