Summer 1998 Issue
$1.4 Million in Grants from the Gates Foundation
The William H. Gates Foundation has awarded the Center $1.4 million over the next three years for three new projects: "Effective Reproductive Health Services for Refugees," "Integrating Family Planning/HIV Prevention in a Rural Uganda Setting," and "Preventing Maternal Mortality in Africa."
The funding, the first ever to be awarded to Columbia University from the newly formed Gates Foundation, represents the Foundation's desire to support population and reproductive health issues in economically deprived areas.
James McCarthy is the P.I. for the three projects, which are supported by three separate grants of $590,000, $160,000 and $610,000 respectively.
Therese McGinn and Roger Vaughan are the coordinators for the "refugee" project. They will work with international relief agencies to develop, implement and evaluate programs providing family planning and reproductive health services to people forced to flee their homes -- perhaps a population in greatest need of family planning and reproductive health services.
The United Nations estimates that, in 1997, approximately 38 million people were either refugees (people who have fled their home country) or were displaced within their own country. For these individuals, access to all health care, but particularly reproductive health care, is severely limited. And because the international family planning and reproductive health communities have such limited experience working with these groups, there are few models to follow.
For this project, the Center will continue to establish linkages and conduct workshops similar to the week-long workshop in Kenya last fall with the International Rescue Committee (IRC), at which Vaughan and McGinn called attention to the technical areas of design, monitoring and evaluation that are key to successful health service programs.
In addition, the project has three components to help relief agencies as they attempt to deliver reproductive health services to refugees. These components involve capacity-building within the relief agencies to develop appropriate design, monitoring and evaluation models for effective reproductive health projects; field-testing of the resulting reproductive health and family planning service delivery models; and dissemination of lessons about the processes and results of the field efforts within the participating agencies and to the field at large.
The new "family planning" project, coordinated by Maria Wawer, will complement the massive "STD Control and AIDS Prevention in Uganda" project, which has now entered its final year.
Family planning programs in rural areas of Uganda face two major hurdles. First, like many other very poor, rural African communities, rural Uganda is largely unserved by effective primary health programs. Being among the poorest people on the poorest continent places most rural Ugandans outside the reach of family planning and reproductive health programs.
Second, in the presence of high deaths rates from HIV/AIDS, research in Uganda shows an ambivalence towards family planning. Some report an interest in the adoption of family planning as a response to economic burdens, including the burdens of HIV. Others report concern that family planning would further reduce the population already suffering from high levels of AIDS mortality.
Yet all recognize that increased condom use would be an important strategy for reducing exposure to HIV, while at the same time contributing to lower fertility. In the face of these conflicting sentiments, there is a pressing need to determine how family planning services can best be implemented in populations facing an HIV epidemic.
The Center's long-standing presence in Uganda, and its strong HIV prevention efforts there, make it extremely well-qualified to undertake such a project.
Deborah Maine will coordinate the new "maternal mortality" project. Through the 1990s, Maine led the Prevention of Maternal Mortality program, which worked with colleagues in anglophone West Africa to develop and implement effective programs to prevent maternal deaths. The project continues today as an entirely African entity through an NGO based in Ghana called the Regional Prevention of Maternal Mortality Program.
Approaches developed by the Center to reduce maternal mortality over the past eight years have become the policies of major international health organizations. The new Gates funding allows the Center to build upon this experience of the PMM program and work with networks of African institutions to extend maternal mortality prevention efforts to East Africa and to francophone West Africa.
The World Health Organization estimates that nearly 600,000 women die each year from pregnancy complications, and almost all of these deaths are in the developing world.
Each of these three projects represents a set of activities that the Center views as critical if the international family planning and reproductive health communities are to build on the successes of recent decades. The Center is grateful to the Gates Foundation for its generous funding and commitment to such issues.
Two New Sponsors for the Young Men's Clinic
Funding Now Available for a Full-Time MSW
The Young Men's Clinic has received one-year grants from the New York Community Trust and the Indian Point Foundation for $60,000 and $25,000, respectively. This new funding enables the YMC to hire a full-time, masters-level social worker (MSW) and to cover a portion of the costs for medical providers at the clinic.
