Homework 7_Barrie
· Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
In my country there is policy to add Family planning Education in secondary schools, this is intended to be an education policy. This policy had health implication in that teaching family planning will help teenagers to understand the issues of sexuality and contraceptive use which could increase the use of contraceptives which reduces the prevalence of teenage pregnancy. As we know teenage pregnancy the cause of 20% maternal deaths in Sierra Leone.
· Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
Evaluation of this policy will inform how it impacts the rate of maternal deaths in Sierra Leone, mediated by the increase in contraceptive use among teenagers and reduction of teenage pregnancy. Sierra Leone is one of the countries with the highest teenage pregnancy in the world and the 2nd highest maternal mortality rate in the world at 1635 death per 100,000 live births.
· Specify the outcomes and populations you think most affected or least affected by the policy.
The outcomes are Contraceptive use among teenagers, teenage pregnancy and Maternal mortality. The population most affected is School going teenagers in Sierra Leone. The least affected is all women of child bearing age in Sierra Leone.
· Propose a study design to evaluate the policy.
I will like to design a cohort study to evaluate the policy. A pre-policy and post policy design. The pre-policy will be looking at a cohort of teenagers in secondary school who started secondary school in 2000, because secondary school is 6 years and who will be about 30-36years currently as the control group and then the teenagers who are currently in secondary school while the policy is being implemented. The Policy is implemented this year. Then look at death registries to see who died as a result of pregnancy related complication and look at those who were pregnant as teenagers and those who used a contraceptive as a teenager. We will administer a survey to find out these thing plus other indicators. While following those currently in School until they 36 years old.
· Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
The biggest challenge will be lost to follow-up, this could be very expensive and also there might be an increase in access to contraceptives and the type of contraceptives available now compared to the time when the control where going to school. Also, the controls and intervention group are in different time period and because the policy is implemented in all school in the country, we could not randomize the schools those receiving the policy and those not receiving the policy. Also, it is a government policy we could not influence the implementation of the policy.