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Community Midwifery Education Program in AfghanistanIn the immediate post conflict period, Afghanistan's health services were in a deplorable and chaotic state. Access and utilization of reproductive health services and skilled care during pregnancy, childbirth, and the first month after delivery are key to saving those women at risk of dying due to pregnancy and childbirth complications. In a society where women seek care only from female providers, one barrier to expansion of services was the lack of qualified female health workers who could be deployed to remote health facilities. Very few midwives who had trained in Kabul or other big cities were willing to work in rural areas, and there were no education facilities and too few female school graduates who could be trained in the provinces. As maternal health was one of the top priorities of the health sector, the shortage of midwives to provide reproductive health services had to be tackled urgently. Hence the Community Midwifery Education (CME) Program was created. The program aimed not only to train more midwives, but also to ensure both their initial deployment in remote health facilities as well as good retention rates. These aims were realized through the creation of a new health cadre known as "community midwives," along with new competency-based curricula; establishment of CME schools in each province; relaxation of the admission criteria for students; and establishment of a strong accreditation board to ensure qualified midwives were trained by the program. The program's success is attributed to stakeholder strong engagement, equity, and strengthened human resource for health. The program should be expanded to address the continuing shortage of midwives. The Mnistry of Public Health considers the program a successful intervention and believes that there is great potential to replicate this model to train other health professionals and tackle the shortage of other human resources for health.
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Stimulating Demand for AIDS Prevention : Lessons from the RESPECT TrialHIV-prevention strategies have yielded
 only limited success so far in slowing down the AIDS
 epidemic. This paper examines novel intervention strategies
 that use incentives to discourage risky sexual behaviors.
 Widely-adopted conditional cash transfer programs that offer
 payments conditioning on easily monitored behaviors, such as
 well-child health care visits, have shown positive impact on
 health outcomes. Similarly, contingency management
 approaches have successfully used outcome-based rewards to
 encourage behaviors that are not easily monitored, such as
 stopping drug abuse. These strategies have not been used in
 the sexual domain, so this paper assesses how incentives can
 be used to reduce risky sexual behavior. After discussing
 theoretical pathways, it discusses the use of
 sexual-behavior incentives in the Tanzanian RESPECT trial.
 There, participants who tested negative for sexually
 transmitted infections are eligible for outcome-based cash
 rewards. The trial was well-received in the communities,
 with high enrollment rates and more than 90 percent of
 participants viewing the incentives favorably. After one
 year, 57 percent of enrollees in the "low-value"
 reward arm stated that the cash rewards "very
 much" motivated sexual behavioral change, rising to 79
 percent in the "high-value" reward arm. Despite
 its controversial nature, the authors argue for further
 testing of such incentive-based approaches to encouraging
 reductions in risky sexual behavior.
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Jamaica’s Effort in Improving Universal Access within Fiscal ConstraintsJamaica's primary health care system was a model for the Caribbean region in the 1990s. Because of it, Jamaicans enjoy relatively better health status than people in other countries of similar income level in the Caribbean region. However, Jamaica's health system is being severely challenged by persistent and reemerging infectious diseases and by the rapid increase in noncommunicable diseases (NCDs) and injuries. At the same time, the country has suffered from low economic growth and carries a high debt burden, which leaves limited fiscal space for improving health care. The Government of Jamaica has been trying to sustain the gain in health outcomes and improve access to health care for its population in an environment of constrained resources during the last decade. With the establishment of the Jamaica National Health Fund (NHF) in 2003 and the abolition of user fees at public facilities in 2008, the Government of Jamaica has taken steps toward achieving universal coverage. This study reviews the achievements and challenges in expanding universal access in Jamaica and assesses the impact of the NHF's drug-subsidy programs and the abolition of user fees on universal access, and discusses policy options for achieving universal coverage.