tailieunhanh - Accelerating reproductive and child health programme impact with community-based services: the Navrongo experiment in Ghana

Assisted reproductive technologies (ART) have enabled millions of people in the world to have biological children who otherwise would not have been able to do so. According to the European Society for Human Reproduction and Embryology, more than three million babies have been born using ART worldwide in the last 30 years, enabling infertile women and men; single women and men; and lesbian, gay, and transgender couples to form genetically-related families. These new technologies have transformed the way we view reproduction. While they have created new hopeful possibilities, they also require that we pay attention to issues of health, ethics,. | Accelerating reproductive and child health programme impact with community-based services the Navrongo experiment in Ghana James F Phillips 3 Ayaga A Bawah a Fred N Binkab Objective To determine the demographic and health impact of deploying health service nurses and volunteers to village locations with a view to scaling up results. Methods A four-celled plausibility trial was used for testing the impact of aligning community health services with the traditional social institutions that organize village life. Data from the Navrongo Demographic Surveillance System that tracks fertility and mortality events over time were used to estimate impact on fertility and mortality. Results Assigning nurses to community locations reduced childhood mortality rates by over half in 3 years and accelerated the time taken for attainment of the child survival Millennium Development Goal MDG in the study areas to 8 years. Fertility was also reduced by 15 representing a decline of one birth in the total fertility rate. Programme costs added US per capita to the US per capita primary health care budget. Conclusion Assigning nurses to community locations where they provide basic curative and preventive care substantially reduces childhood mortality and accelerates progress towards attainment of the child survival MDG. Approaches using community volunteers however have no impact on mortality. The results also demonstrate that increasing access to contraceptive supplies alone fails to address the social costs of fertility regulation. Effective deployment of volunteers and community mobilization strategies offsets the social constraints on the adoption of contraception. The research in Navrongo thus demonstrates that affordable and sustainable means of combining nurse services with volunteer action can accelerate attainment of both the International Conference on Population and Development agenda and the MDGs. Bulletin of the World Health Organization 2006 84 949-955. Voir page .