Browsing by Author "LeFevre, Amnesty"
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Item Avoiding the road to nowhere: Policy insights on scaling up and sustaining digital health(John Wiley and Sons Inc, 2022) LeFevre, Amnesty; Chamberlain, Sara; Singh, Neha S.; Scott, Kerry; Menon, PurnimaThe Principles for Digital Development, launched in 2017, outline 9 items to consider in designing digital health programs to mitigate predictable and preventable factors contributing to program failure (Principles for Digital Development 2020). These items include design with the user, understanding the existing ecosystem, scale design, building for sustainability, being data-driven, using open standards/data/source/ innovation, reuse, and improvement, addressing privacy and security, and being collaborative. This commentary has sought to be more specific than the broader principles and give a range of examples to provide a clearer path to action. As researchers and implementers, we draw on experiences of designing, implementing, and evaluating digital health solutions at a scale in several settings across Asia and Africa, while providing examples from India and South Africa to illustrate ten considerations to support the scale and sustainability of digital health solutions in LMICs. These can be categorized as (1) drivers of equity and unforeseen innovation; (2) foundations for a digital health ecosystem; and(3) elements for systems integration as detailed in FigureItem Program assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania(BioMed Central, 2018) LeFevre, Amnesty; Mpembeni, Rose; Kilewo, Charles; George, Asha S.BACKGROUND: The postpartum period represents a critical window where many maternal and child deaths occur. We assess the quality of postpartum care (PPC) as well as efforts to improve service delivery through additional training and supervision in Health Centers (HCs) in Morogoro Region, Tanzania. METHODS: Program implementers purposively selected nine program HCs for assessment with another nine HCs in the region remaining as comparison sites in a non-randomized program evaluation. PPC quality was assessed by examining structural inputs; provider and client profiles; processes (PNC counselling) and outcomes (patient knowledge) through direct observations of equipment, supplies and infrastructure (n = 18) and PPC counselling (n = 45); client exit interviews (n = 41); a provider survey (n = 62); and in-depth provider interviews (n = 10). RESULTS: While physical infrastructure, equipment and supplies were comparable across study sites (with water and electricity limitations), program areas had better availability of drugs and commodities. Overall, provider availability was also similar across study sites, with 63% of HCs following staffing norms, 17% of Reproductive and Child Health (RCH) providers absent and 14% of those providing PPC being unqualified to do so. In the program area, a median of 4 of 10 RCH providers received training. Despite training and supervisory inputs to program area HCs, provider and client knowledge of PPC was low and the content of PPC counseling provided limited to 3 of 80 PPC messages in over half the consultations observed. Among women attending PPC, 29 (71%) had delivered in a health facility and sought care a median of 13 days after delivery. Barriers to PPC care seeking included perceptions that PPC was of limited benefit to women and was primarily about child health, geographic distance, gaps in the continuity of care, and harsh facility treatment. CONCLUSIONS: Program training and supervision activities had a modest effect on the quality of PPC. To achieve broader transformation in PPC quality, client perceptions about the value of PPC need to be changed; the content of recommended PPC messages reviewed along with the location for PPC services; gaps in the availability of human resources addressed; and increased provider-client contact encouraged.