inTroduCTion To The series of modules in The guide

Document Sample
inTroduCTion To The series of modules in The guide Powered By Docstoc
					inTroduCTion To The series of modules
in The guide

Policymakers	 and	 program	 planners	 are	                       While	 the	 Cochrane	 Collaboration	 reviews	
faced	 with	 a	 wide	 array	 of 	 evidence	 when	                provide	meta-analyses	of 	randomized	clinical	
designing	 reproductive	 health	 interventions.	                 trials,	 there	 are	 many	 health	 problems	 in	
The	 current	 push	 for	 “best	 practices”	 is	 an	              developing	 countries	 that	 are	 not	 amenable	
attempt	to	evaluate	the	evidence	on	programs	                    to	investigation	using	this	methodology.	This	
and	 interventions	 and	 highlight	 those	 that	                 guide	also	adds	to	the	ongoing	work	on	best	
are	most	effective.	With	scarce	resources	for	                   practices	in	reproductive	health.
reproductive	health	and	growing	demand	for	
services,	 program	 priorities	 must	 be	 based	                 This	 guide	 on	 PAC,	 in	 contrast	 to	 the	
on	 effective	 interventions.	 Most	 scientific	                 companion	 volume	 on	 Safe	 Motherhood	
and	 biomedical	 research	 on	 reproductive	                     (Gay	et	al.,	2003),	has	drawn	on	unpublished	
health	 interventions	 has	 been	 written	 for	                  reports	to	supplement	the	research	published	
scientists;	 little	 has	 been	 written	 specifically	           in	peer-reviewed	publications	because	of 	the	
for	policymakers.	This	guide	is	intended	for	                    limited	 amount	 of 	 published	 literature	 on	
policymakers	and	program	planners	who	are	                       PAC.	 Biomedical	 information	 is	 included	
designing	 reproductive	 health	 interventions	                  insofar	 as	 it	 is	 relevant	 to	 programmatic	
and	 who	 are	 deciding	 among	 priority	                        considerations.	
interventions.	 Organizations	 that	 provide	
assistance	 to	 programs	 worldwide	 may	 also	                  Furthermore,	 the	 modules	 in	 this	 guide	
benefit	from	this	guide.                                         categorize	these	interventions	by	those	that	
                                                                 are	effective,	those	that	may	be	on	the	cutting	
This	guide,	What Works: A Policy and Program                     edge	 but	 for	 which	 sufficient	 evidence	
Guide to the Evidence on Postabortion Care, provides	            has	 not	 yet	 been	 gathered,	 and	 common	
a	summary	of 	the	evidence	that	documents	                       interventions	that	are	not	effective.	This	guide	
the	 effectiveness	 of 	 various	 interventions.	                includes	policy	and	program	issues	related	to	
This	guide	will	be	useful	to	those	developing	                   reproductive	 health.	 Most	 evidence	 cited	 in	
guidelines	for	best	practices.                                   the	guide	comes	from	studies	in	developing	
                                                                 countries;	 however,	 when	 such	 research	
The	 modules	 in	 this	 guide	 provide	                          was	 not	 available,	 evidence	 from	 developed	
information	 complementary	 to	 the	                             countries	was	included.
biomedical	information	from	clinical	studies	
in	 the	 WHO	 Reproductive	 Health	 Library,	                    In	 contrast	 to	 the	 Cochrane	 Collaboration,	
based	on	the	Cochrane	Collaboration.	1                           the	authors	have	not	reanalyzed	the	data	on	
 	                                                               interventions,	 rated	 the	 grades	 of 	 evidence,	
                                                                 or	presented	an	analysis	of 	the	implications	
1	The	Cochrane	Collaboration,	an	international	resource	for	     of 	 the	 data.	 For	 some	 interventions,	
evidence-based	medicine	in	all	specialties,	is	a	continuously	
updated	review	of 	randomized	controlled	trials	(PANOS,	
                                                                 many	 large-scale	 studies	 including	 some	
2001).	Information	on	the	Cochrane	Collaboration	and	the	        randomized	 controlled	 trials	 are	 listed;	 for	
related	WHO	Reproductive	Health	Library	is	available	at	         other	 interventions,	 supporting	 research	 is	or

