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This series of briefs, commissioned by the Supply and Awareness Technical Reference Team (TRT) of the United Nations Commission on Life-Saving Commodities for Women's and Children's Health (UNColSC), aims to share some of the promising practices and tested solutions from Every Women Every Child (EWEC) countries.

In low- and middle-income countries (LMICs), health systems have historically focused on the prevention and treatment of highly prevalent and frequently fatal acute infectious illnesses such as malaria, diarrhea, and respiratory infections.

For over 40 years, Management Sciences for Health (MSH) has been working in partnership with nongovernmental organizations (NGOs) around the world to support the delivery of community-based health services to underserved populations.As NGOs and civil society become more prominent in the delivery of health care and related services, such as advocacy and health education, local organizations have gr

Leadership and Management Skills Help Gotani Health Center Improve Maternal and Child Health Outcomes

As national antiretroviral treatment (ART) programmes scale up, it is essential that information is complete, timely and accurate for site monitoring and national planning. This study assessed the quality of quarterly aggregate summary data for April to June 2006 compiled and reported by ART facilities as compared to the "gold standard" facility summary data compiled independently by the Ministry of Health supervision team. The national summary using the site reports resulted in a 12% undercount in the national total number of persons on first-line treatment. While many sites are able to generate complete data summaries, the accuracy of facility reports is not yet adequate for national monitoring. The Ministry of Health and its partners should continue to identify and support interventions such as supportive supervision to build sites' capacity to maintain and compile quality data to ensure that accurate information is available for site monitoring and national planning.

Approximately 1 million people are infected with HIV in Malawi, where AIDS is the leading cause of death in adults. By December 31, 2007, more than 141,000 patients were initiated on antiretroviral treatment (ART) by use of a public health approach to scale up HIV services. In Malawi, a public health approach to ART increased treatment access and maintained high 6- and 12-month survival. Resource-limited countries scaling up ART programs may benefit from this approach of simplified clinical decision making, standardized ART regimens, nonphysician care, limited laboratory support, and centralized monitoring and evaluation.

The global demand for artemisinin-based combination therapy (ACT) has grown sharply since its recommendation by the World Health Organization in 2002. However, a combination of financing and programmatic uncertainties, limited suppliers of finished products, information opacity across the different tiers in the supply chain, and widespread fluctuations in raw material prices have together contributed to a market fraught with demand and supply uncertainties and price volatility. Various short-term solutions have been deployed to alleviate supply shortages caused by these challenges; however, new mechanisms are required to build resilience into the supply chain. This review concludes that a mix of strategies is required to stabilize the artemisinin and ACT market. First, better and more effective pooling of demand and supply risks and better contracting to allow risk sharing among the stakeholders are needed. Physical and financial buffer stocks will enable better matching of demand and supply in the short and medium term. Secondly, physical buffers will allow stable supplies when there are procurement and supply management challenges while financial buffer funds will address issues around funding disruptions. Finally, in the medium to long term, significant investments in country level system strengthening will be required to minimize national level demand uncertainties. In addition a voluntary standard for extractors to ensure appropriate purchasing and sales practices as well as minimum quality and ethical standards could help stabilize the artemisinin market in the long term.

This article assessed private sector accredited drug dispensing outlets in Morogoro and pharmacies in Dar es Salaam, Tanzania, to determine (1) the level of knowledge about tuberculosis (TB) among dispensers in Tanzania's retail pharmaceutical sector; (2) practices related to identification of patients with suspected TB; (3) the availability of educational materials and training; and (4) the availability of first- and second-line anti-tuberculosis treatment in retail drug outlets. Private retail drug outlets are convenient; most are open at least 12 h per day, 7 days/week. Although 95% of dispensers identified persistent cough as a symptom of TB, only 1% had received TB-related training in the previous 3 years; 8% of outlets stocked first-line anti-tuberculosis medicines, which are legally prohibited from being sold at retail outlets. The majority of respondents reported seeing clients with TB-like symptoms, and of these 95% reported frequently referring clients to nearby health facilities. Private retail pharmaceutical outlets can potentially contribute to TB case detection and treatment; however, a coordinated effort is needed to train dispensers and implement appropriate referral procedures.

Bacterial meningitis is a medical emergency associated with high mortality rates. Cerebrospinal fluid (CSF) culture is the “gold standard” for diagnosis of meningitis and it is important to establish the susceptibility of the causative microorganism to rationalize treatment. The Namibia Standard Treatment Guidelines (STGs) recommends initiation of empirical antibiotic treatment in patients with signs and symptoms of meningitis after taking a CSF sample for culture and sensitivity. The objective of this study was to assess the antimicrobial sensitivity patterns of microorganisms isolated from CSF to antibiotics commonly used in the empirical treatment of suspected bacterial meningitis in Namibia. The common organisms isolated from CSF were Streptococcus Pneumoniae, Neisseria meningitidis,Haemophilus influenzae, Staphylococcus, and E. coli. All common organisms isolated from CSF showed high sensitivity to cephalosporins used in the empirical treatment of meningitis. The resistance of the common isolates to penicillin is high. Most ESBL K. pneumoniae were isolated from CSF samples drawn from neonates and were found to be resistant to the antibiotics recommended in the Namibia STGs. Based on these findings, it is recommended to use a combination of aminoglycoside and third-generation cephalosporin to treat non–ESBL Klebsiella isolates. Carbapenems (e.g., meropenem) and piperacillin/tazobactam should be considered for treating severely ill patients with suspected ESBL Klebsiella infection. Namibia should have a national antimicrobial resistance surveillance system for early detection of antibiotics that may no longer be effective in treating meningitis and other life-threatening infections due to resistance.

