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The concept of good governance has gained prominence in development programs over the past decade. Good governance in the health sector and other sectors that have an impact on health is recognized as essential to achieving the Millennium Development Goals.

The Integrated Health Project Plus (IHPplus) was implemented in the Democratic Republic of Congo (DRC) from June 2015 to June 2018 by Management Sciences for Health (MSH) and Overseas Strategic Consulting, Ltd. (OSC), under a subcontract via Pathfinder/Evidence to Action.

The Integrated Health Project Plus (IHPplus) was implemented in the Democratic Republic of Congo (DRC) from June 2015 to June 2018 by Management Sciences for Health (MSH) and Overseas Strategic Consulting, Ltd. (OSC), under a subcontract via Pathfinder/Evidence to Action.

The Integrated Health Project Plus (IHPplus) was implemented in the Democratic Republic of Congo (DRC) from June 2015 to June 2018 by Management Sciences for Health (MSH) and Overseas Strategic Consulting, Ltd. (OSC), under a subcontract via Pathfinder/Evidence to Action.

The Integrated Health Project Plus (IHPplus) was implemented in the Democratic Republic of Congo (DRC) from June 2015 to June 2018 by Management Sciences for Health (MSH) and Overseas Strategic Consulting, Ltd. (OSC), under a subcontract via Pathfinder/Evidence to Action.

In Namibia, Togo, and 10 other countries, MSH pioneered the Electronic Dispensing Tool, a cutting-edge information system that uses the patient as the focal point and captures critical information needed to make decisions about an individual’s drug regimen, as well as stock inventory and aggregate patient statistics. How it's used

Bangladesh is one of the world’s high tuberculosis (TB) burden countries. According to World Health Organization’s 2017 Global TB Report, 38% of drug-sensitive and approximately 84% of drug-resistant patients are undiagnosed or unreported. The most infectious TB patients are these missing cases.

GxAlert is a web-based open-source data connectivity application that includes a system for data management designed to work with any diagnostic device that can connect to the internet or a mobile network.

Ethiopia is one of the most populous countries in Africa with a high TB burden across a wide geography. The national TB program has reached hundreds of thousands of cases and successfully treated them. However, health authorities believe that a third of cases have been missed in the community, development corridors, industries, and crowded settings, such as universities.

Our objective was to assess the knowledge of health professionals on Xpert MTB/RIF assay and associated factors in detecting TB/TB drug resistance. An institution based cross–sectional study was conducted from April 4 to June 5, 2015, in Addis Ababa, that involved 209 healthcare providers working in TB clinics.The overall magnitude of knowledge of healthcare workers on Xpert was found to be low. Health workers above age 35 years and those who had read the guidelines on Xpert had greater knowledge of Xpert. Distribution of the national guidelines on Xpert and assigning experienced clinicians to TB DOTs clinics are recommended.

From 2006 to 2014, Supply Chain Management System (SCMS), the global procurement and distribution project for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), distributed over US$1.6 billion worth of antiretroviral drugs and other health commodities, with over US$263 million purchased from local vendors in 14 countries in sub-Saharan Africa. A simple framework was developed and 39 local suppliers from 4 countries were interviewed between 2013 and 2014 to understand how SCMS local sourcing impacted supplier development. SCMS local suppliers reported new contracts with other businesses (77%), new assets acquired (67%), increased access to capital from local lending institutions (75%), offering more products and services (92%), and ability to negotiate better prices from their principals (80%). Additionally, 70% (n=27) of the businesses hired between 1 and 30 new employees after receiving their first SCMS contract and 15% (n=6) hired between 30 and 100 new employees. This study offers preliminary guidance on how bilateral and multilateral agencies could design effective local sourcing programs to create sustainable local markets for selected pharmaceutical products, laboratory, and transport services.

Inadequate health-care provider performance is a major challenge to the delivery of high-quality health care in low-income and middle-income countries (LMICs). The Health Care Provider Performance Review (HCPPR) is a comprehensive systematic review of strategies to improve health-care provider performance in LMICs. We screened 216,477 citations and selected 670 reports from 337 studies of 118 strategies. For professional health-care providers (generally, facility-based health workers), the effects were near zero for only implementing a technology-based strategy or only providing printed information. For percentage outcomes, training or supervision alone typically had moderate effects (10·3–15·9 percentage points), whereas combining training and supervision had somewhat larger effects than use of either strategy alone. Group problem solving alone showed large improvements in percentage outcomes (28·0–37·5 percentage points), but, when the strategy definition was broadened to include group problem solving alone or other strategy components, moderate effects were more typical (12·1 percentage points).

Quality of tuberculosis (TB) microscopy diagnosis is not a guarantee despite implementation of external quality assurance (EQA) services in all laboratories of health facilities. Hence, we aimed at evaluating the technical quality and the findings of sputum smear microscopy for acid fast bacilli (AFB) at health centers in Hararge Zone, Oromia Region, Ethiopia. Of the total 55 health center laboratories assessed during the study period (July 2014-July 2015), 20 (36.4%) had major technical errors; 13 (23.6%) had 15 false negative results and 17 (30.9%) had 22 false positive results. The quality of AFB smear microscopy reading and smearing was low in most of the laboratories of the health centers. Therefore, it is essential to strength the EQA program through building the capacity of laboratory professionals.

This quasi-experimental study conducted in Afghanistan examines the causal impact of a provincial health governance intervention on the provincial health system’s performance. It compares health system performance indicators between 16 intervention provinces and 18 nonintervention provinces using a difference-in-differences analysis to draw inference. The intervention consisted of governance action planning, implementation of the governance action plan, and self-assessment of governance performance before and after the intervention. The intervention had a statistically and practically significant impact on six indicators.

