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Management Sciences for Health (MSH) has been assisting Malawi since 2003 to strengthen health care systems, increase disease preven- tion education, reduce maternal and childhood mortality rates, and expand access to quality HIV/AIDS services.

Return of Organization Exempt from Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code

To improve quality of HIV care in targeted districts, STAR-E scaled up the Ministery of Health quality improvement framework in March 2013. STAR-E targeted 66 facilities, including high volume and smaller facilities that were underperforming on key indicators.

Key populations, including sex workers, prisoners, and men who have sex with men (MSM), are disproportionately infected with and affected by HIV and AIDS. In 2014, HIV prevalence among sex workers globally was 12 times the prevalence of the mainstream population. Sex workers and other key and priority populations contribute substantially to new HIV infections in Uganda.

Uganda ranks among the top 20 countries in the world with the highest number of TB/HIV co-infection cases and the highest rate of TB cases among people living with HIV(PLHIV). In 2015, HIV prevalence was estimated at 7.1%, and approximately 45% of TB patients were co-infected with HIV.

A Review of SIAPS’ Activities in Eight Countries The USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program has published the results of its activities in eight countries (Angola, Burundi, the Democratic Republic of the Congo (DRC), Ethiopia, Kenya, Guinea, Mali, and South Sudan) to control malaria.

The ongoing conflicts in Syria have had a major impact on the health of the population and have also reduced the capacity of health care service delivery to a minimum.

Recommendations for NCD Care in Low- and Middle-Income Country Settings

Economic studies show that investment in providing safe drinking water to the population and avoiding many deaths also generates many more productive days every year.

Lessons From a Quality Improvement Approach in Uganda

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.

At the beginning of the HEAL TB project in 2011, culture and drug susceptibility testing (DST) using solid media was available to the program in two regions to detect drug-resistant tuberculosis (DR-TB) and for monitoring treatment response, which made identifying drug- resistance patterns possible and allowed health care workers to provide more appropriate drug treatment for DR-TB patients.

In Bangladesh tea and rubber garden workers and indigenous communities live in isolated areas with difficulties to access government health facilities. In addition, the level of poverty of some of these groups put them at risk of getting TB.

GeneXpert has revolutionized the diagnosis of tuberculosis (TB) and drug resistant TB (DR-TB) by effectively detecting M. tuberculosis in clinical specimens and RMP resistance in less than two hours without sophisticated laboratories. This enables patients to begin treatment for rifampicin resistant TB on the same day, rather than after several months of ineffective treatment.

The e-TB Manager was used for drug resistant TB case management from 2010. The number of active DR-TB cases being managed in the system increased from 23 in 2010 to 1,037 in 2016.

Challenge TB was implemented in Ethiopia as part of Management Sciences for Health’s (MSH’s) Innovation Challenge Fund (INCH)2 initiative designed to encourage innovative interventions across MSH supported projects. MSH used the ExpandNet Framework3 to scale up the innovation.

Together with Borena and Guji zonal health department and the Oromia Regional Health Bureau (RHB), MSH, through the HEAL TB project (December 2015-June 2016) and now through Challenge TB (December 2016-present), identified six districts within the mining areas. Six woreda coordinators were trained and deployed to coordinate case finding and treatment observation.

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.

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.

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.

MSH has 10 TENs composed of approximately 600 members from 45 countries. Over two-thirds of members are based in field-based projects supported by MSH. Each TEN is focused on a technical area, such as reproductive, maternal, newborn, and child health, HIV/AIDS, and tuberculosis; a health systems function, such as leadership and governance, health care finance, and human resources for health; or cross-cutting topics, such as gender, youth, monitoring and evaluation, and country operations. A review of the literature, development of an operational framework, assessment, and analysis with case examples provide important insights into how the TENs can be used to collaborate with peers around the world and add value to the agency’s mission and vision. MSH now can identify which TENs are ready to be pushed to the next level of functionality to meet MSH’s evolving performance and learning priorities.

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