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This report summarizes significant USAID MTaPS achievements, key challenges, program performance, and adaptation in response to new demands and lessons learned for the April through June 2019 period. The report is organized by health area, objective, region, and country.

Afghanistan accounts for two-thirds of the global area under opium poppy cultivation and produces 70 percent of the world’s opiates.

The objective of the USAID-funded Keneya Jemu Kan (KJK) project (communication and health prevention) is to promote key healthy behaviors and increase the demand for and use of high-impact health services and commodities. As the capacity building lead, MSH’s role has been to build the organizational leadership, management, and governance (L+M+G) capacities of public sector and health no

In 2014, the Government of Angola introduced a national community development and health worker program to address challenges affecting the poor.

To address the high burden of TB in the Philippines, the National TB Control Program (NTP) of the Department of Health (DOH) is working to ensure access to TB medicines.

One of the key elements of successful tuberculosis (TB) control programs is adherence to treatment, and this is a cornerstone of most international and national policies and guidelines. Non-adherence is often due to patient-related factors, but can also be a result of provider issues, such as stock-outs of TB medicines.

The National TB Control Program (NTP) in the Philippines is continuously scaling up its operations in the diagnosis and treatment of tuberculosis (TB) to achieve the results and deliverables described in the 2010–2016 Philippine Plan of Action to Control Tuberculosis.

USAID’s Safe, Affordable, and Effective Medicines for Ukrainians (SAFEMed) Project supports reforms in managing medicines by strengthening pharmaceutical-sector governance, optimizing pharmaceutical-sector finance, and supporting improved availability and use of essential medicines in Ukraine.

The WHO’s Rapid Access Expansion (RAcE) program supported the Malawi Ministry of Health to align their Community-Based Maternal and Newborn Care (CBMNC) package with the latest WHO guidelines and to implement and evaluate the feasibility and coverage of home visits in Ntcheu district. A population-based survey of 150 households in Ntcheu district was conducted in July-August 2016 after approximately 10 months of CBMNC implementation. Thirty clusters were selected proportional-to-size using the most recent census. In selected clusters, five households with mothers of children under six months of age were randomly selected for interview. The Health Surveillance Assistants (HSAs) providing community-based services to the same clusters were purposively selected for a structured interview and register review. Less than one third of pregnant women (30.7%) received a home visit during pregnancy and only 20.7% received the recommended two visits. Coverage of postnatal visits was even lower: 11.4% of mothers and newborns received a visit within three days of delivery and 20.7% received a visit within the first eight days. These findings were similar to previous studies, calling into question the feasibility of the current visitation schedule. It is time to re-align the CBMNC package with what the existing platform can deliver and identify strategies to better support HSAs to implement home visits to those who would benefit most.

Malawi has a mature integrated community case management (iCCM) programme that is led by the Ministry of Health (MOH) but that still relies on donor support. From 2013 until 2017, under the Rapid Access Expansion (RAcE) programme, the World Health Organization supported the MOH to expand and strengthen iCCM services in four districts. This paper examines Malawi’s iCCM programme performance and implementation strength in RAcE districts to further strengthen the broader programme. Baseline and endline household surveys were conducted in iCCM-eligible areas of RAcE districts. Care-seeking from HSAs and treatment of fever improved over the project period. At endline, however, less than half of sick children were brought to an HSA, many caregivers reported a preference for providers other than HSAs, and perceptions of HSAs as trusted providers of high-quality, convenient care had decreased. HSA supervision and mentorship were below MOH targets. Stockouts of malaria medicines were associated with decreased care-seeking from HSAs. Additional qualitative research is needed to examine challenges and to inform potential solutions. Malawi’s mature iCCM programme has a strong foundation but can be improved to strengthen the continuity of care from communities to facilities and to ultimately improve child health outcomes.

Evidence suggests that disclosure of HIV status between partners may influence prevention of maternal-to-child transmission of HIV (PMTCT) outcomes. We report partner disclosure in relation to maternal antiretroviral therapy (ART) uptake and adherence, and MTCT among postpartum HIV-infected Malawian women. A cross-sectional mixed-method study was conducted as part of a nationally representative longitudinal cohort study. Between 2014–2016, all (34,637) mothers attending 54 under-5 clinics with their 4–26 week-old infants were approached, of which 98% (33,980) were screened for HIV; infants received HIV-1 DNA testing. HIV-exposure was confirmed in 3,566/33,980 (10.5%). Among 2882 couples, both partners, one partner, and neither partner disclosed to each other in 2090 (72.5%), 622 (21.6%), and 169 (5.9%), respectively. In multivariable models, neither partner disclosing was associated with no maternal ART, suboptimal treatment adherence and MTCT.  

