Accessibility - man and woman on a bike

Ideas Addressing ACCESSIBILITY
The primary actor's opportunity to practice the behavior given external, usually physical constraints

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  • A Change in Diet Brings a Change in Health for Kenyan FarmersView Original Source

    The Big Idea: Although women comprise a majority of child caregivers and farmers, women often lack access to new training and techniques offered through agriculture extension services. This can impact productivity as well as family’s food diversity. This program trained farmer’s self-help groups, reaching primarily women farmers in Kenya.

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  • A Community Health Worker Intervention to Increase Childhood Disease Treatment Coverage in Rural Liberia: A Controlled Before-and-After EvaluationView Original Source

    The Big Idea: Health managers who aim to reduce childhood illness and mortality in rural areas, especially in environments that have poor accessibility and utilization of health care services, often rely on integrated case management of childhood illness (iCCM) by general community health workers (CHW).  Supporting CHWs with monthly payments, enhanced skills, and systematic supervision demonstrated reductions in child illness and mortality.

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  • A Disruptive Cue Improves Handwashing in School Children in ZambiaView Original Source

    The Big Idea: Behavioral economics holds great promise in changing patterns of behavior that influence human health, predicated on the idea of making a behavior as easy as possible to do. A study on handwashing in schools suggests that introducing a disruptive cue into the environment interrupted habitual neurological patterns to increase handwashing with soap.

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  • An Evaluation of Trauma Focused Cognitive Behavioral Therapy for Children in ZambiaView Original Source

    The Big Idea:  Broad-based psychosocial support in a variety of forms is the standard of care for Orphans and Vulnerable Children (OVC). Support services may consist of home visits, psychosocial counseling, and/or social activities, but there is limited evidence on the effectiveness of these programs in reducing trauma and stress related problems especially for children. This study assessed trauma-focused cognitive behavioral therapy for children 3-17 years and their parents or caregivers.

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  • An Island Nation's Health Experiment: Vaccines Delivered by DroneView Original Source

    The Big Idea:   Portfolio Managers tasked with overseeing vaccination programs in remote areas are likely familiar with how drone technology has improved over time. Drones now have the potential to rapidly increase delivery of vaccines to remote areas where accessibility has been severely limited due to great distance from any health services, difficult terrain, and severe weather conditions. Programs can reach the "last mile" through innovative partnerships and technology use, including on remote islands.

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  • Behavior Change Communication Model Enhancing Parental Practices for Improved Early Childhood Growth and Development Outcomes in Rural Armenia - A Quasi-Experimental StudyView Original Source

    The Big Idea:  Early childhood development (ECD) interventions to enhance parent practices in children's health and growth, protection from neglect, abuse, and injury have lifelong impact on health, learning, economic productiveness outcomes. Many programs consider integrating ECD through existing health delivery platforms. This study reviews how this can be done effectively and the results of this integration.

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  • Behavior Change without Behavior Change Communication: Nudging Handwashing among Primary School Students in BangladeshView Original Source

    The Big Idea:  Program planners who provide oversight of school-based handwashing programs for children are likely to be familiar with educational programs, training, and communication campaigns that help build self-efficacy and skills. Promising behavioral research has indicated that creating simple and cost effective environmental cues -- nudges -- such as a colorful path of footprints from the toilet to the handwashing station can also positively drive the unconscious decision-making processes to prompt children to wash their hands with soap and water.

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  • Building a Scalable Business in Ghana Because Every Family Deserves a ToiletView Original Source

    The Big Idea: WASH program managers have long been challenged on how to best address the safe disposal of feces in low resource settings where many households do not have access to toilets with connections to water in their homes. A low-cost toilet and waste removal service was designed to address these barriers.

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  • Building Support for Adolescent Sexuality and Reproductive Health Education and Responding to Resistance in Conservative Contexts: Cases from PakistanView Original Source

    The Big Idea: Well-designed, evidence-based sexuality education is an effective strategy to help young people delay first intercourse and use modern methods of contraception. However, school-based sexuality education often faces organized resistance from religious leaders and parent groups, among others. Building coalitions across communities, teachers, adolescent influencers, media, and religious leaders, gives programs better chance of success and scale-up.

