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In Nigeria, tuberculosis (TB) is a major public health problem and low case finding remains a challenge to its eradication. The USAID-funded Challenge TB project supports GeneXpert sites across the country. However sub-optimal GeneXpert utilization due to modular failures, power supply issues, and inadequate samples has contributed to low TB case finding.

Over the past two decades, Rwanda has realized impressive declines in preventable child and maternal mortality, serving as an example of what is possible through committed, collective action.

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

In Bangladesh, the Directorate General of Family Planning (DGFP), with assistance from the US Agency for International Development (USAID), is well ahead of other countries in its use of locally developed and automated inventory management tools, especially at the upazila (sub-district) and warehouse levels.

In collaboration with the USAID-funded Rwanda Health Systems Strengthening Project and partners, Rwanda’s Ministry of Health introduced the Workload Indicator of Staffing Needs (WISN) tool in all public district and provincial hospitals in the country.

The Rwanda Medical Procedure Coding (RMPC) system was developed by Rwanda’s Ministry of Health, with technical assistance from the USAID-funded Rwanda Health Systems Strengthening Project, to harmonize procedure coding with an international standard.

A key challenge identified by a study on health sector staff retention, conducted by the USAID-funded Rwanda Health Systems Strengthening Project in 2017, was the lack of access to credit at a reasonable interest rate from commercial banks for building a home, purchasing essential items or meeting emergency expenses.

In collaboration with the Ministry of Health and other health sector stakeholders, the USAID-funded Rwanda Health Systems Strengthening Project conducted many interventions aimed at improving the performance of the health system at all levels.

Launched and administered with support from the USAID Rwanda Health Systems Strengthening Project, the District Operational Research Challenge Fund aims to build and grow the capacity of MOH’s district hospital staff and young health researchers to conduct research and implement sustainable public health programs.

In 2000, the Government of Rwanda decentralized health and other services to the district level. After nearly two decades of progressively taking on responsibilities for the health sector, district leaders are demonstrating stronger ownership of health initiatives.

In Rwanda, the Ministry of Health has committed to providing universal access to health services and improving the quality of care. An important factor that impacts quality and access to care is the amount of time patients wait to see providers at health facilities.

One of the most successful interventions designed to provide universal health coverage to the citizens of Rwanda has been the establishment of the Community Based Health Insurance (CBHI) Scheme. This provides a basic package of primary care and referral services through a wide network public and some private health facilities at an affordable cost for those who can pay.

Market intelligence data, United Nations Commodity Trade Statistics for insulin trade, the International Medical Products Price Guide for prices of human insulin and additional web searches were used as data sources. A total of 34 insulin manufacturers were identified. Most countries and territories are reliant on a limited number of supplying countries. The overall median government procurement price for a 10‐ml, 100‐IU/ml vial during the period 1996–2013 equivalent was US$4.3, with median prices in Africa and low-income and low‐ to middle‐ income countries being higher over this period.This research shows the high variability of insulin prices and the reliance on a few sources, both companies and countries, for global supply. In addressing access to insulin, countries need to use existing price data to negotiate prices, and mechanisms need to be developed to foster competition and security of supply of insulin, given the limited number of truly global producers.

The National Drug Authority (NDA) inspects and certifies private and public sector pharmacies in Uganda using an indicator-based inspection tool that measures adherence to good pharmacy practices (GPP). 67 measures identify the situation in the domains of premises, dispensing quality, stores management, and operating requirements. Although the GPP measures are well-recognized and used internationally, little is known about their validity and reliability. The study aimed to assess validity, which measures agreement of GPP measures between a gold standard inspector and NDA inspector and inter-rater reliability (IRR), which measures agreement among NDA inspectors, of GPP measures. We assessed validity and IRR by four teams of inspectors in eight government health facilities that represent three levels of care. Each team inspected two facilities, resulting in 24 total inspections. Our findings question the validity and reliability of many GPP inspection measures, particularly critical measures that greatly impact certification decision. This study demonstrates the need for assessments of, and interventions to improve, validity and reproducibility of GPP measures and inspections.

Stillbirth rates in Afghanistan have declined little in the past decade with no data available on key risk factors. Health care utilisation and maternal complications are important factors influencing pregnancy outcomes but rarely captured for stillbirth in national surveys from low‐ and middle‐income countries. The 2010 Afghanistan Mortality Survey (AMS) is one of few surveys with this information. We used data from the 2010 AMS that included a full pregnancy history and verbal autopsy. Our sample included the most recent live birth or stillbirth of 13 834 women aged 12‐49 years in the three years preceding the survey. The risk of stillbirth was increased among women in the Central Highlands and of Nuristani ethnicity. Women who did not receive antenatal care had three times increased risk of stillbirth, while high‐quality antenatal care was important for reducing the risk of intrapartum stillbirth. Bleeding, infection, headache, and reduced fetal movements were antenatal complications strongly associated with stillbirth. Reduced fetal movements in the delivery period increased stillbirth risk by almost seven. Facility births had a higher risk of stillbirths overall, but not for intrapartum stillbirths. Targeted interventions are needed to improve access and utilisation of services for high‐risk groups. Early detection of complications through improved quality of antenatal and obstetric care is imperative. We demonstrate the potential of household surveys to provide country‐specific evidence on stillbirth risk factors for LMICs where data are lacking.