Currently, the YMC operates on Monday nights. According to clinic coordinator Bruce Armstrong, a full-time MSW will work the rest of the week performing a multitude of much-needed tasks that will greatly improve the quality of clinic services. These tasks include rigorous case management, group work outside of the clinic, identifying young men in the neighborhood who would most benefit from clinic services, and establishing linkages to other young men's services in the city.
In terms of case management, the new MSW can follow patients across programs, systems and geographic areas -- informing them of services, helping them make initial connections, brokering when necessary, ensuring appointments are kept, and tracking the men to ensure that services are appropriate.
Group work outside of clinic hours can address three common and important issues for many young men who come to the clinic: managing stress; developing job-related skills; and, for those who are already fathers, connecting or reconnecting to their children.
Drawing "high risk" young men into the clinic is the YMC's most effective means for reducing STDs, unwanted pregnancies, violence, disillusionment and substance abuse in Washington Heights. The MSW can regularly visit key sites in the neighborhood -- such as the Morgan Place Prenatal Clinic or the Center's many clinics and community outreach programs -- where health colleagues might know of such young men or their girlfriends.
Establishing linkages to local educational, vocational, employment and mental health services for young men can not only benefit YMC patients, but also publicize the YMC's valuable services to those who are unfamiliar with the clinic. The MSW can establish personal contact with key "gatekeepers" of each agency, and at the same time provide information on how to access YMC services.
Bruce Armstrong hopes to hire an English/Spanish-speaking MSW by the end of the summer, which will allow the social worker to establish himself for the new school year.
An Intensive Summer Seminar in Reproductive Health
Applications and inquiries are flow ing in for the first of a series of in tensive Center-based seminars for health professionals.
The week-long course, entitled "Planning Reproductive Health Programs: An Intensive Seminar in the Effective Design, Monitoring and Evaluation of Reproductive Health Programs in Developing Countries," seems to be striking at a core need for many health professionals.
"Several of the applicants said they have been grappling with the issue of how to systematically approach the design of a program with the end goals of monitoring and evaluation," said Roger Vaughan, who is facilitating the seminar with Therese McGinn. "The learning objectives fit quite specifically with the types of tasks they have in mind."
The learning objectives are for participants to understand and be able to use practical, empirically based planning tools for the design, monitoring and evaluation of reproductive health interventions; to be able to choose appropriate indicators and data collection methods to monitor and evaluate interventions; and to improve their skills in interpreting project-generated data and applying other health-related information to project design and evaluation.
"One prospective participant told us that the timing of this course couldn't be more perfect," said McGinn. "She will start to design a complex health program for her organization this summer."
While most applicants are mid-level or senior health professionals working on reproductive service delivery projects in both the United States and abroad, workers trained in other fields but working on health projects have also expressed interest in the seminar. One such participant, with a background in human rights, enrolled in the seminar to give herself a more solid grounding in health and program design issues.
With such a diversity of applicants, McGinn and Vaughan expect the seminar to be highly participatory. These two faculty members will lead most of the sessions but will call upon other Center faculty who have already volunteered their expertise.
The seminar runs Monday July 13 to Friday July 17 in the Irving Center Conference Room. Brochures are available at the Center. For more information, contact Vaughan (212-304-5211) or McGinn (212-304-5224).
FIGO Putting Stock in PMM
The International Federation of Gynecology and Obstetrics (FIGO) will use the methodology developed by the staff of the Center's Prevention of Maternal Mortality program in undertaking its needs assessment and implementing subsequent demonstration projects for a new maternal mortality initiative.
This methodological approach is described in three PMM publications, on which Deborah Maine is the lead author or editor: "Guidelines for Monitoring the Availability and Use of Obstetric Services," published jointly by UNICEF, UNFPA and WHO; "The Design and Evaluation of Maternal Mortality Programs," published by the Center; and the papers from the 1996 PMM Results Conference, as presented in a special supplement to the International Journal of Gynecology and Obstetrics, the official FIGO publication.
Allan Rosenfield commented that PMM has been a remarkable program since its inception, perhaps the most important activity in this field, and that this is demonstrated, in part, by the outstanding materials that PMM has prepared .
"FIGO is building its international effort around materials prepared by PMM, with technical assistance to be provided by Deborah Maine and other PMM staff," said Rosenfield. "This alone is testimony to the importance of the PMM work of the last decade."
Faculty Activities, In Brief...
