Kim Longfield

• PhD, MPH
• Global Health and Research Specialist at Independent Consultant

Family planning is a rich field that has evolved dramatically over the last 40 years, driven by attention to client-centered care, client rights and engagement, and data for evidence-based program management. We have set ambitious global targets for increasing contraceptive use under the Sustainable Development Goals (2016-2030) and the Family Plan...

Background: Social franchising programs in low- and middle-income countries have tried using the standard wealth index, based on the Demographic and Health Survey (DHS) questionnaire, in client exit interviews to assess clients’ relative wealth compared with the national wealth distribution to ensure equity in service delivery. The large number of...

Population Services International (PSI) is an international NGO working to improve outcomes in developing countries through behavior change communications and the social marketing of health products and services. Consumer insight is central to PSI's social marketing strategy because it informs which messages to promote and which products and servic...

This Lancet commentary aims at explaining some of the nuances behind such estimates and suggests some constructive ways going forward.

Background: Concerns about appropriate pricing strategies and the high market share of subsidized condoms prompted Population Services International (PSI)/Myanmar to adopt a total market approach (TMA). This article presents data on the size and composition of the Myanmar condom market, identifies inefficiencies and recommends methods for better t...

Most vaginally inserted methods have limited availability and use despite offering characteristics that align with many women's stated preferences (e.g., nonhormonal and/or on demand). The objective of this review was to identify enablers and barriers to women's adoption and continuation of vaginally inserted contraceptive methods in low‐ and middl...

Background Zimbabwe faces an uncertain future for condom funding and potential condom insecurity as international donors prioritize creating more self-sustaining markets and the government identifies how to best ensure access and uptake. We tested the impact of an intensive intervention on demand and supply after a price increase to the social mark...

Countries are increasingly cognizant of resource constraints and are eager to increase health system efficiency, including through integration. This case study on Malawi offers practical guidance for policymakers who need to make decisions about whether and how to more fully integrate specific vertical programs into the broader health system, with...

Countries are increasingly cognizant of resource constraints and are eager to increase health system efficiency, including through integration. This case study on Ghana offers practical guidance for policymakers who need to make decisions about whether and how to more fully integrate specific vertical programs into the broader health system, with a...

The universal health coverage movement has strengthened advocacy for integration in service delivery and its enabling systems and inputs, particularly following the 2018 Global Conference on Primary Health Care, which marked the 40th anniversary of the Alma Ata Declaration. Many see integration as a way to ensure equitable financing for and access...

Zimbabwe has one of the strongest condom programs in Africa and, over time, the government and international donors have made significant investments in condoms to prevent the spread of HIV. By 2016, the future of condom funding was uncertain. International donors were questioning their investments and were focused on creating a self-sustaining con...

This presentation outlines major challenges organizations face and mistakes they make when using research to influence decision-making. I identify five must-haves for any research program: 1) A Link between Strategy and Measurement; 2) A Connection to Others’ Work; 3) The Right Team; 4) An Audience for their Work; and 5) A Communications Strategy.

Background In developing regions, an estimated 214 million women have an unmet need for family planning. Reaching Family Planning 2020 (FP2020) commitments will require a shift in modern contraceptive promotion, including improved access to long-acting reversible contraceptives (LARCs). Until now, a lack of market data limited understanding of the...

Background An estimated 214 million women have unmet need for family planning in developing regions. Improved utilization of the private sector is key to achieving universal access to a range of safe and effective modern contraceptive methods stipulated by FP2020 and SDG commitments. Until now, a lack of market data has limited understanding of the...

This presentation demonstrates the importance of communicating evidence and describes what happens when researchers fail to share their work effectively. It also describes factors that get in the way of communication and outlines five critical steps researchers should follow: 1) Set your Objectives; 2) Know your audience and how to target them; 3)...

This chapter introduces the concept and practice of social franchising as an approach to delivering high- quality prevention, care, and treatment services in developing countries; explains and illustrates how social franchising can be used in the health context to improve access to health services and to prevent and treat disease; explores some of...

This presentation covers the development of the EquityTool, a a free, easy-to-use, mobile-based application that assesses the wealth of program beneficiaries in low- and middle-income countries. The presentation then unpacks the the communication strategy used to promote the tool and its success on influencing stakeholder decision making.

This interactive workshop covers the development of the EquityTool, a free, easy-to-use, mobile-based application that assesses the wealth of program beneficiaries in low- and middle-income countries. The workshop illustrates the difference between wealth quintiles and other measures of economic equity, and walks participants through the process fo...

