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Malnutrition causes stunting in over 40 percent of Congolese children under five, according to DRC's 2013-2014 Demographic Health Survey. Assisting the ministry of health by providing training for health workers, promoting breastfeeding, and establishing infant and young child feeding support groups for parents, the Integrated Health Project (DRC-IHP) is making lasting changes in child health.

Under results-based financing, staff, community health committees, and other stakeholders agree on goals to improve infrastructure and services, get training on leadership and management, and receive a sum to start improvements. The facility then receives payments based on milestones met, rather than just hours open.

Half of all cases of tuberculosis (TB) go undetected and therefore untreated. TB is often considered a curse rather than a curable disease, and few consult health workers about it until they become incapacitated. Bringing information into the home is critical. Once a community understands TB, they tend to tell others who are coughing to go to the hospital.

Safe water sources and usable toilets are vital for public health. In DRC, their lack leads to high levels of water-borne disease. Diarrheal disease is a major cause of infant and child mortality. Since sanitation facilities require new habits, community mobilization is critical.

To provide the evidence to develop staffing norms for health facilities, the Workload Indicators of Staffing Need (WISN) tool of the World Health Organization (WHO) was adopted for assessing workload pressures to inform and improve human resource planning in facilities that provide HIV/AIDS services. This is a mixed methodology approach combining qualitative (separate group discussions for each OPC position) and secondary data extraction (number of patients/clinic from routine reports) in 23 outpatient clinics (OPCs) of Hai Phong City, Vietnam, from January-March 2014. The results showed that, with one exception, there is no shortage of manpower in the OPC system in Hai Phong. The pilot implementation of this toolkit for other HIV/AIDS service providers and other health care facilities could help calculate staff requirements, inform manpower planning, and help staff at health facilities develop job descriptions and plan their work accordingly.

Abstract Family caregivers play a critical role in caring for children living with HIV, however, there is little knowledge about their experiences. The aim of this study was to illuminate the family caregivers' lived experiences of caring for a child when he or she has been diagnosed with HIV and enrolled to antiretroviral treatment. Qualitative interviews with 21 family caregivers of 21 children diagnosed with HIV were analyzed using an inductive design with a hermeneutic phenomenological approach. The caregivers' experience were articulated in 5 subthemes under the main theme of "Surviving overwhelming challenges": "Committed care-giving," "Breaking the family life," "Caring burdens," "Confronting conflicts," and "Living with worry." Despite the difficult situation the family caregivers experienced with extensive worry, caring burdens, and disrupted family and social networks, they were committed caregivers. They were empowered by their belief in God but also by their strong belief in the child's treatment and support from healthcare workers. The healthcare system needs to consider possible ways to support the family caregivers during child's HIV diagnosis and treatment initiation as part of a continuum of care.

The objective of this study was to assess the quality of cotrimoxazole tablets produced by a Tanzanian manufacturer by a newly instituted quality assurance program. Tablets underwent a diffuse reflectance spectroscopy procedure with periodic quality assessment confirmation by assay and dissolution testing using validated HPTLC techniques (including weight variation and disintegration evaluations). Based on results from the primary test methods, the first batch of product was <80% compliant, whereas subsequent batches reached >99% compliance. This approach provides a model for rapidly assuring product quality of future procurements of other products that is more cost effective than traditional pharmaceutical testing techniques.

In this commentary, the authors discuss why integrating HIV testing, treatment and care into child survival platforms is important, as well as its potential to advance progress towards global targets that call for, by 2020, 90% of children living with HIV to know their status, 90% of those diagnosed to be on treatment and 90% of those on treatment to be virally suppressed (90-90-90). Integration is critical in improving health outcomes and efficiency gains. In children, integration of HIV in programmes such as immunization and nutrition has been associated with an increased uptake of HIV infant testing. Integration is increasingly recognized as a case-finding strategy for children missed from prevention of mother-to-child transmission programmes and as a platform for diffusing emerging technologies such as point-of-care diagnostics. These support progress towards the 90-90-90 targets by providing a pathway for early identification of HIV-infected children with co-morbidities, prompt initiation of treatment and improved survival. There are various promising practices that have demonstrated HIV outcomes; however, few have documented the benefits of integration on child survival interventions. The Double Dividend framework is well positioned to address the bidirectional impacts for both programmes.

Assessing the state of country readiness for the introduction of new, child-friendly anti-tuberculosis formulations can highlight potential bottlenecks, facilitate early planning, and accelerate access to appropriate treatment for children with tuberculosis (TB). To understand pathways and potential obstacles to the introduction of new pediatric formulations, we performed a desk review of key policy documents and conducted 146 stakeholder interviews in 19 high-burden countries. Issuance of World Health Organization (WHO) guidance serves as the trigger for considering adoption in most countries; however, the degree of alignment with WHO recommendations and duration ofintroduction processes vary. Endorsement by experts and availability of local evidence are leading criteria for adoption in upper-middle- and high-income countries. Ease of administration, decreased pill burden, and reduced treatment costs are prioritized in low- and lower-middle-income settings. Countries report an average of 10 steps on the path to new treatment introduction, with core steps taking between 18 and 71 months. The process of new treatment introduction is complicated by diverse country processes, adoption criteria, and evidence requirements. Challenges differ between low- and middle-to-high-income countries. Responsiveness to the unique hurdles faced across settings is important in ensuring a sustainable market for improved pediatric anti-tuberculosis treatment.

