From papers to practices: district level priority setting processes and criteria for family planning, maternal, newborn and child health interventions in Tanzania

Background: There is a growing body of literature on evidence-informed priority setting. However, the literature on the use of evidence when setting healthcare priorities in low-income countries (LICs), tends to treat the healthcare system (HCS) as a single unit, despite the existence of multiple programs within the HCS, some of which are donor supported. Objectives: (i) To examine how Ugandan health policy-makers define and attribute value to the different types of evidence; (ii) Based on 6 health programs (HIV, maternal, newborn and child health [MNCH], vaccines, emergencies, health systems, and non- communicable diseases [NCDs]) to discuss the policy-makers’ reported access to and use of evidence in priority setting across the 6 health programs in Uganda; and (iii) To identify the challenges related to the access to and use of evidence. Methods: This was a qualitative study based on in-depth key informant interviews with 60 national level (working in 6 different health programs) and 27 sub-national (district) level policy-makers. Data were analysed used a modified thematic approach. Results: While all respondents recognized and endeavored to use evidence when setting healthcare priorities across the 6 programs and in the districts; more national level respondents tended to value quantitative evidence, while more district level respondents tended to value qualitative evidence from the community. Challenges to the use of evidence included access, quality, and competing values. Respondents from highly politicized and donor supported programs such as vaccines, HIV and maternal neonatal and child health were more likely to report that they had access to, and consistently used evidence in priority setting. Conclusion: This study highlighted differences in the perceptions, access to, and use of evidence in priority setting in the different programs within a single HCS. The strong infrastructure in place to support for the access to and use of evidence in the politicized and donor supported programs should be leveraged to support the availability and use of evidence in the relatively under-resourced programs. Further research could explore the impact of unequal availability of evidence on priority setting between health programs within the HCS.

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Enhancing the Knowledge and Behaviors of Fieldworkers to Promote Family Planning and Maternal, Newborn, and Child Health in Bangladesh Through a Digital Health Training Package: Results From a Pilot Study

International Quarterly of Community Health Education ◽

10.1177/0272684x19861866 ◽

2019 ◽

Vol 40 (2) ◽

pp. 143-149

Author(s):

Rupali J. Limaye ◽

Anne Ballard Sara ◽

Naheed Ahmed ◽

Saori Ohkbuo ◽

Sidhartha Deka ◽

...

Keyword(s):

Family Planning ◽

Child Health ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Digital Health ◽

Birth Spacing ◽

Health Training ◽

Newborn And Child Health ◽

The Difference ◽

And Child Health

Community health workers, also known as fieldworkers (FWs), are frontline health-care providers in Bangladesh, where unmet need in family planning outcomes related to maternal and child health are high. A digital health intervention provided netbook computers to Bangladeshi FWs with eLearning courses and an eToolkit, which included material on family planning, maternal, newborn, and child health topics to enhance FWs’ knowledge and skills. To understand how the intervention affected FW’s knowledge and counseling behavior, this pre-poststudy measured FWs’ knowledge related to family planning, maternal, newborn, child health, and counseling on family topics before and after the pilot. Bivariate analyses were used to determine changes in FW knowledge, and multivariate analyses were conducted to determine changes in behavior, comparing knowledge and behaviors prepilot to postpilot. Comparing mean knowledge scores after and before the pilot, the difference in mean scores was significant ( p < .05) related to knowledge of benefits of birth spacing (1.26) and benefits of a small family (1.3) and related to maternal health, anemia prevention (0.95), and recommended number of antenatal care visits (0.13). Regarding newborn and child health, the difference in mean scores was significantly ( p < .05) related to knowledge of proper attachment for breastfeeding (3.56) and signs of adequate breast milk supply (1.08). Postintervention, FWs were significantly more likely to counsel couples on all available contraceptive options (adjusted odds ratio: 4.64; 95% CI [3.16, 6.83]) and birth spacing benefits (adjusted odds ratio: 4.54; 95% CI [3.17, 6.50]). Digital health training approaches can improve FWs’ knowledge and counseling skills within an international context, specifically in low-resource settings.

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