List of Boxes.List of Field Perspectives.Foreword.Preface.Acknowledgments.Chapter 1: Invitation to Explore.Chapter 2: The Language and Logic of Qualitative Research.Chapter 3: Designing the Study.Chapter 4: Collecting Qualitative Data: The Science and the Art.Chapter 5: Logistics in the Field.Chapter 6: Qualitative Data Analysis.Chapter 7: Putting It into Words: Reporting Qualitative Research Results.Chapter 8: Disseminating Qualitative Research.Appendix 1: Samples of Behavioral Frameworks.Appendix 2: Examples of Oral Consent Forms.Appendix 3: Example of a Qualitative-Quantitative Research Design.Appendix 4: Procedural Guidelines for Managing Focus Group Discussions.Appendix 5: Sample Budget Categories for Planning Focus Group Discussions.Appendix 6: Topic Guides for Focus Group Discussions on Reproductive Health.Appendix 7: Sample Interviewer Training Program Agenda.Appendix 8: Common Errors in Moderating Focus Groups.Appendix 9: Critical Appraisal Skills Programme (CASP): Ten Questions to Help You Make Sense of Qualitative Research.Appendix 10: Where to Publish.Appendix 11: Sample Research Brief on the Female Condom.Appendix 12: Who Is an Author?Appendix 13: Sample Brochure to Share Qualitative Study Findings with Participating Communities.Appendix 14: Making Study Findings Accessible to Other Researchers.Suggested Readings and Selected Internet Resources.References.The Authors.The Contributors.Index.

Qualitative Methods in Public Health: A Field Guide for Applied Research

High-quality health systems in the Sustainable Development Goals era: time for a revolution

Family planning: the unfinished agenda

This report reviews the debate over the effects of demographic change on economic growth and examines the research evidence on the economic impact of changes in age structure. It also examines the relationship between population change and economic development in particular regions of the world including the Middle East and North Africa. Finally it discusses how changes in the age structure interact with labor-market health and education policies to contribute to economic growth. (excerpt)

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The demographic dividend : a new perspective on the economic consequences of population change

AFRICA'S DEVELOPMENT CRISIS is unique. Not only is Africa the poorest region in the world, but it was also the only major developing region with negative growth in income per capita during 1980-2000 (table 1). Some African countries grew during the 1990s, but for the most part this growth recovered ground lost during the 1980s. Moreover, Africa's health conditions are by far the worst on the planet. The AIDS pandemic is wreaking havoc, as is the resurgence of malaria due to rising drug resistance and the lack of effective public health systems. Africa's population continues to soar, adding ecological stresses to the economic strains. Policy-based development lending to Africa over the past twenty years, known as structural adjustment lending, did not solve the problem. A heavy debt burden is evidenced by the 155 Paris Club restructurings of African countries' debt between 1980 and 2001, much more than for any other region. In general, Africa remains mired in poverty and debt. This paper focuses on the tropical sub-Saharan African countries with populations of at least 2 million people in 2001. We leave out North Africa (Algeria, Egypt, Libya, Morocco, and Tunisia,), southernmost Africa (Botswana, Lesotho, Namibia, South Africa, and Swaziland), and a number of very small economies (Cape Verde, Comoros, Djibouti, Equatorial Guinea, Gabon, The Gambia, Guinea-Bissau, Mauritius, Sao Tome and Principe, and Seychelles). Both nontropical ends of Africa are much richer than tropical Africa. They grow temperate crops, escape the worst of malaria, enjoy (in the south) vast deposits per capita of gold and diamonds, and (in the north) benefit from proximity to EU markets. The smallest economies present idiosyncrasies that would distract more than inform the analysis. The thirty-three sub-Saharan African countries on which we focus (and which are listed in table 2) had a combined population of 617 million in 2001, with a population-weighted average annual income of $271 per person, or a mere 74 cents a day. Every country on the list is a low-income country according to World Bank country classifications, and twenty-six are among the forty-nine Least Developed Countries in the world by the United Nations classification. Of the four countries with income per capita of $500 or more, three (Angola, Cameroon, and Congo) are oil exporters, and only Cote d'Ivoire, which is currently in a vertiginous political and economic collapse, is a non-oil exporter. Every country on the list has a life expectancy at birth below sixty years, and in all but Ghana, Madagascar, and Sudan life expectancy at birth is below fifty-five years. Child mortality rates (deaths before the age of five per 1,000 live births) are above 100 in every country. The standard diagnosis is that Africa is suffering from a governance crisis. With highly visible examples of profoundly poor governance, for example in Zimbabwe, and widespread war and violence, as in Angola, the Democratic Republic of the Congo, Liberia, Sierra Leone, and Sudan, the impression of a continent-wide governance crisis is understandable. Yet it is wrong. Many parts of Africa are well governed even though stuck in poverty. Governance is a problem, but Africa's development challenges run much deeper. Using our thirty-three-country sample, table 2 reports some common governance indicators that make this point. The first column presents a ranking of African governance compiled by Steven Radelet, (1) who regresses a set of widely used World Bank governance indicators due to Daniel Kaufmann, Aart Kraay, and Massimo Mastruzzi on GDP per capita, (2) and ranks countries according to the residuals from that regression, thereby standardizing the measurement of governance by level of income. This procedure recognizes that poorer countries have systematically poorer governance measures than richer countries, since good governance itself requires real resources. Well-governed African countries are defined as those with residuals at least 1 standard error above, and poorly governed countries as those with residuals at least 1 standard error below, the regression line. …

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Ending Africa's Poverty Trap

This article argues for attention to a neglected dimension of family planning services--their quality. A framework for assessing quality from the client's perspective is offered, consisting of six parts (choice of methods, information given to clients, technical competence, interpersonal relations, follow-up and continuity mechanisms, and the appropriate constellation of services). The literature is reviewed regarding evidence that improvements in these various dimensions of care result in gains at the individual level; an even scarcer body of literature is reviewed for evidence of gains at the level of program efficiency and impact. A concluding section discusses how to make practical use of the framework and distinguishes three vantage points from which to view quality: the structure of the program, the service-giving process itself, and the outcome of care, particularly with respect to individual knowledge, behavior, and satisfaction with services.

