Package Of Essential Services Research Articles

Canadian Strategy Against Gender-Based Violence and Gaps

Promoting the Essential Services Package (ESP) for Women and Girls Subject to Violence has led to an emphasis on legislative commitments to a survivor-centred strategy. Such legislation includes provisions for fiscal planning, standards of services, and official programs to support networks of community-based interventions to build capacity, share information, and co-generate knowledge across regions. This study identifies gaps in the Canadian strategy against gender-based violence in the operation of mechanisms for coordinating multi-sectoral trauma-informed “wrap-around” services that prioritize survivors in their distinct and diverse contexts and communities. It also recommends ways to transform the Canadian strategy in a global context.

Abortion in South-Africa: Does a liberal legislation really impact safe access and use?

The World Health Organization (WHO) considers comprehensive abortion care as part of their essential healthcare service package, which includes the provision of information, abortion management, and post-abortion care. The WHO estimated that globally, 45% of all induced abortions were unsafe, and it noted that nearly half of all the abortions occurred under the least safe circumstances in Africa. Abortion has been legal in South Africa since the implementation of the Choice of Termination of Pregnancy (CTOP) Act (No. 92 of 1996), which was a significant departure from the country's previously restrictive abortion laws. While the CTOP Act (1996) has made provision for access to safe abortion services and pre- and post-abortion counselling, this has not been effectively implemented into effective service delivery. It's estimated that between 52% and 58% of abortions take place in informal medical settings, and that only 7% of the public health facilities in South Africa were performing abortion services in 2017. The WHO noted that the lack of access to safe, affordable, timely, and respectful abortion care, and the stigma associated with abortion pose risks to women's physical and mental well-being throughout the life-course. The aim of this paper was to explore how women in South Africa experience and cope with induced abortion. Additionally, this research looks at how religion, culture and stigma, impact abortion and mental health post-abortion of South African's women. This study utilises data from the latest South African Demographic and Health Surveys (SADHS), in 2016, which includes data from 8514 women aged 15-49 years. This study highlights the need for more data and research related to challenges and experiences of South African women around mental health and the nature of abortion within the country. In this interview conducted by Professor Jean-Pierre Bouchard, population analysts Robynn Ashely Hera and Siposethu Nojoko together with demographer Professor Nancy Stiegler from the University of the Western Cape discuss safe and unsafe abortion incidence and access and the psychological effects thereof.

Essential Package of Palliative Care for Iranian Children with Cancer

Background: Despite medical advancements and treatment development, children with cancer experience a wide range of symptoms related to the disease and treatment side effects. Providing palliative care is essential to improve the quality of life for both the child and the family. Given limited available resources, cost-effective service packages can address this need. Objectives: This study aimed to develop an essential palliative care package for children with cancer in Iran. Methods: The study was under Health System Research and employed an exploratory mixed method design in three phases. The initial stage involved two sub-studies including a review of literature and a qualitative study. In the subsequent phases, the package draft was compiled and validated using the Delphi technique with input from 12 experts. Results: The essential palliative care package for children with cancer comprised two main components: INPUT, including dimensions related to medicine, human resources, equipment, and service delivery setting. INTERVENTION, encompasses physical, psychological, social, spiritual symptom management, and growth and development. Conclusions: Customized for Iran's social and cultural context, this essential service package provides safe, efficient, convenient, and affordable care. Physicians and nurses with primary training can integrate it into primary care including home care, emphasizing the importance of palliative care.

Needs Assessment and the Identification of Palliative Care Dimensions of the Essential Service Package for the Elderly with Alzheimer's Disease: A Mixed Exploratory Study.

This study was conducted with the aim of assessing the needs and determining the care dimensions of the essential palliative care service package for the elderly with Alzheimer's disease. The mixed exploratory study was conducted in three phases. The first phase of the study was conducted in the form of a qualitative study and a literature review. This qualitative research was done through in-depth and semi-structured interviews with 19 qualified caregivers (11 informal caregivers and 8 formal caregivers) The samples were selected using the purposive sampling method by referring to hospitals, nursing homes, and active branches of the Alzheimer's Association in some provinces. In the second phase, the dimensions of palliative care were codified, and in the third phase, the prioritization and the validation of the dimensions of palliative care were performed in the form of two Delphi rounds. Based on the results of the first phase of the study, the care dimensions of the service package were placed in eight categories based on National Consensus Project. In the second phase, the needs of Alzheimer's patients were arranged in the form of a questionnaire consisting of 8 parts, with 180 indicators. Then, in the third phase, the dimensions of the palliative care essential package were designed with 74 items in the form of 4 dimensions. The dimensions of the essential service package of palliative care included a series of interventions as well as physical, psychological, cognitive, and spiritual support.

