Community-based health insurance (CBHI) as a demand-side intervention is presumed to drive improvements in health services quality, and the quality of health services is an important supple-side factor in motivating CBHI enrollment and retention. There is, however, limited evidence on this interaction. This study examined the interaction between quality of health services and CBHI enrollment and renewal. A mixed-method comparative study was conducted in four agrarian regions of Ethiopia. The study followed the Donabedian model to compare quality of health services in health centers located in woredas/districts that implemented CBHI with those that did not. Data was collected through facility assessments, client-exit interviews, and key informant interviews. In addition to manual thematic analysis of qualitative data, quantitative descriptive and inferential analyses were done using SPSS vs 25. The process related (composite index including provider-client interpersonal communication) and outcome related (client satisfaction) measures of service quality in CBHI woreda/districts differed significantly from non-CBHI woredas/districts, but there were no significant differences in overall measures of structural quality between the two. The study found better diagnostic test capacity, availability of tracer drugs, provider interpersonal communication, and service quality standards in CBHI woredas. A higher proportion of clients at CBHI health centers gave high ratings of overall satisfaction with services. Individual and household factors including family size, age, household health care-related expenditures, and educational status, played a more significant role in CBHI enrollment and renewal decisions than health service quality. Key-informants reported in interviews that participation in the scheme increased accountability of health facilities in CBHI woredas/districts, because they promised to provide quality services using the CBHI premium collected at the beginning of the year from all enrolled households. This study indicates a need for follow-up research to understand the nuanced linkages between quality of care and CBHI enrollment.
We describe the implementation and select findings from Adolescent X, an arts-based research project that used story circles and body mapping to elucidate how young people understand the relationship between their social contexts and their sexual and reproductive health, with a particular focus on youth’s understandings of gender, sexuality, and the body as sites of possibility and power. A community-based sample of N = 24 youth of color was recruited from the South and West Sides of Chicago to participate in 3-day workshops. In addition to story circles and body mapping, data were collected via brief surveys with N = 24 youth, debriefing groups (n = 10 youth), and focus groups (n = 14 youth). Study data consisted of (1) body map visuals, that is, legends, mini-, and full-body maps; (2) written body map narratives; and (3) audio recordings of the story circles, body mapping activities, debriefing groups, and focus groups. All audio recordings were transcribed, deidentified, and uploaded in Dedoose for qualitative thematic analysis. Data analysis was conducted by a team of independent coders. Across all sources of data, three major themes were identified: (1) strong feelings of unsafety related to how young people’s bodies are gendered, sexualized, and racialized in different social settings; (2) the extent to which adults and institutions foster youth safety; and (3) sources of young people’s coping and resilience. Implications for public health research, practice, and policy are discussed.
Findings: Out of 497 enrolled women, 275 (55.3%) presented for VL testing and 234 (85.1%) had their samples collected. Out of 213 (91.0%) available results, 171 (80.3%) were virally suppressed/ adherent. ART regimen (EFV vs NVP vs PI) (p¼0.56), duration on ART (p¼0.43), employment status (p¼0.72), educational status (p¼0.15) were not determinants of suppression. For distance lived from PHC, there was a positive but weak correlation where VL was higher with further distance lived (p¼0.08). Interpretation: While the target of 90% was not achieved, a substantial proportion of women (80%) were adherent to ART. Only distance lived from facility approached significance as a determinant of suppression/adherence. This is understandable as rural areas often have difficult terrain, and residents are often economically disadvantaged. Additionally, ART regimen did not make a difference in suppression rate, giving EFV vs NVP comparable efficacy in our study cohort. Approximately 20% of women failed treatment; however they were not labeled "non-adherent" due to the possibility of acquired resistance, which was not assessed in this study. While this study demonstrates appreciable treatment success in a cohort of rural women, more robust studies are needed in Nigeria to determine factors associated with ART non-adherence and non-suppression among PMTCT clients.
Supporting the development of young family planning professionals is key to fostering communities of practitioners that can help countries achieve family planning goals. The Family Planning Voices (FP Voices) storytelling initiative, created by The Knowledge for Health Project and Family Planning 2020, documents stories from people around the world who are passionate about family planning. This qualitative evaluation used in-depth interviews ( n = 11) with young professionals (ages 18-30) to uncover the effects of sharing their story with FP Voices. Participants came from 10 countries in one of three regions, Latin America ( n = 2), South Asia ( n = 2), and Africa ( n = 7). Findings highlight that sharing one’s story with FP Voices served as a professional development opportunity and instilled confidence and pride among young professionals. Additionally, participants linked access to a professional headshot and the experience of participating in an interview to their professional development. Participants often discussed the recognition they gained from sharing their story and the resulting increase in professional connections and opportunities. Participants hoped that their stories would inspire and encourage others and support recognition of the value of young professionals to the larger family planning field. In sum, storytelling initiatives like FP Voices can motivate and create community and opportunity among young professionals.
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