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The Prevention and Organizational Systems - AIDS Care and Treatment (Pro-ACT) project strengthens the capacity of Nigeria's public private, and community sectors for sustainable HIV/AIDS and TB prevention, control, care and treatment integrated within the health system. This fact sheet shows the project's results in Zamfara State from October 2013 to July 2016.

The Prevention and Organizational Systems - AIDS Care and Treatment (Pro-ACT) project strengthens the capacity of Nigeria's public private, and community sectors for sustainable HIV/AIDS and TB prevention, control, care and treatment integrated within the health system. This fact sheet shows the project's results in Kwara State from July 2009 to July 2016.

The Prevention and Organizational Systems - AIDS Care and Treatment (Pro-ACT) project is a seven-year project (2009-2016) funded by USAID and implemented by MSH in five Nigerian states: Niger, Kwara, Kebbi, Sokoto, and Zamfara.

The Prevention and Organizational Systems - AIDS Care and Treatment (Pro-ACT) project is a seven-year project (2009-2016) funded by USAID and implemented by MSH in five Nigerian states: Niger, Kwara, Kebbi, Sokoto, and Zamfara.

The Prevention and Organizational Systems - AIDS Care and Treatment (Pro-ACT) project is a seven-year project (2009-2016) funded by USAID and implemented by MSH in five Nigerian states: Niger, Kwara, Kebbi, Sokoto, and Zamfara.

The Prevention and Organizational Systems - AIDS Care and Treatment (Pro-ACT) project is a seven-year project (2009-2016) funded by USAID and implemented by MSH in five Nigerian states: Niger, Kwara, Kebbi, Sokoto, and Zamfara.

The Prevention and Organizational Systems - AIDS Care and Treatment (Pro-ACT) project is a seven-year project (2009-2016) funded by USAID and implemented by MSH in five Nigerian states: Niger, Kwara, Kebbi, Sokoto, and Zamfara.

The Prevention and Organizational Systems - AIDS Care and Treatment (Pro-ACT) project is a seven-year project (2009-2016) funded by USAID and implemented by MSH in five Nigerian states: Niger, Kwara, Kebbi, Sokoto, and Zamfara.

From 2011–16, the HEAL TB project supported Ethiopia's Federal Ministry of Health (FMOH) in Amhara and Oromia regions to improve comprehensive TB services, including finding and treating TB in children, adults, and special populations; expanding multidrug-resistant TB (MDR-TB) diagnosis and treatment; integrating TB and HIV services; improving laboratory diagnostics and reporting; and s

While TB is a national and international priority, Ethiopia's high TB rates were not declining rapidly in the 2000s. From 2011-16, USAID funded a project to support the Federal Ministry of Health (FMOH) to dramatically improve TB services and outcomes in Oromia and Amhara Regions. Its formal name is "Help Ethiopia Address Low TB Performance," or HEAL-TB.

While TB is a national and international priority, Ethiopia's high TB rates were not declining rapidly in the 2000s. From 2011-16, USAID funded a project to support the Federal Ministry of Health (FMOH) to dramatically improve TB services and outcomes in Oromia and Amhara Regions. Its formal name is "Help Ethiopia Address Low TB Performance," or HEAL-TB.

While TB is a national and international priority, Ethiopia’s high TB rates were not declining rapidly in the 2000s. From 2011-16, USAID funded a project to support the Federal Ministry of Health (FMOH) to dramatically improve TB services and outcomes in Oromia and Amhara Regions. Its formal name is “Help Ethiopia Address Low TB Performance,” or HEAL-TB.

While TB is a national and international priority, Ethiopia's high TB rates were not declining rapidly in the 2000s. From 2011-16, USAID funded a project to support the Federal Ministry of Health (FMOH) to dramatically improve TB services and outcomes in Oromia and Amhara Regions. Its formal name is "Help Ethiopia Address Low TB Performance," or HEAL-TB.

While TB is a national and international priority, Ethiopia's high TB rates were not declining rapidly in the 2000s. From 2011-16, USAID funded a project to support the Federal Ministry of Health (FMOH) to dramatically improve TB services and outcomes in Oromia and Amhara Regions. Its formal name is "Help Ethiopia Address Low TB Performance," or HEAL-TB.

The Prevention and Organizational Systems - AIDS Care and Treatment (Pro-ACT) project strengthens the capacity of Nigeria's public private, and community sectors for sustainable HIV/AIDS and TB prevention, control, care and treatment integrated within the health system. 

This collection of stories represents some of the lifesaving work of USAID, Ethiopia's federal ministry of health, and the HEAL TB project.

Last year, tuberculosis (TB) killed more people than did HIV and AIDS—becoming the world's deadliest single infectious agent. More than 95 percent of TB deaths occur in low- and middle-income countries, especially those with weak health systems.

Through the Challenge TB project, MSH’s work contributes to USAID’s goal of a world free of TB as part of its End TB Strategy, which seeks to reduce TB mortality by 35 percent and reduce incidence levels by 20 percent by 2019.