Assessing essential service provision for prevention and management of violence against women in a remote indigenous community in Amantaní, Peru

BackgroundWomen living in indigenous communities in Peru currently experience extremely high rates of intimate partner violence (IPV). Over the past 10 years, there has been a large multi-sectoral initiative to establish a national network of Centros de Emergencia de la Mujer (Women’s Emergency Centres) that integrate health and police services, and substantial increase in efforts from non-governmental organisations in supporting survivors of violence. However, there is currently little evidence on how existing services meet the needs of indigenous women experiencing violence in Peru.MethodsAs part of a broader mixed-methods participatory VAWG prevention study, we assessed existing service provision for women experiencing violence in an indigenous Quechua community from Amantaní, Peru. This involved 17 key informant interviews with legal, government, police, and civil society representatives. We used the UN Women Essential Services Package for Women and Girls Subject to Violence framework to guide our analysis.ResultsParticipants identified major gaps in existing services for indigenous women survivors of violence in Peru. They discussed survivors and perpetrators not being identified by the health system, a lack of IPV response training for health professionals, IPV not being prioritised as a health concern, and a lack of health services that are culturally appropriate for indigenous populations. Survivors who report to police are often treated poorly and discriminated against. Legal systems were perceived as insufficient and ineffective, with inadequate legal measures for perpetrators. While legal and policy frameworks exist, they are often not applied in practice. Service provision in this region needs to adopt an intercultural, rights based, gendered approach to IPV response and prevention, considering cultural and linguistic relevance for indigenous populations.ConclusionThe role of structural violence in perpetuating indigenous women’s experiences of violence and undermining their access to services must be central to designing and implementing appropriate policies and services if they are to meet the needs of indigenous women in Peru.

Evolution and lessons from an integrated service delivery network in North West Syria

BackgroundNorthwest Syria (NWS) is a complex and extremely fragile operating environment, with more than 2.8 million people needing humanitarian assistance. To support a common standard of care delivery and enable coordination among the multiple providers in NWS, WHO developed an Essential Health Services package (EHSP) in 2016-17 and subsequently supported a facility network model to deliver the EHSP. This article provides an evaluation of the network to date, aiming to inform further development of the network and draw wider lessons for application of similar approaches in complex emergency settings.MethodsThis mixed method study included document review, participatory, qualitative and quantitative data, gathered in the first half of 2021. Participatory data came from two group model building workshops with 21 funders and implementers. Semi-structured interviews with 81 funders, health professionals and community members were also conducted. Analyses of the workshops and interviews was inductive, however a deductive approach was used for synthesising insights across this and the document review. The final component was a survey of health providers (59 health care professionals) and service users (233 pregnant women and 214 persons living with NCDs) across network and other comparable facilities, analysed using routine descriptive and inferential statistics. Findings across all methods were triangulated.ResultsThe study finds that the network and its accompanying essential service package were relevant to the dynamic and challenging context, with high but shifting population needs and multiple uncoordinated providers. Judged in relation to its original goals of comprehensive, coordinated services, equitable access and efficient service delivery, the data indicate that gains have been made in all three areas through the network, although attribution is challenging, given the complex environment. The context remains challenging, with shifting boundaries and populations displaced by conflict, difficulties in retaining staff, the need to import medicines and supplies across borders, and governance gaps.ConclusionThis study adds to a very limited literature on coordinated network approaches used to raise care quality and improve referrals and efficiency in a complex emergency setting. Although areas of ongoing challenge, including for sustainability, are noted, the network demonstrated some resilience strategies and can provide lessons for other similar contexts.