Linda Cushman was promoted to the rank of Associate Clinical Professor of Public Health by the Health Sciences Committee on Appointments and Promotions in March. Cushman's recent work on condom use and long-term contraception will be published later this year in Family Planning Perspectives. She is currently envolved in the home-based STD screening project in Washington Heights, coordinating the efforts of a handful of local health workers as they test for syphilis, gonorrhea, chlamydia and trichomoniasis is a sample of 200 households.
Martin Gorosh helped develop the Family Planning Program Monitoring and Evaluation System (FPPMES) with former Center staff. FPPMES is a Lotus spreadsheet tool that converts contraceptive supply data, population size and growth rate information into estimates of couple years of protection (CYP) and contraceptive prevalence rates (CPR). Originally designed for sub-Saharan African family planning programs, the FPPMES is currently being adapted for monitoring and evaluating the achievement of the New York City Health Department's Tuberculosis Control Program. The spreadsheet is available online at "http://erc.msh.org/toolkit/fppmes.htm".
Deborah Maine received her doctoral degree in Epidemiology this May. She will now spend the beginning of the summer meeting with collegues in Africa. In Morocco, she will meet with representative from the World Bank, John Snow International and USAID to discuss their maternal mortality programs. Maine will assist in planning the final evaluation for a JSI/USAID program that the Center helped establish in 1995. In Ghana, Maine will meet with the Regional Prevenion of Maternal Mortality Program and the new teams from eastern Africa. RPMM is a continuation of PMM, the West African-based network which Maine led through the 1990s. Since the creation of RPMM last year, the program has expaned to Tanzania, Kenya and Uganda. The meeting marks the first time for Maine to see the new teams and learn of their initial efforts in establishing the techniques that made the PMM program so successful.
Alicia Yamin organized and participated in a SIPA-sponsored conference, "Chiapas: Human Rights and Democratizaton in Mexico." The conference -- stemming from concerns about the massacre in Chiapas three days before Christmas and its effect on the peace process -- brought together Ambassador Jorge Pinto of the Mexican Consul in New York and several representatives of prominent Mexican and international human rights NGOs. Yamin, who partook in a fact-finding mission in Chiapas last year to survey access to health care facilities, also organized a lecture at the Center entitled "Health and Human Rights in Chiapas, Mexico." There, members of an NGO that provides humanitarian support to comunities in Chiapas discussed the situation in that southern Mexican state.
Finding Common Ground: An Update
The Finding Common Ground project received funding this spring from the Maternal Child Health Bureau for $25,000. According to James McCarthy, this is the first funding for the Center from the MCH Bureau in several years.
Finding Common Ground is an evolving project dedicated to developing a public agenda that integrates the health needs and rights of women and children.
In its current phase, Wendy Chavkin, the principal investigator, and Deborah Elman, the project director, are collaborating with a number of groups evaluating welfare reform and Medicaid managed care to monitor the interaction between welfare reform, managed care, women's rights and needs, and children's well-being and interests. They are documenting these changes through a 50-state survey of directors at Child Protective Services, as other groups conduct surveys at Welfare, Medicaid, and Substance Abuse Services.
The surveys will be followed by in-depth case studies of these issues in five states.
The project is also working with a group of reproductive health experts to develop reproductive health parameters that can be used by community groups and health professionals to provide technical insight into how the limits, contradictions, and constructive opportunities of current welfare policies are being expressed in patterns of reproductive and child health.
Chavkin, a gynecologist and Editor-in-Chief of the Journal of the American Medical Women's Association, has been quite vocal on equity issues in public health. In May, Chavkin wrote an op-ed on sex bias in medicine -- namely insurance companies' willingness to cover the costs of anti-impotence pill Viagra but not cost of contraceptive medicines or devices for women.
Head Start Conference in July
As Head Start's fourth national research conference, "Children and Families in an Era of Rapid Change," rapidly approaches, Faith Lamb Parker and Ruth Robinson are busy finalizing program presenters and preparing for the expected 800 participants and attendees.
Special topics for the July 9-12 Washington conference include language development, behavior problems, and research on children of criminal offenders. The central theme is to create and implement research agendas and programs for young children and their families as we approach the 21st century. The focus will be on areas of rapid change in education, health care, child care, social services, economics, and diversity of ethnic groups.
