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Dedicated to what works in global health programs GLOBAL HEALTH: SCIENCE AND PRACTICE 2017 Volume 5 Number 3 www.ghspjournal.org EDITORS Editor-in-Chief James D. Shelton, MD, MPH, Johns Hopkins Center for Communication Programs Deputy Editor-in-Chief Stephen Hodgins, MD, DrPH, Senior Technical Advisor, Save the Children, Newborn Health 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 Digital Health: Margaret d'Adamo, MLS, MS, Knowledge Management/Information Technology Advisor, 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: Health Surveillance Assistants in Malawi review data on integrated community case management using wall chart templates. © Emmanuel Chimbalanga, 2013. Table of Contents September 2017 | Volume 5 | Number 3 EDITORIALS Maternal Death Surveillance and Response: A Tall Order for Effectiveness in Resource-Poor Settings Most countries with high maternal (and newborn) mortality have very limited resources, overstretched health workers, and relatively weak systems and governance. To make important progress in reducing mortality, therefore, they need to carefully prioritize where to invest effort and funds. Given the demanding requirements to effectively implement the maternal death surveillance and response (MDSR) approach, in many settings it makes more sense to focus effort on the known drivers of high mortality, e.g., reducing geographic, financial, and systems barriers to lifesaving maternal and newborn care. Marge Koblinsky Glob Health Sci Pract. 2017;5(3):333–337 https://doi.org/10.9745/GHSP-D-17-00308 Routine Health Facility and Community Information Systems: Creating an Information Use Culture Substantial progress has been made to strengthen health information systems, with most efforts focusing on digitization, improving data quality and analysis, and identifying problems. But the ultimate goal is using information to solve problems, which requires building an information use culture over time. How? Human-centered design, role modeling by senior managers in use of data, and incentive-based systems hold considerable promise. Theo Lippeveld Glob Health Sci Pract. 2017;5(3):338–340 https://doi.org/10.9745/GHSP-D-17-00319 COMMENTARIES Seeking Synchrony Between Family Planning and Immunization: A Week-10 DMPA Start Option for Breastfeeding Mothers Many mothers initiate DMPA injectables at 6 weeks postpartum, at the time of their baby’s first immunization visit. Offering an optional delayed DMPA start at the next (10-week) immunization visit has potential advantages including a reduced follow-up schedule with DMPA visits synchronized with other immunization visits, and, possibly, improved contraceptive and immunization outcomes. John Stanback Glob Health Sci Pract. 2017;5(3):341–344 https://doi.org/10.9745/GHSP-D-17-00063 Global Health: Science and Practice 2017 | Volume 5 | Number 3 Table of Contents www.ghspjournal.org ORIGINAL ARTICLES Implementing Maternal Death Surveillance and Response in Kenya: Incremental Progress and Lessons Learned A national coordinating structure was established but encountered significant challenges including: (1) a low number of estimated maternal deaths identified that only included some occurring within facilities, (2) only half of those identified were reviewed, (3) reviewers had difficulties assessing the cause of death largely because of limited documentation in clinical records; and (4) resulting actions were limited. Successful implementation will require addressing many issues, including building support for the process lower down in the health system. Helen Smith, Charles Ameh, Pamela Godia, Judith Maua, Kigen Bartilol, Patrick Amoth, Matthews Mathai, Nynke van den Broek Glob Health Sci Pract. 2017;5(3):345–354 https://doi.org/10.9745/GHSP-D-17-00130 Using Data to Improve Programs: Assessment of a Data Quality and Use Intervention Package for Integrated Community Case Management in Malawi Use of simple wall charts by community and facility health workers to collect and visualize data helped inform data- based decision making for community health education activities, tracking stock-outs, staffing decisions, and other programming issues. Since intervention scale-up, however, use of the wall chart has dropped, demonstrating need for continued investment in supportive supervision. Elizabeth Hazel, Emmanuel Chimbalanga, Tiyese Chimuna, Humphreys Nsona, Angella Mtimuni, Ernest Kaludzu, Kate Gilroy, Tanya Guenther Glob Health Sci Pract. 2017;5(3):355–366 https://doi.org/10.9745/GHSP-D-17-00103 National Assessment of Data Quality and Associated Systems-Level Factors in Malawi Nearly all facility registers were available and complete. But accuracy varied, with antenatal care and HIV testing and counseling performing the best and family planning and acute respiratory infections data less well. Most facilities visibly displayed routine health data and most hospitals and district health offices had staff trained in health management information systems, but training was lacking at the facility level as were routine data quality checks and regular supervision. Richael O’Hagan, Melissa A Marx, Karen E Finnegan, Patrick Naphini, Kumbukani Ng’ambi, Kingsley Laija, Emily Wilson, Lois Park, Sautso Wachepa, Joseph Smith, Lewis Gombwa, Amos Misomali, Tiope Mleme, Simeon Yosefe Glob Health Sci Pract. 2017;5(3):367–381 https://doi.org/10.9745/GHSP-D-17-00177 Global Health: Science and Practice 2017 | Volume 5 | Number 3 Table of Contents www.ghspjournal.org Family Planning in the Context of Latin America’s Universal Health Coverage Agenda Latin American countries have expanded family planning along with universal health coverage (UHC). Leveraging UHC-oriented schemes to increase family planning program coverage, equity, and financing requires: � Prioritizing poor and indigenous populations � Including family planning services in all benefits packages � Ensuring sufficient supply of commodities and human resources to avoid stock-outs and implicit rationing � Reducing nonfinancial barriers to access Thomas Fagan, Arin Dutta, James Rosen, Agathe Olivetti, Kate Klein Glob Health Sci Pract. 2017;5(3):382–398 https://doi.org/10.9745/GHSP-D-17-00057 Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects Investments in a national logistics management unit and electronic logistics management information system resulted in better data use and improvements in some, but not all, management practices. After 1 year, key improvements included reduced stock-out rates, stock-out duration, and expiry rates. Although the upgraded systems were not inexpensive, they contributed to greater system efficiency and generated modest savings that defrayed much of the investment and maintenance costs. Marasi Mwencha, James E Rosen, Cary Spisak, Noel Watson, Noela Kisoka, Happiness Mberesero Glob Health Sci Pract. 2017;5(3):399–411