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Prevention of mother-to-child transmission of HIV (PMTCT) programs can greatly reduce the vertical transmission rate (VTR) of HIV, and Malawi is expanding PMTCT access by offering HIV-infected pregnant women life-long antiretroviral therapy (Option B+). There is currently no empirical data on the effectiveness of Malawian PMTCT programs. This study describes a surveillance approach to obtain population-based estimates of the VTR of infants

Abstract In 2001, Afghanistan's Ministry of Public Health inherited a devastated health system and some of the worst health statistics in the world. The health system was rebuilt based on the Basic Package of Health Services (BPHS). This paper examines why the BPHS was needed, how it was developed, its content and the changes resulting from the rebuilding.

Abstract The Paris Declaration defined five components of aid effectiveness: ownership, alignment, harmonisation, managing for results and mutual accountability. Afghanistan, which has received a high level of donor aid for health since 2002, has seen significant improvements in health indicators, expanded access to health services and an increased range of services.

Abstract In Afghanistan, malnutrition in children less than 60 months of age remains high despite nutritional services being offered in health facilities since 2003.

In recent years, there has been a shift in how the international community is addressing the HIV epidemic. As more people are receiving antiretroviral therapy, we are seeing the benefits of reduced viral load on a population level. Fewer babies are being born HIV positive and prevalence rates are dropping in most countries with the highest HIV burdens.

Ethiopia’s Federal Ministry of Health (FMOH) began integrating mother mentors with a Mother Support Group (MSG) into national HIV programing in 2005 to address the special needs of HIV-positive pregnant and postpartum women and their children.

This report reviews the role of mother mentors and their Mother Support Groups (MSGs) in supporting HIV-positive mothers to live healthy lives and use appropriate health services.

Strengthening health systems is the core of management Sciences for Health’s response to the HIV epidemic. We build the capacity of the public and private sector in more than 35 countries to prevent, treat, and manage HIV & AIDS.

This paper examines the possible relationship between Hb concentration and severity of anemia with individual and household characteristics of children aged 6-59 months in Nigeria; and explores possible geographical variations of these outcome variables. Spatial analyses reveal a distinct north-south divide in Hb concentration of the children analyzed. States in Northern Nigeria possess a higher risk of anemia. Other important risk factors include the household wealth index, sex of the child, whether or not the child had fever or malaria in the 2 weeks preceding the survey, and age under 24 months of age. There is a need for state-level implementation of programs that target vulnerable children.

BRICS’ leaders have an opportunity to pool capacity, technical expertise and financial resources to accelerate progress towards the 2020 goals for neglected tropical disease control and elimination. First, they can lead by example. Brazil, China, India and South Africa can help close the treatment gap by prioritizing neglected tropical diseases, scaling up national programmes and achieving domestic goals for control and elimination of the diseases relevant to their settings. Second, by sharing expertise each BRICS country can help other countries tackle neglected tropical diseases, through new partnerships. Third, BRICS can shape the policy agenda, increasing political commitment, mobilizing resources and implementing policies that support neglected tropical disease control and elimination on the international level.

A world where everyone has the opportunity for a healthy life—this is MSH’s vision, guiding our efforts to achieve lifesaving results by strengthening health systems. In the coming years, universal health coverage (UHC) will play a pivotal role in attaining this vision.

Key components to support local institutional and consumer markets are: supply chain, finance, clinical use, and consumer use. Key lessons learned: (1) Build supply and demand simultaneously. (2) Support a lead organization to drive the introduction process. (3) Plan for scale up from the start. (4) Profitability for the private sector is an absolute.

Bi-Annual Newsletter A publication of Health Commodities and Services Management Program Implemented by Management Sciences for Health

Bi-Annual Newsletter A PUBLICATION OF HEALTH COMMODITIES AND SERVICES MANAGEMENT PROGRAM IMPLEMENTED BY MANAGEMENT SCIENCES FOR HEALTH

This study assessed the effects of facility-based interventions using existing resources to improve overall patient attendance and adherence to antiretroviral therapy (ART) at ART-providing facilities in Uganda. Patients’ adherence was improved with low-cost and easily implemented interventions using existing health facilities’ resources. We recommend that such interventions be considered for scale-up at national levels as measures to improve clinic attendance and ART adherence among patients in Uganda and other low-resource settings in sub-Saharan Africa.

Recent studies in Guyana and Suriname revealed diminished efficacy of artemisinin derivatives based on day-3 parasitaemia. Data on malaria medicine quality and pharmaceutical management, generated in the context of the Amazon Malaria Initiative, were reviewed and discussed. Numerous substandard artemisinin-containing malaria medicines were identified in both countries, particularly in Guyana. The quality of malaria medicines and the availability and use of non-recommended treatments could have played a role in the diminished efficacy of artemisinin derivatives described in Guyana and Suriname.