In this qualitative study, we aimed to understand how community and healthcare providers' perceptions and practices around stillbirth influence stillbirth data quality in Afghanistan. We collected data through 55 in-depth interviews with women and men that recently experienced a stillbirth, female elders, community health workers, healthcare providers, and government officials in Kabul province, Afghanistan between October-November 2017. The results showed that at the community level, there was variation in local terminology and interpretation of stillbirth which did not align with the biomedical categories of stillbirth and miscarriage and could lead to misclassification. At the facility level, we identified that healthcare providers' practices, driven by institutional culture and demands, family pressure, and socio-cultural influences, could contribute to under-reporting or misclassification of stillbirths. Data collection methodologies need to take into consideration the socio-cultural context and investigate thoroughly how perceptions and practices might facilitate or impede stillbirth reporting in order to make progress on data quality improvements for stillbirth.

In the early 2000s, Rwanda implemented a performance-based financing (PBF) system to improve quality and increase the quantity of care delivered at its public hospitals. PBF evaluations identified quality gaps that prompted a movement to pursue an accreditation process for public hospitals. Since it was prohibitively costly to implement an accreditation program overseen by an external entity to all of Rwanda’s public hospitals, the Ministry of Health developed a set of standards for a national 3-Level accreditation program. In 2012, Rwanda launched the first phase of the national accreditation system at five public hospitals. The program was then expected to expand across the remainder of the public hospitals throughout the country. Out of Rwanda’s 43 public hospitals, a total of 24 hospitals have achieved Level 1 status of the accreditation process and 4 have achieved Level 2 status of the accreditation process. Linking the program to the country’s existing PBF program increased compliance and motivation for participation, especially for those who were unfamiliar with accreditation principles. Furthermore, identifying dedicated quality improvement officers at each hospital has been important for improving engagement in the program. Lastly, to improve upon this process, there are ongoing efforts to develop a non-governmental accreditation entity to oversee this process for Rwanda’s health system moving forward.

This study’s objective was to determine the prevalence of TB among mentally ill patients in Afghanistan. A cross-sectional study was conducted in five public health facilities and one private facility. All patients in those centers were screened for TB, and the diagnosis of TB was made with GeneXpert or made clinically by a physician. Out of 8,598 patients registered, 8,324 (96.8%) were reached and 8,073 (93.9%) were screened for TB, of whom 1,703 (21.1%) were found to be presumptive TB patients. A total of 275 (16.7%) were diagnosed with all forms of TB, of whom 90.5% were women. The overall prevalence of TB among mentally ill patients was 3,567/100,000—20 times higher than the national incidence rate. TB was independently associated with married and widowed adults, young adults, females, and oral sleep drug users. TB among mentally ill patients is very high, and we recommend that TB care and prevention services be integrated into mental health centers.

CB DOTS is an approach for engaging communities to support detection and treatment of TB, while also bringing TB services closer to their communities. In Afghanistan, CB DOTS has been implemented in more than 715 health facilities and 15 provinces, and the national Ministry of Public Health is integrating the CB DOTS strategy into the nationwide basic package of health services.

The 50th Union World Conference on Lung Health, October 30-November 3, brings together researchers, global advocates, scientists, healthcare professionals, students and community members working on all aspects of lung health. MSH staff will be participating in a variety of symposia, workshops, posters, and oral presentations to share our experience and expertise on a range of topics that

While old age is a known risk factor for developing active tuberculosis (TB), studies on TB in the population aged 60 years and older (considered elderly in this study) are few, especially in the developing world. Results of the TB prevalence survey in Uganda found high TB prevalence (570/100,000) in people over 65. We focused on treatment outcomes in the elderly to understand this epidemic better. We conducted a retrospective analysis of data from TB facility registers in Kampala City for the period 2014-2015. We analyzed the 2014-15 cohort with respect to age, sex, disease class, patients' human immunodeficiency virus (HIV) and directly observed therapy (DOT) status, type of facility, and treatment outcomes and compared findings in the elderly (≥60) and younger (<60) age groups. Of 15,429 records, 3.3% (514/15+,429) were for elderly patients. The treatment success rate (TSR) among elderly TB patients (68.3%) was lower than that of the non-elderly (80.9%) and the overall TSR 80.5%, (12,417/15,429) in Kampala. Although the elderly were less likely to test positive for HIV than the young, they had a two-fold higher risk of unfavorable treatment outcomes and were more likely to die while on treatment. However, there was no statistically significantly difference between treatment outcomes among HIV-positive and HIV-negative elderly TB patients. Compared to the younger TB patients, elderly TB patients have markedly poorer treatment outcomes, although TB/HIV co-infection rates in this age group are lower.

