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The Accessible Continuum of Care and Essential Services Sustained (ACCESS) program is a five-year (2018-2023) integrated health project funded by the United States Agency for International Development (USAID) and led by Management Sciences for Health (MSH).

The Accessible Continuum of Care and Essential Services Sustained (ACCESS) program is a five-year (2018-2023) integrated health project funded by the United States Agency for International Development (USAID) and led by Management Sciences for Health.The goal of the program is to accelerate sustainable health impacts for the Malagasy population through three primary objectives:• Quality healt

The aim of the study was to investigate the prevalence of renal function and liver enzyme abnormalities among HIV‐infected children, changes in prevalence with time on combination antiretroviral therapy (cART), and the factors associated with these abnormalities. A high prevalence of liver enzyme and renal function abnormalities was observed at enrolment. Decreasing liver enzyme levels during follow‐up are possibly reassuring, while the progressive reduction in GFR and the increase in BUN are worrisome and require further study.

Factors in Democratic Republic of Congo (DRC) that lead to excess mortality and poor maternal, newborn and child health (MNCH) include poor nutrition, lack of adequate services for antenatal (ANC) and postnatal care (PNC), poor immunization coverage for women and children, elevated rated of malaria and low treatment rates, inadequate water, sanitation and hygiene, and increased rates of gender based violence. This study analyzed the impact of a modified Champion Community Approach (CCA) implemented in DRC on MNCH indicators. Between 2012 and 2017, 73 Champion Communities were developed. Among health areas with Champion Communities compared with health areas with no champion community, there were statistically significant increases in health area indicator rates in antenatal care (48%), early and exclusive breastfeeding (77%), family planning (55%), assisted birth (50%) and decreased moderate malnutrition rates (44%). The modified CCA implemented in DRC was an innovative community mobilization approach that fostered and institutionalized community leadership. Income generation and NGO status were unique and transformative steps that led to independence, autonomy and sustainability of the approach and were associated with improved MNCH indicators through behavior change.

Recent years have witnessed an increased interest in the use of multicriteria decision analysis (MCDA) to support health technology assessment (HTA) agencies for setting healthcare priorities. However, its implementation to date has been criticized for being “entirely mechanistic,” ignoring opportunity costs, and not following best practice guidelines. This article provides guidance on the use of MCDA in this context. The present study was based on a systematic review and consensus development. We developed a typology of MCDA studies and good implementation practice. We reviewed 36 studies over the period 1990 to 2018 on their compliance with good practice and developed recommendations. We identified 3 MCDA study types: qualitative MCDA, quantitative MCDA, and MCDA with decision rules. The types perform differently in terms of quality, consistency, and transparency of recommendations on healthcare priorities. We advise HTA agencies to always include a deliberative component. Agencies should, at a minimum, undertake qualitative MCDA. 

Tanzania has made great progress in reducing diarrhea mortality in under-five children. We examined factors associated with the decline and projected the impact of scaling up interventions or reducing risk factors on diarrhea deaths. Diarrhea-specific mortality among under-five children in Tanzania declined by 89% from 35.3 deaths per 1000 live births in 1980 to 3.9 deaths per 1000 live births in 2015. Factors associated with diarrhea-specific under-five mortality reduction included oral rehydration solution (ORS) use, changes in stunting prevalence, vitamin A supplementation, rotavirus vaccine, change in wasting prevalence and change in age-appropriate breastfeeding practices. Universal coverage of direct diarrhea, nutrition and WASH interventions has the potential reduce the diarrhea-specific mortality rate by 90%.

To evaluate the utility of a volunteer health development army in conducting population screening for active tuberculosis (TB) in a rural community in southern Ethiopia, a population-based cross-sectional survey was conducted in six kebeles (the lowest administrative units). All 24,517 adults in the study area had a symptom screen performed. Overall, 34 TB cases (6%) were identified by culture and/or Xpert, corresponding to a prevalence of 139 per 100,000 persons. This study demonstrated the capability of community health workers (volunteer and paid) to rapidly conduct a large-scale population TB screening evaluation and highlight the high yield of such a programme in detecting previously undiagnosed cases when combined with Xpert MTB/RIF testing. This could be a model to implement in other similar settings.

