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The aim of the present study was to indentify the epidemiological factors of drug-resistant (DR TB) patients in the northern part of Bangladesh. A cross-sectional study was conducted of registered DR TB patients at two chest diseases hospitals. The present study demonstrated that males (68.9%) were more affected by DR TB than females (31.8%).This study suggested that sex, age, type of treatment, residence, education and smoking status were important factors for getting MDR TB. It is expected that this study can help government to take activities for controlling and prevent MDR TB disease.

We assessed a participatory community and health system intervention to reduce the prevalence of disrespect and abuse during childbirth in Tanzania. After implementation of the combined intervention, the likelihood of women’s reports of disrespectful treatment during childbirth was substantially reduced. These results were observed nearly 1 year after the end of the project’s facilitation of implementation, indicating the potential for sustainability. The results indicate that a participatory community and health system intervention designed to tackle disrespect and abuse by changing the norms and standards of care is a potential strategy to improve the treatment of women during childbirth at health facilities.

TB data for 2015 were combined with cost data using a simple type of cost-benefit analysis in a decision tree model to show the economic burden under different scenarios. In Indonesia, there were an estimated 1, 017,378 new active TB cases in 2015, including multidrug-resistant TB. It is estimated that 417,976 of these cases would be treated and cured, 160,830 would be unsuccessfully treated and would die, 131,571 would be untreated and would achieve cure spontaneously, and 307,000 would be untreated and would die. The total economic burden related to treated and untreated cases would be approximately US$6.9 billion. Loss of productivity due to premature death would be by far the largest element, comprising US$6.0 billion (discounted), which represents 86.6% of the total cost. Loss of productivity due to illness would be US$700 million (10.1%), provider medical costs US$156 million (2.2%), and direct non-medical costs incurred by patients and their households US$74 million (1.1%). The economic burden of TB in Indonesia is extremely high. Detecting and treating more cases would result not only in major reductions in suffering but also in economic savings to society.

Launched in 1999, Community-Based Health Insurance (CBHI) in Rwanda has reached extensive coverage for health care services. CBHI was developed by the Government of Rwanda in response to a drop in the use of health services after the reintroduction of user fees in 1996.

To determine if children presenting without complaints related to the Integrated Management of Childhood Illness (IMCI) are at greater risk for suboptimal screening for IMCI conditions, we randomly sampled and observed 3072 sick child visits in 33 provinces of Afghanistan. The study indicated that children with non-IMCI complaints are at greater risk of suboptimal screening compared to children with IMCI-related complaints. We concluded that facility and provider capacity needs to be improved, particularly during training, supervision and guideline dissemination, to ensure that all children receive routine screening for common IMCI conditions.

Purpose: To examine the effectiveness of stock monitoring and record-keeping practices in warehouses and help users identify suggestions for improvement.

Purpose: To allow effective, rapid, inexpensive, large-scale, decentralized implementation of health programs and projects. Intended Users: Ministry of Health (MOH) at central, provincial, and district level, non-government organizations (NGOs), hospitals, and any organizations or groups responsible for program implementation within a decentralized health care system. Description:

The International Medical Products Price Guide (formerly International Drug Price Indicator Guide) contains a spectrum of prices from pharmaceutical suppliers, international development organizations, and government agencies.

We implemented a group randomized controlled trial in 24 reproductive and child health clinics in eight districts in Mbeya region. Three months pre-intervention, we identified 1924 and 1226 patients established on antiretroviral therapy for six months or more in intervention and control clinics, respectively, of whom 83.4% and 86.9% had one or more post-intervention visits. The unadjusted rate of missed visits declined from 36.5% to 34.4% in intervention clinics and increased from 38.9% to 45.5% in control clinics following the intervention. Interrupted time series analyses demonstrated a net decrease of 13.7% (95% CI [-15.4,-12.1]) for missed visits at six months post-intervention. Similar differential changes were observed for visits missed by 3, 7, 15, or 60 days. Appointment-tracking and community outreach significantly improved appointment-keeping for women on antiretroviral therapy. The facility staff controlled their workload better, identified missing patients rapidly, and worked with existing community organizations. There is now enough evidence to scale up this approach to all antiretroviral therapy and Option B+ reproductive and child health clinics in Tanzania as well as to evaluate the intervention in medical clinics that treat other chronic health conditions.

MSH authors have published a number of journal articles describing the accredited drug seller implementation experience and lessons learned in Tanzania—home of the flagship ADDO program. A new compendium reviews highlights ranging from robust multi-method quantitative to informative qualitative research. 

The Management of Medicines Benefit Programs in Low- and Middle-Income Settings manual serves as a primer for managers, government officials, or consultants who are tasked by a government, health insurance plan, or other institution with designing or implementing a medicines benefit program.

A Conference on Epidemic Preparedness November 13, 2017 The Joseph B. Martin Conference Center I Harvard Medical School

Several recent studies have attempted to measure the prevalence of disrespect and abuse (D&A) of women during childbirth in health facilities. Variations in reported prevalence may be associated with differences in study instruments and data collection methods. This systematic review and comparative analysis of methods aims to aggregate and present lessons learned from published studies that quantified the prevalence of D&A during childbirth.