Ethiopia is among the high-burden countries for tuberculosis (TB), TB/HIV, and drug-resistant TB. The aim of this nationwide study was to better understand TB-related knowledge, attitudes, and practices (KAPs) and generate evidence for policy and decision-making. Of 3,503 participants, 884 (24.4%), 836 (24.1%), and 1,783 (51.5%) were TB patients, families of TB patients, and the general population, respectively. The mean age was 34.3 years, and 50% were women. Forty-six percent were heads of households, 32.1% were illiterate, 20.3% were farmers, and 19.8% were from the lowest quintile. The majority (95.5%) had heard about TB, but only 25.8% knew that TB is caused by bacteria. The majority (85.3%) knew that TB could be cured. Most Ethiopians have a high level of awareness about TB and seek care in public health facilities, and communities are generally supportive. Inadequate knowledge about TB transmission, limited engagement of community health workers, and low preference for using community health workers were the key challenges.

The objective of this study was to examine job satisfaction, motivation and associated factors among nurses working in the public health facilities of Ethiopia, with the aim of improving performance and productivity in the health care system. From a random sample of 125 health facilities, 424 nurses were randomly selected for face-to-face interviews in all regions of Ethiopia. Overall, 60.8% of nurses expressed satisfaction with their job. Job satisfaction levels were significantly higher for female nurses, those older than 29  years and those who had over 10  years of work experience. Satisfaction with remuneration, recognition, professional advancement, features of the work itself, and nurses’ work experiences from 5 to 10  years were significantly associated with overall job satisfaction after controlling for other predictors. The study findings are signals for the Ministry of Health to strengthen the human resource management system and practices to improve nurses’ overall job satisfaction and motivation, especially among nurses with 5 to 10  years of experience on the job. Expanded recognition systems and opportunities for advancement are required to increase nurses’ job satisfaction and motivation. Equitable salary and fringe benefits are also needed to reduce their dissatisfaction with the job.

Tuberculosis (TB) elimination requires innovative approaches. The new Global Tuberculosis Network (GTN) aims to conduct research on key unmet therapeutic and diagnostic needs in the field of TB elimination using multidisciplinary, multisectorial approaches. The TB Pharmacology section within the new GTN aims to detect and study the current knowledge gaps, test potential solutions using human pharmacokinetics informed through preclinical infection systems, and return those findings to the bedside. Moreover, this approach would allow prospective identification and validation of optimal shorter therapeutic durations with new regimens. Optimized treatment using available and repurposed drugs may have an increased impact when prioritizing a person-centered approach and acknowledge the importance of age, gender, comorbidities, and both social and programmatic environments. In this viewpoint article, we present an in-depth discussion on how TB pharmacology and the related strategies will contribute to TB elimination.

The aim of this study was to assess the uptake and determinants of HIV testing among men in Malawi. Secondary data analysis was conducted on cross–sectional household data for 7478 men aged 15 to 54 years drawn from the 2015–16 Malawi Demographic and Health Survey. Secondary data analysis was conducted on cross–sectional household data for 7478 men aged 15 to 54 years drawn from the 2015–16 Malawi Demographic and Health Survey. Descriptive statistics, bivariate and multivariable logistic regression analyses were performed to identify the socio–demographic, behavioral and health service related factors that are associated with HIV testing service utilisation by men in Malawi. All analyses were performed using the complex sample analysis procedure of the Statistical Package for the Social Sciences version 22.0 to account for the multistage sampling used in Demographic Health Survey. Overall, 69.9% of the participants had ever been tested for HIV. The results indicate that age, region of residence, marital status, covered by health insurance, education and age at first sexual debut are significant predictors of HIV testing among men in Malawi. In particular, men who were in the age group 30–39 years, married, those with secondary or above education, and those who had health insurance were more likely to utilise HIV testing service than their counterparts. The findings suggest that HIV testing services and programmes need to target younger unmarried men aged 15–19 and men with low level or no education and expand HIV testing services to the central and southern regions of Malawi. 

In order to gain more in-depth understanding of the overall problem with substandard and falsified (SF) medical products and how other countries have combated the issue, USAID’s SAFEMed project carried out a landscape analysis that included a desktop review of policies and guidance on the subject matter coupled with interviews with relevant stakeholders in Ukraine to understand their perspec

Please download to read the USAID Safe, Affordable, and Effective Medicines for Ukrainians (SAFEMed) Activity in Ukraine News Digest, October 2019 edition. 

USAID's SAFEMed Bioequivalence Report provides an in-depth analysis of current and future legislative requirements for better governance of bioequivalence in Ukraine.