Impact Of Health Program Research Articles

Maternal and perinatal death surveillance and response in Bangladesh: A case study on measuring impact through health information systems

The health sector in Bangladesh is thriving, and the Maternal and Perinatal Death Surveillance and Response (MPDSR) program has been in place to investigate the causes of maternal and perinatal death. This study aimed to investigate the availability of information systems for measuring the status of an MPDSR program and the planning process and actions developed based on real-time information. This study delved into innovative information systems that can be used to monitor and measure the impact of health programs. The study included both the primary and secondary data. A total of six key informant interviews were conducted to explore the enablers and strengths of information systems. Secondary data were collected from government websites and MPDSR action plans. This study highlights the potential and challenges of governmental health information systems in notifying maternal and neonatal deaths. While the current notification rates are not up to national standards, it is encouraging to see health managers develop action plans and address this issue. The MPDSR information system is a valuable tool to help health managers measure changes in maternal and perinatal mortality rates and design locally targeted interventions. However, several obstacles must be addressed, such as insufficient data, lack of monitoring, and irregularities in MPDSR review meetings. By finding ways to overcome these challenges, we can unlock the full potential of MPDSR and improve maternal and neonatal health outcomes. The success of an MPDSR program relies on how the information is utilized to take action and measure the outcome. Advanced information systems, such as health dashboards, scorecards, and administrative data, can play a vital role in measuring the progress and impact of a program. The primary challenge lies in capturing all deaths, including their causes, and having the capacity to analyze the data effectively to develop action plans for health managers.

Cigarette smoking focus: A modeling approach for estimating the impact of health programs

Cigarette smoking focus: A modeling approach for estimating the impact of health programs Theodore R. Holford from Yale University charts a modeling approach for estimating the impact of health programs in this cigarette smoking research focus. Cigarette smoking is one of the most harmful causes of increasing illness risk and shortening life. Its effect was not expected initially, but the recognition of a growing epidemic in lung cancer became apparent in the middle of the twentieth century, stimulating a research effort to find the cause of an alarming trend. This work demonstrated the strong association between smoking and lung cancer. Still, as work continued, it became clear that lung cancer was but the first of a long list of other diseases affecting the lungs, the heart, and other organs.

Maternal and perinatal death surveillance and response in Bangladesh: A case study on measuring impact through health information systems

The health sector in Bangladesh is thriving, and the Maternal and Perinatal Death Surveillance and Response (MPDSR) program has been in place to investigate the causes of maternal and perinatal death. This study aimed to investigate the availability of information systems for measuring the status of an MPDSR program and the planning process and actions developed based on real-time information. This study delved into innovative information systems that can be used to monitor and measure the impact of health programs. The study included both the primary and secondary data. A total of six key informant interviews were conducted to explore the enablers and strengths of information systems. Secondary data were collected from government websites and MPDSR action plans. This study highlights the potential and challenges of governmental health information systems in notifying maternal and neonatal deaths. While the current notification rates are not up to national standards, it is encouraging to see health managers develop action plans and address this issue. The MPDSR information system is a valuable tool to help health managers measure changes in maternal and perinatal mortality rates and design locally targeted interventions. However, several obstacles must be addressed, such as insufficient data, lack of monitoring, and irregularities in MPDSR review meetings. By finding ways to overcome these challenges, we can unlock the full potential of MPDSR and improve maternal and neonatal health outcomes. The success of an MPDSR program relies on how the information is utilized to take action and measure the outcome. Advanced information systems, such as health dashboards, scorecards, and administrative data, can play a vital role in measuring the progress and impact of a program. The primary challenge lies in capturing all deaths, including their causes, and having the capacity to analyze the data effectively to develop action plans for health managers.

