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Global Health: Science and Practice Dedicated to what works in global health programs GLOBAL HEALTH: SCIENCE AND PRACTICE 2018 Volume 6 Number 1 www.ghspjournal.org EDITORS Editor-in-Chief Stephen Hodgins, MD, MSc, DrPH, Associate Professor, Global Health, School of Public Health, University of Alberta Editor-in-Chief Emeritus James D. Shelton, MD, MPH, Johns Hopkins Center for Communication Programs Associate Editors Matthew Barnhart, MD, MPH, Senior Science Advisor, United States Agency for International Development (USAID), Bureau for Global Health Cara J. Chrisman, PhD, Biomedical Research Advisor, USAID, Bureau for Global Health Margaret d'Adamo, MLS, MS, Knowledge Management/Information Technology Advisor, USAID, Bureau for Global Health Elaine Menotti, MPH, Health Development Officer, USAID, Bureau for Global Health Malaria: Michael Macdonald, ScD, Consultant, World Health Organization, Vector Control Unit, Global Malaria Programme Maternal Health: France Donnay, MD, MPH, FRCOG, FACOG, Women's Health Consultant Maternal Health: Marge Koblinsky, PhD, Independent Consultant Nutrition: Bruce Cogill, PhD, MS, Consultant Managing Editors Natalie Culbertson, Johns Hopkins Center for Communication Programs Ruwaida Salem, MPH, Johns Hopkins Center for Communication Programs EDITORIAL BOARD Al Bartlett, Save the Children, USA Vinand Nantulya, Uganda AIDS Commission, Uganda Zulfiqar Bhutta, Aga Khan University, Pakistan Emmanuel (Dipo) Otolorin, Jhpiego, Nigeria Kathryn Church, London School of Hygiene and Tropical James Phillips, Columbia University, USA Medicine, United Kingdom Yogesh Rajkotia, Institute for Collaborative Development, Scott Dowell, Centers for Disease Control and Prevention, USA USA Suneeta Singh, Amaltas, India Marelize Görgens, World Bank, USA David Sleet, CDC, USA Lennie Kamwendo, White Ribbon Alliance for Safe John Stanback, FHI 360, USA Motherhood, Malawi Lesley Stone, USAID, USA Jemilah Mahmood, Malaysian Medical Relief Society, Douglas Storey, Johns Hopkins Center for Communication Malaysia Programs, USA Global Health: Science and Practice (ISSN: 2169-575X) is a no-fee, open-access, peer-reviewed journal published online at www.ghspjournal. org. It is published quarterly by the Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD 21202. The jour- nal is made possible by the support of the American People through the United States Agency for International Development (USAID). The Knowledge for Health (K4Health) Project is supported by USAID's Office of Population and Reproductive Health, Bureau for Global Health, under Cooperative Agreement #AID-OAA-A-13-00068 with the Johns Hopkins University. GHSP is editorially independent and does not necessarily represent the views or positions of USAID, the United States Government, or the Johns Hopkins University. Global Health: Science and Practice is distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. For further information, please contact the editors at [email protected]. Front cover: In Pakistan, young girl students engage in sports to help enhance a positive body image and increase self-confidence. © 2016 Khaula Jameel/AAHUNG. Table of Contents March 2018 | Volume 6 | Number 1 EDITORIALS The Coming-of-Age of Subcutaneous Injectable Contraception DMPA-SC is a contraceptive injectable formulation that provides women and couples another important voluntary family planning option. It offers characteristics that many women like, including cost and time savings, and has the potential to be delivered by a range of health care cadres in a variety of service delivery channels. Kimberly Cole, Abdulmumin Saad Glob Health Sci Pract. 2018;6(1):1–5 https://doi.org/10.9745/GHSP-D-18-00050 Human Resources for Health: The Best Learning, the Best Skill Mix, and the Most Impact Acting in a difficult environment, constructive efforts to improve medical education in Zimbabwe included revised curricula, investing in faculty and improved teaching skills, competency-based learning, and modern technology. But an ideal approach to health systems strengthening would put more emphasis on primary care and prevention, equity, and the many other vital health cadres besides physicians. James D Shelton Glob Health Sci Pract. 2018;6(1):6–7 https://doi.org/10.9745/GHSP-D-18-00092 COMMENTARIES ANewWorldHealthEra Unprecedented economic progress and demands for social protection have engendered an economic transition in health in many low- and middle-income countries, characterized by major increases in domestic health spending and growing national autonomy. At the global level, development assistance is refocusing on fragile states, the poorest communities, and cooperation on global public goods like health security, technical norms, and innovation. Intergovernmental organizations like WHO need the wherewithal and support to provide leadership and to properly advance this new world health era. Ariel Pablos-Méndez, Mario C Raviglione Glob Health Sci Pract. 