Financing gaps for Pakistan's contraceptive prevalence goals: Analyses using the Guttmacher adding-it-up methodology

The objective of the paper is to identify levels of and gaps in family planning financing in Pakistan and to assess whether current funding is sufficient to meet national and FP2030 goals to increase contraceptive use to 60% by 2030. We estimate the cost of family planning services nationally and by province based on the Essential Services Package and WHO/UNFPA cost by applying the existing Guttmacher global Adding-It-Up methodology. Additional data are also analyzed to assess trends in expenditures on family planning between 2017 and 2021. The estimated cost of family planning services provided in Pakistan in 2017 was US$81 million, equivalent to US$0.38 per capita. The estimated gap in costs to provide contraceptive services to the additional 8.6 million women with unmet need for modern contraception was US$93 million. While we found evidence of an upward trend in overall government expenditure on family planning services over the period 2017-21, the pace of increase was slow and uneven across regions. The evidence highlights the persistent inadequacy of financing for contraceptive services especially if Pakistan intends to achieve its ambitious national and FP2030 goal of increasing contraceptive prevalence to 60% by 2030. A doubling of current funding for contraceptive services is required in Pakistan. Additional financing needs to be directed towards the poorest women with unmet need to avoid unintended pregnancies and to improve equity in reproductive health outcomes.

Preconception care practices among primary health care nurses working in public health facilities in KwaZulu-Natal

ABSTRACT Background Preconception care (PCC) is necessary to identify and deal with all the risk factors before conception. Some aspects of PCC, like folic acid supplementation, would be relevant to people desiring a pregnancy. Alternatively, PCC could provide contraceptive support to those with no pregnancy intention. In South Africa, primary healthcare nurses provide a comprehensive package of essential services in public health facilities to about 90% of the population at no cost. Therefore, they are the key providers of promotive, preventive, and curative services, including PCC. Objective This study aimed to determine the level of PCC practice among primary healthcare nurses and identify determinants of effective practice. Methods This cross-sectional descriptive survey was conducted among 196 nurses undertaking a specialisation Primary HealthCare program in a selected higher education institution. A pretested questionnaire was used to collect data that were analysed with SPSS version 27 software. Results The overall practice of PCC was 87.8%. Older participants were significantly less likely to exhibit good PCC practice than their younger counterparts. Female participants were also less likely to have good PCC practices than their male counterparts. Married participants were significantly more likely to practice PCC than their unmarried counterparts. Participants practicing in rural areas were also less likely to have good PCC practices than their urban counterparts. Conclusion The PCC practice of most primary healthcare nurses in the study is relatively high. The study also identified the determinants of good PCC practice that can enhance its practice. There is a need to revisit the PCC training of healthcare workers, as most indicated the need for further training.

Construction of Essential Care Service Package for People Living with Dementia in Smoke-free Environment under Disease Pandemic in China

Objectives: In recent years, the harm of smoking has attracted more and more public attention. Creating a healthy smoke-free environment has been widely favored and supported by the public. Smokeless environment has a certain positive effect on the rehabilitation of dementia patients. Sustained smoking cessation is associated with significantly decreased the future prevalence of dementia. Therefore, hospitals often establish a special organizational structure and management model for tobacco control, and carry out training and assessment for all staff. The nursing group also took it as the basic nursing standard. The 2019 disease pandemic has posed unique health threats to people living with dementia (PLWD). Therefore, a strict smoke-free environment is more necessary for the nursing group. One of the key challenges is scaling up long-term care services to meet the needs of the rapidly growing population of PLWD in developing countries. The aim of the study is to explore the care service needs, utilization and build an essential care service package (ECSP) for PLWD under the disease pandemic in China. Methods: From July 2018 to October 2019, a total of 1255 elderly with dementia in six cities in China by a cluster sampling were investigated with the self-designed questionnaire. Care service needs and utilization for PLWD with different levels of cognitive impairment were summarized. Results: The ECSP for PLWD was composed of 30 service items (7 for core care) in order to guarantee that all PLWD enjoy equal care services, basing on public financing and implementing strategies and taking China's situations into account. The selection plan for ECSP at different levels is designed as 'General Care Services + Selective Care Services ', in which respective service items for low, mid, and high-level care for PLWD are 7+3, 7+6, and 7+10, and requires 151.41 hours, 201.88 hours, and 252.35 hours per month, respectively. Conclusion: The present study provides the first large-scale data on care service needs and utilization for PLWD in mainland China. The ECSP for PLWD based on the needs advanced in the paper was a practicable and effective quantitative management means that deserves a large-scale application. Some safeguard mechanisms and operational implementing pathways of ECSP for PLWD during and after the disease pandemic in China are proposed.

