Concern about rapid growth in demand for reproductive health services in developing countries has created interest in productivity and costs of existing programmes. Staff costs usually constitute the largest share of total service costs, meriting special effort to ensure that they are measured accurately. Several techniques have been used in the literature to analyze staff activity, but these techniques have not been validated. This paper reports on a study conducted in three Ecuadoran clinics. The study uses an observational time-motion (TM) technique as a benchmark, and compares results from three other techniques to those obtained using TM. None of the alternative techniques produces estimates that agreed with TM estimates; deviations from TM are particularly large for non-contact time, defined as clinician activities carried out when clients are not present. Implications of these findings for productivity and cost studies are discussed, and possible avenues for future research are proposed.

Background: Family Planning (FP) is a key developmental focus for the government of Nepal. Use of modern contraceptives has stagnated at 43.2% since 2011. Unmet need for family planning (FP) in Nepal remains high at 27%. Despite relatively high unmet need, a factor contributing to this levelling of contraceptive use is the limited range of methods available to most clients at most sites. To address the FP need among married women of reproductive age (WRA), we tested integration of FP into agricultural programs. Aim: To assess the effectiveness of a FP program integrated into an agriculture (e.g., non-health) sector program. Methods: A descriptive cross-sectional (post interventional) study was conducted November 2015 to February 2016 among 525 WRA participating in an agriculture program. Results: The contraceptives commonly used by women in the study location were Depo Provera and Minilap. After Technical Integration Coverage and Access (TICA) interventions, almost all of the respondents (99.6%) had heard about FP of which 67.8% correctly understood FP as a method to prevent unwanted pregnancy. About 50% of the respondents were found currently using FP. The percentage of WRA aware of long-acting and permanent FP methods increased from 49.0% to 62.0% and 39.0% to 52.0% respectively. Decisions on using a FP method were predominantly made by the husband (68.0%). However, 68.4% women reported that they were accompanied by their husband. The proportion of men willing to use FP increased from 5.2% to 15.5% after TICA activities implementation. The main reason identified for not currently using FP devices was that the husband and wife were not living together (88.8%). Most of the women (98.0%) reported that FP utilization improved their quality of life. Conclusion: TICA activities were very successful in both increasing FP knowledge level as well as utilizing FP services among the targeted beneficiaries. The use of FP increased

This article reports on an evaluation of the Merck Childhood Asthma Network, Inc. (MCAN) initiative using pooled cross-site data on patient-reported outcomes pre- and postintervention to quantify the changes experienced by children in five program sites supported by the network. The results show a consistent pattern of improvement across all measured outcomes, including symptoms, hospital and emergency department use, school absences, and caregiver confidence. Children who started with uncontrolled asthma experienced larger improvements than children with controlled asthma at baseline. However, even considering the significant gains made by children with uncontrolled asthma at baseline, after 12 months, most of the outcomes for these children were significantly worse than the 12-month outcomes for children with controlled asthma at baseline. The evaluation of the MCAN initiative offers a model that can be used in cases where resources must be balanced between evaluation and delivering services to children. The design process and results from the common survey instrument provide information for future initiatives seeking to translate evidence-based interventions in a community-based setting.

This coalition-developed, telephone-based, system-level intervention had a significant impact on childhood asthma morbidity as measured by utilization endpoints of follow-up hospitalizations and emergency department visits. Telephone-based care coordination and service integration may be a viable and economic way to impact childhood asthma and other chronic diseases.

Both methods were able to successfully identify children with asthma in hard-to-reach populations. These methods can easily be replicated in other cities and the results can be used to inform programs, services, and policy developments.