Ethiopia has a high prevalence of tuberculosis (TB) and is one of the countries with the highest burden of multidrug-resistant TB (MDR-TB). This study's purpose was to understand the costs that patients incur in obtaining diagnosis and treatment for MDR-TB. In March 2013, interviews were conducted with 169 MDR-TB patients at three hospitals in Ethiopia to identify the cost to patients and the impact on employment and family income. The average MDR-TB patient incurred a total cost of US$1378, which represented 25 months of a mid-treatment household income of US$54. The impact on the patient's employment and on overall patient and family income was generally catastrophic: 74% of all respondents reported losing their jobs, 66% of patients lost household income, and household income was reduced by 38%. To help cover the costs, 38% of patients sold some type of property, while 7% leased out property and 41% took out loans, any of which could jeopardize their future financial situation even further. Despite services being officially free of charge, most patients incurred catastrophic costs and suffered significant income loss as a result of obtaining diagnosis and treatment for MDR-TB.

Once thought nearly conquered, tuberculosis (TB) is now a global epidemic. With the combined threats of HIV, diabetes, and other chronic diseases, as well as the emergence of multidrug-resistant TB, the challenges of the disease are overwhelming national health systems.

Tuberculosis remains one of the world’s top infectious killers. MSH works in 22 countries with international, national, and local partners to strengthen the capacity of health systems to prevent the spread of TB and improve the lives of those affected by it.

Using a people-centered approach, MSH works with local partners to develop health systems solutions that meet the needs of communities affected by TB. Strengthening national, regional, district, and local health managers and their institutions to provide quality health services is a core strategy to support health systems resilience and sustainability.

The 49th Union World Conference on Lung Health, October 24-27, brings together over 3,000 researchers, global advocates, scientists, healthcare professionals, students and community members working on all aspects of lung health. 

As MSH has shown, innovations in TB prevention and treatment are needed throughout health systems.

A follow up study among 735 new TB cases registered at health facilities in districts of southwest Ethiopia was conducted from January 2015 to June 2016. Patients reported days elapsed between onset of illness and treatment commencement. The overall treatment success among the treatment cohort was 89.7% respectively among those initiated treatment beyond and within of 30 days of onset of illness. Higher risk of unsuccessful outcome was predicted by treatment initiation beyond 30 days of onset, HIV co-infection, and received treatment at hospital. On the other hand, lower risk of unsuccessful outcome was predicted by weight gain and sputum smear negative conversion the end of second month treatment. Higher risk of unsuccessful outcome is associated with prolonged days elapsed between onset of illness and treatment commencement. Hence, promotion of early care seeking, improving diagnostic and case holding efficiencies of health facilities and TB/HIV collaborative interventions can reduce risk of unsuccessful outcome.

A longitudinal study among 735 new TB cases was conducted from January 2015 through June 2016 in 10 woredas (districts) of southwestern Ethiopia. Between onset of illness and anti-TB treatment course, patients incurred a median of US$201.48. Of the total cost, the indirect and direct costs respectively constituted 70.6 and 29.4%. TB patients incurred a median of US$97.62 and US$93.75 during the pre- and post-diagnosis periods, respectively. Thus, patients incurred 53.6% of the total cost during the pre-diagnosis period. Direct out-of-pocket expenses during the pre- and post-diagnosis periods respectively amount to median of US$21.64 and US$35.02. Patient delay days, provider delay days, number of healthcare facilities visited until TB diagnosis, and TB diagnosis at private facilities independently predicted increased pre-diagnosis cost. Similarly, rural residence, hospitalization during anti-TB treatment, patient delay days, and provider delay days predicted increased post-diagnosis costs. TB patients incur substantial cost for care seeking and treatment despite “free service” for TB. Therefore, promoting early care seeking, decentralizing efficient diagnosis, and treatment services within reach of peoples, and introducing reimbursement system for direct costs can help minimize financial burden to the patient.

In response to the HIV and tuberculosis (TB) epidemics, we build the capacity of our public- and private-sector partners to prevent TB and HIV and improve diagnosis and management of co-infected patients.

Observational data characterizing the pediatric and adolescent HIV epidemics in real-world settings are critical to informing clinical guidelines, governmental HIV programs, and donor prioritization. In this commentary, we describe existing sources of observational data for children and youth living with HIV, focusing on larger regional and global research cohorts, and targeted surveillance studies and programs. Observational studies were among the first to highlight the growing population of children surviving perinatal HIV and transitioning to adolescence and young adulthood, and have raised serious concerns about high rates of treatment failure, loss to follow-up, and death among older perinatally infected youth. The use of observational data to inform modeling of the current global epidemic, predict future patterns of the youth cascade, and facilitate antiretroviral forecasting are critical priorities and key end products of observational HIV research. Greater investments into data infrastructure are needed at the local level to improve data quality and at the global level to faciliate reliable interpretation of the evolving patterns of the pediatric and youth epidemics. Harmonized data forms, use of unique patient identifiers to allow for data linkages across routine data sets, electronic medical record systems, and competent data managers and analysts are essential to make optimal use of the data collected.

We present Ethiopia's experience in implementing LTBI management. Our objective is to share promising practices and existing opportunities and to suggest specific steps required for further scale up of the services. Our report is based on synthesis of data from secondary sources including official routine reports of Ministry of Health, materials presented at review meetings, and findings from supervisory visits to districts and health facilities. Our results suggest that Ethiopia has made significant strides toward strengthening LTBI management in people living with HIV and among under-five-year-old household contacts of TB patients. The use of contact investigation as entry point for LTBI management could be taken as best practice.