Fall 1999 Issue
$1.4 Million in Grants from the Gates Foundation
The William H. Gates Foundation has awarded the Center $1.4 million over the next three years for three new projects: "Effective Reproductive Health Services for Refugees," "Integrating Family Planning/HIV Prevention in a Rural Uganda Setting," and "Preventing Maternal Mortality in Africa."
The funding, the first ever to be awarded to Columbia University from the newly formed Gates Foundation, represents the Foundation's desire to support population and reproductive health issues in economically deprived areas.
James McCarthy is the P.I. for the three projects, which are supported by three separate grants of $590,000, $160,000 and $610,000 respectively.
Therese McGinn and Roger Vaughan are the coordinators for the "refugee" project. They will work with international relief agencies to develop, implement and evaluate programs providing family planning and reproductive health services to people forced to flee their homes -- perhaps a population in greatest need of family planning and reproductive health services.
The United Nations estimates that, in 1997, approximately 38 million people were either refugees (people who have fled their home country) or were displaced within their own country. For these individuals, access to all health care, but particularly reproductive health care, is severely limited. And because the international family planning and reproductive health communities have such limited experience working with these groups, there are few models to follow.
For this project, the Center will continue to establish linkages and conduct workshops similar to the week-long workshop in Kenya last fall with the International Rescue Committee (IRC), at which Vaughan and McGinn called attention to the technical areas of design, monitoring and evaluation that are key to successful health service programs.
In addition, the project has three components to help relief agencies as they attempt to deliver reproductive health services to refugees. These components involve capacity-building within the relief agencies to develop appropriate design, monitoring and evaluation models for effective reproductive health projects; field-testing of the resulting reproductive health and family planning service delivery models; and dissemination of lessons about the processes and results of the field efforts within the participating agencies and to the field at large.
The new "family planning" project, coordinated by Maria Wawer, will complement the massive "STD Control and AIDS Prevention in Uganda" project, which has now entered its final year.
Family planning programs in rural areas of Uganda face two major hurdles. First, like many other very poor, rural African communities, rural Uganda is largely unserved by effective primary health programs. Being among the poorest people on the poorest continent places most rural Ugandans outside the reach of family planning and reproductive health programs.
Second, in the presence of high deaths rates from HIV/AIDS, research in Uganda shows an ambivalence towards family planning. Some report an interest in the adoption of family planning as a response to economic burdens, including the burdens of HIV. Others report concern that family planning would further reduce the population already suffering from high levels of AIDS mortality.
Yet all recognize that increased condom use would be an important strategy for reducing exposure to HIV, while at the same time contributing to lower fertility. In the face of these conflicting sentiments, there is a pressing need to determine how family planning services can best be implemented in populations facing an HIV epidemic.
The Center's long-standing presence in Uganda, and its strong HIV prevention efforts there, make it extremely well-qualified to undertake such a project.
Deborah Maine will coordinate the new "maternal mortality" project. Through the 1990s, Maine led the Prevention of Maternal Mortality program, which worked with colleagues in anglophone West Africa to develop and implement effective programs to prevent maternal deaths. The project continues today as an entirely African entity through an NGO based in Ghana called the Regional Prevention of Maternal Mortality Program.
Approaches developed by the Center to reduce maternal mortality over the past eight years have become the policies of major international health organizations. The new Gates funding allows the Center to build upon this experience of the PMM program and work with networks of African institutions to extend maternal mortality prevention efforts to East Africa and to francophone West Africa.
The World Health Organization estimates that nearly 600,000 women die each year from pregnancy complications, and almost all of these deaths are in the developing world.
Each of these three projects represents a set of activities that the Center views as critical if the international family planning and reproductive health communities are to build on the successes of recent decades. The Center is grateful to the Gates Foundation for its generous funding and commitment to such issues.
Two New Sponsors for the Young Men's Clinic
Funding Now Available for a Full-Time MSW
The Young Men's Clinic has received one-year grants from the New York Community Trust and the Indian Point Foundation for $60,000 and $25,000, respectively. This new funding enables the YMC to hire a full-time, masters-level social worker (MSW) and to cover a portion of the costs for medical providers at the clinic.