A public-private partnership in Tanzania launched the accredited drug dispensing outlet (ADDO) program to improve access to quality medicines and pharmaceutical services in rural areas. ADDO dispensers play a potentially important role in promoting the rational use of antimicrobials, which helps control antimicrobial resistance (AMR). The study objectives were to 1) improve dispensing practices of antimicrobials, 2) build ADDO dispensers' awareness of the consequences of misusing antimicrobials, and 3) educate consumers on the correct use of antimicrobials through the use of printed materials and counseling.The percentage of ADDO dispensers following good dispensing practices increased from an average of 67% in the first monitoring visit to an average of 91% during the last visit. After the intervention, more dispensers could name more factors contributing to AMR and negative consequences of inappropriate antimicrobial use, and over 95% of ADDO customers knew important information about the medicines they were dispensed. Conclusions: Providing educational materials and equipping ADDO dispensers with knowledge and tools helps significantly improve community medicine use and possibly reduces AMR. The number of community members who learned about AMR from ADDO dispensers indicates that they are an important source of information on medicine use.

Health Must Remain a Top Priority We believe the Post-2015 Development Agenda must accelerate progress on unmet MDGs and create a tangible, bold vision for achieving future health progress. It should have a strong emphasis on country ownership and empowering locals to take greater control over their own development. 

In most low-income countries, when people are sick enough to seek treatment, their first stop is usually a drug seller— an unlicensed drug seller. Too often, the medicine they receive is poor quality or costly—or even the wrong drug altogether. They stay sick, or worse, die from receiving the wrong drug. It doesn't have to be that way.

Management Sciences for Health serves on the steering group of The NCD Alliance, which has issued this polcy brief on universal health coverage and non-communicable diseases. 

The Rwandan Ministry of Health, in collaboration with the USAID-funded Integrated Health Systems Strengthening Project (IHSSP), carried out a study to determine the costs of providing health centre services. The results of the costing were intended for use in re-designing insurance reimbursement mechanisms and levels.

Some countries have made great strides in expanding Tuberculosis (TB) control over the last few years, with significant assistance from donors, such as the Global Fund (GF) for Acquired Immune Deficiency Syndrome (AIDS), TB and Malaria. While there is still substantial donor funding for TB programs, these funds are expected to diminish in countries that have improving economies.

Indonesia has made great strides in expanding Tuberculosis (TB) control over the last few years, with significant assistance from donors, such as the Global Fund against Acquired Immune Deficiency Syndrome (AIDS), TB and Malaria (GFATM) and the United States Agency for International Development (USAID).

Understanding the economic burden to society from a disease like TB is important as it can be used as evidence when advocating for greater investment. This report describes the development of a tool to estimate the economic burden of TB in Indonesia and the results stemming from its use.

This report describes recommended actions for the National Tuberculosis Control Program (NTP) to consider in developing its Exit Strategy implementation plan. It also describes a set of recommended technical assistance and training activities aimed at supporting the NTP in this process.

In many countries tuberculosis (TB) control programs are scaling-up the detection and treatment of TB cases to reduce the burden on patients, their families and society. This will result in significantly increased costs over the next few years until prevalence begins to fall.

Based on Primary Health Care approaches, the Ministry of Health (Myanmar) had formulated four yearly People’s Health Plans from 1978 to 1990, followed by the National Health Plans from 1991-1992 to 2006-2011. These plans have been formulated within the framework of National Development Plans for the corresponding period.

The Rwandan Ministry of Health, in collaboration with the USAID-funded Integrated Health Systems Strengthening Project (IHSSP), carried out a study to determine the costs of providing hospital services. The results of the costing were intended for use in re-designing insurance reimbursement mechanisms and levels.

Ethiopia has a high prevalence of tuberculosis (TB) and is one of the 22 highest TB burden countries in the world. It is also one of the countries where many people who develop TB every year do not get treated. One of the reasons why infected people delay or do not seek diagnosis and treatment is economic access – the cost to patients and their families.

The purpose of this study was to develop estimates of the cost of the scaled-up scorecard interventions. Based on the action plans developed by the programmes, the interventions would require resources costing $79.9 million from 2007 through 2010 to achieve the targeted coverage levels.

The primary objective of this study was to model the costs and funding requirements of the Ministry of Health’s Minimum Package of Activities (MPA), which covers services provided by health centers.

Year Ended June 30, 2013, drawn from audited financial statements.

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