Reproductive health (RH) outcomes worsen during conflict and displacement, the causes of which are considered multi-factorial. In conflict and displacement settings, there are unique challenges in providing emergency obstetric care. There has been increased recognition of the need to provide adequate RH in emergency responses. Providing appropriate assistance to populations affected by conflict requires continued monitoring and evaluation, and the further development of life-saving interventions. Learning objectivesTo understand the effect of conflict on RH. To discuss the reasons why RH outcomes worsen during conflict and displacement.To consider the ways in which responses can be made during an emergency. Ethical issuesShould RH be considered a priority during an emergency response to conflict and disasters? Does offering RH assistance to conflict-affected populations put other local groups at a disadvantage? Will greater knowledge of how conflict and displacement affect RH help in understanding and treating refugees and asylum seekers in the UK?

IntroductionGeographic access to family planning (FP) services has been characterised through a variety of proximity metrics. However, there is little evidence on the validity of women’s self-reported compared with modelled travel time to an FP outlet, or between different distance measures.MethodsWe used data from four urban sites in Kenya. A longitudinal FP outlet census was directly linked with data from cross-sectional FP user surveys. We combined characteristics of outlet visited to obtain FP, transport mode, self-reported travel time and location of households and outlets with data on road networks, elevation, land use and travel barriers within a cost-distance algorithm to compute modelled travel time, route and Euclidean distance between households and outlets. We compared modelled and self-reported travel times, Euclidean and route distances and the use of visited versus nearest facility.Results931 contraceptive users were directly linked to their FP source. Self-reported travel times were consistently and significantly higher than modelled times, with greater differences for those using vehicles rather than walking. Modelled and Euclidean distances were similar in the four geographies. 20% of women used their nearest FP outlet while 52% went to their nearest outlet when conditional on it offering their most recently used FP method.ConclusionIn urban areas with high facility density and good road connectivity, over half of FP users visited their nearest outlet with their chosen method available. In these settings, Euclidean distances were sufficient to characterise geographic proximity; however, reported and modelled travel times differed across all sites.

Accurately testing, treating, and tracking all malaria cases is critical to achieving elimination. Ensuring health providers are able and motivated to test, treat, and report cases is a necessary component of elimination programs, and particularly challenging in low endemic settings where providers may not encounter a large volume of cases. With funding from the Bill & Melinda Gates Foundation, this study aimed to identify and validate distinctive subtypes of motivation among private sector providers enrolled in the Greater Mekong Subregion Elimination of Malaria through Surveillance (GEMS) program, implemented by Population Services International. Quantitative questionnaires were administered electronically in person by trained enumerators to various provider groups in Myanmar, Lao PDR, and Vietnam. A three-stage confirmatory factor analysis was then conducted in STATA. Following this analysis, a two-factor solution that describes motivation in this population of providers was identified, and providers were scored on the two dimensions of motivation. Provider motivations were analyzed by provider characteristics, and associations with intentions and outcomes related to malaria service provision were explored. These providers, who are often assumed to only be financially motivated, engaged in malaria elimination activities because of both internal and external motivational factors that are independent of remuneration or financial gain. Motivation varied by provider characteristics and was associated with outcomes of importance to malaria elimination. Understanding components of provider motivation to test, treat, and report malaria cases in elimination settings will ensure that malaria programs can establish mechanisms to encourage lasting engagement by providers in pursuit of elimination goals.

Background Accurately testing, treating, and tracking all malaria cases is critical to achieving elimination. Ensuring health providers are able and motivated to test, treat, and report cases is a necessary component of elimination programmes, and particularly challenging in low endemic settings where providers may not encounter a large volume of cases. This study aimed to understand provider motivations to test, treat, and report malaria cases to better optimize programme design, adjust incentive schemes, and ultimately improve reporting rates while growing the evidence base around private providers in the Greater Mekong Subregion (GMS). Methods With funding from the Bill & Melinda Gates Foundation, this study aimed to identify and validate distinctive subtypes of motivation among private sector providers enrolled in the Greater Mekong Subregion Elimination of Malaria through Surveillance (GEMS) programme, implemented by Population Services International. Quantitative questionnaires were administered electronically in person by trained enumerators to various provider groups in Myanmar, Lao PDR, and Vietnam. A three-stage confirmatory factor analysis was then conducted in STATA. Results Following this analysis, a two-factor solution that describes motivation in this population of providers was identified, and providers were scored on the two dimensions of motivation. The correlation between the two rotated factors was 0.3889, and the Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy was 0.93, indicating an excellent level of suitability. These providers, who are often assumed to only be financially motivated, engaged in malaria elimination activities because of both internal and external motivational factors that are independent of remuneration or financial gain. For all three countries’ data, significant covariances between the two latent variables for internal and external motivation were found. The models were found to be of adequate to good fit for the data across all three countries. It was determined that private sector providers, who were previously believed to be primarily financially motivated, were also motivated by personal factors. Motivation was also associated with key outcomes of importance to malaria elimination, such as reporting and stocking of tests and treatments. Conclusion Maintaining or increasing provider motivation to test and treat is essential in the fight to eliminate malaria from the GMS, as it helps to ensure that providers continue to pursue this goal, even in a low incidence environment where cases may be rare and in which providers face financial pressure to focus on areas of health service provision. Establishing mechanisms to better motivate providers through intrinsic factors is likely to have a substantive impact on the sustainability of malaria case management activities.

Community health workers and facility-based providers in the public and private sectors successfully added the Caya diaphragm to their offering and found this new self-care contraceptive method of interest to many clients, including women who had never used modern contraception. n Women and men described a unique value proposition for Caya: the product causes no side effects for most users, works on demand, and is reusable for up to 2 years. n Most women who adopted Caya continued to use it after 6 months. The top reasons for discontinuation were the desire for pregnancy and concerns about effectiveness of the method.