Despite Uganda’s long-standing commitment to its medicines policy, the pharmaceutical supply chain has faced many well-documented constraints. In an effort to improve medicines management capacity at health facilities, Uganda developed and implemented a multi-pronged, evidence-based supervision, performance assessment, and recognition strategy (SPARS). We wanted to estimate the costs and cost effectiveness of SPARS implementation in public (government and private not-for-profit) health facilities in Uganda. This information is critical for further SPARS scale up in Uganda and for SPARS implementation in countries with similar contexts that want to consider rolling out SPARS as a national strategy. SPARS has been implemented by Uganda’s Ministry of Health since 2010 with support from the US Agency for International Development. SPARS is implemented by district-level health care staff who are trained as MMS to provide on-the-job supervision and training of health workers. Evidence shows that SPARS is an effective intervention to improve performance in key medicines management domains. Based on our estimates from this study, implementing and operating SPARS costs about US$370,000 annually for 1460 facilities, which would extrapolate to approximately US$760,000 for about 3000 government sector facilities or about 0.3% of the total government- and donor-funded EMHS budget.

AbstractMalawi is midway through its current Malaria Strategic Plan 2017–2022, which aims to reduce malaria incidence and deaths by at least 50% by 2022. Malariometric data are available with health surveillance data housed in District Health Information Software 2 (DHIS2) and household survey data from two recent Malaria Indicator Surveys (MIS) and a Demographic and Health Survey (DHS).

South Sudan has continued to suffer some of the worst health indicators globally with an under-five mortality rate of 96 deaths per 1,000 live births and with 75 percent of child deaths due to the preventable diseases of diarrhea, malaria, and pneumonia.

The Democratic Republic of the Congo adopted the strategy of using, at the community level, a dose of rectal artesunate as a pre-referral treatment for severe malaria amongst children under 5 years who could not quickly reach a health care facility and take oral medication. However, the adherence to referral advice after the integration of this strategy and the acceptability of the strategy were unknown. To assess adherence by the mothers/caretakers of children under 5 years to referral advice provided by the community health workers after pre-referral treatment of severe malaria with rectal artesunate, the authors conducted a noninferiority community trial with a pre- and post-intervention design in 63 (pre-intervention) and 51 (post-intervention) community care sites in 4 provinces (Kasaï-Oriental, Kasaï-Central, Lomami, Lualaba) from August 2014 through June 2016. The integration of pre-referral rectal artesunate for severe malaria into the community care site in the DR Congo is feasible and acceptable. It positively affected adherence to referral advice. However, more health education is needed for parents of children under 5 years and community health workers.

ABSTRACTKnowledge management (KM) plays an important role in global health and development where resources for programme implementation are limited and needs to collaborate and learn across organization and sector boundaries are great. Health and development professionals depend on KM approaches to access, share, and use critical health knowledge.

Despite efforts to find and treat TB, about four million cases were missed globally in 2017. Barriers to accessing health care, inadequate health-seeking behavior of the community, poor socioeconomic conditions, and stigma are major determinants of this gap. This is the first national stigma survey conducted in seven regions and two city administrations of Ethiopia. A total of 3463 participants (844 TB patients, 836 from their families, and 1783 from the general population) were enrolled for the study. More than a third of Ethiopians have high scores for TB-related stigma, which were associated with educational status, poverty, and lack of awareness about TB. Stigma matters in TB prevention, care, and treatment and warrants stigma reduction interventions.

We evaluated the benefit of socioeconomic support (S-E support), comprising various financial and nonfinancial services that are available based on assessment of need, in reducing mortality and loss to follow-up (LTFU) at Reach Out Mbuya, a community-based, antiretroviral therapy program in Uganda.Retrospective observational cohort data from adult patients enrolled between May 31, 2001, and May 31, 2010, were examined. In total 6654 patients were evaluated. Provision of S-E support reduced LTFU and mortality, suggesting the value of incorporating such strategies for promoting continuity of care.Conclusions—Provision of S-E support reduced LTFU and mortality, suggesting the value of incorporating such strategies for promoting continuity of care.