This presentation covers the development of the EquityTool, a free, easy-to-use, mobile-based application that assesses the wealth of program beneficiaries in low- and middle-income countries. The EquityTool enables programs to rapidly evaluate their effectiveness at reaching their target population. This presentation also demonstrates how stakehol...

This chapter focuses on a Central American case study where ethnographic research was used to gather improved consumer insight, to shape the marketing planning process and programme design for a campaign to improve adherence to HIV treatment.

Background: Male-to-male sexual transmission of HIV in China has increased ten-fold over the past decade. Overlapping sexual partnerships and unprotected sex are driving forces. We examine patterns of sexual concurrency and its association with other HIV risks among men who have sex with men (MSM), using data from a 2013 behavioral survey in China....

This study evaluates the effectiveness of a training programme for improving the diagnostic and treatment quality of the most complex service offered by Sun Primary Health (SPH) providers, paediatric malaria. The study further assesses whether any quality improvements were sustained over the following 12 months. The study took place in 13 townships...

Background: The private sector makes up a significant portion of healthcare in low- and middle-income countries (LMICs). One strategy for improving healthcare standards for the poor is social franchising, which applies the contracting and managerial systems of commercial franchising to social aims. In 2011, the Social Franchising Metrics Working Gr...

Background: Eligibility criteria and sub-optimal coverage inhibit many PLWH in Central America from receiving the health benefits of ART. Social, structural, and individual factors also impede effective treatment and care. Across Central American countries, between 13-46% PLWH abandon ART within one year of initiation. In 2012, as part of the USAID...

Background: Eligibility criteria and sub-optimal coverage inhibit many PLWH in Central America from receiving the health benefits of ART. Social, structural, and individual factors also impede effective treatment and care. Across Central American countries, between 13-46% of PLWH abandon ART within one year of initiation. In 2012, as part of the US...

This presentation features work completed with the Social Franchising Metrics Working Group (SFMWG), its process for aligning measurement, developing standard metrics, and improving routine reporting against the goals of social franchising. Contributors were Dominic Montagu, Andrea Sprockett, and Dana Sievers.

Background: Condom social marketing has been critical to sexual health programs in the developing world. The discipline has matured and social marketers are now applying a total market approach (TMA) to fill market gaps, satisfy unmet need, and increase commercial sector engagement. This paper presents case studies from Myanmar (PSI/M) and Viet Nam...

This objectives of the panel were to: 1) raise awareness about the 5 goals of social franchising that are forwarded by the Social Franchising Metrics Working Group; 2) issue a call for greater consistency in reporting; 3) disseminate evidence from specific programs about performance across these metrics; and 4) demonstrate how measurement can lead...

We present findings from evaluations of condom markets in six African countries to determine if actions taken over the last five to seven years have increased condom use equitably and sustainably. While there have been improvements in condom use in five countries, use is concentrated among the wealthy in three countries. All markets are dominated b...

Background HIV transmission among people who inject drugs (PWID) is high in Yunnan and Guangxi provinces in southwest China. To address this epidemic, Population Services International (PSI) and four cooperating agencies implemented a comprehensive harm reduction model delivered through community-based drop-incenters (DiC) and peer-led outreach to...

This presentation reviews PSI's adoption of the DALY averted as a bottom-line metric, how it helped inform decision making, and how the organization used the metric to measure performance against its last and current strategic plans.

Between November 2012 and November 2013, PSI and UNFPA completed six total market approach (TMA) case studies for male condoms with support from two independent researchers. This case study highlights Mali. It has a large condom social marketing program, is affected by HIV, and has high maternal morbidity and mortality relative to its economic deve...

Between November 2012 and November 2013, PSI and UNFPA completed six total market approach (TMA) case studies for male condoms with support from two independent researchers. This case study highlights Lesotho. It has a large condom social marketing program, is affected by HIV, and has high maternal morbidity and mortality relative to its economic d...

Between November 2012 and November 2013, PSI and UNFPA completed six total market approach (TMA) case studies for male condoms with support from two independent researchers. This case study highlights Swaziland. It has a large condom social marketing program, is affected by HIV, and has high maternal morbidity and mortality relative to its economic...

Between November 2012 and November 2013, PSI and UNFPA completed six total market approach (TMA) case studies for male condoms with support from two independent researchers. This case study highlights Botswana. It has a large condom social marketing program, is affected by HIV, and has high maternal morbidity and mortality relative to its economic...