This brief provides details on the achievements, challenges, and lessons learned from the TRACK TB project's Urban DOTS component. TRACK TB works to strengthen the capacity of the National TB/Leprosy Programme in Uganda, to provide leadership for TB response, and deliver quality, well-organized, and efficient services in close collaboration with other USAID programs.   

MSH-Peru builds on the success of the Healthy Communities and Municipalities I-II projects (2006-2015).  This program, and others managed by MSH in Peru, provided access to thousands of individuals, families, and communities in various regions of Peru to live healthy lives, while changing paradigms in health care and local development.  

Performance-based Financing (PBF) is a powerful means of increasing the quality and quantity of health services by providing incentives to suppliers to improve performance and achieve results.

This editorial introduces the Lancet series on maternal health.

The purpose of this study was to investigate the quality of a select group of medicines sold in accredited drug dispensing outlets (ADDOs) and pharmacies in different regions of Tanzania as part of an in-depth cross-sectional assessment of community access to medicines and community use of medicines. We collected 242 samples of amoxicillin trihydrate, artemether-lumefantrine (ALu), co-trimoxazole, ergometrine maleate, paracetamol, and quinine from selected ADDOs and pharmacies in Mbeya, Morogoro, Singida, and Tanga regions. The analysis included physical examination and testing with validated analytical techniques. The physical examination of samples revealed no defects in the solid and oral liquid dosage forms, but unusual discoloration in an injectable solution, ergometrine maleate. Over 90% of the medicines sold in ADDOs and pharmacies met quality standards. Policy makers need to reconsider ergometrine maleate’s place on the list of medicines that ADDOs are allowed to dispense, by either substituting a more temperature-stable therapeutically equivalent product or requiring those sites to have refrigerators, which is not a feasible option for rural Tanzania.

In 2003, the government  of Tanzania introduced the accredited drug dispensing outlet (ADDO) program to improve access to good-quality medicines in rural and peri-urban areas that have frequent drug shortages in public health facilities and few or no registered pharmacies. However, increasing access may also contribute to antimicrobial resistance (AMR) due to the potential overuse and misuse of drugs. We conducted a cross-sectional household survey in four regions in mainland Tanzania to characterize consumer care-seeking habits and medicines use and to determine the extent to which members of the community are knowledgeable about antimicrobials and AMR. We revealed that communities in the four regions have low levels of knowledge of the concepts of antimicrobials and their use and AMR. Level of public understanding rose with wealth status and education. Only one-third of 1,200 respondents (33.6%) had ever heard of a medicine called an antimicrobial, and 5–15% could name at least one antimicrobial spontaneously. Some thought other medicines, such as paracetamol, were antimicrobial (7.5%). People were equally likely to agree that pneumonia should be treated with an antimicrobial (21.4%) as well as common cold (28.4%). Understanding of AMR risks was better, particularly related to HIV and AIDS (32.2%) and malaria (38.6%)—most likely due to information campaigns focused on those two diseases. The level of knowledge decreased the further away respondents lived from an ADDO and where ADDO density was lower, which supports the use of ADDO dispensers as sources of community information and change agents for more appropriate medicine use. Lack of knowledge about antimicrobials and AMR in Tanzanian communities needs to be addressed through multi-pronged strategies that focus on prescribers and the public— especially those who are poorer and less educated.

In Tanzania, a public-private partnership launched in 2003 used an accreditation approach to improve access to quality medicines and pharmaceutical services in underserved areas. The government scaled up the accredited drug dispensing outlet (ADDO) program nationally, with over 9,000 shops now accredited. This study assessed the relationships between community members and their sources of health care and medicines, particularly antimicrobials, with a specific focus on the role ADDOs play in the health care system. We surveyed 1,185 households and audited 96 ADDOs and 84 public/nongovernmental health facilities using a list of 17 tracer drugs. To determine practices in health facilities, we interviewed 1,365 exiting patients. To assess dispensing practices, mystery shoppers visited 306 ADDOs presenting one of three scenarios (102 each) about a child’s respiratory symptoms. Of 614 household members with a recent acute illness, 73% sought outside care-30% at a public facility and 31% at an ADDO. However, people bought medicines more often at ADDOs no matter who recommended the treatment; of the 581 medicines that people had received, 49% came from an ADDO. ADDO dispensers are trained to refer complicated cases to a health facility, and notably, 99% of mystery shoppers presenting a pneumonia scenario received an antimicrobial (54%), a referral (90%), or both (45%), which are recommended practices for managing pediatric pneumonia. However, one-third of the dispensers needlessly sold antibiotics for cold symptoms, and 85% sold an antibiotic on request. In addition, the pneumonia scenario elicited more advice on handling the illness than the cold symptoms scenario (61% vs. 15%; p<0.0001), but overall, only 44% of the dispensers asked any of the shoppers about danger signs potentially associated with pneumonia in a child. Poor prescribing in health facilities, poor dispensing at ADDOs, and inappropriate patient demand continue to contribute to inappropriate medicines use. Therefore, while accreditation has attempted to address the quality of pharmaceutical services in private sector drug outlets, efforts to improve access to and use of medicines in Tanzania need to target ADDOs, public/nongovernmental health facilities, and the public to be effective.

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