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  • Can Behaviour Change Approaches Improve the Cleanliness and Functionality of Shared Toilets? A Randomised Control Trial in Dhaka, BangladeshView Original Source

    The Big Idea: Households living in urban slums often lack the space for their own toilet, making shared sanitation the only viable solution, but these are notoriously difficult to keep clean and functional. As a result, many people do not use toilets consistently. Conventional behaviour change messages around using toilets usually fail to address the real causes of unclean and poorly maintained facilities.

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  • Can Village Savings and Loan Groups be a Potential Tool in the Malnutrition Fight? Mixed Method Findings from Mozambique View Original Source

    The Big Idea: Many households lack money to purchase food to supplement home-grown stables, especially during recurring periods of extreme scarcity or sporadic crises. Village Savings and Loan Groups for women can help to smooth income during these times.

     

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  • Cash or Food Assistance Boosts HIV Treatment AdherenceView Original Source

    The Big Idea:  Following HIV treatment instructions is a challenge for many people, especially those who are food insecure.  This study found that food or cash transfers can help to improve HIV treatment adherence and retention among people faced with food insecurity.

     

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  • Cervical Cancer and the Story-telling Cloth in MaliView Original Source

    The Big Idea: Using arts, such as textiles, for communicating messages is a common practice in Mali and many other parts of Africa. This article describes the process of creating a new textile in Mali to increase use of services as a centerpiece of a campaign. More than beautiful art or a message, the textile tells a story of HPV and cervical cancer, and motivating screening that is meaningful to communities.

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  • CHN on the Go: Technology to Help Ghana's Frontline Nurses go the Extra MileView Original Source

    The Big Idea: Community Health Nurses (CHNs) often work in remote and under-served locations that leave them isolated from their peers and supervisors and without easy access to clinical knowledge. By creating a mobile application to address these challenges and involving nurses and managers as core partners in the design process, a useful tool was created to meet the users’ needs.

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  • Commitment Savings Accounts Help Farmers Invest in Their CropsView Original Source

    Social psychology has found that when people make commitments they are more likely to do a behavior.  Researchers tested this technique with smallholder farmers in rural Malawi. One type of account featured a commitment device that allowed the owner to restrict access to their own funds until a future date of their choosing.

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  • Community Health Workers: Bringing Family Planning Services to Where People Live and WorkView Original Source

    The Big Idea: Community health worker (CHW) programs can increase use of contraception, particularly where unmet need is high, access is low, and geographic or social barriers to use of services exist. 

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  • Community-level Impact of the Reproductive Health Vouchers Programme on Service Utilization in KenyaView Original Source

    The Big Idea: Innovative financing mechanisms can encourage the utilization of maternity services. Vouchers have the added advantage of giving the client the choice of health care providers.

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  • EDUCATE! Riding the Reform Wave to Scale Up Youth Entrepreneurship in Uganda View Original Source

    The Big Idea: The mismatch between what is taught in school and what skills are demanded by the labor market is far too common. This program narrows the gap by providing practical, real-world skills and experience for youth during the final two years of secondary school so that young people are equipped to begin employment.

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  • Effect of a Behaviour-Change Intervention on Handwashing with Soap in India (Superamma): A Cluster Randomized TrialView Original Source

    The Big Idea: In most countries, knowledge about the health benefits of handwashing with soap is high, but does not correspond to actual behavior change. Emotional, non-health messages focused around disgust were shown to be more effective, have a longer-lasting impact on handwashing behaviors, and have the potential to achieve sufficient scale for population-level impact.

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  • Effect of a Participatory Multisectoral Maternal and Newborn Intervention on Maternal Health Service Utilization and Newborn Care Practices: A Quasi-Experimental Study in Three Rural Ugandan Districts View Original Source

    The Big Idea: To improve newborn care practices, evidence-informed community-based strategies involve the training of community health workers, community mobilization and facility-based improvements. Improved newborn care practices are supported by combination of timely and appropriate services including facility delivery and home visits after childbirth.

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  • Efforts to Track Food Intake on Smartphone App Impacted by Day of Week but Not Season of YearView Original Source

    The Big Idea:  Dietary self-monitoring is a component of successful behavioral weight loss interventions and is essential for facilitating other behavior change techniques, e.g. setting goals, providing behavioral feedback. Few studies had examined time of dietary self-monitoring. This study found that the amount of time in a study and day of the week were associated with dietary self-monitoring.