Emergencies can often directly impact health systems of an affected region or country, especially in resource-constrained areas. Health system recovery following an emergency is a complex and dynamic process. Health system recovery efforts have often been structured around the World Health Organization’s health systems building blocks as demonstrated by the Post-Disaster Needs Assessment. Although this structure is valuable and well known, it can overlook the intricacies of public health systems. We retrospectively examine public health systems recovery, a subset of the larger health system, following the 2010 Haiti earthquake and cholera outbreak, through the lens of the 10 essential public health services. This framework illustrates the comprehensive nature of and helps categorize the activities necessary for a well-functioning public health system and can complement other assessments. Outlining the features of a public health system for recovery in structured manner can also help lay the foundation for sustainable long-term development leading to a more robust and resilient health system.

The objective of this study is to explore selected pharmacies' readiness to serve women seeking emergency contraception (EC). This study used a mystery client (MC) methodology to visit 73 pharmacies in Kinshasa, Democratic Republic of Congo (DRC). Findings indicate that more than two-thirds of EC providers were knowledgeable about EC dosage, timeframe, and side effects, and 90% were deemed helpful towards novice EC users. Rare but glaring misconceptions about EC timeframe (20% of providers) and long-term side effects (4% of providers), as well as frequent stock-out (22%) and cost issues highlight priorities for programmatic improvements. As new service delivery strategies are explored to complement the uneven network of health structures in DRC, this study suggests that, given proper training and integration in FP programming, private-sector pharmacies have the potential to meet specific contraceptive needs for women living in Kinshasa.

The objective of this study was to understand motives for contraceptive implant discontinuation in Luanda and Huambo, Angola. We conducted 45 in-depth interviews and six focus groups amongst former and current contraceptive implant clients and family planning nurses in eight clinics. Motives for discontinuation reflect findings from other studies in similar settings, in particular the influence of adverse side effects and desire for pregnancy as motivating factors. We contextualize these findings in the Angolan setting to tease out the relationship between cultural norms of ideal family size and the perceived role of women in regards to fertility and child-bearing. We suggest that programs enter into dialog with communities to address these concerns, rather than working exclusively on improving service delivery and quality.

The objective of the NSP is to improve network effectiveness to meet their member’s needs and enhance their long-term sustainability. The content of the program includes: membership and benefits, distributed leadership, network governance, financial systems and sustainability, and communications for resource mobilization.

The Pre-service Integration Guide is designed to assist heads of departments and faculty in pre-service health training institutions that train medical, nursing, pharmacy, laboratory and other allied health professionals to successfully introduce practical and action-oriented leadership and management modules into pre-service curricula for their students.

This guide was developed as an abbreviated companion to the longer Management Sciences for Health publication Leaders Who Govern, with two main goals: To facilitate finding practical information about specific aspects of good governance

FinMAT helps managers assess their organizations’ financial management capacity, identify areas for improvement, make specific action plans to address shortcomings, and monitor for improvement The heart of FinMAT is an instrument for collecting and summarizing technical information about an organization’s financial management systems and practices.

In Gavi-eligible countries partnerships are dynamic networks of immunization actors who work together to support all stages and aspects of Gavi support. This paper describes a conceptual framework--the partnership framework--and analytic approach for evaluating the perceptions of partnerships’ value as well as the results from an application to one case in Uganda. We used a mixed-methods case study design embedded in the Gavi Full Country Evaluations to test the partnership framework on Uganda’s human papillomavirus vaccine application partnership. The partnership was not perceived to have increased the efficiency of the process, perhaps as a result of unclear or absent guidelines around roles and responsibilities. We concluded that the health and functioning of global health partnerships can be evaluated using the framework and approach presented here. Network theory and methods added value to the conceptual and analytic processes, and we recommend applying this approach to other global health partnerships to ensure that they are meeting the complex challenges they were designed to address.

Kobe Refugee camp hosts roughly 39,000 refugees displaced from Somalia during the 2011–2012 Horn of Africa Crisis. Sexual and reproductive health (SRH) issues, as well as the greater issues of health and well-being for adolescents displaced from this crisis, remain largely unknown and neglected. In 2013, the Women’s Refugee Commission, Johns Hopkins University, and International Medical Corps in Ethiopia implemented qualitative and quantitative research to explore the factors and risks that impact the health of very young adolescents (VYAs), those 10–14 years of age, in this setting. This research identified several factors that were found to influence the health and well-being of VYAs in Kobe refugee camp, including newfound access to education and security, combined with gender divisions and parental communication around early SRH and puberty that remained intact from traditional Somali culture. Girls were found to face an additional risk of child marriage and early pregnancy since displacement, which significantly limited their ability to access education and achieve future aspirations.

In February and March 2016, a team of MSH staff and consultants collaborated with the MOHS,UNICEF/Sierra Leone, and other stakeholders to collect data for piloting the methodology and tool.MSH staff conducted interviews and collected data at all levels of the health system, including visitsto health facilities in two districts where facility staff, CHW supervisors, and CHWs were interviewed.MSH st

MSH designed and piloted this methodology and tool in Malawi and Sierra Leone, countries that were selected given the important role that community health workers play within each of the countries' health systems.

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