Package of Essential Noncommunicable Disease Services at Peri-Urban Community Setting in Chandigarh, India- An Implementation Research Study

Background: The National Programme for prevention and control of cancer, diabetes, cardiovasculardisease,and stroke (NPCDCS) has been launched since 2011-2012 but there is paucity of information on progressand implementation of this program.Method: The objective was to do situational analysis for assessing the current implementation of NCDprograms in peri-urban area and to implement the package of essential NCD services by capacity buildingof existing staff through routine health care delivery for effective coverage. After training of ANMsimplementation was started. Baseline assessment was performed through pre-tested questionnaire amongsubjects (n=1026) who were aged> 30 years and residing in that area for >6 months.Result: About 37% (n= 406) of the people were screened for hypertension, 34% (n=352) were screened fordiabetes in the last one year. Post intervention screening coverage was increased to 96.9%, 97.5% for bloodsugar and blood pressure respectively and 95.4%, 93.4% and 54.8% for oral, breast and cervical cancer.After implementation 23(2.4%) new cases of diabetes and 132 (13.2%) new cases of hypertension werediagnosed.Conclusion: Screening coverage at baseline analysis was found to be 37.1% and 34% for blood pressure andblood sugar measurement respectively and 0.5%, 0.2%, 0.3% for oral, breast and cervical cancer screening,respectively. This highlights the poor implementation of the programme. After implementation, screeningcoverage for measurement of blood pressure and blood sugar improved by about 60% and by about 90% forthree common cancers.

Integration of mental health and psychosocial support services into primary health care in Gaza: a cross-sectional evaluation

BackgroundIntegration of mental health and psychosocial support (MHPSS) into primary health care in the Gaza Strip involves the delivery of mental health services within the essential service package provided by UNRWA, as recommended by WHO to fill the treatment gap. In early 2016, a successful pilot demonstrated that the integration is achievable in limited resource settings, and resulted in the adoption of a stepped care model to screen, identify, support, and treat patients. This study aimed to evaluate the MHPSS integration process and outcomes at UNRWA health centres in the Gaza Strip. MethodsWe used a descriptive analytical study design, with quantitative and qualitative data collected from records, and individual feedback from patients and health care providers (HCPs). The study was performed in the 22 UNRWA health centres of the Gaza Strip and all participants agreed to participate either verbally or by written consent. Approval was also obtained from the UNRWA Health Program Gaza Field Office. FindingsThe integration process started with the comprehensive training of 460 medical and nursing HCPs, in accordance with the Mental Health Gap Action Programme (mhGAP) Intervention Guide. On completion of training, the HCPs put into practice their learning, under close supervision for the first month and with only technical support thereafter. During the period of technical support, MHPSS activities, referral pathways, and proper reporting were ensured and standardised in all health centres. Overall, the integration process achieved success in training, implementation, and supervision. The success of training was assessed with an evaluation form and participants’ feedback, the success of implementation by the numbers of people who benefitted, their response to the intervention, and their feedback, and the success of supervision by the standardisation of the process and the technical validity of the intervention. By the end of September, 2018, 80 857 high-risk patients were screened using the General Health Questionnaire 12 (GHQ-12) and 9·0% (7327) were identified as requiring intervention and support, and were assisted using the UNRWA stepped care approach. Of the individuals who were assisted, 30·2% (2212 of 7327) showed significant improvement and 38·9% (2849) were identified as having mental health issues according to the mhGAP. In the same period, 1020 patients benefited from 113 support groups, with excellent effects on their physical and mental health as assessed with qualitative data, patients’ testimonies and, in some cases, laboratory investigations. The challenges that were faced were due to manual documentation and reporting, sociopolitical uncertainty, an increase in the number and needs of patients, and the imposed burden on HCPs. In addition, during implementation many individuals who were screened and identified required an urgent response: individuals who were suicidal and individuals whose mental health had been affected by the Great March of Return. InterpretationThe integration showed remarkable success in a short time as a result of the collective effort of all participants. However, there are challenges to overcome, and observation, further evaluation, and refinement of the process are needed to stabilise and sustain the integration of MHPSS services into primary health care for maximum benefit. FundingWHO, and UNRWA resources.