Трансформація цінностей дівчаток-підлітків під впливом комплексної оздоровчої програми

The study on the impact of a health program using the means of health fitness, motivational training, and psychocorrective activities on the transformation of value orientations of underweight teenage schoolgirls is relevant. The aim of the study is to investigate the impact of a comprehensive health program on the transformation of value orientations and school anxiety of underweight adolescent girls. The study involved 69 underweight adolescent girls (among them 54 12-yearold girls and 15 13-year-old girls). Methods. To assess value orientations, the M. Rokych’s methodology was used. The Phillips test was used to assess the level and nature of school anxiety in teenage girls. The factor structure of value orientations and school anxiety of 12-13-year-old girls with body weight deficiency was studied using factor analysis. Results. Based on the factor analysis, the transformation of the girls’ instrumental values, as well as the positive dynamics of the decrease in their school anxiety indicators, were accepted as criteria for the effectiveness of the health program. The program was designed for 9 months of duration and included psychocorrective activities, motivational training, and health-enhancing recreational physical activity. After the study, the value of health increased by 2 points and was in the top three most important values, and the value of knowledge rose by 6 units in the ranking of values. Among the positive changes, it should be noted that the rating of such a value as “Sensitivity” increased by 7 points and “Intolerance to shortcomings in oneself and others” decreased by 9 points. After participation in the program, there was a decrease in school anxiety indicators (frustration of the need to achieve success, which is expressed in an unfavorable mental background that does not allow the child to achieve a high result and fear of self-expression, which is manifested in negative emotional experiences of situations related to the need t present myself to others). Conclusions. The proposed program had a positive effect on the transformation of value orientations, the reduction of school anxiety indicators of 12–13-year-old girls with a body weight deficit.

The Role of Anthropology in India's Public Health

Abstract Conducting research on healthcare systems, policy implementation and the impact of health programmes can systematically identify the gaps and challenges in public health service delivery in India. Anthropology is particularly useful for so doing, but the role of anthropologists in health policy and planning needs recognition in India, as they can evaluate the effectiveness of interventions through a cultural lens, informing the development of evidence-based policies. The USA and Europe are more advanced in the use of anthropology in public health, due to their established academic programmes, robust research funding and infrastructure, and effective integration into public health institutions. Anthropological analysis and intervention has the capacity to improve Indian public health practice, particularly in terms of inclusivity and diversity issues.

Impact of Worksite Wellness Programs on Health-Related Outcomes in White Collar Workers-A Narrative Review

Worksite wellness programs are often implemented to increase work productivity and improve the health in employees however there is very little evidence on how effective these programs are. This review of literature aims to investigate the impact Worksite Wellness Programs have on the physiological and psychological health-related outcomes in white-collar workers. Electronic databases including PubMed Web of Science and CINAHL were screened. Publications between 2010 and 2020 were included. A total of nine studies were reviewed. Six out of nine studies showed positive improvements in physical health characteristics like BMI fat mass waist circumference occupational sitting time and step counts. Four out of nine studies showed significant differences in psychological outcomes like quality of life emotional exhaustion ruminative depression and other stress-related symptoms. No significant changes were found in job satisfaction performance and cognitive function. The study yielded mixed results regarding the impact of wellness programs on health outcomes. There exists strong evidence demonstrating the impact of Worksite wellness programs on major physiological outcomes such as BMI step counts waist circumference sitting time waist-to-hip ratio and blood pressure. Significant reductions in major psychological outcomes such as anxiety and depression were reported.

A Scoping Review of Burnout in Neurosurgery.

Burnout is a negative workplace syndrome of emotional exhaustion, cynicism, and perceived professional inefficacy that risks the patient-provider relationship, patient care, and physician well-being. To assimilate the neurosurgical burnout literature in order to classify burnout among domestic and international neurosurgeons and trainees, identify contributory factors, and appraise the impact of wellness programs. A scoping review identified the available literature, which was reviewed for key factors related to burnout among neurosurgeons. Two researchers queriedPubMed, Embase, Google Scholar, Cochrane, and Web of Science for articles on burnout in neurosurgery and reduced 1610 results to 32 articles. A total of 32 studies examined burnout in neurosurgery. A total of 26 studies examined prevalence and 8 studies detailed impact of wellness programs. All were published after 2011. Burnout prevalence was measured mostly through the Maslach Burnout Inventory (n=21). In 4 studies, participants defined their own understanding of "burnout." Domestically, burnout prevalence was 11.2% to 67% among residents and 15% to 57% among attendings. Among trainees, poor operative experience, poor faculty relationships, and social stressors were burnout risks but not age, sex, or marital status. Among attendings, the literature identified financial or legal concerns, lack of intellectual stimulation, and poor work-life balance as risks. The impact of wellness programs on trainees is unclear but group exercises may offer the most benefit. Noticeable methodological differences in studies on trainee and attending burnout contribute to a wide range of neurosurgery burnout estimates and yield significant knowledge gaps. Environment may have greater impact on trainee burnout than demographics. Wellness programs should emphasize solidarity.