2018;6(1):8–16 https://doi.org/10.9745/GHSP-D-17-00297 Global Health: Science and Practice 2018 | Volume 6 | Number 1 Table of Contents www.ghspjournal.org PROGRAMMATIC REVIEWS & ANALYSES Liftoff: The Blossoming of Contraceptive Implant Use in Africa Contraceptive implant use is rising rapidly, substantially, and equitably in many sub-Saharan African countries, across almost all sociodemographic categories. Gains in implant use have exceeded combined gains for IUDs, pills, and injectables. Key contributing factors include sizeable reductions in commodity cost, much-increased commodity supply, greater government commitment to expanded method choice, and wider adoption of high-impact service delivery practices that broaden access and better reach underserved populations. Continued progress in meeting women's reproductive intentions with implants calls for further investment in quality services for both insertion and removal, and for addressing issues of financing and sustainability. Roy Jacobstein Glob Health Sci Pract. 2018;6(1):17–39 https://doi.org/10.9745/GHSP-D-17-00396 Family Planning in the Democratic Republic of the Congo: Encouraging Momentum, Formidable Challenges Formidable challenges: uncertain political situation, cultural norms favoring high fertility, a thin patchwork of service delivery institutions, logistical issues in a vast country with weak infrastructure, and low capacity of the population to pay for contraceptive services. Encouraging progress: increasing government and donor support, openness to progressive service delivery policies, innovative programming including robust social marketing and initiatives with nursing schools and the military, strong collaboration among stakeholders, high unmet need suggesting strong latent demand for family planning, and an increasingly balanced method mix including long-acting methods. Dieudonné Kwete, Arsene Binanga, Thibaut Mukaba, Théophile Nemuandjare, Muanda Fidele Mbadu, Marie-Thérèse Kyungu, Perri Sutton, Jane T Bertrand Glob Health Sci Pract. 2018;6(1):40–54 https://doi.org/10.9745/GHSP-D-17-00346 ORIGINAL ARTICLES Expanding Access to Injectable Contraception: Results From Pilot Introduction of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) in 4 African Countries Nearly half a million doses of DMPA-SC were administered over 2 years in Burkina Faso, Niger, Senegal, and Uganda, with 29% of doses provided to first-time family planning users and 44% (in 3 countries) to adolescent girls and young women under age 25. Switching from intramuscular DMPA (DMPA-IM) was not widespread and generally decreased over time. Community health workers provided a higher proportion of DMPA-SC than DMPA-IM injections. Stock-outs in 2 countries hindered product uptake, highlighting the need to strengthen logistics systems when introducing a new method. Anna Stout, Siri Wood, George Barigye, Alain Kaboré, Daouda Siddo, Ida Ndione Glob Health Sci Pract. 2018;6(1):55–72 https://doi.org/10.9745/GHSP-D-17-00250 Global Health: Science and Practice 2018 | Volume 6 | Number 1 Table of Contents www.ghspjournal.org Rapid Uptake of the Subcutaneous Injectable in Burkina Faso: Evidence From PMA2020 Cross-Sectional Surveys Availability and use of the subcutaneous injectable increased rapidly during national scale-up in 2016. Substantial increases were found in rural areas, where unmet need for family planning is higher. Since the method is amenable to community- based distribution, a new pilot is testing provision by community health workers to further improve access. Guiella Georges, Turke Shani, Coulibaly Hamadou, Scott Radloff, Choi Yoonjoung Glob Health Sci Pract. 2018;6(1):73–81 https://doi.org/10.9745/GHSP-D-17-00260 Medical Education Partnership Initiative (MEPI) in Zimbabwe: Outcomes and Challenges The 5-year medical education and research strengthening initiative in Zimbabwe increased faculty retention and student enrollment, improved information technology infrastructure, provided mentoring for postgraduates and clinical training in specialty areas, instituted a competency-based curriculum reform process, and created new departments and centers to institutionalize health education and research implementation. A comprehensive review of the curriculum is still underway and uptake of technology-assisted teaching
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