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  • Employer-Based Models to Increase Support for and Provision of LA/PMs in IndiaView Original Source

    The Big Idea: Offering family planning services through employers is one way to increase access to services. This program tested the feasibility of sustaining access to services through small and medium enterprises that employ both men and women in India.

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  • Entrepreneurs and Value-Added Foods: How Capacity Building is Boosting Trade and Productivity in MalawiView Original Source

    The Big Idea:  To improve food product quality and productivity, and grow markets, farmers need reliable buyers and processors need reliable suppliers of raw materials. An initiative Malawi is helping value-add processers identify and meet opportunities in bringing the product to market and contribute to the nation’s overall economic and nutritional health.

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  • Factors Affecting Adoption of Improved Rice Varieties among Rural Farm Households in Central NepalView Original Source

    The Big Idea: The use of improved high yielding crop varieties is an important behavior for many small holder farmers to increase productivity and improve food security. Yet farmers do not adopt many new agricultural technologies, such as improved seeds, to the extent desired or expected. This analysis explored the probability of smallholder farmers adopting new improved rice varieties from two regions of Central Nepal.

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  • Free Malaria Tests Coupled with Diagnosis-Dependent Vouchers for Over-the-Counter Malaria TreatmentView Original Source

    The Big Idea: More than half of all Artemisinin combination therapy (ACTs) consumed globally are dispensed over the counter in the private retail sector, where diagnostic testing is uncommon. This leads to overconsumption and misuse of antimalarial drugs. Offering free tests and discount vouchers for ACT can improve rational use of the medicine.

     

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  • From Out of Reach to At Your Fingertips: How 1.4 Million Kenyans Are Gaining Access to HealthcareView Original Source

    The Big Idea: In places where lack of money prevents people from seeking health care treatment, digital technology can promote service use.

     

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  • From Struggling Milk Producer to Thriving Entrepreneur in Burkina FasoView Original Source

    The Big Idea: Increased access to animal source foods are critical to improved nutrition. In some places, like rural Burkina Faso, milk is not always available. Small business are trying to fill this need. This post discusses the factors associated with limitations to starting and maintaining small businesses that provide locally produced milk especially for women entrepreneurs.

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  • Gamification of Nutrition: A Preliminary Study on the Impact of Gamification on Nutrition Knowledge, Attitude, and Behavior of Adolescents in NigeriaView Original Source

    The Big Idea: Many young people around the world are consuming larger amounts of sugar, salt and saturated fats and less from traditional diets such as fruits, vegetables and high fiber foods, which can result in obesity, diabetes and other health challenges. Gamifying nutrition education for adolescents can increase intake of fruits and vegetables.

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  • Gender Norms and Economic Empowerment Intervention to Reduce Intimate Partner Violence Against Women in Rural Cote d'Ivoire: A Randomized Controlled Pilot StudyView Original Source

    The Big Idea: In a society where household power dynamics favor men, directly engaging men and women together on issues of gender norms led to gains in empowerment and reduction of intimate partner violence. Adding a gender dialogue component where men and women discussed household dynamics proved successful in extending benefits of a village savings and lending scheme.

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  • Getting Strategic with Interpersonal Communication: Improving Feeding Practices in BangladeshView Original Source

    The Big Idea:  Managers who oversee large-scale infant and young child feeding programs may rely primarily on mass media to spread the word about life-saving infant and young child nutrition behaviors.  Integrating strategic face-to-face communication that engages women and their families with mass media can accelerate positive outcomes.   

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  • Helping Farmers Talk Back to the Radio in TanzaniaView Original Source

    The Big Idea: Communication activities need rapid, cost-effective methods to get real-time feedback from audiences to be able to learn and adapt in a timely way. In Tanzania, Farm Radio added a return voice call back survey to radio listeners to get detailed feedback from their listeners on a radio program.

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  • How Smartphones are Becoming a Weapon in the Global Fight against TuberculosisView Original Source

    The Big Idea: Mobile technology with videos shows promising results in increasing TB drug adherence as well as the ease and efficiency of treatment for both health providers and TB patients.

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  • Human Papillomavirus Vaccine Introduction in South Africa: Implementation Lessons from an Evaluation of the National School-Based Vaccination Campaign View Original Source

    The Big Idea: HPV vaccination is a critical component of effective primary prevention against cervical cancer. Vaccinating girls prior to sexual debut (9 to 13 years) is the most cost-effective public health measure against cervical cancer in high-prevalence settings. Coverage tends to be highest when vaccination is delivered through school-based programs, but these campaigns need to carefully address potential vaccine hesitancies and rumors.