This issue of PSI’s Impact magazine explores how NGOs, donors, charity watchdogs and corporations measure impact and what role measurement plays in decision-making. My article “Measurement Matters” examines different types of measurement, who values them, and why. The article provides a glimpse into PSI’s history and how we have focused on measurem...

Between November 2012 and November 2013, PSI and UNFPA completed six total market approach (TMA) case studies for male condoms with support from two independent researchers. This case study highlights Uganda. It has a large condom social marketing program, is affected by HIV, and has high maternal morbidity and mortality relative to its economic de...

Between November 2012 and November 2013, PSI and UNFPA completed six total market approach (TMA) case studies for male condoms with support from two independent researchers. This case study highlights South Africa. It has a large condom social marketing program, is affected by HIV, and has high maternal morbidity and mortality relative to its econo...

Implementing organisations want burden of disease data to inform decisions about where to work and what to target. Population Services International (PSI) incentivises staff to target health conditions with the greatest burden. Within a new strategic plan, PSI added an ambitious goal to target 42% of the burden of disease, measured as Global Burden...

Population Services International (PSI) is one of the largest social marketing agencies in the world but is challenged to demonstrate the effectiveness of its strategies for achieving health improvements in low- and middle-income countries. In response, PSI created the Social Marketing Evidence Base (SMEB), a web-based database of systematically re...

PSI/China promotes harm reduction among people who inject drugs in southwestern China through peer outreach and drop-in centers in four cities. This study was designed to evaluate the impact of the program on use of clean needles and syringes, HIV testing, and consistent condom use among the population injecting drugs. 1,037 respondents who reporte...

Background: Concerns about appropriate pricing strategies and the high market share of subsidized condoms prompted PSI/Myanmar to adopt a total market approach (TMA). This paper presents data on the size and composition of the Myanmar condom market, identifies inefficiencies, and recommends methods for better targeting public subsidy. Methodology:...

One of PSI’s most important channels for delivering health impact is social franchising, and one of our most comprehensive franchises is PSI/Myanmar's Sun Quality network. The network has been operating since 2001 and offers services for HIV/AIDS, malaria, tuberculosis, reproductive health, pneumonia and diarrhea. This report provides the first cle...

PSI's 2012 health impact report was derived from products and services provided across 69 countries. These interventions represented 35.2 million years of healthy life gained. PSI addresses serious challenges like lack of family planning, HIV and AIDS, barriers to maternal health, and the greatest threats to children under five, including malaria,...

Background: Social marketing interventions play a large role in condom markets, especially in developing countries. For 15 years, Population Services International/Myanmar (PSI/M) has socially marketed condoms to female sex workers (FSW), their male clients (MC), and men who have sex with men (MSM). Concerns about cost recovery, appropriate pricing...

Background: Implementing organizations in global health are pressured to be accountable for performance. Many health impact metrics present limitations for priority setting; they do not permit comparisons across different interventions or health areas. In response, Population Services International (PSI) adopted the disability-adjusted life year (D...

Issue: For 15 years, Population Services International/Myanmar (PSI/M) has socially marketed condoms to female sex workers (FSW), their male clients (MC), and men who have sex with men (MSM). Concerns about appropriate pricing strategies, “crowding out” the private sector, and inefficient use of public funds, prompted PSI/M to adopt a total market...

Background: Implementing organizations want burden of disease to inform decisions about where to work and what to target. Population Services International (PSI) incentivizes staff to target health conditions with greatest burden. Within a new strategic plan, PSI added an ambitious goal to target 42% of the burden of disease, measured as Global Bur...

Background Implementing organizations are pressured to be accountable for performance. Many health impact metrics present limitations for priority setting; they do not permit comparisons across different interventions or health areas. In response, Population Services International (PSI) adopted the disability-adjusted life year (DALY) averted as it...

Measurement and accountability for programmatic results are increasingly important for the work that publicly funded organizations do. This special supplement in the journal BMC Public Health represents a collaboration between PSI, Pathfinder, MSI, and UCSF. It includes articles by all four organizations, which describe approaches for estimating th...

Motivating improved health provider behaviors related to quality, productivity, customer satisfaction and equity is central to the success of health service delivery through PSI’s 24 social franchise networks globally. In order to do this PSI applies the same marketing rigor to influencing providers as an important target audience as would be appli...

The need for standard metrics and evaluation protocols is large and growing. It isn’t enough for organizations to say how well they do; they need to measure it. Until now it has been difficult to draw comparisons across programs, countries, and health service areas. Different stakeholders have different expectations for metrics: a) Program Manager...