The community-based health insurance (CBHI) scheme launched by the Government of Rwanda (GoR) reached 91% of the population in 2010, starting from 7% in 2003. Initially, all CBHI members paid the same fees, regardless of their personal income, and the poorest citizens faced challenges in paying premiums (almost US$1.50 per person). A mechanism was thus urgently needed to guarantee access to health care for the most vulnerable and promote equity among members. The GoR decided to introduce a stratification system based on the socioeconomic status of the population. Together with partners, including the Integrated Health Systems Strengthening Project (IHSSP), the GoR developed a national database that stratifies Rwandan citizens by income. To date, more than 10 million residents’ records, representing 96% of Rwanda’s population, have been entered into the database. This database helped identify the most vulnerable based on socioeconomic status (about 25% of the population). Identification of the poorest among the population has allowed an increase in CBHI funds due to identification of individuals who have a greater capacity to pay. The database thus improved the financial viability and management capacity of the CBHI scheme.

Improving governance is one of the essential elements of realizing the dream of a strong health system achieving greater health impact. Good governance enables the effective use of medicines, information, human resources, and finances to deliver better health service performance and better health outcomes.

In 2015, MSH’S projects reached more than 84.2m people worldwide. Since 2012, MSH has contributed to saving more than 500,000 lives and has trained more than 107,000 people - from health officials to frontline health workers.   

This systematic review (Jan. 2003-Dec. 2014) synthesized evidence on interventions that have directly reduced mortality in high-HIV-prevalence populations. Antiretroviral therapy (ART)was the only intervention identified that decreased death in HIV-infected pregnant and postpartum women. Multivitamin use was shown to reduce disease progression while other micronutrients and antibiotics had no beneficial effect on maternal mortality. The findings support global trends in encouraging initiation of lifelong ART for all HIV-infected pregnant and breastfeeding women (Option B+), regardless of their CD4+ count, as an important step in ensuring appropriate care and treatment.

The five-year Program to Build Leadership and Accountability in Nigeria's Health System (PLAN-Health) is funded by the US Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR) and implemented by MSH.

The five-year Program to Build Leadership and Accountability in Nigeria's Health System (PLAN-Health) is funded by the US Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR), and is implemented by MSH.

Akwa Ibom ranks sixth out of Nigeria’s 36 states for the highest number of people living with HIV in the country. The 2012 National AIDS and Reproductive Health Survey showed the state as having a prevalence rate of 6.5 percent. Providing equitable services and interventions to address the HIV burden in Akwa Ibom State is a health management emergency.

The FCI Program of MSH advocates at the global, country, and community levels, for improved sexual, reproductive, maternal, newborn, child and adolescent health and rights.

More than 100 countries are in the process of adopting or embarking on universal health coverage (UHC) and health reform strategies, such as pro-poor national insurance and decentralization.

More than 50 MSH staff from the home and country offices traveled to Cape Town, South Africa to participate in the 46th Union World Conference on Lung Health December 2-6, 2015. MSH, along with the USAID-funded, MSH-led Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, co-hosted four workshops, and presented 22 posters, 7 oral presentations and 7 symposiums.

MSH mobilizes communities, including community health workers, health officials, and religious and traditional leaders to support increased access to and use of family planning and reproductive health services, including prevention and treatment of cervical cancer.

These standards harmonize prevention, treatment and care provided throughout the region’s transport corridors, starting from the existing Cross Border Initiative roadside wellness centers.

HIV prevalence is disproportionately high among sex workers and long distance truck drivers compared to the general population, both globally and in the Southern African region.

While measurement and attribution of maternal mortality is challenging, available evidence indicates that HIV-infected pregnant and postpartum women have an increased risk of death compared to their uninfected peers.

In 2014, the budget for high cost drugs in the Dominican Republic was USD 107 million, accounting for 51% of the Ministry of Health (MoH) budget for medicines. Resources allocated for the 2015 budget were USD 49 million, leaving a shortfall of USD 62 million. The MoH requested technical assistance from the USAID-funded SIAPS project to conduct an evidence based analysis of the 98 products included in the list.

The aim of this study was to assess the prevalence of MDR-TB and associated risk factors in West Armachiho and Metema districts of North Gondar. A cross-sectional study was conducted between February 1 and June 25, 2014. A total of 124 consecutive smear-positive pulmonary TB patients were included in the study. Socio-demographic and possible risk factor data were collected using a semi-structured questionnaire. Drug susceptibility testing was first performed for rifampicin using GeneXpert MTB/RIF. For those rifampicin resistant strains, drug susceptibility testing was performed for both isoniazid and rifampicin to identify MDR-TB. Of 124 smear-positive pulmonary TB patients, 117 (94.4 %) were susceptible to rifampicin, while 7 (5.7 %) were confirmed to be resistant to rifampicin and isoniazid. History of previous treatment was significantly associated with MDR-TB. Maximizing early case detection and treatment, strengthening TB infection control activities and proper implementation of DOTS are recommended to reduce the burden of MDR-TB.

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