Stakeholder perspectives on the implementation and impact of Indigenous health interventions: A systematic review of qualitative studies.

BackgroundEvaluations of health interventions for Indigenous peoples rarely report outcomes that reflect participant and community perspectives of their experiences. Inclusion of such data may provide a fuller picture of the impact of health programmes and improve the usefulness of evaluation assessments.AimTo describe stakeholder perspectives and experiences of the implementation and impact of Indigenous health programmes.MethodsWe conducted a systematic review of qualitative studies evaluating complex health interventions designed for Indigenous communities in high‐income countries. We searched 6 electronic databases (through to January 2020): MEDLINE, PreMEDLINE, Embase, PsycINFO, EconLit and CINAHL and hand‐searched reference lists of relevant articles.ResultsFrom 28 studies involving 677 stakeholders (mostly clinical staff and participants), six main themes were identified: enabling engagement, regaining control of health, improving social health and belonging, preserving community and culture, cultivating hope for a better life, and threats to long‐term programme viability.ConclusionThe prominence of social, emotional and spiritual well‐being as important aspects of the health journey for participants in this review highlights the need to reframe evaluations of health programmes implemented in Indigenous communities away from assessments that focus on commonly used biomedical measures. Evaluators, in consultation with the community, should consistently assess the capacity of health professionals to meet community needs and expectations throughout the life of the programme. Evaluations that include qualitative data on participant and community‐level outcomes can improve decision‐makers' understanding of the impact that health programmes have on communities.Patient or public contributionThis paper is a review of evaluation studies and did not involve patients or the public.

The Impact of Health Programs on Political Opinion: Evidence from Malaria Control in Tanzania

For elections to produce accountable government, citizens must reward politicians who deliver benefits. Yet there is relatively limited causal evidence of changes in public opinion in direct respon...

Changes in disease burden in Poland between 1990-2017 in comparison with other Central European countries: A systematic analysis for the Global Burden of Disease Study 2017.

BackgroundSystematic collection of mortality/morbidity data over time is crucial for monitoring trends in population health, developing health policies, assessing the impact of health programs. In Poland, a comprehensive analysis describing trends in disease burden for major conditions has never been published. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides data on the burden of over 300 diseases in 195 countries since 1990. We used the GBD database to undertake an assessment of disease burden in Poland, evaluate changes in population health between 1990–2017, and compare Poland with other Central European (CE) countries.MethodsThe results of GBD 2017 for 1990 and 2017 for Poland and CE were used to assess rates and trends in years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs). Data came from cause-of-death registration systems, population health surveys, disease registries, hospitalization databases, and the scientific literature. Analytical approaches have been used to adjust for missing data, errors in cause-of-death certification, and differences in data collection methodology. Main estimation strategies were ensemble modelling for mortality and Bayesian meta-regression for disability.ResultsBetween 1990–2017, age-standardized YLL rates for all causes declined in Poland by 46.0% (95% UI: 43.7–48.2), YLD rates declined by 4.0% (4.2–4.9), DALY rates by 31.7% (29.2–34.4). For both YLLs and YLDs, greater relative declines were observed for females. There was a large decrease in communicable, maternal, neonatal, and nutritional disease DALYs (48.2%; 46.3–50.4). DALYs due to non-communicable diseases (NCDs) decreased slightly (2.0%; 0.1–4.6). In 2017, Poland performed better than CE as a whole (ranked fourth for YLLs, sixth for YLDs, and fifth for DALYs) and achieved greater reductions in YLLs and DALYs than most CE countries. In 2017 and 1990, the leading cause of YLLs and DALYs in Poland and CE was ischaemic heart disease (IHD), and the leading cause of YLDs was low back pain. In 2017, the top 20 causes of YLLs and YLDs in Poland and CE were the same, although in different order. In Poland, age-standardized DALYs from neonatal causes, other cardiovascular and circulatory diseases, and road injuries declined substantially between 1990–2017, while alcohol use disorders and chronic liver diseases increased. The highest observed-to-expected ratios were seen for alcohol use disorders for YLLs, neonatal sepsis for YLDs, and falls for DALYs (3.21, 2.65, and 2.03, respectively).ConclusionsThere was relatively little geographical variation in premature death and disability in CE in 2017, although some between-country differences existed. Health in Poland has been improving since 1990; in 2017 Poland outperformed CE as a whole for YLLs, YLDs, and DALYs. While the health gap between Poland and Western Europe has diminished, it remains substantial. The shift to NCDs and chronic disability, together with marked between-gender health inequalities, poses a challenge for the Polish health-care system. IHD is still the leading cause of disease burden in Poland, but DALYs from IHD are declining. To further reduce disease burden, an integrated response focused on NCDs and population groups with disproportionally high burden is needed.

