Publication: Applying the WHO Strategic Approach to Strengthening First and Second Trimester Abortion Services in Mongolia
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Published
2008
ISSN
0968-8080
Date
2012-03-30
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Abortion was made legal on request in Mongolia in 1989, following the collapse of the socialist regime, and later bound by a range of regulations. Concerned about the high number of abortions and inadequate quality of care in abortion services, the Ministry of Health applied the World Health Organization's Strategic Approach to issues related to abortion and contraception in 2003. The aim was to develop policies and programmes to reduce unintended pregnancies, mitigate complications from unsafe abortion, and improve the quality of abortion and contraception services for all socio-economic groups, including adolescents. This paper describes the changes that arose from a strategic assessment, highlighting the introduction of mifepristone-misoprostol for second trimester abortion. The aim was to replace mini-caesarean section and intra-uterine injection of Rivanol (ethacridine lactate), so that second trimester abortions could take place earlier than at 20 weeks gestation. Notional standards and guidelines for comprehensive abortion core were developed, the national pre-service training curriculum was harmonised with the new guidelines, at least one-third of the country's obstetrician-gynaecologists were trained in manual vacuum aspiration and medical abortion, and three model comprehensive abortion care units were established to provide high quality services to women, high quality training for providers and serve as nodes for further scaling up. (c) 2008 Reproductive Health Matters. All rights reserved.
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Publication Comparison of Vaginal and Sublingual Misoprostol for Second Trimester Abortion : Randomized Controlled Equivalence Trial(2009)BACKGROUND: To identify an effective misoprostol-only regimen for the termination of second trimester pregnancy, we compared sublingual and vaginal administration of multiple doses of misoprostol in a randomized, placebo-controlled equivalence trial. METHODS: Six hundred and eighty-one healthy pregnant women requesting medical abortion at 13-20 weeks' gestation were randomly assigned within 11 gynaecological centres in seven countries into two treatment groups: 400 microg of misoprostol administered either sublingually or vaginally every 3 h up to five doses, followed by sublingual administration of 400 microg misoprostol every 3 h up to five doses if abortion had not occurred at 24 h after the start of treatment. We chose 10% as the margin of equivalence. The primary end-point was the efficacy of the treatments to terminate pregnancy in 24 h. Successful abortion within 48 h was also considered as an outcome along with the induction-to-abortion-interval, side effects and women's perceptions on these treatments. RESULTS: At 24 h, the success (complete or incomplete abortion) rate was 85.9% in the vaginal administration group and 79.8% in the sublingual group (difference: 6.1%, 95% CI: 0.5 to 11.8). Thus, equivalence could not be concluded overall; the difference, however, was driven by the nulliparous women, among whom vaginal administration was clearly superior to sublingual administration (87.3% versus 68.5%), whereas no significant difference was observed between vaginal and sublingual treatments among parous women (84.7% versus 88.5%). The rates of side effects were similar in both groups except for fever, which was more common in the vaginal group. About 70% of women in both groups preferred sublingual administration. 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The IFC Russia Cleaner Production Program encountered that question when initiating a benchmarking study of the ferrous foundry sector in Russia. The author knew that no agent of change is more powerful than an idea. The key is to get the idea firmly planted in the hearts and minds of the participants, who then will act on it and achieve the desired impact. To engage the whole sector in converting to resource-efficiency practices, the author had to approach communications strategically. The objective: root the use of benchmarking in the minds of sector decision makers and engage multiple stakeholders the author did not have direct access to and convince them to participate in the study. This smart lesson outlines the three keys to effective strategic communications, which can apply to any Advisory Services (AS) program with a similarly ambitious target of changing the mindset of stakeholders.Publication Applying the HDM-4 Model to Strategic Planning of Road Works(World Bank, Washington, DC, 2008-09)The Highway Development and Management Model (HDM-4) is a software system for evaluating options for investing in road transport infrastructure. Worldwide, the HDM-4 model is most commonly used as a basis for feasibility studies, in which a road project is evaluated in terms of its economic viability. A more comprehensive type of evaluation based on HDM-4 is a network evaluation, which assesses an entire road network to help decision makers in their strategic planning of road investments and/or the definition of a rational road works program, with or without budget constraints. A network economic evaluation is the most challenging use of the model, but the effort is well justified given the potential savings to be achieved on transport costs by comparing various project alternatives and performing an optimization under budget constraints. This technical note presents the author's experience applying HDM-4 and its predecessor, the Highway Design and Maintenance Standards Model (HDM-III), to road network strategic planning evaluations in developing countries, with the objective of providing recommendations and tools to the readers who are involved in strategic planning activities. The purpose of the evaluations, the methodology itself, the input requirements, the challenges, and the presentation of results to decision makers are each reviewed in turn.
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