Changing national health policies for introduction, uptake and scale-up of self-care interventions for sexual and reproductive health and rights in the Eastern Mediterranean Region

AbstractInnovative people-centered care modalities including self-care interventions offer an opportunity to ensure continuity of healthcare services during COVID-19 and in post-COVID-19, as well as contribute to the achievement of universal health coverage. Parliamentarians are uniquely positioned to promote self-care interventions for sexual and reproductive health and rights through their legislative, budget allocation, oversight, and advocacy roles. However, existing health systems governance challenges in the Eastern Mediterranean region such as weak institutions setups, fragmentation of health programs, and limitation of resources could impede parliamentarians’ progress. To address these challenges, the following recommended actions should be considered: (1) promote the adaptation of sexual and reproductive health and rights service packages at primary healthcare level to integrate self-care interventions (2) govern innovative people-centered care channels including self-care interventions; and (3) engage in a dialogue with civil society and communities to meet needs, raise public awareness and generate demand.

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Adopting self-care interventions for sexual and reproductive health in the Eastern Mediterranean Region

Eastern Mediterranean Health Journal ◽

10.26719/2019.25.6.441 ◽

2019 ◽

Vol 25 (6) ◽

pp. 441-442

Keyword(s):

Reproductive Health ◽

Mediterranean Region ◽

Sexual And Reproductive Health ◽

Eastern Mediterranean ◽

Self Care ◽

Eastern Mediterranean Region

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Sexual and reproductive health self-care interventions in the Eastern Mediterranean Region: findings from a cross-sectional values and preferences survey to inform WHO normative guidance on self-care interventions

Health Research Policy and Systems ◽

10.1186/s12961-020-00659-w ◽

2021 ◽

Vol 19 (S1) ◽

Author(s):

Carmen H. Logie ◽

Heather Abela ◽

Tarek Turk ◽

Samantha Parker ◽

Karima Gholbzouri

Keyword(s):

Health Care ◽

Reproductive Health ◽

Sexual And Reproductive Health ◽

Eastern Mediterranean ◽

Self Care ◽

Eastern Mediterranean Region ◽

Future Research ◽

Cross Sectional ◽

Web Based ◽

Exposure Prophylaxis

Abstract Background Self-care strategies for sexual and reproductive health (SRH) include practices, tools, and strategies for people to manage their health. Access to SRH services has increased in the Eastern Mediterranean Region (EMR) in the past decade. The objective of this manuscript is to provide a preliminary assessment of self-care SRH interventions focusing on access, knowledge, perceived challenges, and recommendations for the future. We aim to contribute to the evidence base on knowledge and uptake of self-care SRH strategies in the EMR. Methods We conducted an online cross-sectional Global Values and Preferences Survey (GVPS) to inform WHO guideline development on self-care interventions for SRH. Recruitment was web-based and included hosting the survey on the WHO Department of Reproductive Health and Research website, and sharing the survey link to diverse SRH websites. Analyses included the subsample of respondents living in EMR countries. We first conducted descriptive statistics of sociodemographic and self-care intervention responses. We then conducted bivariate analyses to examine statistically significant differences in knowledge for each intervention between EMR and non-EMR regions. We extracted open-text responses and applied thematic analysis techniques. Results There were 53 respondents from the EMR spanning 14 countries, including16 health care providers (HCP) and 37 laypersons. Qualitative responses (n = 16) suggest that (a) perceived benefits of self-care SRH strategies include enhanced SRH access, knowledge, and improved SRH outcomes; (b) perceived concerns include misuse and safety; (c) linkage to care following self-care SRH interventions can consider mobile phone apps, hotlines, health care liaisons, and community outreach; (d) HCP want additional training on strengthening therapeutic alliances with patients and practical information on interventions; and (e) future research can focus on reproductive health, condom use, service barriers, and implementation. EMR respondents reported lower knowledge levels than non-EMR respondents on the following strategies: diaphragm/cervical cap, contraceptive patch, web-based SRH information, post-exposure prophylaxis, re-exposure prophylaxis, and HIV treatment. Conclusions Knowledge of self-care SRH strategies varies by intervention type in the EMR. Future research with larger and more representative samples can inform regional self-care SRH implementation. Knowledge dissemination, stigma reduction, accessibility, and training of health care professionals are key domains for advancing access to self-care SRH strategies in the EMR.

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Implementation of WHO Recommended Policies and Interventions on Healthy Diet in the Countries of the Eastern Mediterranean Region: From Policy to Action

Nutrients ◽

10.3390/nu12123700 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3700

Author(s):

Ayoub Al-Jawaldeh ◽

Asmus Hammerich ◽

Radhouene Doggui ◽

Kaia Engesveen ◽

Krista Lang ◽

...