The Impact of Wellness Programs on Employee Job Satisfaction in Colleges and Universities

This study examines the impact of wellness programs on employee job satisfaction in Colleges and Universities. Utilizing a sample of full time or part time college and university faculty members of for-profit and brick and mortar universities in the United States, the results of this correlational study did not predict job satisfaction among employees who participated in wellness programs. In addition, it was found that interaction analyses indicated a relationship between gender and job satisfaction. Females were more likely than males to have higher levels of job satisfaction, as well as years of experience and job satisfaction. Faculty who had employed between 11 and 15 years were more likely to have higher levels of job satisfaction.

The impact of health programmes to prevent vertical transmission of HIV. Advances, emerging health challenges and research priorities for children exposed to or living with HIV: Perspectives from South Africa.

Over the past three decades, tremendous global progress in preventing and treating paediatric HIV infection has been achieved. This paper highlights the emerging health challenges of HIV-exposed uninfected (HEU) children and the ageing population of children living with HIV (CLHIV), summarises programmatic opportunities for care, and highlights currently conducted research and remaining research priorities in high HIV-prevalence settings such as South Africa. Emerging health challenges amongst HEU children and CLHIV include preterm delivery, suboptimal growth, neurodevelopmental delay, mental health challenges, infectious disease morbidity and mortality, and acute and chronic respiratory illnesses including tuberculosis, pneumonia, bronchiectasis and lymphocytic interstitial pneumonitis. CLHIV and HEU children require three different categories of care: (i) optimal routine child health services applicable to all children; (ii) routine care currently provided to all HEU children and CLHIV, such as HIV testing or viral load monitoring, respectively, and (iii) additional care for CLHIV and HEU children who may have growth, neurodevelopmental, behavioural, cognitive or other deficits such as chronic lung disease, and require varying degrees of specialised care. However, the translation thereof into practice has been hampered by various systemic challenges, including shortages of trained healthcare staff, suboptimal use of the patient-held child's Road to Health book for screening and referral purposes, inadequate numbers and distribution of therapeutic staff, and shortages of assistive/diagnostic devices, where required. Additionally, in low-middle-income high HIV-prevalence settings, there is a lack of evidence-based solutions/models of care to optimise health amongst HEU and CLHIV. Current research priorities include understanding the mechanisms of preterm birth in women living with HIV to optimise preventive interventions; establishing pregnancy pharmacovigilance systems to understand the short-, medium- and long-term impact of in utero ART and HIV exposure; understanding the role of preconception maternal ART on HEU child infectious morbidity and long-term growth and neurodevelopmental trajectories in HEU children and CLHIV, understanding mental health outcomes and support required in HEU children and CLHIV through childhood and adolescence; monitoring HEU child morbidity and mortality compared with HIV-unexposed children; monitoring outcomes of CLHIV who initiated ART very early in life, sometimes with suboptimal ART regimens owing to medication formulation and registration issues; and testing sustainable models of care for HEU children and CLHIV including later reproductive care and support.

