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A demonstration project (January 2010 to June 2011) in Malawi improved the exchange and use of family planning/reproductive health and HIV/AIDS knowledge among health workers using a short message service (SMS) network.

Despite lower levels of artemether-lumefantrine (AL) stock-outs compared to the reports in 2008, the stock-outs at Kenyan facilities during 2010-2011 are still substantial and of particular worry for the most detrimental: simultaneous absence of any AL pack. Only minor decrease was observed in the stock-outs of individual AL packs. Recently launched interventions to eliminate AL stock-outs in Kenya are fully justified.

Of 48 surveyed hospitals and health centers in Ethiopia, 9 (19%), 9 (19%), and 10 (21%) did not have malaria, TB, or HIV drugs, respectively. Similarly, of 27 health posts, 9 (33%) and 6 (22%) did not have rapid diagnostic tests and antimalarial drugs, respectively. The findings indicated an inadequate availability of essential drugs and commodities in the surveyed facilities as well as weaknesses in human resources and training.

This article is the lead article in the Human Resources for Health journal's first quarterly feature. The series of seven articles was contributed by Management Sciences for Health (MSH) under the theme of leadership and management in public health. The journal invited Dr. Manuel M. Dayrit, Director of the WHO Department of Human Resources for Health and former Minister of Health for the Philippines, to launch the feature with an opening editorial in the journal's blog. This opening article describes the human resource challenges that managers around the world report and analyses why solutions often fail to be implemented. The case studies in this issue were chosen to illustrate results from using the Leadership Development Program (LDP) at different levels of the health sector. The LDP makes a profound difference in health managers' attitudes towards their work. Rather than feeling defeated by a workplace climate that lacks motivation, hope, and commitment to change, people report that they are mobilized to take action to change the status quo. The lesson is that without this capacity at all levels, global policy and national HR strategies will fail to make a difference.

Background: International initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief and the President's Malaria Initiative have significantly increased availability and access to medicines in some parts of the developing world. Despite this, however, skills remain limited on quantifying needs for medications and order

As part of the special feature on leadership and human resources, Management Sciences for Health profiles three leaders who have made a significance difference in the HR situation in their countries.

Despite a pool of unemployed health staff available in Kenya, staffing levels at most facilities were only 50%, and maldistribution of staff left many people without access to antiretroviral therapy (ART).

This article is the third article in the Human Resources for Health journal's feature on the theme of leadership and management in public health. The third article presents a successful application in Mozambique of a leadership development program created by Management Sciences for Health (MSH).

This article is the second article in the Human Resources for Health journal's first quarterly feature. This article describes the experience of the Family Life Education Programme (FLEP), a reproductive health program that provides community-based health services through 40 clinics in five districts of Uganda, in improving retention and performance by using the Management Sciences for Health (MSH) Human Resource Management Rapid Assessment Tool.

Background: In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers' competence. In response to this challenge, Management Sciences for Health (MSH) has implemented a program of formative supervision.

Low-income countries with high HIV/AIDS burdens in sub-Saharan Africa must deal with severe shortages of qualified human resources for health. This situation has triggered the renewed interest in community health workers, as they may play an important role in scaling-up antiretroviral treatment for HIV/AIDS by taking over a number of tasks from the professional health workers.

Background: East African countries have in the recent past experienced a tremendous increase in the volume of antiretroviral drugs. Capacity to manage these medicines in the region remains limited.

To strengthen Haiti’s primary health care (PHC) system, the country first piloted performance-based financing (PBF) in 1999 and subsequently expanded the approach to most internationally funded non-government organizations. PBF complements support (training and technical assistance).

Background: The Ministry of Health in Malawi is implementing a pragmatic and innovative approach for the management of all HIV-infected pregnant women, termed Option B+, which consists of providing life-long antiretroviral treatment, regardless of their CD4 count or clinical stage. Our objective was to determine if Option B+ represents a cost-effective option.

In 2011, the Malawi Ministry of Health (MOH) implemented an innovative approach (called "Option B+"), in which all HIV-infected pregnant and breastfeeding women are eligible for lifelong antiretroviral therapy (ART) regardless of CD4 count. Since that time, several countries have adopted the Option B+ policy. Using data collected through routine program supervision, this report is the first to summarize Malawi's experience implementing Option B+ under the direction of the MOH and supported by the Office of the Global AIDS Coordinator through the President's Emergency Plan for AIDS Relief (PEPFAR). In Malawi, the number of pregnant and breastfeeding women started on ART per quarter increased by 748%, from 1,257 in the second quarter of 2011 (before Option B+ implementation) to 10,663 in the third quarter of 2012 (1 year after implementation). Of the 2,949 women who started ART under Option B+ in the third quarter of 2011 and did not transfer care, 2,267 (77%) continue to receive ART at 12 months; this retention rate is similar to the rate for all adults in the national program. Option B+ is an important innovation that could accelerate progress in Malawi and other countries toward the goal of eliminating mother-to-child transmission of HIV worldwide.

Setting: The National Tuberculosis Programs of Ghana, Viet Nam and the Dominican Republic. Objective: To assess the direct and indirect costs of tuberculosis (TB) diagnosis and treatment for patients and households.

Background: Artemisinin-based combination therapy (ACT), the treatment of choice for uncomplicated falciparum malaria, is unaffordable and generally inaccessible in the private sector, the first port of call for most malaria treatment across rural Africa.

Summary Points Expansion of prevention of mother-to-child transmission in resource-limited settings remains a challenge. In many countries, most HIV-exposed infants do not benefit from PMTCT programs, which results in a 30% or more transmission rate.

Letter to the editor  Anna Coutsoudis and colleagues worry that international organisations have too hastily endorsed a strategy to provide lifelong triple antiretroviral therapy (ART), irrespective of CD4 count, to pregnant women with HIV in high-burden countries. This strategy for preventing mother-to-child transmission is called Option B+.

BackgroundThroughout Africa, the private sector plays an important role in malaria treatment complementing formal health services. However this sector is faced by a number of challenges including poor dispensing practices by unqualified staff.

Rationale, aims, and objectives: For a successful patient outcome, a high level of adherence to antiretroviral therapy (ART) is needed. A 2008 report in Tanzania indicated poor clinic attendance and a high lost to follow-up rate as major threats to optimal ART program effectiveness.

In developing countries, particularly in Africa, the provision of health services leans heavily towards today’s epidemics, including HIV and AIDS, malaria, tuberculosis and other infectious diseases. This calls for different approaches to the implementation of interventions from a public health perspective.

Background: Mortality and morbidity among HIV-exposed children are thought to be high in Malawi. We sought to determine mortality and health outcomes of HIV-exposed and unexposed infants within a PMTCT program.

The national scale up of antiretroviral therapy in Malawi is based on a public health approach, with principles and practices borrowed from the successful World Health Organization "DOTS" tuberculosis control framework.

A few underlying facts drove the decision to create a new society for health systems research (HSR). There is growing acknowledgement that health systems performance problems in low- and middle-income countries (LMICs) are a major impediment to making more rapid progress in achieving the Millennium Development Goals (MDGs) and ensuring universal health coverage.


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