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  • Impact Evaluation of the Saving for Change Program in MaliView Original Source

    The Big Idea: Women’s informal savings groups are common around the world. Their formats can limit flexibility in responding to members' needs, particularly when it comes to loans or coping with unexpected expenses.

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  • Impact of an Intensive Perinatal Handwashing Promotion Intervention on Maternal Handwashing Behavior in the Neonatal Period: Findings from a Randomized Controlled Trial in Rural Bangladesh View Original Source

    The Big Idea: Infections in the neonatal period cause up to on-quarter of neonatal mortality, including pneumonia, sepsis, and infections of the umbilical cord. Handwashing with soap could potentially reduce the risk of infection during the vulnerable neonatal period.

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  • Impact of Social Franchising on Contraceptive Use When Complemented by Vouchers: A Quasi-Experimental Study in Rural PakistanView Original Source

    The Big Idea: In many rural areas, limited access to affordable contraceptive services results in low uptake of Long-Acting Reversible Contraception (LARC) methods. By establishing a network of high-quality private providers and offering vouchers for LARC methods, the program was able to address access and affordability issues that often prevent women from using them.

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  • Increasing Contraceptive Use Among Young Married Couples in Bihar, India: Evidence from a Decade of Implementation of the PRACHAR ProjectView Original Source

    The Big Idea: In contexts of early marriage, early and rapid repeat pregnancies among young married women, and inequitable social and gender norms, a comprehensive intervention is required. This review of program data over more than a decade of implementation sheds light on the key elements to sustained social and behavior change, including use of a socioecological intervention model; a gender-synchronized approach that engages both male and female partners; and intensity of interventions calibrated to different moments in the life cycle of young people.

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  • Increasing Vaccination: Putting Psychological Science Into ActionView Original Source

    The Big Idea: Managers who seek to increase vaccination uptake, especially in low resource settings, can improve vaccine uptake by leveraging existing thoughts and feelings to facilitate action through a combination of facilitating action, reducing logistical barriers and regulating.

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  • Informed Push Distribution of Contraceptives in Senegal Reduces Stockouts and Improves Quality of Family Planning ServicesView Original Source

    The Big Idea: Contraceptive stockouts in public health facilities in urban areas severely limit women and couple’s abilities to space births, and nation’s abilities to achieve their health and development goals. Senegal developed, tested and scaled up an “integrated push model” to reduce stockouts.

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  • Market-Testing a Smartphone Application for Family Planning: Assessing Potential of the Cyclebeads App in Seven Countries Through Digital Monitoring View Original Source

    The Big Idea: The Standard Days Method™ (SDM), a modern method of family planning, is a low-cost, highly acceptable family planning method. Mobile applications that provide women with a digital platform for practicing SDM may expand access and address a portion of global unmet need for family planning.

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  • Maternity Leave and Its Impact on Breastfeeding: A Review of the LiteratureView Original Source

    The Big Idea: Maternity leave and maternity protection are identified as important for breastfeeding support, but studies have showed inconsistent information between maternity leave and breastfeeding duration. This review clarifies the association between the length of maternity leave and breastfeeding duration by socioeconomic strata.

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  • Mexico and Hungary Tried Junk Food Taxes - and They Seem to Be WorkingView Original Source

    The Big Idea: Quickly rising rates of overweight and obesity require new solutions to support consumers to purchase and eat healthier food options. Some countries are trying taxes on junk foods. This report summarizes the key findings from Mexico and Hungary’s tax experiences.

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  • Motorcycle Ambulance Service: Understanding Emergency Transport in Kigezi, Uganda and Developing an Innovative Solution

    The Big Idea: Health managers seeking to reduce maternal mortality are often faced with the reality that skilled care and health facilities may not be within reach for the pregnant women who need them most, especially those requiring emergency care. To help mitigate long distances and high costs for transportation to reach skilled care, a novel motorcycle ambulance service helps women reach skilled obstetric care in adequate time for delivery.

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  • Nepal Scale up Chlorhexidine as Part of Essential Newborn Care: Country ExperienceView Original Source

    The Big Idea: The use of chlorhexidine for neonate cord care can reduce neonatal mortality and prevent severe cord infections. Countries now working to integrate the use of this life-saving intervention in newborn care can learn from Nepal’s experience of nationwide scale-up.

