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Management Sciences for Health (MSH) is implementing a project to strengthen high-quality, culturally appropriate antenatal care (ANC) for indigenous women in the Quetzaltenango department of Guatemala.

Metro Manila, PhilippinesAugust 19-20, 2019 The Department of Health (DOH) of the Philippines, with support from its technical partners, is strengthening the procurement and supply chain management (PSCM) system for health commodities.

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.

In support of the government of Angola's efforts to maintain the country’s relatively low HIV prevalence, MSH, under USAID Angola’s Health For All (HFA) Project (2017–2019) helped to establish a sustainable model for providing high-quality HIV and AIDS services through the prevention, care, and treatment continuum.To accelerate early HIV diagnosis and linkage to care, HFA support

To accelerate progress in early diagnosis and linkage to treatment of people living with HIV, the Health For All (HFA) Project in Angola trained and deployed 16 patient assistant facilitators (PAFs) across seven health facilities in Luanda.In support of the Government of Angola’s (GoA) strategic plan to accelerate early diagnosis of HIV, HFA supported initiatives to ensure that people living

Until recently, TB and HIV have been treated separately under Angola’s National TB Control Program (NCTB) and the National Institute for the Fight Against AIDS (INLS).In support of TB/HIV service integration, the Health for All (HFA) project provided coordination and advocacy at the national level to align NCTB and INLS goals, infrastructural support to facilities to ensure that they have th

The Health For All (HFA) Project worked in partnership with the Government of Angola to integrate provider-initiated HIV testing services into family planning services in health facilities. To support the integration of FP and HIV services, HFA developed standard operating procedures (SOPs) based on each clinical intervention, job aids, and checklists and provided training to health prov

The Health for All (HFA) Project (April 2017– September 2019) was funded by USAID, led by Population Services International, and implemented in partnership with Management Sciences for Health (MSH) and local partners Rede de Mulheres Angolanas and the MENTOR Initiative. MSH led implementation of the project’s work on HIV and AIDS at seven health facilities selected by the US Presi

HFA works in support of the Government of Angola’s strategic plan to accelerate early HIV diagnosis and linkage to care through implementation of the Busca Activa Consentida Através do Caso Indice (BACCI) or index case testing and tracing (ICTT).

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.

The Health for All (Saúde para Todos) Project in Angola, funded by the US Agency for International Development (USAID) and led by Population Services International (PSI), was launched in January 2017 to support the government’s efforts to increase quality health service delivery in the country.

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.

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.

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