RE-AIM in the Real World: Use of the RE-AIM Framework for Program Planning and Evaluation in Clinical and Community Settings.

Background: The RE-AIM framework has been widely used in health research but it is unclear the extent to which this framework is also used for planning and evaluating health-related programs in clinical and community settings. Our objective was to evaluate how RE-AIM is used in the “real-world” and identify opportunities for improving use outside of research contexts.Methods: We used purposive and snowball sampling to identify clinical and community health programs that used RE-AIM for planning and/or evaluation. Recruitment methods included surveys with email follow-up to funders, implementers, and RE-AIM working group members. We identified 17 programs and conducted structured in-depth interviews with key informants (n = 18). Across RE-AIM dimensions, respondents described motivations, uses, and measures; rated understandability and usefulness; discussed benefits and challenges, strategies to overcome challenges, and resources used. We used descriptive statistics for quantitative ratings, and content analysis for qualitative data.Results: Program content areas included chronic disease management and prevention, healthy aging, mental health, or multiple, often behavioral health-related topics. During planning, most programs considered reach (n = 9), adoption (n = 11), and implementation (n = 12) while effectiveness (n = 7) and maintenance (n = 6) were considered less frequently. In contrast, most programs evaluated all RE-AIM dimensions, ranging from 13 programs assessing maintenance to 15 programs assessing implementation and effectiveness. On five-point scales, all RE-AIM dimensions were rated as easy to understand (Overall M = 4.7 ± 0.5), but obtaining data was rated as somewhat challenging (Overall M = 3.4 ± 0.9). Implementation was the most frequently used dimension to inform program design (M = 4.7 ± 0.6) relative to the other dimensions (3.0–3.9). All dimensions were considered similarly important for decision-making (average M = 4.1 ± 1.4), with the exception of maintenance (M = 3.4 ± 1.7). Qualitative corresponded to the quantitative findings in that RE-AIM was reported to be a practical, easy to understand, and well-established implementation science framework. Challenges included understanding differences among RE-AIM dimensions and data acquisition. Valuable resources included the RE-AIM website and collaborating with an expert.Discussion: RE-AIM is an efficient framework for planning and evaluation of clinical and community-based projects. It provides structure to systematically evaluate health program impact. Programs found planning for and assessing maintenance difficult, providing opportunities for further refinement.

Evaluation designs of outpatient health centres focusing on vulnerable patient groups

Abstract Background Homeless and non-insured persons experience worse physical and mental health than comparable populations. Outpatient (public) health institutions, which are easily accessible, contribute considerably to the medical treatment of vulnerable patient groups. Sound evaluation methods, indicators and instruments are necessitated to target patients’ needs and to enable strategic health and social policy planning. Methods We conducted a systematic literature search in several databases (PubMed, EMBASE, PsycINFO etc.) for studies from 2000 to 2019 reporting on evaluations in outpatient health institutions for homeless and/ or non-insured patients. In addition, we contacted 5 Austrian public health/ research institutions dealing with complex interventions for relevant publications. Results 12 evaluation studies and 7 evaluation reports met our inclusion criteria. Evaluation designs mostly considered various target groups and nearly all assessments pursued a ’mixed-method’ approach. 13 publications assessed socio-demographic data, 11 the use of health and social services and 7 patients’ health status. Further indicators related to ’satisfaction issues’ such as patients’ satisfaction with the provided range of health and social services (n = 7). 6 publications reported on health economic indicators. In total, 7 out of 19 studies reported on evaluation instruments; most instruments (n = 6) were on patients’ mental health status. Conclusions Patients represented the major target group in the included evaluations. There is little research on evaluation indicators directing on health professionals. Evaluations focusing on the intersectional levels (e.g. the impact of health programmes for vulnerable groups on various institutions) are lacking. Key messages Evaluation designs involving ‘hardly to reach populations’ shall consider a ‘participatory assessment approach’ to avoid drop-outs and to create a trustworthy evaluation situation. Hence, evaluation indicators shall be commonly selected and adequately reflect patients’ realities.