Background: Implementing organizations and donors are keen to quantify health impact and demonstrate value for money. For several years, PSI and MSI have used modeling to convert their programs’ outputs to outcomes. PSI and MSI are learning from one another to improve their calculations, decision-making, and accountability. Objective: For participa...

Background: A component of Population Services International-Myanmar’s (PSI/Myanmar) social franchising program, known as Sun Primary Health (SPH), is the recruitment and training of rural residences to provide a range of health services. Assessing the quality of providers is critical in ensuring the health of the public. PSI/Myanmar, in collaborat...

Belize has the highest rates of HIV infection in Central America and is experiencing a genera-lized epidemic. The Garífuna, a minority ethnic population, is at risk for HIV. This study uses survey data from Garífuna men and women to examine the frequency of multiple partnerships as well as sociodemographic characteristics and behavioral constructs...

IntroductionBrand Research Methods Brand Equity and PSI Brand ResearchMadagascar Protector Plus Brand of CondomsDiscussionConclusion References

Background Social marketing interventions are important in developing nations. Both increasing use and shifting users from receiving subsidised condoms need to be pursued using a Total Market Approach (TMA). This paper reviews the performance of social marketing through a cross-country comparison of condom use, equity and market share, plus a case...

This chapter describes social marketing of condom brands in Central America as a strategy to combat the HIV/AIDS epidemic in the region. Branding in the health and not-for-profit sector represents an important strategy to simplify and streamline consumer product and behavioral choices to reduce health risks and prevent disease. Efforts to brand con...

Although HIV prevalence has remained low in Laos thus far, there is reason to be concerned that Lao male-to-female (MtF) transgender persons (kathoy) and their partners may facilitate the spread of HIV. Little is known about how to most effectively reach kathoy with HIV prevention programming. This paper evaluates an intervention with Lao kathoy wi...

Zimbabwe suffers from one of the greatest burdens of HIV/AIDS in the world that has been compounded by social and economic instability in the past decade. However, from 2001 to 2009 HIV prevalence among 15-49 year olds declined from 26% to approximately 14%. Behavior change and condom use may in part explain this decline.PSI-Zimbabwe socially marke...

This study sought to determine whether including two types of questions in surveys administered via face-toface interview can contribute to more accurate measures of correct and consistent condom use among populations at risk for HIV. The study compared initial rates of self-reported condom use to rates found when respondents were asked to provide...

Purpose: In Asia, men who have sex with men (MSM) are at an elevated risk for HIV infection due to low levels of condom use, low perceived threat of HIV infection, and high levels of stigma. PSI launched an HIV prevention intervention in late 2002 for a subgroup of Lao MSM, male-to-female transgenders (hereafter referred to as “transgenders”). PSI...

In Asia, men who have sex with men (MSM) are at an elevated risk for HIV infection due to low levels of condom use, low perceived threat of HIV infection, and high levels of stigma. PSI launched an HIV prevention intervention in late 2002 for a subgroup of Lao MSM, male-to-female transgenders. Data from 2004 and 2006 tracking surveys revealed signi...

We used data from 25 focus groups to examine the ways in which relationship dynamics between young women and young men in Tanzania, Zambia, and Zimbabwe may heighten young women’s vulnerability to HIV infection. Our analysis of gender role expectations, mistrust, and sexual violence provides insight into how all of these factors have the potential...

This study was undertaken in two locations in Trinidad, Sea Lots and Point Fortin, between November and December 2007. Participants were women aged 16-24. The data revealed that within the target population sexual relationships and financial benefits are intimately linked within all relationships. Despite the differences in economic context between...

This study was undertaken in two locations in Trinidad, Sea Lots and Point Fortin, between November and December 2007. Participants were women aged 16-24. The data revealed that within the target population sexual relationships and financial benefits are intimately linked within all relationships. Despite the differences in economic context between...

Background: A qualitative study was conducted among youth (ages 15-24) in Kunming, PRC to obtain information about sexual and drug use risk behaviors for HIV. Methods: Twenty-three dyad and triad interviews were conducted with 59 unmarried vocational school and migrant youth that visit entertainment venues at least twice a month. Analysis was condu...

Background: Tracking studies were conducted in 2004 and 2006 among IDUs in Yunnan Provice, PRC. Researchers identified predictors of not sharing needles, monitored changes in risk behavior, and evaluated existing IDU interventions. Methods: Data come from a representative sample of IDUs in three compulsory detox centers in Yunnan, admitted less tha...

Objectives: In Laos, katoey are biological males who self identify as female and are sexually active with men. This study investigates trends in condom use with katoey and their male partners and evaluates the association between exposure to IPC activities and changes in behavior. Data and Methods: Quantitative surveys were conducted in 2004 and...