Making foundational changes to the way people receive their health care requires an understanding of the whole system, from economics to environment, government to community, and hospital to community health worker. The work that is required, often behind the scenes, to ensure someone receives the right medicine, the right diagnosis, and the right support is as complex as it is essential.

Year Ended June 30, 2019, drawn from audited financial statements.

Nigeria has the largest population in Africa, now exceeding 200 million, and is home to 25% of the world’s malaria burden. As a sub-recipient to Catholic Relief Services (CRS), Management Sciences for Health (MSH) is a partner to the government of Nigeria in combating malaria.

Please download to read the USAID Safe, Affordable, and Effective Medicines for Ukrainians (SAFEMed) Activity in Ukraine News Digest, February 2020 edition. 

On March 4, 2020, staff from the MSH-led ONSE Health Activity in Malawi presented recent results and lessons learned on strengthening malaria services through Outreach Training and Supportive Supervision (OTSS).

Please download to read the USAID Safe, Affordable, and Effective Medicines for Ukrainians (SAFEMed) Activity in Ukraine News Digest, March 2020 edition.

For nearly 50 years in 150 countries, MSH has worked with and through local health actors to strengthen health systems, improve the quality of health care, and ensure that all people, even the poorest and most vulnerable, have the opportunity for a healthy life.

The LAC Regional InterAgency Task Force for Maternal Mortality Reduction (Grupo de Trabajo Regional - GTR) hosted a Spanish-language webinar, "Sexual and Reproductive Health in Times of COVID-19: Evidence, Perspectives, and Challenges in Latin America and the Caribbean." 

Community participation is critical to detecting unusual health events before they develop into public health crises. Through MSH’s electronic Community EventBased Surveillance (eCEBS) system, communities are engaged in identifying and stopping outbreaks at their source, which can lessen the impact on the community and decrease negative health outcomes.

We used a qualitative approach to explore the contribution of contextual, individual, household-level and health system factors to stillbirth in Afghanistan. We conducted semi-structured in-depth interviews with women and men that experienced stillbirth, female elders, community health workers, healthcare providers, and government officials in Kabul Province, Afghanistan, between October-November 2017. We used thematic analysis to identify contributing factors and developed a conceptual map describing possible pathways to stillbirth. We found that low utilisation and access to healthcare was a key contributing factor, as were unmanaged conditions in pregnancy that increased women’s risk of complications and stillbirth. Sociocultural factors related to the treatment of women and perceptions about medical interventions deprived women of interventions that could potentially prevent stillbirth. The quality of care from public and private providers during pregnancy and childbirth was a recurring concern exacerbated by health system constraints that led to unnecessary delays; while environmental factors linked to the ongoing conflict were also perceived to contribute to stillbirth. These pathways were underscored by social, cultural, economic factors and individual perceptions that contributed to the three-delays.

This survey assessed recently pregnant women's knowledge of malaria in pregnancy (MIP) and their experiences with community health workers (CHWs) prior to implementing community delivery of intermittent preventive treatment in pregnancy (cIPTp). Data were collected via a household survey in Ntcheu and Nkhata Bay Districts, Malawi, from women aged 16-49 years who had a pregnancy resulting in a live birth in the previous 12 months. A total of 370 women were interviewed. Women in both districts found their community health workers (CHWs) to be helpful (77.9%), but only 35.7% spoke with a CHW about antenatal care and 25.8% received assistance for malaria during their most recent pregnancy. A greater proportion of women in Nkhata Bay than Ntcheu reported receiving assistance with malaria from a CHW (42.7% vs 21.9%); women in Nkhata Bay were more likely to cite IPTp-SP as a way to prevent MIP (41.0% vs 24.8%) and were more likely to cite mosquito bites as the only way to spread malaria (70.6% vs 62.0%). Women in Nkhata Bay were more likely to receive 3 + doses of IPTp-SP (IPTp3) (59.2% vs 41.8%). Adequate knowledge was associated with increased odds of receiving IPTp3, although not statistically significantly so. Women reported positive experiences with CHWs, but there was not a focus on MIP. Women in Nkhata Bay were more likely to be assisted by a CHW, had better knowledge, and were more likely to receive IPTp3+ . Increasing CHW focus on the dangers of MIP and implementing cIPTp has the potential to increase IPTp coverage.

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