Research shows that CHWs are effective in delivering health services in low- and middle-income countries. They can also improve equitable health care and extend access for populations who are difficult to reach. But data are often too patchy or project specific. Several assumptions are commonly made about CHWs including that they are less expensive than formal health care workers as a way of delivering key services. What is striking, however, is the lack of robust evidence on the cost-effectiveness of CHWs. In order to enhance understanding and inform policy dialogue on the role of CHWs in the health system, the…
The concept of a technological quick fix or ‘magic-bullet’ for control and elimination of Neglected Tropical Diseases (NTDs) is flawed. NTDs are embedded within complex biological and social systems that are shaped by ecological and political contexts. This commentary emphasises the need for implementation research to address implementation gaps in the control of NTDs. With a specific focus on sub-Saharan Africa and helminth diseases amenable to preventive chemotherapy through mass drug administration, we explore the important role of context, programme partnerships and community in achieving equitable and effective NTD control.
The recent thematic series on close-to-community providers published in this journal brings together 14 papers from a variety of contexts and that use a range of research methods. The series clearly illustrates the renewed emphasis and excitement about the potential of close-to-community (CTC) providers in realising universal health coverage and supporting the sustainable development goals. This editorial discusses key themes that have emerged from this rich and varied set of papers and reflect on the implications for evidence-based programming. We are at a critical stage in the development of CTC programming and policy which requires the creation and communication of…
Gender—the socially constructed roles, behaviours, activities and attributes that a given society considers appropriate for males, females and other genders—affects how people live, work and relate to each other at all levels, including in relation to the health system. Health systems research (HSR) aims to inform more strategic, effective and equitable health systems interventions, programs and policies; and the inclusion of gender analysis into HSR is a core part of that endeavour. We outline what gender analysis is and how gender analysis can be incorporated into HSR content, process and outcomes . Starting with HSR content, i.e. the substantive focus of HSR,…
In the health sector we are facing a double challenge; there is a shortage of formal health workers and a concurrent push to scale up programmes to meet targets such as Universal Health Coverage and the Millennium Development Goals. Working with Community Health Workers (CHWs) is thought to be a potential solution. Ensuring that CHWs are properly supported is vital if they are to fulfill the critical role they can play in improving the health of communities. There are management challenges associated with CHW programmes, including attracting recruits, turnover and performance. A range of different health actors are involved in…
A new way to prevent HIV, known as pre-exposure prophylaxis (PrEP), can provide protection where condoms are not used. Integrating it into HIV and sexual health programming for various communities has become a focus of researchers and health and development agencies. However, PrEP raises important challenges in the context of female sex work. To protect sexual and reproductive health and avoid pregnancy, PrEP must be used with condoms but that may be difficult where clients perceive PrEP as an alternative. Frequent HIV testing and medicalisation of HIV prevention in low-income settings presents challenges for those who lack the rights and…
Kembatti Mentti Gezzimma (KMG) is an Ethiopian organisation working to encourage communities to abandon the practice of FGM-C. There has been a phenomenal reduction in FGM-C prevalence levels in Kembatta Zone where KMG has worked for the last two decades. Between 1999 and 2008, the number of people practising FGM-C in Kembatta zone reduced by approximately 92% (OHCHR 2008). KMG has expanded its work to other zones, including most recently the Sidama zone, and nearly the entire southern region of Ethiopia has been reached by its FGM-C prevention efforts.
The Living Peace four year project is being implemented in Democratic Republic of Congo (DRC), a country where conflict has led to millions of deaths, mass displacement, and many victims and perpetrators of violence. In addition, DRC exhibits a prevalence of highly inequitable, violent partner relationships driven by childhood experiences of violence, gender inequitable beliefs, power inequalities, economic stress and insufficient coping mechanisms around post-conflict trauma. Living Peace provides psychosocial support through group therapy for men (and their partners) to reduce sexual and gender based violence, promote healing, restore relationships and rebuild communities in postconflict settings. The aim of the…
This policy brief looks at the context of gender and health, and how they are affected by conflict. It also assesses whether humanitarian assistance in the immediate post- conflict period addresses the impact of conflict on health from a gender perspective. A second sister brief examines long-term reform of the health system through a gender lens, using the World Health Organization’s health system building blocks as a framework.
This brief examines the reform of health systems in post-conflict settings through a gender lens, using the World Health Organization’s health system building blocks as a framework. Research into the importance of reconstructing health systems after a crisis or war is relatively new, therefore literature discussing challenges and best practices related to gender equity is weak and the evidence base limited. Further study is clearly needed into the impact of strengthening the health system on gender equity.