Mapping under-5 and neonatal mortality in Africa, 2000–15: a baseline analysis for the Sustainable Development Goals

SummaryBackgroundDuring the Millennium Development Goal (MDG) era, many countries in Africa achieved marked reductions in under-5 and neonatal mortality. Yet the pace of progress toward these goals substantially varied at the national level, demonstrating an essential need for tracking even more local trends in child mortality. With the adoption of the Sustainable Development Goals (SDGs) in 2015, which established ambitious targets for improving child survival by 2030, optimal intervention planning and targeting will require understanding of trends and rates of progress at a higher spatial resolution. In this study, we aimed to generate high-resolution estimates of under-5 and neonatal all-cause mortality across 46 countries in Africa.MethodsWe assembled 235 geographically resolved household survey and census data sources on child deaths to produce estimates of under-5 and neonatal mortality at a resolution of 5 × 5 km grid cells across 46 African countries for 2000, 2005, 2010, and 2015. We used a Bayesian geostatistical analytical framework to generate these estimates, and implemented predictive validity tests. In addition to reporting 5 × 5 km estimates, we also aggregated results obtained from these estimates into three different levels—national, and subnational administrative levels 1 and 2—to provide the full range of geospatial resolution that local, national, and global decision makers might require.FindingsAmid improving child survival in Africa, there was substantial heterogeneity in absolute levels of under-5 and neonatal mortality in 2015, as well as the annualised rates of decline achieved from 2000 to 2015. Subnational areas in countries such as Botswana, Rwanda, and Ethiopia recorded some of the largest decreases in child mortality rates since 2000, positioning them well to achieve SDG targets by 2030 or earlier. Yet these places were the exception for Africa, since many areas, particularly in central and western Africa, must reduce under-5 mortality rates by at least 8·8% per year, between 2015 and 2030, to achieve the SDG 3.2 target for under-5 mortality by 2030.InterpretationIn the absence of unprecedented political commitment, financial support, and medical advances, the viability of SDG 3.2 achievement in Africa is precarious at best. By producing under-5 and neonatal mortality rates at multiple levels of geospatial resolution over time, this study provides key information for decision makers to target interventions at populations in the greatest need. In an era when precision public health increasingly has the potential to transform the design, implementation, and impact of health programmes, our 5 × 5 km estimates of child mortality in Africa provide a baseline against which local, national, and global stakeholders can map the pathways for ending preventable child deaths by 2030.FundingBill & Melinda Gates Foundation.

Abstract P154: Short-Term Health Care Expenditures Increase After Workplace Wellness Program

Introduction: A major goal of workplace wellness programs is to improve employee health and lower health care costs. Research on wellness program effectiveness is often limited by either a lack of a control comparison groups or confounding when the intervention and control groups differ on baseline health. Our study objective was to assess the effect on health expenditures of an employee wellness program (BeFit), already shown to improve diet, physical activity, cholesterol, and BP. We compared participants to a matched non-participant control group. Hypothesis: We hypothesized that health care costs would be lower for participants than for non-participants. Methods: BeFit is a 10 week nutrition/exercise program that includes measurement of cardiovascular risk factors, weekly meetings with a nutritionist and personal trainer, gym membership, and team competition to achieve weight and exercise goals. For this study, participants were matched by age, sex, period of employment, and pre-participation Diagnostic Cost Group (DCG) risk score (a predictor of future health care use based on past-year use), to two non-participant control employees. Health expenditures were gathered from claims data obtained by the employer’s human resource department. Subjects in the analysis had at least 12 months pre- and post-program claims data. Within-subject quarterly health care cost trends were compared after subjects’ BeFit start dates using multivariable generalized least squares regression controlling for age, sex, and baseline health. Control subjects were assigned the start date of the subject to whom they were matched. Expenditures were capped at the 99 th percentile ($42,393) so results were not unduly influenced by extreme events unlikely to be affected by a wellness program. We analyzed overall, domain-specific (outpatient, inpatient, pharmaceutical), and diagnosis-specific costs. Results: From 2010-2014, 412 BeFit participants and 824 controls met the inclusion criteria (77% female, mean age 41 [range 23,78], mean baseline DCG risk score of 92.3 [range 3, 2315]). After participation in BeFit, the regression-adjusted health expenditures decreased by $15/quarter among BeFit participants compared to $85/quarter among control subjects (95% CI for difference $27, $113). Trends were significantly more negative in the control group for outpatient, inpatient, and pharmaceutical costs, as well. There were no differences in trends for cardiovascular or diabetes-related costs. Conclusions: Contrary to our hypothesis, trends in health expenditures decreased more for the matched control group than for participants in the employee wellness program. This result may be due to increased attention to health and higher health care use spurred by participation in the program. Further work is necessary to understand the long-term impact of wellness programs on health and health expenditures.

