Family Planning

From Cairo to Dakar: Population Dynamics in Mali

This post was originally published on the IntraHealth International blog.

Twenty yeSara Pacqué-Margolisars ago I arrived in Bamako, Mali, and discovered a capital city settling into relative calm following a military-led coup. My first images of Bamako were of cows, cars, and citizens grazing, grinding gears, and gridlocked on Bamako’s main artery through town—the Route de Koulikoro. 

One did not have to travel far on this road to experience the full spectrum of Malian culture and economy. Brand-new, shiny Land Rovers shared the road with bush taxis, mopeds, bikes, an occasional chicken, and many, many pairs of shuffling feet. Read more »

The Seven-Billionth Person: A Global Health Workforce Perspective

This post was originally published on the IntraHealth International blog.

Sara Pacqué-MargolisOn October 31st the world welcomed Danica in the Philippines, Nargis in India, and numerous other babies who symbolize the seven-billionth person on our planet. It’s a timely moment to shine some light on the implications of population growth for the health and well-being of all our children and the generations to come.

Here’s the crux: the global shortage of health workers translates to an estimated billion people with no access to essential health services, according to a 2010 World Health Organization (WHO) report. So exactly how many health workers do we need to address this problem? The WHO has determined that 2.3 doctors, nurses, and midwives per 1,000 people is the minimum threshold needed to cover the population with essential health services. This is commonly referred to as the health worker density ratio.

Now here’s where the issue of population growth comes in. Planning and policy efforts to improve the health worker density ratio have focused on increasing the ratio’s numerator (health workers). Makes sense, right? But they’ve largely ignored the ratio’s denominator (population size). Read more »

The Key to Progress: Health Workforce Lessons from the Family Planning Movement

Maurice MiddlebergOne of the great privileges of my life has been to know bold leaders in family planning and reproductive health. As I listen to the current debates about “task shifting” and “task sharing,” I am reminded of the pioneering work of Mechai Viravaidya and Allan Rosenfield in Thailand dating back to the 1960s. Along with Chitt Hemachudha, they introduced innovative approaches to family planning that can inform our current efforts to improve the health of women and their families.

The situation in Thailand at that time was similar to that faced today by many countries with a health workforce crisis. The number of doctors was quite low and they were very inequitably distributed; this meant that in large swaths of the country the doctor-patient ratio was on the order of one doctor per hundred thousand people. The Thai government had become committed to reducing the rate of population growth and improving maternal and child health. This led to the obvious conclusion that a diverse set of providers would be needed to make family planning widely available. Read more »

Community Health Workers: Meeting the Unmet Need for Family Planning in West and Central Africa

Sara Pacqué-MargolisA recent New York Times article featured an updated United Nations forecast that projects the world’s population will reach 10.1 billion by the end of the century, rather than stabilizing at nine billion midcentury as previously predicted. In part, these high rates of population growth are fueled by lower than expected declines in fertility in some of the poorer regions of the world—with the slowest fertility declines observed in West and Central Africa.

Behind the data
Demographers and other global health professionals argue that these sustained high rates of fertility and population growth are the result of a weakened commitment to family planning (FP) programs in the last two decades following a significant focus on FP during the 1970s and 1980s. Read more »

Model Families to Model Country: Community Workers Help Scale Up Ethiopia’s Health Program

Mesrak BelatchewIn a typical farmhouse scenario, families live in single-room homes—made of straw, wood, and mud—together with their cattle and other animals. They cook in the same room and do not have latrines or isolated waste disposal facilities. However, Ethiopia’s “model families”—a cornerstone of the country’s successful Health Extension Program (HEP)—build separate kitchens, arrange a place for their cattle outside the family tukul, and dig latrines.

Empowering families with healthy behaviors
Training model families is one of the HEP’s important strategies, and is adapted from Paul Lazarsfeld’s and Everett Rogers’ theories of mass communication and diffusion of innovation. Read more »

Saving Mothers’ Lives

Amanda PuckettMuch literature has celebrated the recent World Health Organization report that maternal mortality declined by a third in the past decade. Though this downward trend is remarkable, the global public health community is concerned that the declaration will shift attention away from sustaining and increasing efforts to address maternal deaths throughout the world. Also important is decreasing maternal morbidity, which creates huge costs in terms of human suffering, health care expenditures, and lost productivity.

Health systems strengthening reduces maternal mortality
The headline The Top Three Things We’re Not Doing to Save Mother’s Lives recently caught our attention. CapacityPlus’s result areas—global leadership, policy and planning, education and training, workforce effectiveness, and evaluation and knowledge-sharing—are key pieces of the health systems strengthening puzzle needed to improve health outcomes for men, women, and children. Addressing the global health worker shortage, which is most critical in countries with higher maternal mortality rates, will strengthen health systems and improve more than just maternal outcomes. Read more »

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