The impact of the COVID-19 crisis on meeting needs for family planning: a global scenario by contraceptive methods used.

The COVID-19 crisis could leave significant numbers of women and couples without access to essential sexual and reproductive health care. This research note analyses differences in contraceptive method mix across Sustainable Development Goal regions and applies assumed method-specific declines in use (from 0 per cent to 20 per cent) to produce an illustrative scenario of the potential impact of COVID-19 on contraceptive use and on the proportion of the need for family planning satisfied by modern methods. Globally, it had been estimated that 77 per cent of women of reproductive age (15-49years) would have their need for family planning satisfied with modern contraceptive methods in 2020. However, taking into account the potential impact of COVID-19 on method-specific use, this could fall to 71 per cent, resulting in around 60 million fewer users of modern contraception worldwide in 2020. Overall declines in contraceptive use will depend on the methods used by women and their partners and on the types of disruptions experienced. The analysis concludes with the recommendation that countries should include family planning and reproductive health services in the package of essential services anddevelop strategies toensure that women and couplesare able toexercise their reproductive rights during the COVID-19 crisis.

The impact of the COVID-19 crisis on meeting needs for family planning: a global scenario by contraceptive methods used

The COVID-19 crisis could leave significant numbers of women and couples without access to essential sexual and reproductive health care. This research note analyses differences in contraceptive method mix across Sustainable Development Goal regions and applies assumed method-specific declines in use (from 0 per cent to 20 per cent) to produce an illustrative scenario of the potential impact of COVID-19 on contraceptive use and on the proportion of the need for family planning satisfied by modern methods. Globally, it had been estimated that 77 per cent of women of reproductive age (15-49 years) would have their need for family planning satisfied with modern contraceptive methods in 2020. However, taking into account the potential impact of COVID-19 on method-specific use, this could fall to 71 per cent, resulting in around 60 million fewer users of modern contraception worldwide in 2020. Overall declines in contraceptive use will depend on the methods used by women and their partners and on the types of disruptions experienced. The analysis concludes with the recommendation that countries should include family planning and reproductive health services in the package of essential services and develop strategies to ensure that women and couples are able to exercise their reproductive rights during the COVID-19 crisis.

The impact of the COVID-19 crisis on meeting needs for family planning: a global scenario by contraceptive methods used

The COVID-19 crisis could leave significant numbers of women and couples without access to essential sexual and reproductive health care. This research note analyses differences in contraceptive method mix across Sustainable Development Goal regions and applies assumed method-specific declines in use to produce an illustrative scenario of the potential impact of COVID-19 on contraceptive use and on the proportion of the need for family planning satisfied by modern methods. Globally, it had been estimated that 77 per cent of women of reproductive age (15-49years) would have their need for family planning satisfied with modern contraceptive methods in 2020. However, taking into account the potential impact of COVID-19 on method-specific use, this could fall to 71 per cent, resulting in around 60 million fewer users of modern contraception worldwide in 2020. Overall declines in contraceptive use will depend on the methods used by women and their partners and on the types of disruptions experienced. The analysis concludes with the recommendation that countries should include family planning and reproductive health services in the package of essential services anddevelop strategies toensure that women and couplesare able toexercise their reproductive rights during the COVID-19 crisis.

Readiness of primary health-care facilities for the management of non-communicable diseases in rural Bangladesh: a mixed methods study