Naxal Movement and Health Status of Tribes in Base Camp (A Case Study of Dantewada District of Chhattisgarh State of India)

Present study is based on Naxal movement in Chhattisgarh state and its impact on Tribal life. Study is focus on comparative study of social life of tribal people before coming to base camps and changes after boarding to base camps. Researcher has been try to find out that what are the change in tribal culture due to naxal incidents and what is impact of health program in the region after naxal activity. Findings of the study shows that in some context the naxal incidents are benificial of tribal people because in the base camp they having sufficient heath facility, especially in the context of women and children health facility which is provided by the govt.

Nurturing Health: Impact of Health Programmes on Rural Women of Kumaun

The health of Indian women is intrinsically linked to their status in society, especially for those living in a rural area. Keeping in view the importance of women health, successive Governments, from time to time, have launched various health schemes for improving the health conditions of women. One of the major programmers in this regard is National Rural Health mission. Under the umbrella of NRHM major health schemes for maternal and child health are Janani Suraksha Yojana, Janani Shishu Suraksha Karyakaram, Village Health and Nutrition Day, Universal Immunization Programme(UIP), Reproductive and Child Health Camps. The present paper focuses on evaluating the impact of two important health schemes namely Universal Immunization Programme (UIP) and Village Health and Nutrition Day (VHND) on the rural women of district Almora. The study of the selected sample blocks of district Almora, on the basis of primary data collected, has revealed that overall 87.9% rural women immunised themselves and their children at appropriate time. The study revealed that the overall awareness level about VHND programme was found to be only 37.14% which is dismally low. The study provides useful insight of the impact of the selected schemes and suggests some recommendations for better delivery of health services.

Methodological and Policy Limitations of Quantifying the Saving of Lives: A Case Study of the Global Fund's Approach

David McCoy and colleagues critique the dominance of "lives saved" models of assessing the impact of health programs, using The Global Fund as a case study. Please see later in the article for the Editors' Summary.

Factors affecting job satisfaction and retention of medical laboratory professionals in seven countries of Sub-Saharan Africa

Effective implementation and sustainability of quality laboratory programmes in Sub-Saharan Africa relies on the development of appropriate staff retention strategies. Assessing the factors responsible for job satisfaction and retention is key for tailoring specific interventions aiming at improving the overall impact of health programmes. A survey was developed to assess these factors among 224 laboratorians working in the laboratory programme the University of Maryland implemented in seven Sub-Saharan African countries. Lack of professional development was the major reason for leaving the previous job for 28% of interviewees who changed jobs in the past five years. Professional development/training opportunities was indicated by almost 90% (195/224) of total interviewees as the most important or a very important factor for satisfaction at their current job. Similarly, regular professional development/opportunities for training was the highest rated incentive to remain at their current job by 80% (179/224). Laboratory professionals employed in the private sector were more likely to change jobs than those working in the public sector (P = 0.002). The findings were used for developing specific strategies for human resources management, in particular targeting professional development, aiming at improving laboratory professionals within the University of Maryland laboratory programme and hence its long-term sustainability.