A cross-sectional study was conducted among 735 new adult tuberculosis (TB) cases registered between January to December 2015 in 10 woredas, equivalent to districts, of southwestern Ethiopia. TB patients waited too long time to initiate anti-TB treatment, reflecting longer periods of morbidity and disease transmission. The delays are attributed to patient, disease and health system related factors. Hence, improving community awareness, and involving informal providers, health extension workers and TB treatment supporters can reduce the patient delay. Similarly, cough screening and improving diagnostic efficiencies of healthcare facilities should be in place to reduce provider delays.

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 7,478 men aged 15 to 54 years drawn from the 2015–16 Malawi Demographic and Health Survey. Overall, 69.9% of the participants had ever been tested for HIV. The results indicate that age, region of residence, marital status, coverage by health insurance, education and age at first sexual debut are significant predictors of HIV testing among men in Malawi. 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. Targeting the undiagnosed men living with HIV in a timely manner is a crucial and necessary step not only for achieving the UNAIDS 90–90–90 targets but for individuals to benefit from antiretroviral treatment and to sustainably reduce population–level HIV transmission.

In their discussion of universal health coverage (UHC), the Editors (Jan 5, p 1) rightly state that “simply convening a UN high-level meeting is not enough” to achieve UHC. The Civil Society Engagement Mechanism for UHC2030 (CSEM) strongly agrees and is concerned that, without a radically different approach, the meeting will be a business-as-usual global health event. We are concerned that speakers at the high-level meeting on UHC on Sept 23, 2019, will declare support for UHC and leaving no one behind, but will not be held to account for their contradictory policies and actions. Bilateral and multilateral donors, and the intentions of the Sustainable Development Goals 3 Global Action Plan, will be applauded without scrutiny of stagnating aid that is tied to disease-specific priorities, thereby limiting the funding for and focus on primary health care. Participants will propose inclusion of the private sector without mitigating the inequality that the private sector drives.

Managed entry agreements (MEAs)—a type of formal institutional arrangement between pharmaceutical companies and payers for sharing the risk with respect to the introduction of new pharmaceutical technologies—may expand access to new pharmaceutical technologies for non-communicable diseases. Although common in high-income countries (HICs), there is limited evidence of their use in low- and middle-income countries (LMICs). This article aims to document international experiences of countries implementing MEAs and potential barriers and facilitators for their use in LMICs. We reviewed published literature sources on MEAs over the past 10 years considering peer-reviewed publications and gray literature data. While the use of MEAs in LMICs is very limited, this could be the result of limited empirical evidence on its use and possibly due to the use of a different taxonomy for describing MEAs in these settings. Since there is limited evidence on their use in LMICs, the identified cases of implementation in HICs may serve to inform the interest on MEAs in resource limited settings. Therefore, further research in this field especially in the context of LMICs may be of value for the global community as all countries are embarking into fairer and sustainable Universal Health Coverage.

Multigram drug depot systems for extended drug release could transform our capacity to effectively treat patients across a myriad of diseases. For example, tuberculosis (TB) requires multimonth courses of daily multigram doses for treatment. To address the challenge of prolonged dosing for regimens requiring multigram drug dosing, we developed a gastric resident system delivered through the nasogastric route that was capable of safely encapsulating and releasing grams of antibiotics over a period of weeks. Initial preclinical safety and drug release were demonstrated in a swine model with a panel of TB antibiotics. We anticipate multiple applications in the field of infectious diseases, as well as for other indications where multigram depots could impart meaningful benefits to patients, helping maximize adherence to their medication.

Persistent dyslipidemia in children is associated with risks of cardiovascular accidents and poor combination antiretroviral therapy (cART) outcome. We report on the first evaluation of prevalence and associations with dyslipidemia due to HIV and cART among HIV-infected Ethiopian children. High prevalence of cART-associated dyslipidemia, particularly low HDLc and hypertriglyceridemia, was observed among treatment-experienced HIV-infected children. The findings underscore the need for regular follow-up of children on cART for lipid abnormalities.

TB infection prevention and control (IPC) is an important strategy to prevent disease transmission—it is a combination of measures to minimize the risk of transmission from a TB case to other patients, health care providers, and the wider population.

Bangladesh is one of the world’s high MDR-TB burden countries. According to the WHO, the MDR-TB burden is 1.6% among new cases and 29% among retreatment cases. The longer duration of MDR-TB treatment regimens and the toxicity of certain agents discourage many patients from completing treatment.

In collaboration with the National TB Control Program (NTP) in Bangladesh, the USAID-funded Challenge TB established a high-quality Bio-Safety Level-3 Laboratory (BSL-3 lab) in Sylhet to accelerate TB and DR-TB diagnosis and treatment in the northeast region of the country. The BSL-3 lab, the highest level of safety of its type in Bangladesh, provides rapid and quality services.

Tuberculosis is a major cause of morbidity and mortality among children. In Ethiopia, more than 15,000 pediatric, drug-sensitive TB cases were reported in 2017 and 2018. Until recently there were no appropriately dosed TB medicines for children.