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The success of the Namibian government’s “treatment for all” approach to control and stop the country’s HIV epidemic is dependent on an uninterrupted supply of antiretrovirals (ARVs) for people living with HIV. The public health system in Namibia, however, was constrained by an inefficient paper-based pharmaceutical information system resulting in unreliable and inaccessible data, contributing to persistent stock-outs of ARVs and other essential pharmaceuticals. This article describes the incremental implementation of an integrated pharmaceutical management information system to provide timely and reliable commodity and patient data for decision making in Namibia’s national antiretroviral therapy (ART) program and the Ministry of Health and Social Services (MoHSS). Namibia’s pharmaceutical management information system demonstrates the feasibility and benefits of integrating related tools while maintaining their specialized functionality to address country-specific information and inventory management needs.

Blended learning is an approach that combines independent reading with short off-site training. Management Sciences for Health (MSH), under the guidance of the Ethiopia National TB Program and in partnership with the All-Africa Leprosy, Tuberculosis and Rehabilitation Training Center (ALERT), pioneered a blended learning approach for TB training in Ethiopia.

A strong pharmaceutical sector is a precondition for effective and efficient health care and financing systems, and thus for achieving the best possible health of a population. Supported by visionary, long-term donor funds, in conjunction with mutual trust, the USAID-funded Securing Ugandans' Rights to Essential Medicines (SURE) and Uganda Health Supply Chain (UHSC) program engaged in a close, more than 10 year-long (in 2018) collaboration with the Ministry of Health of Uganda. Over time, the partnership implemented numerous multi-pronged comprehensive changes in the pharmaceutical sector and conducted research to document successes and failures. We describe the evolution and key characteristics of the SURE/UHSC interventions.

Uganda introduced a multipronged intervention, the supervision, performance assessment, and recognition strategy (SPARS), to improve medicines management (MM) in public and not-for-profit health facilities. This paper, the first in a series, describes the SPARS intervention and reports on the MM situation in Uganda before SPARS (baseline).

Uganda’s Ministry of Health in 2012 implemented a comprehensive strategy (SPARS) to build medicines management capacity in public sector health facilities. The approach includes supportive supervision. This structured observational study assesses supportive supervision competency among medicines management supervisors (MMS). The study used structured observations of two groups of five purposely selected MMS—one group supervising facilities with greater medicines management improvement during one year of SPARS and one group with less improvement, based on quantitative metrics. Our results suggest that MMS’ supportive supervision competency is positively related to the SPARS effectiveness scores of the facilities they supervise. We recommend strategies to strengthen supportive supervision behaviors and skills.

To build capacity in medicines management, the Uganda Ministry of Health introduced a nationwide supervision, performance assessment and recognition strategy (SPARS) in 2012. Medicines management supervisors (MMS) assess performance using 25 indicators to identify problems, focus supervision, and monitor improvement in medicines stock and storage management, ordering and reporting, and prescribing and dispensing. Although the indicators are well-recognized and used internationally, little was known about the reliability of these indicators. An initial assessment of inter-rater reliability (IRR), which measures agreement among raters (i.e., MMS), showed poor IRR; subsequently, we implemented efforts to improve IRR. The aim of this study was to assess IRR for SPARS indicators at two subsequent time points to determine whether IRR increased following efforts to improve reproducibility. Initially only five (21%) indicators had acceptable reproducibility, defined as an IRR score ≥ 75%. At the initial assessment, prescribing quality indicators had the lowest and stock management indicators had the highest IRR. By the third IRR assessment, 12 (50%) indicators had acceptable reproducibility, and the overall IRR score improved from 57% to 72%. The IRR of simple indicators was consistently higher than that of complex indicators in the three assessment periods. We found no correlation between IRR scores and MMS experience or professional background.

Half of the Ugandan population obtains medicines from the public sector. Yet, we found only 3/5 of 455 inspected public health facilities meet Good Pharmacy Practice (GPP) standards. Facilities using SPARS (the Supervision, Performance Assessment, and Recognition Strategy) tended to perform better than unsupervised facilities, substantiating the value of supporting supervision interventions in GPP areas that need strengthening. Non-compliant indicators can be improved through practices and behavioral changes; some require infrastructure investments. We conclude that regular National Drug Authority inspections of public sector pharmacies in conjunction with interventions to improve GPP adherence can revolutionize patient care in Uganda.

Abstract Background: To ascertain equity in financing for essential medicines and health supplies (EMHS) in Uganda, this paper explores the relationships among government funding allocations for EMHS, patient load, and medicines availability across facilities at different levels of care.