Keyword(s):

Mediterranean Region ◽

Eastern Mediterranean ◽

Scale Up ◽

Eastern Mediterranean Region ◽

Absolute Number ◽

Overweight And Obesity ◽

Healthy Diet ◽

Salt Reduction ◽

Nutrition And Diet ◽

Concrete Action

Non-communicable diseases (NCDs) are responsible for almost two-thirds of the deaths in the 22 countries and territories of the WHO Eastern Mediterranean Region and unhealthy diets are a major contributor. Prevalence of overweight and obesity has increased among adults, adolescents and older children in recent decades. Among countries with the highest prevalence there are signs that the increase is slowing down or even that prevalence is declining. There has been no increase in the prevalence rate in younger children, although the absolute number of children under five years affected by overweight has increased. This review summarizes prevalence data and examines current implementation of regulatory, fiscal and voluntary measures to promote healthy diet across the Region. The last decade has seen a step up in such action. Ten of the Region’s countries have policies relating to trans-fatty acids and they are increasingly implementing specific regulatory measures. Thirteen countries had fully or partially implemented national salt reduction policies by 2019. Only four countries had adopted policies relating to aspects of marketing food to children by 2019, and concrete action in this area is still lacking. Eight countries have introduced taxes—sometimes at a rate of 50%—on carbonated or sugar-sweetened beverages. In order to meet the agreed global and regional goals relating to nutrition and diet-related NCDs, countries will need to build on this progress and scale up action across the Region while intensifying efforts in areas where concrete action is lacking.

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Productivity change of national health systems in the WHO Eastern Mediterranean region: application of DEA-based Malmquist productivity index

Global Health Research and Policy ◽

10.1186/s41256-018-0077-8 ◽

2018 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Maysoun Dimachkie Masri ◽

Eyob Zere Asbu

Keyword(s):

Health Systems ◽

National Health ◽

Mediterranean Region ◽

Eastern Mediterranean ◽

Eastern Mediterranean Region ◽

Malmquist Productivity Index ◽

Productivity Index ◽

Productivity Change

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Factors influencing contraceptive decision making and use among young adolescents in urban Lilongwe, Malawi: a qualitative study

Reproductive Health ◽

10.1186/s12978-021-01259-9 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Gift Mtawali Dombola ◽

Wanangwa Chimwaza Manda ◽

Effie Chipeta

Keyword(s):

Decision Making ◽

Reproductive Health ◽

Qualitative Study ◽

Sexual And Reproductive Health ◽

Contraceptive Use ◽

Reasoned Action ◽

Scale Up ◽

Health Policies ◽

Hormonal Contraceptives ◽

Young Adolescents

Abstract Background The prevalence of teenage pregnancies in Malawi is 29%. About 25% of those are married while 30% are unmarried adolescents (15–19 years old) who use contraceptives. Data on contraceptive use has focused on older adolescents (15–19 years old) leaving out the young adolescents (10–14 years old). This study assessed factors that influence contraceptive decision-making and use among young adolescents aged 10–14 years. Methods This was a qualitative study that used the Theory of Reasoned Action (TRA) model to understand the processes that influence contraceptive decision-making among young adolescents (10–14 years old) in urban Lilongwe. The study was conducted in six youth health-friendly service centers and 12 youth clubs. Two focus group discussions and 26 in-depth interviews were conducted among sexually active in and out of school young adolescents and key informants. The results are organized into themes identified during the analysis. Results Results showed that contraceptive decision-making is influenced by social factors (individual, interpersonal, society) and adolescents’ perceptions regarding hormonal contraceptives. There is also a disconnect between Education and Adolescent Sexual and Reproductive Health policies. Conclusion The findings suggest that interventions that scale up contraceptive use need male and female involvement in decision making. Addressing myths around contraceptives, and harmonization of Education and Sexual and Reproductive Health policies in the country would motivate adolescents to use contraceptives.

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Global Fund Financing and Human Resources for Health Investments in the Eastern Mediterranean Region

10.21203/rs.2.23756/v2 ◽

2020 ◽

Author(s):

Adeyemi Okunogbe ◽

Diana Bowser ◽

Gulin Gedik ◽

Saha Naseri ◽

Ayat Abu-Agla ◽

...

Keyword(s):

Human Resources ◽

Mediterranean Region ◽

Global Fund ◽

Technical Assistance ◽

Human Resources For Health ◽

Eastern Mediterranean ◽

Scale Up ◽

Eastern Mediterranean Region ◽

Training Costs ◽

Mediterranean Countries

Abstract Background: Despite the large investments in donor-related health activities in areas of the globe prone to tension and conflict, few studies have examined in detail the role of these donor investments in human resources for health (HRH). Methods: We used a mixed-methods research methodology comprising both quantitative and qualitative analysis to analyze the Enhanced Financial Reporting System of the Global Fund to Fight AIDS, Tuberculosis and Malaria budget and expenditure data from 2003-2017 for 13 countries in the Eastern Mediterranean Region (EMR). We analysed additional detailed budgetary data over the period 2013-2017 for a sub-set of these countries. Two country-case studies were conducted in Afghanistan and Sudan for a more in-depth understanding of the HRH-related activities that occurred as a result of Global Fund grants. Results: The results show that US$2.2 billion Global Fund dollars had been budgeted and US$1.6 billion were expended over the period 2003-2017 in 13 Eastern Mediterranean countries. The average expenditures for human resources for health (training and human resources) as a percentage of total expenditure is 28%. Additional detailed budgetary data analysis shows a more conservative investment in HRH with 13% of total budgets allocated to “direct” HRH activities such as salaries, training costs, and technical assistance. HRH-related activities supported by the Global Fund in Afghanistan and Sudan were similar, including pre-service and in-services training, hiring of program coordinators and staff, and top-ups for clinical staff. Conclusions: HRH remains a key issue in strengthening the health systems of low- and middle-income countries. While this study suggests that Global Fund’s HRH investments in the EMR are not lagging behind the global average, there appears to be a need to further scale up these investments considering this region’s unique HRH challenges.

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