BackgroundNon-communicable diseases (NCDs) account for 67% of all deaths in Bangladesh. Several programmes are being implemented at the primary health-care level for NCD control in rural Bangladesh. This study aimed to assess the readiness for NCD health services provision in primary health-care facilities in rural Bangladesh, and explore health-care providers' perceptions about NCD care provision at the facilities. MethodsThis study was conducted in the Parbatipur sub-district of Bangladesh using an embedded mixed method design. We used the modified WHO Service Availability and Readiness Assessment tool to assess primary health-care facilities and completed in-depth interviews with health-care providers (community health workers, nurses, and doctors with experience in management of NCDs). We used descriptive statistics to analyse quantitative data and mean domain score was based on the availability of the items as a percentage for each facility type. Service readiness score for each NCD was calculated across facility types as the mean score of all domains of service readiness (management guideline, trained staff, equipment, medicine). Higher scores indicated better service readiness. Thematic analysis was used for qualitative data. FindingsBetween Nov 18 and Dec 3, 2018, we assessed 24 primary health-care facilities and completed 15 in-depth interviews. Of the 24 facilities surveyed, 23 were government-owned and one was a non-governmental organisation facility. Overall readiness score was highest for cardiovascular disease (22·6% [SD 28·8]) followed by diabetes (17·2% [25·0]) and asthma (13·2% [12·2]). Health-care providers mentioned lack of training, unavailability of medicine, and inadequate supervision as barriers to achieving readiness for NCD services. InterpretationThat functions and resources required for NCD care such as management guidelines, medicine, equipment, and trained staff were unavailable in the primary health-care facilities suggests a need to integrate NCD services into the Essential Services Package in government facilities. A limitation of the study is that the small sample size did not allow analysis to assess differences in service readiness between facility types. FundingMasters dissertation funded by BRAC James P Grant School of Public Health, BRAC University.

Moving Towards Universal Health Coverage in Haiti

ABSTRACT Haiti announced in 2018 its aim to achieve universal health coverage. In this paper, we discuss what this objective means for the country and what next steps should be taken. To contextualize the notion, we framed Haiti en route to the 2030 goal and analyzed qualitatively the status quo in terms of geographic, financial, and service access. For each dimension, we focused on the context, the government’s policies and political agendas, their implementation progress, and key influential factors. Our analysis found little progress and numerous challenges. Geographic access was limited due principally to the insufficient number of facilities, difficulties in reaching health facilities, and local customs. Financial coverage was low because of the government’s insufficient budgets, inefficient budget allocation, and ineffective management. Service access also had room for significant improvement for a lack of basic infrastructure and resources, gaps between the essential service package guidelines, health professionals’ skills, and the needs, as well as deficiencies in people-centered care. These factors affected not only health service coverage but also its quality. We found that the root causes of these issues were composed of unstable financing mechanisms, opportunistic resource allocation, and ineffective management control systems. We suggest that to overcome these issues and achieve universal health coverage with decent service quality, Haiti’s health system needs to be reformed by implementing strategic financing, decentralized management systems, and community engagement in primary health care.

Utilization of Essential Service Package by rural community

Background: Government has implemented Essential Service Package (ESP) under Health, Nutrition and Population Sector Program (HNPSP) to reach and maintain the highest attainable level of health care to the people of Bangladesh.
 Objective: To assess the utilization of Essential Service Package by rural community.
 Methodology: A descriptive, cross-sectional study was carried out during January 2011 to June 2011 on 160 respondents of age 18 years and above.Sample was selected purposively from Nababganj Upazila under Dhaka district. After taking informed consent data were collected by face to face interview using structured questionnaire. Data analysis was done by SPSS version 16.
 Results: The study revealed that highest number (71.9%) of respondents attended Upazila health Complex (UHC) to utilize ESP services. Among the respondents female (85.6%) were more than male. The lower class (19.4%) and middle class population (46.9%) utilized significantly more than upper class (8.7%).The most of the respondents had primary level of education (31.9%). Utilization of Expanded Programme on Immunization (EPI) (82.9%), Antenatal care (ANC) (16.2%), Family planning (FP) (11.2%), treatment of communicable diseases (40%) and limited curative care (12.5%) were found. Regarding Behavioural change communication (BCC) (41.3%) said that they got health education from the UHC and 58.9% response was negative.
 Conclusion: The overall utilization of ESP services is good. To utilize the ESP from the existing UHC facilities for the rural community population is needed to be strengthening for achieving the health goals.
 Northern International Medical College Journal Vol.10 (2) Jan 2019: 377-380

Knowledge and Prevalence of Family Planning Measures among Community People of Chisapani, Banke