Fundamental elements of the quality of care: a simple framework.

Since the 1960s, survey data have indicated that substantial proportions of women who have wanted to stop or delay childbearing have not practiced contraception. This discrepancy is referred to as the "unmet need" for contraception. The traditional interpretation, that these women lack access to contraceptive supplies and services, has led in turn to an emphasis on expanding family planning programs. This study analyzes survey data and related anthropological studies on the causes of unmet need and concludes that the conventional explanation is inadequate. Although for many environments geographic access to services remains a problem, the principal reasons for nonuse are lack of knowledge, fear of side effects, and social and familial disapproval. This finding underscores the need for expanded investment in services that not only provide contraceptives, but also attend to closely related health and social needs of prospective clients. Programs are likely to be most successful when they reach beyond the conventional boundaries of service provision to influence and alter the cultural and familial factors that limit voluntary contraceptive use.

The causes of unmet need for contraception and the social content of services

This monograph reports on a study of the status of adolescent girls in developing countries that was constructed from a review and interpretation of available data in the relevant literature. In most cases statistics are illustrative; when possible comparisons are made with boys. The monograph opens with a chapter that discusses the characterization of adolescence as a distinct stage of life reviews current approaches to research on adolescents and presents the analytic approach used in this study. The next two chapters chart the developmental experience of adolescent girls. Chapter 2 follows their socioeconomic progress as they move from their childhood homes into the larger world of school and work and covers such topics as living arrangements domestic roles and responsibilities social and physical mobility schooling and work. Chapter 3 deals with such reproductive health topics as menstruation sexual activity knowledge of reproductive biology and health fertility regulation marriage and childbearing. The final chapter proposes an agenda to guide policy programs and research that will make adolescent girls in developing countries visible and valued; recognize the particularity of girls adolescence and change gender rules; move adolescent policy beyond reproductive health; support girls through sexual initiation pregnancy and marriage; widen and deepen research priorities; and lead to investment in the largest generation of girls ever.

https://knowledgecommons.popcouncil.org/cgi/viewcontent.cgi?article=1763&context=departments_sbsr-pgy

The Uncharted Passage: Girls' Adolescence in the Developing World

The Population Council continues to resist setting quality of care standards for family planning programs. It contends that professionals responsible for each family planning program must define intended and achievable levels of care. The Population Council does claim however that a high quality program is client-oriented and assists clients in reaching their reproductive goals. Even though a high quality program would reduce fertility by increasing contraceptive use it must not execute fertility reduction policies that conflict with clients well being. 6 components of quality care include appropriate choice of methods responsible information technical competence interpersonal relations mechanisms to encourage continuity and appropriate mixture of services. A key problem with setting universal standard is that each country or program must validate the standards and make them work. For example standards may require providers to understand clients reproductive intentions and to help them choose a method which meets their needs yet the standards cannot define how they should do so. The standard setting process for individual countries and programs should include the technical and affective aspects of care and address the following: What quality of care does a program propose to offer can it offer is actually offered and is received by clients? Rapid assessment techniques can be used to compare the quality of care a program wants to offer and the care that is actually given to clients. Program managers can then discern gaps between intention and reality and reasons to improve service standards. In conclusion solutions to problems with quality of family planning care are only found locally.

Setting standards of quality in family planning programs.

The assumption is made in this discussion that fertility reduction component of family planning programs should be replaced with reproductive health approaches. Demographic objectives have been shown to result in an inferior quality of services and undesirable means for achieving fertility decline through coercion quotas and incentives. The objective should be assure an individuals safe and effective control of fertility. Efficacy measures should link program success to improvement in individual welfare or achievement of individual reproductive intentions in a healthful manner. Priority should be placed on defining indicators of morbidity associated with avoiding unwanted or unplanned childbearing and with use of contraception. Panel studies should reveal the links between reproductive intentions and subsequent fertility and morbidity. Population policies rarely operationalize the design of broad development and health programs for reducing infant and child mortality or control over resources. When population policy is redefined to included reduction in morbidity and mortality the goals of reducing class ethnic and gender disparities and improvement in health are successfully integrated. Shifts in priorities of development and population programs involve securing within the next 10-15 transitional years policies and legal frameworks that create conditions conducive to voluntary fertility decline. Attention should focus on achieving reproductive intentions healthfully and on reproductive health services that act to prevent unwanted and unplanned pregnancy. The issue is not whether or not to direct public policy toward investment in the population sector but how to allocate funds to maximize human welfare and reduce population growth. The aim of family planning programs should be to reduce unplanned and unwanted childbearing and related morbidity and mortality. Fertility behavior is expected to change when fertility regulation information and methods and motivational messages about the small family norm and birth spacing is provided. There have been many problems in specification of measures of program evaluation of family planning effectiveness. The HARI index proposed by Jain in 1992 with modifications for a morbidity measure would best suit evaluation of family planning program effectiveness in client terms.

Judith Bruce

Papers

Fundamental elements of the quality of care: a simple framework.

The causes of unmet need for contraception and the social content of services

The Uncharted Passage: Girls' Adolescence in the Developing World

Setting standards of quality in family planning programs.

A reproductive health approach to the objectives and assessment of family planning programs.