Our objective in this study was to identify the missed opportunities for the integration of HIV care and family planning services and to inform future network strengthening. In two sub-cities of Addis Ababa, we identified each organization providing either HIV care or family planning services. We interviewed representatives of each of them about exchanges of clients with each of the others. With network analysis, we identified network characteristics in each sub-city network, such as referral density and centrality; and gaps in the referral patterns. Representatives from the networks confirmed the results reflected their experience and expressed an interest in establishing more links between organizations. Because of organizations not working together, women in the two sub-cities were at risk of not receiving needed family planning or HIV care services. Facilitating referrals among a few organizations that are most often working in isolation could remedy the problem, but the overall referral densities suggests that improved connections throughout might benefit conditions in addition to HIV and family planning that need service integration.

The Integrated Infectious Diseases Capacity Building Evaluation designed two interventions for mid-level practitioners from 36 primary care facilities in Uganda: the Integrated Management of Infectious Disease (IMID) training program and On-Site Support (OSS). We evaluated their effects on 23 facility performance indicators, including malaria case management.The combination of IMID and OSS was associated with statistically significant improvements in malaria case management.

Estimating the size of populations most affected by HIV such as men who have sex with men (MSM) though crucial for structuring responses to the epidemic presents significant challenges, especially in a developing society. Using capture-recapture methodology, the size of MSM-SW in Nigeria was estimated in three major cities (Lagos, Kano and Port Harcourt) between July and December 2009. Following interviews with key informants, locations and times when MSM-SW were available to male clients were mapped and designated as "hotspots." Port Harcourt had the largest estimated population of MSM sex workers, 723, followed by Lagos state with 620, and Kano with 353. This study documents a large population of MSM-SW in three Nigerian cities where higher HIV prevalence among MSM compared to the general population has been documented. Research and programming are needed to better understand and address the health vulnerabilities that MSM-SW and their clients face.

A pilot project, implemented in 2 rural districts of Malawi between 2010 and 2011, introduced a mobile phone system to strengthen knowledge exchange within networks of CHWs and district staff. To evaluate the mobile phone intervention, a participatory evaluation method called Net-Map was used. At baseline, community health workers were not mentioned as actors in the information network, while at endline they were seen to have significant connections with colleagues, beneficiaries, supervisors, and district health facilities, as both recipients and providers of information. Focus groups with CHWs complemented the Net-Map findings with reports of increased self-confidence and greater trust by their communities. These qualitative results were bolstered by surveys that showed decreases in stock-outs of essential medicines, lower communication costs, wider service coverage, and more efficient referrals. As an innovative, participatory form of social network analysis, Net-Map yielded important visual, quantitative, and qualitative information at reasonable cost.

Problems with the quality of medicines abound in countries where regulatory and legal oversight are weak, where medicines are unaffordable to most, and where the official supply often fails to reach patients. Quality is important to ensure effective treatment, to maintain patient and health-care worker confidence in treatment, and to prevent the development of resistance. In 2001, the WHO established the Prequalification of Medicines Programme in response to the need to select good-quality medicines for UN procurement. Member States of the WHO had requested its assistance in assessing the quality of low-cost generic medicines that were becoming increasingly available especially in treatments for HIV/AIDS. From a public health perspective, WHO PQP’s greatest achievement is improved quality of life-saving medicines used today by millions of people in developing countries. Prequalification has made it possible to believe that everyone in the world will have access to safe, effective, and affordable medicines. Yet despite its track record and recognized importance to health, funding for the programme remains uncertain.

Improving women’s health throughout the life course will contribute to other post-2015 goals. Conversely, women’s social empowerment will improve health. For this virtuous cycle to occur, the next iteration of the Millennium Development Goals (MDGs) has to embrace women’s health and wellbeing as a priority—particularly since indicators of women’s health are those lagging the farthest behind in the current MDGs. Universal health coverage is generally agreed to be an essential means of achieving post-2015 health goals, including addressing inequalities in women’s health care. This article looks at critical factors for designing and implementing universal health coverage to improve women’s health. The authors draw on examples from Afghanistan, Mexico, Thailand, and Rwanda.

In low income countries, Ziehl-Neelsen sputum smear microscopy is the only cost-effective tool for diagnosis and monitoring of patients on treatment for tuberculosis.The objective of this study was to investigate the role of AFB microscopy refresher training on the performance of laboratory professionals in Ethiopia. Training has improved theoretical and practical performance of laboratory professionals. Pre-placement and continuous training irrespective of lab professionals' qualifications and service year and sustainable external quality assessment are highly recommended to ensure quality of AFB microscopy services.

The Health Commodities and Services Management (HCSM) Program, in collaboration with the Kenyan Ministry of Health, works with public, private, and faith-based health facilities, including Esther’s, to minimize commodity stock outs and ensure access to care. HCSM provides training, manuals, and electronic tools that help facility staff manage TB services.

Management Sciences for Health (MSH) envisions a world where all women and men have access to quality family planning and reproductive health services.We promote universal health coverage and strengthen health systems to deliver the promise of full choice and rights for women and girls.

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