Introduction: Global threat of increasing population has become a challenge to control. That's why Family planning is a strong matter of concern for most of the developing countries like Nepal. The first family planning service in Nepal was provided by Family Planning Association Nepal (FPAN) in 1959 to provide an Integrated Package of Essential Services (IPES) that includes comprehensive counseling; family planning and sexual health services; safe abortion services; HIV and AIDS and other sexually-transmitted infection (STI) services; gynecological, prenatal, and post-natal care; and GBV care. Several studies reflect that increment in population is directly related to the level of education, low family income, and lack of awareness, strong cultural beliefs and many more. Especially, village areas of Nepal are deprived of Family Planning services and measures due to lack of coverage and other facilities. Thus knowledge regarding Family planning and contraception needs to be accessed and hence a village in Chisapani, Banke district of Nepal was chosen for this study.
 Objectives: The overall objectives of our study were to access the knowledge regarding Family planning, to access the practise of Contraceptive measures and to find out the contraceptive prevalence rate (CPR) among community people of Chisapani village, Banke.
 Material and Method: A Cross-sectional descriptive study with population size of 410 community people was performed in Chisapani, Banke; starting from 18th June to 2nd September, 2018. A pre-tested questionnaire containing structural, semi-structural and open ended questions were made as data collection tool. All the people in this study were interviewed after receiving consent as an ethical clearance.
 Result: 393 out of 410 (i.e. 95.85%) people in our studyhave known about Family planning via Mass Media (75.82%). Only 70.48% people responded to have used any Contraceptive measure. Depo was found to be the most used measure (i.e. 54.87%). 42.43% people have heard about emergency contraceptive pills but only 20.68% among them have ever used it.
 Conclusion: Though 95.85% of the respondents of our study had known about Family Planning however only 70.48% people have been using any of the contraceptive measures. Emergency contraceptive pills were used by only 20.68% of the respondents.

Global Surgery – Redirecting Strategies for a Global Research Agenda Comment on "Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa"

More than three years have passed since the publication of the Lancet Commission on Global Surgery and its recommendations on scaling up surgery in sub-Saharan Africa (SSA). An important gap, the voice of the districts as well as lack of contextualized research, has been noted in its support of national surgical plans that run the risk of being at best, aspirational. Moreover, a ‘one-size-fits-all approach’ may not adequately address country-specific challenges on the ground. There is a need to redirect attention, effort, and funding in creating a global mechanism to gather baseline country information documenting every single district level government health facility’s ability and readiness to provide safe surgical, obstetric, trauma, and anesthesia care using the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA) tool to aid in directing country-specific efforts in surgical systems strengthening and ensuring that a basic package of essential surgical and anesthesia services is made available to each citizen with adequate financial protection by 2030. This global mechanism will enable benchmarking, accountability, and streamlining of the work of the global surgical community to achieve true progress in scaling up surgery not only in SSA, but for the rest of the developing world.

Costing essential services package provided by a non-governmental organization network in Bangladesh.

The health profile of Bangladesh has improved remarkably, yet gaps in delivering quality health care remain. In response to the need for evidence to quantify resources for providing health services in Bangladesh, this study estimates unit costs of providing the essential services package (ESP) in the not-for-profit sector. This study used a stratified sampling approach to select 18 static clinics, which had fixed facilities, from 330 non-profit clinics under Smiling Sun network in Bangladesh. Costs were estimated from the providers' perspective, using both top-down and bottom-up methods, from July 2014 to June 2015. In total, there were 1115 observations (clients) for the 13 primary care services analysed. The estimated 2015 average costs per visit were: antenatal care ($7.03), postnatal care ($4.57), control of diarrheal diseases ($1.32), acute respiratory infection ($1.53), integrated management of child illness ($2.02), sexually transmitted infections ($4.70), reproductive tract infections ($3.56), tuberculosis ($41.65), limited curative care ($4.30), immunization ($2.23), family planning ($0.72), births by normal delivery ($29.45) and C-section ($114.83). Unit costs varied widely for each service, both between individual patients and among clinic level means. The coefficient of variation for the 13 services averaged 66%, implying potential inefficiencies. In addition, 32.9% of clients were not offered any lab test during the first antenatal visit. The unit cost of essential services differed by the type and location of clinics. Ultra clinics, on average, incurred 37% higher costs than vital (outpatient type) clinics, and urban clinics spent 40% more than rural clinics to deliver a unit of service. The study suggests that inefficiency and quality concerns exist in health service delivery in some facilities. Increasing the volume of clients through demand-side mechanisms and standardization of services would help address those concerns. Unit costs of services provide essential information for estimating resource needs for scaling up the ESPs.