Browsing by Author "Lawn, Joy"

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    Assessment of the uptake of neonatal and young infant referrals by community health workers to public health facilities in an urban informal settlement, KwaZulu-Natal, South Africa
    (Biomed Central, 2013) Nsibande, Duduzile; Doherty, Tanya; Ijumba, Petrida; Tomlinson, Mark; Jackson, Debra; Sanders, David; Lawn, Joy
    Background: Globally, 40% of the 7.6 million deaths of children under five every year occur in the neonatal period (first 28 days after birth). Increased and earlier recognition of illness facilitated by community health workers (CHWs), coupled with effective referral systems can result in better child health outcomes. This model has not been tested in a peri-urban poor setting in Africa, or in a high HIV context. Methods: The Good Start Saving Newborn Lives (SNL) study (ISRCTN41046462) conducted in Umlazi, KwaZulu- Natal, was a community randomized trial to assess the effect of an integrated home visit package delivered to mothers by CHWs during pregnancy and post-delivery on uptake of PMTCT interventions and appropriate newborn care practices. CHWs were trained to refer babies with illnesses or identified danger signs. The aim of this sub-study was to assess the effectiveness of this referral system by describing CHW referral completion rates as well as mothers’ health-care seeking practices. Interviews were conducted using a structured questionnaire with all mothers whose babies had been referred by a CHW since the start of the SNL trial. Descriptive analysis was conducted to describe referral completion and health seeking behaviour of mothers. Results: Of the 2423 women enrolled in the SNL study, 148 sick infants were referred between June 2008 and June 2010. 62% of referrals occurred during the first 4 weeks of life and 22% between birth and 2 weeks of age. Almost all mothers (95%) completed the referral as advised by CHWs. Difficulty breathing, rash and redness/discharge around the cord accounted for the highest number of referrals (26%, 19% and 17% respectively). Only16% of health workers gave written feedback on the outcome of the referral to the referring CHW. Conclusions: We found high compliance with CHW referral of sick babies in an urban South African township. This suggests that CHWs can play a significant role, within community outreach teams, to improve newborn health and reduce child mortality. This supports the current primary health care re-engineering process being undertaken by the South African National Department of Health which involves the establishment of family health worker teams including CHWs.
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    Behind the billions: policies, politics and power of the Global Financing Facility for women’s, children’s, and adolescents’ health
    (Taylor and Francis Ltd, 2025) George, Asha; Kinney, Mary; Lawn, Joy
    The landscape of global health financing has shiftedprofoundly in recent years – with redirection of donor aid to national security spending, economic shocks from the COVID-19 pandemic, and rising debt burdens – placing immense pressures on low- and middle-income countries (LMICs) to self-finance theirhealth systems . Sudden major donor cuts to global health amplify the need to transform health financing to more sustainable and equitable models that protect vulnerable populations, especially women, children, and adolescents . Many LMICs, and notably those in sub-Saharan Africa, are off track or haveslowed down in progressing towards the Sustainable Development Goals targets for ending preventable maternal, neonatal and child deaths by 2030. This requires urgent action and increased investment. Concurrently, global health initiatives (GHIs), including the Global Financing Facility (GFF), are also beingreimagined to better support countries on their path towards Universal Health Coverage . The GFF launched in 2015 with a compelling mission: to close financing gaps for women’s, children’s, and adolescents’ health through smarter, more sustainable investments . Framed as a ‘country-led’ mechanism that could both mobilize and coordinate domestic and external financing, the GFF promised to move beyond traditional aid models by catalyzing investment cases tailored to each country’s priorities. A decade since its inception, there remains relatively little peer-reviewed research about how the GFF operates in practice, how its promises of country leadership and catalytic financing are realized, and what lessons can be drawn for the future of global health financing .