What Works: Postabortion Care                                                                                          
     available	from	only	one	study	using	a	small	              evidence	that	falls	in	strength	levels	I,	II,	IV,	
     sample	size.	With	review	articles,	the	original	          and	 V	 is	 included.	 The	 evidence	 presented	
     studies	are	cited	as	reported	in	the	review.	An	          in	 the	 guide	 represents	 the	 best	 available	
     attempt	 has	 been	 made	 to	 use	 the	 original	         research	on	reproductive	health	interventions	
     studies	 and	 primary	 sources,	 but	 where	 the	         the	 authors	 were	 able	 to	 gather	 at	 the	 time	
     original	 could	 not	 be	 located,	 the	 authors	         each	module	was	published.	In	the	“Summary	
     relied	 on	 review	 articles.	 Evidence	 from	            of 	Evidence”	column,	the	authors	have	noted	
     review	 articles	 is	 clearly	 noted	 (e.g.,	 x	 cited	   whether	 the	 preponderance	 of 	 evidence	 is	
     in	y).	                                                   strong	 or	 whether	 the	 issue	 related	 to	 PAC	
                                                               needs	 more	 evidence	 (e.g.,	 “needs	 more	
     Gray	 (1997)	 lists	 the	 five	 strengths	 of 	           research”).	 The	 “Gray	 Type”	 column	 refers	
     evidence	in	research:                                     to	Gray	Scale’s	strength	of 	evidence	for	each	
                                                               particular	study.	
      Type             Strength of evidence
                                                               This	 PAC	 guide	 attempts	 to	 address	 the	
         I      Strong	evidence	from	at	                       issues	 of 	 cost	 and	 sustainability.	 Unlike	 the	
                least	one	systematic	review	                   companion	volume	on	Safe	Motherhood	(Gay	
                of 	multiplewell	designed,	                    et	 al.,	 2003),	 which	 did	 not	 cover	 the	 issues	
                randomized	controlled	trials.                  of 	cost,	equity,	and	sustainability,	the	data	on	
                                                               PAC	 provide	 some	 clear-cut	 cost	 data.	 PAC	
         II     Strong	evidence	from	at	                       studies,	which	provide	cost	data,	are	included	
                least	one	properly	designed,	                  in	this	guide.	
                randomized	controlled	trial	of 	
                appropriate	size.                              This	module	is	organized	as	follows:	

        III     Evidence	from	well-designed	                   •    Introduction	summarizing	critical	issues.
                trials	without	randomization,	                 •    Effective	interventions,	presented	in	table	
                single	group	pre-post,cohort,	                      format,	with	the	summary	of 	the	evidence	
                time	series,	or	matched	case-                       related	 to	 the	 interventions	 in	 the	 left	
                control	studies.                                    hand	column	and	details	of 	the	relevant	
                                                                    research	that	supports	the	intervention	or	
        IV      Evidence	from	well-designed,	                       particular	policy	direction	in	the	right	hand	
                non-experimental	studies	from	                      column.	The	interventions	are	listed	in	the	
                more	than	one	center	or	research	                   table	of 	contents	of 	the	module	and	are	
                group.                                              organized	by	the	three	core	components	
                                                                    of 	 the	 new	 USAID	 PAC	 strategy:	 1)	
         V      Opinions	of 	respected	                             emergency	treatment;	2)	family	planning	
                authorities,	based	on	clinical	                     counseling	 and	 service	 delivery	 with	
                evidence,	descriptive	studies,	or	                  provision	of 	selected	reproductive	health	
                reports	of 	expert	committees.                      services	 (STI	 evaluation	 and	 treatment;	
                                                                    and	 HIV	 counseling	 and/or	 referral	
                                                                    for	 HIV	 testing);	 and	 3)	 community	
     The	evidence	available	for	this	guide	primarily	               empowerment	via	community	awareness,	
     falls	 in	 strength	 level	 III;	 however,	 some	              and	mobilization.	

10                                                                                   What Works: Postabortion Care
•   Policy	and	program	issues	(such	as	access	        References	 to	 a	 number	 of 	 important	 PAC	
    to	care	and	quality	of 	care).                    interventions	 and	 studies	 are	 repeated	
•   Web-based	 resources	 for	 program	               in	 a	 number	 of 	 sections	 of 	 this	 module	
    design.                                           for	 example	 in	 the	 emergency	 treatment,	
•   References	and	clinical	manuals.                  counseling,	training,	and	policy	sections.	
•   Annotated	index	of 	interventions.                 	
                                                      Regular	 updates	 will	 be	 posted	 to	
It	is	important	to	note	that	high-quality	PAC	        the	 online	 document	 available	 at	          	
is	 a	 package	 or	 constellation	 of 	 services.
This	 package	 includes	 a	 reorganization	 of 	       	
services;	 infection	 control	 practices;	 patient	   In	addition,	a	CD-ROM	version	of 	the	guide	
information	 and	 informed	 consent	 for	             will	be	made	available.
emergency	treatment	and	pain	management.	
Patient	 information	 and	 counseling	 related	
to	 possible	 complications,	 follow-up	 care	
at	 home;	 family	 planning	 counseling	 and	
services,	 information	 on	 return	 to	 fertility;	
and	information	and	services	related	to	STI/
HIV/AIDS	 is	 also	 a	 part	 of 	 the	 package	
of 	 services.	 Community	 empowerment	
via	 awareness	 and	 mobilization	 to	 address	
these	issues	is	new	to	the	postabortion	care	
package	so	fewer	interventions	have	included	
these	components.	

What Works: Postabortion Care                                                                            11

Shared By:
gregoria gregoria