Currently, the YMC operates on Monday nights. According to clinic coordinator Bruce Armstrong, a full-time MSW will work the rest of the week performing a multitude of much-needed tasks that will greatly improve the quality of clinic services. These tasks include rigorous case management, group work outside of the clinic, identifying young men in the neighborhood who would most benefit from clinic services, and establishing linkages to other young men's services in the city.
In terms of case management, the new MSW can follow patients across programs, systems and geographic areas -- informing them of services, helping them make initial connections, brokering when necessary, ensuring appointments are kept, and tracking the men to ensure that services are appropriate.
Group work outside of clinic hours can address three common and important issues for many young men who come to the clinic: managing stress; developing job-related skills; and, for those who are already fathers, connecting or reconnecting to their children.
Drawing "high risk" young men into the clinic is the YMC's most effective means for reducing STDs, unwanted pregnancies, violence, disillusionment and substance abuse in Washington Heights. The MSW can regularly visit key sites in the neighborhood -- such as the Morgan Place Prenatal Clinic or the Center's many clinics and community outreach programs -- where health colleagues might know of such young men or their girlfriends.
Establishing linkages to local educational, vocational, employment and mental health services for young men can not only benefit YMC patients, but also publicize the YMC's valuable services to those who are unfamiliar with the clinic. The MSW can establish personal contact with key "gatekeepers" of each agency, and at the same time provide information on how to access YMC services.
Bruce Armstrong hopes to hire an English/Spanish-speaking MSW by the end of the summer, which will allow the social worker to establish himself for the new school year.
An Intensive Summer Seminar in Reproductive Health
Applications and inquiries are flow ing in for the first of a series of in tensive Center-based seminars for health professionals.
The week-long course, entitled "Planning Reproductive Health Programs: An Intensive Seminar in the Effective Design, Monitoring and Evaluation of Reproductive Health Programs in Developing Countries," seems to be striking at a core need for many health professionals.
"Several of the applicants said they have been grappling with the issue of how to systematically approach the design of a program with the end goals of monitoring and evaluation," said Roger Vaughan, who is facilitating the seminar with Therese McGinn. "The learning objectives fit quite specifically with the types of tasks they have in mind."
The learning objectives are for participants to understand and be able to use practical, empirically based planning tools for the design, monitoring and evaluation of reproductive health interventions; to be able to choose appropriate indicators and data collection methods to monitor and evaluate interventions; and to improve their skills in interpreting project-generated data and applying other health-related information to project design and evaluation.
"One prospective participant told us that the timing of this course couldn't be more perfect," said McGinn. "She will start to design a complex health program for her organization this summer."
While most applicants are mid-level or senior health professionals working on reproductive service delivery projects in both the United States and abroad, workers trained in other fields but working on health projects have also expressed interest in the seminar. One such participant, with a background in human rights, enrolled in the seminar to give herself a more solid grounding in health and program design issues.
With such a diversity of applicants, McGinn and Vaughan expect the seminar to be highly participatory. These two faculty members will lead most of the sessions but will call upon other Center faculty who have already volunteered their expertise.
The seminar runs Monday July 13 to Friday July 17 in the Irving Center Conference Room. Brochures are available at the Center. For more information, contact Vaughan (212-304-5211) or McGinn (212-304-5224).
FIGO Putting Stock in PMM
The International Federation of Gynecology and Obstetrics (FIGO) will use the methodology developed by the staff of the Center's Prevention of Maternal Mortality program in undertaking its needs assessment and implementing subsequent demonstration projects for a new maternal mortality initiative.
This methodological approach is described in three PMM publications, on which Deborah Maine is the lead author or editor: "Guidelines for Monitoring the Availability and Use of Obstetric Services," published jointly by UNICEF, UNFPA and WHO; "The Design and Evaluation of Maternal Mortality Programs," published by the Center; and the papers from the 1996 PMM Results Conference, as presented in a special supplement to the International Journal of Gynecology and Obstetrics, the official FIGO publication.
Allan Rosenfield commented that PMM has been a remarkable program since its inception, perhaps the most important activity in this field, and that this is demonstrated, in part, by the outstanding materials that PMM has prepared .
"FIGO is building its international effort around materials prepared by PMM, with technical assistance to be provided by Deborah Maine and other PMM staff," said Rosenfield. "This alone is testimony to the importance of the PMM work of the last decade."
Faculty Activities, In Brief...