Objectives: This study investigates trends in new needle use, condom use, and HIV testing among male injecting drug users (IDUs) in Mong Cai and Uong Bi towns and Thai Nguyen City in Northern Vietnam. The association between changes in behavior and exposure to a peer education and outreach strategy is also assessed. Data and Methods: Quantitative s...

This paper reports on research that aimed to identify risk factors and preventive behaviours for HIV/STIs among men who have sex with men in Bulgaria, Kosovo, Macedonia and Romania. Twelve peer researchers conducted interviews on sexual behaviour, condom use and HIV/STI awareness. Data analysis revealed common themes across countries. Sexual activi...

This case study aims to share a successful implementation of the minimum package approach to HIV prevention for most-at-risk populations. The minimum package approach, which aims to implement a package of effective HIV prevention interventions in a coordinated fashion, is being implemented in a number of sites across the Mekong region. The program...

This case study aims to share a successful implementation of the minimum package approach to HIV prevention for most-at-risk populations. The minimum package approach, which aims to implement a package of effective HIV prevention interventions in a coordinated fashion, is being implemented in a number of sites across the Mekong region. The program...

This report presents results from a process of qualitative research and data synthesis carried out with indigenous men and women living in small towns and villages around 50km from Guatemala city. The work was carried out to provide an evidence base for PASMO’s work on family planning (FP) and HIV prevention with indigenous peoples. The PEER method...

This report presents results from a process of qualitative research and data synthesis carried out with indigenous men and women living in small towns and villages around 50km from Guatemala city. The work was carried out to provide an evidence base for PASMO’s work on family planning (FP) and HIV prevention with indigenous peoples. The PEER method...

This study describes partner categories common to young women in Abidjan, Côte d'Ivoire, the underlying domains of their sexual partnerships, and relationship dynamics that contribute to their risk for STIs and HIV. Data from free lists and pile sorts underwent dichotomous variable testing to create comprehensive partner categories. Interview trans...

The aim of this study is to contribute to the understanding of motivations for cross-generational relationships and how the perception of risk of acquiring sexually transmitted infections (STIs) including HIV affects condom use in Kenya. Eight focus-group discussions were conducted with women and 28 interviews were held with men in four Kenyan town...

Editor's Comments: Kim Longfield’s essay is particularly revealing when considering condom use and multiple sex partners. Longfield presents a complex, albeit entertaining, description of “partner supercategories” as cited by some of her female interviewees. “Boyfriend/girlfriend,” “marriage material,” “spare tire,” “sugar daddy/auntie,” “rich fool...

Objectives: This study describes potential risk factors and preventive behaviors for HIV/AIDS and sexually transmitted infections (STIs) among men who have sex with men (MSM) in Southeastern Europe. Study findings are used to suggest future areas of study and appropriate intervention strategies for promoting safer sexual behavior among MSM in the r...

Objectives: This study describes potential risk factors and preventive behaviors for HIV/AIDS and sexually transmitted infections (STIs) among men who have sex with men (MSM) in Southeastern Europe. Study findings are used to suggest future areas of study and appropriate intervention strategies for promoting safer sexual behavior among MSM in the r...

Objectives: This study identifies young Zambian males’ misconceptions and folk explanations for sexually transmitted infections (STIs), as well as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). In addition, this study describes their sources of information and assesses the reliability of those sources. The authors...

Objectives: To understand youth’s conceptions of trust in sexual partnerships and examine how trust can serve as an obstacle to adopting risk reduction methods for STIs/HIV, such as consistent condom use or HIV testing. Methods: A total of 33 focus groups with youth aged 15-24 years were conducted in Eritrea, Tanzania, Zambia and Zimbabwe. Particip...

Objective: To determine why sexually experienced males and females from multiple countries in sub-Saharan Africa do not use condoms. Methods : We used data from sample surveys conducted in eight countries in sub-Saharan Africa. Respondents were asked about their use of condoms and their reasons for not using a condom in last sex with a marital, a r...

This study of youth in Tajikistan and Uzbekistan identifies factors that render them vulnerable to drug use. It explores youth's definitions of and attitudes toward drug use and examines how substances other than heroin and opiates influence higher risk behaviors, especially injecting drug use. Findings were used to identify strategies for discoura...

Objectives: To understand women’s and men’s motivations for entering into cross generational relationships and to examine how their risk perception for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) affects sexual decision-making and condom use. Methods : A total of eight focus groups were conducted with women aged 15...