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  • No Lost Generation: Cash Transfers for Displaced Syrian Children in LebanonView Original Source

    The Big Idea:   Managers tasked with overseeing humanitarian efforts need to work with partners to finance and deliver services to meet the basic needs of displaced refugee children. Poor households often cannot afford even the residual costs of school participation including transport to school. A recent analysis of a monthly cash payment when children enroll in school shows the impact of this transfer on children's health and well-being, as well as school attendance.

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  • Offering Inputs for Sale When Farmers Have Liquidity Can Drive Up AdoptionView Original Source

    The Big Idea:   Improved agricultural technologies and inputs can raise productivity and incomes for smallholder farmers, but use of these promising technologies and inputs remains low in many settings. This study offered farmers an opportunity to receive partial payment for cash crop sales in the form of high-quality hybrid maize seed at the time of sale, thereby increasing use of improved seeds.

     

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  • Overcoming Hurdles in Handwashing: A Clinician's Perspective on Driving Change in Healthcare FacilitiesView Original Source

    The Big Idea: A large proportion of neonatal deaths are attributed to sepsis, sometimes acquired during delivery or post-natal care in a healthcare facility. Lessons from Cameroon’s effective initiative that improved hand hygiene practices of health providers can be scaled up to reduce neonatal sepsis worldwide.

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  • Perception and Adoption of a New Agricultural Technology: Evidence from a Developing CountryView Original Source

    The Big Idea: Sustainable growth of the agriculture sector critically depends on the adoption of improved technologies, including new disease-resistant and climate-adjusted seeds, modern management practices, and conservation of resources using new machinery.   This article reviews the experiences of introducing a more efficient irrigation machine in Bangladesh.

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  • Private Provider Mapping and Accreditation for Contracting: Lessons Learned from After Action ReviewView Original Source

    The Big Idea: Some very poor women are not able to use maternal health services.  This Activity in Uganda aims to change this picture by accrediting private providers to deliver a package of safe motherhood services, for which providers are then reimbursed through vouchers. 

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  • Proactive Community Case Management and Child Survival in Periurban MaliView Original Source

    The Big Idea: Urban and periurban poor often have as bad or even worse access to quality health services than rural counterparts; urban health systems need to respond to the unique situations faced by urban poor families. ‘Proactive case management’ in periurban neighborhoods can improve access and therefore timely care-seeking for childhood malaria.

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  • Promoting Clean Hands Among Children in Uganda: A School-Based Intervention Using "Tippy-Taps"View Original Source

    The Big Idea:  Handwashing with soap programs often focus on education without consideration of the enabling environment (i.e., water). School-based programs that teach and equip children to build simple and affordable handwashing stations have the potential to transform knowledge into behavior. In addition, children can act as agents of change and disseminate this information to their families.

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  • Realizing the Potential of a Homestead Food Production ProgramView Original Source

    The Big Idea: Programs often promote home gardens and provide nutrition education expecting benefits to both mothers and young children although lacking evidence from rigorous evaluation. This study shows the pathways to improved nutrition outcomes for women and children through home gardens.

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  • Saving for School with LockboxesView Original Source

    The Big Idea:  Commitment devices, which offer an opportunity to restrict future choices, have been shown to be effective in helping people save. However, severe restrictions can deter participation. This study assessed a program that offered different options to encourage students to save.

     

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  • Savings Groups as A Platform for Women's Political EmpowermentView Original Source

    The Big Idea:  In Sierra Leone, like many countries around the world, women comprise the majority of voters but are underrepresented in national and sub-national decision-making processes. This gap impedes progress in achieving gender equality and advancing inclusive development. Women’s savings group provide a platform to inspire and support women to take office.

     

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  • Smallholder Farmers Gain Access to Inputs, Finance and Markets through Senegal's Millet "Hubs"View Original Source

    The Big Idea: As agricultural produce yields improve with greater inputs, farmers need new ways of aggregating and using proper storage and marketing to ensure that their produce and earnings last throughout the seasons.  Millet Business Service Hubs offer a collective solution to making services, training and loans available as needed by producers.