Linda Cushman was promoted to the rank of Associate Clinical Professor of Public Health by the Health Sciences Committee on Appointments and Promotions in March. Cushman's recent work on condom use and long-term contraception will be published later this year in Family Planning Perspectives. She is currently envolved in the home-based STD screening project in Washington Heights, coordinating the efforts of a handful of local health workers as they test for syphilis, gonorrhea, chlamydia and trichomoniasis is a sample of 200 households.
Martin Gorosh helped develop the Family Planning Program Monitoring and Evaluation System (FPPMES) with former Center staff. FPPMES is a Lotus spreadsheet tool that converts contraceptive supply data, population size and growth rate information into estimates of couple years of protection (CYP) and contraceptive prevalence rates (CPR). Originally designed for sub-Saharan African family planning programs, the FPPMES is currently being adapted for monitoring and evaluating the achievement of the New York City Health Department's Tuberculosis Control Program. The spreadsheet is available online at "http://erc.msh.org/toolkit/fppmes.htm".
Deborah Maine received her doctoral degree in Epidemiology this May. She will now spend the beginning of the summer meeting with collegues in Africa. In Morocco, she will meet with representative from the World Bank, John Snow International and USAID to discuss their maternal mortality programs. Maine will assist in planning the final evaluation for a JSI/USAID program that the Center helped establish in 1995. In Ghana, Maine will meet with the Regional Prevenion of Maternal Mortality Program and the new teams from eastern Africa. RPMM is a continuation of PMM, the West African-based network which Maine led through the 1990s. Since the creation of RPMM last year, the program has expaned to Tanzania, Kenya and Uganda. The meeting marks the first time for Maine to see the new teams and learn of their initial efforts in establishing the techniques that made the PMM program so successful.
Alicia Yamin organized and participated in a SIPA-sponsored conference, "Chiapas: Human Rights and Democratizaton in Mexico." The conference -- stemming from concerns about the massacre in Chiapas three days before Christmas and its effect on the peace process -- brought together Ambassador Jorge Pinto of the Mexican Consul in New York and several representatives of prominent Mexican and international human rights NGOs. Yamin, who partook in a fact-finding mission in Chiapas last year to survey access to health care facilities, also organized a lecture at the Center entitled "Health and Human Rights in Chiapas, Mexico." There, members of an NGO that provides humanitarian support to comunities in Chiapas discussed the situation in that southern Mexican state.
Finding Common Ground: An Update
The Finding Common Ground project received funding this spring from the Maternal Child Health Bureau for $25,000. According to James McCarthy, this is the first funding for the Center from the MCH Bureau in several years.
Finding Common Ground is an evolving project dedicated to developing a public agenda that integrates the health needs and rights of women and children.
In its current phase, Wendy Chavkin, the principal investigator, and Deborah Elman, the project director, are collaborating with a number of groups evaluating welfare reform and Medicaid managed care to monitor the interaction between welfare reform, managed care, women's rights and needs, and children's well-being and interests. They are documenting these changes through a 50-state survey of directors at Child Protective Services, as other groups conduct surveys at Welfare, Medicaid, and Substance Abuse Services.
The surveys will be followed by in-depth case studies of these issues in five states.
The project is also working with a group of reproductive health experts to develop reproductive health parameters that can be used by community groups and health professionals to provide technical insight into how the limits, contradictions, and constructive opportunities of current welfare policies are being expressed in patterns of reproductive and child health.
Chavkin, a gynecologist and Editor-in-Chief of the Journal of the American Medical Women's Association, has been quite vocal on equity issues in public health. In May, Chavkin wrote an op-ed on sex bias in medicine -- namely insurance companies' willingness to cover the costs of anti-impotence pill Viagra but not cost of contraceptive medicines or devices for women.
Head Start Conference in July
As Head Start's fourth national research conference, "Children and Families in an Era of Rapid Change," rapidly approaches, Faith Lamb Parker and Ruth Robinson are busy finalizing program presenters and preparing for the expected 800 participants and attendees.
Special topics for the July 9-12 Washington conference include language development, behavior problems, and research on children of criminal offenders. The central theme is to create and implement research agendas and programs for young children and their families as we approach the 21st century. The focus will be on areas of rapid change in education, health care, child care, social services, economics, and diversity of ethnic groups.