In late 2010, Uganda introduced a supervision, performance assessment, and recognition strategy (SPARS) to improve staff capacity in medicines management in government and private not-for-profit health facilities. This paper assesses the impact of SPARS in health facilities during their first year of supervision. SPARS was effective in building health facility capacity in medicines management, with a median overall improvement of almost 70% during the first year. The greatest improvements occurred in prescribing quality and at lower levels of care, although the highest level of performance was achieved in storage management. We recommend broad dissemination of the SPARS approach in all Ugandan health facilities as well as in other countries seeking a practical strategy to improve medicines management performance.

All health care systems face problems of justice and efficiency related to setting priorities for allocating limited financial resources. Health Technology Assessment (HTA) and Multi-Criteria Decision Analysis (MCDA) have emerged as policy tools to assist informed decision-making. Both, MCDA and HTA have pros and cons. This paper briefly presents the current challenges of the Colombian health system, the general features of the new health sector reform, the main characteristics of HTA in Colombia and the potential benefits and caveats of incorporating MCDA approaches into the decision-making process. Further testing and validation of HTA and MCDA solely or combined in LMICs are needed to advance these approaches into healthcare decision-making worldwide.

Why is Gender Responsiveness in Health Governance so important? Gender-responsiveness in governance has the potential to enhance positive health outcomes not only for women but also for the entire community. Women play three important roles in a health system: 1) as decision makers; 2) as health workers and health care providers; and 3) as users of services.

Mobile health (mHealth) is the use of mobile and wireless technologies to support the achievement of health objectives. The rapid growth in access to mobile phones and networks has opened opportunities for health programs and systems to harness these technologies to positively impact the health of Africans.

This poster demonstrates that Urban DOTS helped to significantly improve TB treatment outcomes in Kabul city and recommends that Urban DOTS should be expanded in similar settings to improve TB case detection and treatment outcomes by engaging both the private and public sectors in DOTS implementation.

CORE Plus training course conducted for Syrian NGOs in Turkey, 2017. Photo Credit: Steven Collins/MSH PURPOSE

This issue of The eManager focuses on governing in the health sector, and presents four effective governing practices and their nine key enablers. It shows how health leaders and managers can contribute to a better-governed institution and, ultimately, improve health services and the health of the people they serve.

The FCI Program of MSH advocates at the global, country, and community levels, for improved sexual, reproductive, maternal, newborn, child and adolescent health and rights.

More than 100 countries are in the process of adopting or embarking on universal health coverage (UHC) and health reform strategies, such as pro-poor national insurance and decentralization.

Burkina Faso: Amid times of political crisis, civil society advocates call for increased invesment in women's and children's health Kenya: Women's and children's health in a devolved state: Advocates tackle crippling health worker shortages through budget advocacy

To improve quality of service provision and data accuracy and timeliness, USAID Mikolo is introducing mobile technology to replace paper-based tools used by community health volunteers (CHVs).Working alongside the Ministry of Public Health and other partners, the project has developed a smartphone application that CHVs will use to manage their health services and record-keeping and disseminate inf

In Madagascar, despite years of efforts to improve maternal health, the maternal mortality ratio remains as high at 487 deaths per 100,000 live births, whereas the average for developing countries is 235. Additionally, only 51% of pregnant women receive four antental care (ANC) visits, which is the recommended number to prevent and manage possible pregnancy complications.

The USAID Mikolo Project created a new approach to assure, improve, and sustain the quality of community-based health services.This technical brief describes the Mikolo approach and assesses its impact on community health volunteer performance between 2014 and 2016. The USAID Mikolo Project quality assurance / quality improvement approach included ve key activities:

The USAID Mikolo Project, in collaboration with the Ministry of Public Health and the Ministry of Youth and Sports, established aYouth Peer Educators (YPE) initiative.The initiative aims to improve youth education and awareness on reproductive health and FP in order to increase contraceptive prevalence rates among 15–24 year olds in USAID Mikolo intervention areas.

In spite of substantial advances in maternal and newborn health over recent decades, roughly 300,000 girls and women still die due to pregnancy-related complications every year. At present, the global community largely agrees on what needs to be done to prevent these deaths and improve the health and wellbeing of women and babies.

Access to safe and effective family planning is a fundamental human right, essential for achieving gender equality, eliminating extreme poverty, and reducing maternal and child deaths.

Each year the world loses 300,000 women and more than 2 million newborns to preventable causes related to pregnancy and childbirth. Millions of mothers in low-resource settings miss out on proper antenatal care, give birth without a skilled attendant, and don’t receive postpartum care for themselves or their babies.

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