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  • SMILE OVC Program Uses Targeted Approach to Boost TB Case-Finding Among Vulnerable ChildrenView Original Source

    The Big Idea: For children with TB and HIV co-infection, illness progression is likely to be rapid and fatal, thus early identification of both, as well as prompt treatment initiation and adherence, are crucial life-saving interventions. Yet, TB notification rates are often low.  One model for high-TB burden slum community settings has increased care and treatment for children through active case finding within an Orphan and Vulnerable Children (OVC) program.

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  • Social Media May Help Seniors in Pain Ward Off DepressionView Original Source

    The Big Idea: People who experience pain and chronic illnesses often become isolated, which can lead to depression.  This may lead to even more limited use of health services and home-based practices. A new study finds that people who experience isolation benefit from using social media.

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  • System Redesign of the Immunization Supply Chain: Experiences from Benin and MozambiqueView Original Source

    The Big Idea: Even as health system improvement work continues to ensure that supply chains deliver needed vaccines, they face new, additional challenges due to growing populations and new vaccine introductions. Redesigning supply chains by introducing informed push systems and streamlining storage and distribution tiers can improve vaccine availability.

     

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  • The Effect of Farmer Nutrition Schools on Household Food Production and Women's Dietary Diversity in Bangladesh View Original Source

    The Big Idea: Even as trends in nutrition improve in rural areas, pregnant and lactating women may lack needed nutrients for their own health and their child’s health and growth. A multi-sectoral model that combined a farmer field school model with nutrition and hygiene education into farmer for the poorest women demonstrated improved results through women’s dietary diversity.

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  • Trial of a Novel Intervention to Improve Multiple Food Hygiene Behaviors in NepalView Original Source

    The Big Idea: Research into food hygiene is often a neglected area of diarrhea and undernutrition prevention programs. While a number of studies have assessed risk factors and microbial contamination in food, few have developed or tested interventions to counter this problem in domestic settings. This trial assessed whether an intervention could improve multiple food hygiene behaviors in 4 villages in rural Nepal.

     

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  • Tubaramure, a Food-Assisted Integrated Health and Nutrition Program, Reduces Child Stunting in Burundi: A Cluster-Randomized Controlled Intervention TrialView Original Source

    The Big Idea: Food assistance within maternal and child health and nutrition programs is often used to address undernutrition. This rigorous study in Burundi evaluates the effectiveness of food assistance in improving child linear growth.

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  • Two Promising Social Accountability Approaches to Improve Health in Malawi: Community Score Cards, and National Health Budget Consultation, Analysis and Advocacy View Original Source

    The Big Idea: In many countries, effective participation and community voice in health programming remains an obstacle as communities do not know their rights or have channels to share feedback with authorities, and local government may not have full autonomy in budget planning and allocation. The Community Scorecard offers one cost-effective model for strengthening communities’ ability to use information from the local level to the national level in order to hold duty bearers accountable. 


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  • Using a Community-Based Early Childhood Development Center as a Platform to Promote Production and Consumption Diversity Increases Children's Dietary Intake and Reduces Stunting in Malawi: A Cluster-Randomized TrialView Original Source

    The Big Idea: Early childhood development (ECD) platforms have the potential to deliver child development and nutrition interventions. This study explored the additional opportunity of utilizing this platform to deliver nutrition-sensitive agriculture support to families with young children.

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  • Using Community Health Workers to Refer Pregnant Women and Young Children to Health Care Facilities in Rural West Bengal, India: A Prospective Cohort StudyView Original Source

    The Big Idea: Health managers who oversee maternal and child health programs in medically underserved areas are likely familiar with the important role of community health workers (CHWs) who reach marginalized and underserved populations.  When CHWs screen for risk, pregnant women and caregivers of young children may be more likely to seek timely and appropriate services.

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  • Where Do Female Sex Workers Seek HIV and Reproductive Health Care and What Motivates These Choices? A Survey in 4 Cities in India, Kenya, Mozambique and South Africa View Original Source

    The Big Idea: Programs that work to increase timely use of reproductive health care services benefit from understanding what motivates people to seek services and choose from available services.

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  • “Cool Foam”: How Constraint Yields NoveltyView Original Source

    The Big Idea: Health managers seeking to reduce diarrheal and respiratory disease often promote handwashing with soap as a powerful preventive tool. In many communities, however, soap is considered an expensive luxury and water is scarce. A promising new product concept, “Cool Foam,” creates a foamy soap and “stretches” the amounts of soap and water for effective handwashing.

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