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Infectious disease outbreaks devastate communities and cost the world $60 billion a year in response efforts—matching the toll of wars and natural disasters in terms of economic impact and lives lost. Local preparedness is the key to stopping outbreaks at the source.

Tuberculosis (TB) remains a major public health problem in the regions of East, Central, and Southern Africa (ECSA). Because TB is an airborne disease, its transmission is facilitated by the movement of people across internal and national borders.

The primary goal of the Challenge TB (CTB) project in Afghanistan is to assist the NTP to reach its strategic objective of increasing TB case notifications by at least 8% annually through comprehensive TB care and prevention activities.

In high TB- and HIV-burden settings, the two diseases reinforce each other and share common risk factors. Single, categorical services provided to persons with multiple, related risk factors miss opportunities to diagnose, treat, and prevent TB and/or HIV.

Bangladesh is one of the world’s high tuberculosis (TB) burden countries. According to World Health Organization’s 2017 Global TB Report, 38% of drug-sensitive and approximately 84% of drug-resistant patients are undiagnosed or unreported. The most infectious TB patients are these missing cases.

Ethiopia is one of the most populous countries in Africa with a high TB burden across a wide geography. The national TB program has reached hundreds of thousands of cases and successfully treated them. However, health authorities believe that a third of cases have been missed in the community, development corridors, industries, and crowded settings, such as universities.

The Technical Support Services Project (TSSP) worked with the Tanzania Ministry of Health, Community Development, Gender, the Elderly, and Children (MoHCDGEC) to support and strengthen the Star Rating Assessment (SRA) Tool system. The project integrated HIV/AIDS indicators into the tool to create more comprehensive assessments of the country’s health care facilities. 

This report summarizes significant USAID MTaPS achievements, key challenges, program performance, and adaptation in response to new demands and lessons learned for the January through March 2019 period. The report is organized by health area, objective, region, and country.

Funded by USAID and led by Management Sciences for Health and its consortium of partners, the goal of the five-year Medicines, Technologies, and Pharmaceutical Services (MTaPS) program (2018–2023) is to help low- and middle- income countries strengthen their pharmaceutical systems to ensure sustainable access to and appropriate use of safe, effective, quality-assured, and affordable essentia

USAID MTaPS supports the Global Health Security Agenda (GHSA), whose purpose is to help build countries’ capacity to protect themselves from infectious disease threats and to raise global health security as a national and worldwide priority. The GHSA has 11 action packages, including one to combat antimicrobial resistance (AMR).

Attaining the goals of universal health coverage requires clear policies, robust legislation, and sound management practices supported by good governance. This premise is relevant to pharmaceutical systems, which are particularly vulnerable to corruption due to the economic value of medicines and the multiplicity of stakeholders.

USAID MTaPS applies systems-based approaches using proven tools, interventions, and quality improvement methodologies to strengthen in-country capacity and enhance patient-centered pharmaceutical care. In doing so, MTaPS embeds the culture of quality of care emphasized by the Sustainable Development Goals, the World Health Organization, and other global and national bodies.

Following USAID’s Journey to Self-Reliance framework and the agency’s health system and disease-specific strategies, MTaPS strengthens country human resources and institutions to: develop sustainable, high-impact country capacity for transparent, accountable pharmaceutical systems-related law, policy, planning, leadership, and management; improve countries’ capacity to collect, a

WHO’s Global Technical Strategy (GTS) for Malaria 2016–2030 aims to reduce global malaria incidence and deaths by at least 90% by 2030. To achieve these targets, high malaria burden countries need strong national pharmaceutical systems that can support the effective implementation of key malaria interventions.

USAID supports strategies to improve pharmaceutical-sector financing, including resource mobilization, allocation, and use.

Weaknesses in pharmaceutical regulatory systems contribute to limited access to quality-assured, safe, and efficacious life-saving essential medicines, including those for malaria; HIV/AIDS; and reproductive, maternal, and childhood diseases, and to the disruption of health service delivery, thereby preventing achievement of better health outcomes.

Meeting the Sustainable Development Goals’ maternal, newborn, and child mortality targets will require a systems-strengthening approach; however, a large proportion of deaths could be avoided if women and children had access to quality medicines and supplies and skilled health care providers.

In recent years, significant donor and global TB community support has led to encouraging developments, giving low- and middle-income countries better diagnostic, prevention, and treatment tools to increase case detection and improve outcomes.

An AIDS-free world requires resilient and sustainable pharmaceutical systems that ensure universal access to the best available diagnostic, preventive, and treatment tools.

Pharmaceutical systems and the health system in general in many low- and middle-income countries suffer from poor data availability and accessibility. Typically, data are manually collected at service delivery points and then sent to the district, regional, or Ministry level for processing and storage with the hope that they will be captured electronically and analyzed.

Ensuring the uninterrupted availability of quality-assured medicines and health technologies from the manufacturer to end users is the ultimate goal of pharmaceutical supply chain systems. However, strategies to strengthen key supply chain components are inadequate in many low- and middle-income countries (LMICs), and systems cannot effectively manage local and global health program demands.

In Bangladesh, the Directorate General of Family Planning (DGFP), with assistance from the US Agency for International Development (USAID), is well ahead of other countries in its use of locally developed and automated inventory management tools, especially at the upazila (sub-district) and warehouse levels.

Over the past two decades, Rwanda has realized impressive declines in preventable child and maternal mortality, serving as an example of what is possible through committed, collective action.

Market intelligence data, United Nations Commodity Trade Statistics for insulin trade, the International Medical Products Price Guide for prices of human insulin and additional web searches were used as data sources. A total of 34 insulin manufacturers were identified. Most countries and territories are reliant on a limited number of supplying countries. The overall median government procurement price for a 10‐ml, 100‐IU/ml vial during the period 1996–2013 equivalent was US$4.3, with median prices in Africa and low-income and low‐ to middle‐ income countries being higher over this period.This research shows the high variability of insulin prices and the reliance on a few sources, both companies and countries, for global supply. In addressing access to insulin, countries need to use existing price data to negotiate prices, and mechanisms need to be developed to foster competition and security of supply of insulin, given the limited number of truly global producers.

In collaboration with the USAID-funded Rwanda Health Systems Strengthening Project and partners, Rwanda’s Ministry of Health introduced the Workload Indicator of Staffing Needs (WISN) tool in all public district and provincial hospitals in the country.

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