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While TB is a national and international priority, Ethiopia's high TB rates were not declining rapidly in the 2000s. From 2011-16, USAID funded a project to support the Federal Ministry of Health (FMOH) to dramatically improve TB services and outcomes in Oromia and Amhara Regions. Its formal name is "Help Ethiopia Address Low TB Performance," or HEAL-TB.

While TB is a national and international priority, Ethiopia's high TB rates were not declining rapidly in the 2000s. From 2011-16, USAID funded a project to support the Federal Ministry of Health (FMOH) to dramatically improve TB services and outcomes in Oromia and Amhara Regions. Its formal name is "Help Ethiopia Address Low TB Performance," or HEAL-TB.

While TB is a national and international priority, Ethiopia’s high TB rates were not declining rapidly in the 2000s. From 2011-16, USAID funded a project to support the Federal Ministry of Health (FMOH) to dramatically improve TB services and outcomes in Oromia and Amhara Regions. Its formal name is “Help Ethiopia Address Low TB Performance,” or HEAL-TB.

While TB is a national and international priority, Ethiopia's high TB rates were not declining rapidly in the 2000s. From 2011-16, USAID funded a project to support the Federal Ministry of Health (FMOH) to dramatically improve TB services and outcomes in Oromia and Amhara Regions. Its formal name is "Help Ethiopia Address Low TB Performance," or HEAL-TB.

While TB is a national and international priority, Ethiopia's high TB rates were not declining rapidly in the 2000s. From 2011-16, USAID funded a project to support the Federal Ministry of Health (FMOH) to dramatically improve TB services and outcomes in Oromia and Amhara Regions. Its formal name is "Help Ethiopia Address Low TB Performance," or HEAL-TB.

In February and March 2016, a team of MSH staff and consultants collaborated with the MOHS,UNICEF/Sierra Leone, and other stakeholders to collect data for piloting the methodology and tool.MSH staff conducted interviews and collected data at all levels of the health system, including visitsto health facilities in two districts where facility staff, CHW supervisors, and CHWs were interviewed.MSH st

In February and March 2016, a team of MSH staff and consultants worked with the ministry of health, UNICEF/Malawi and other stakeholders to collect data that could be used to pilot the methodology and tool.

MSH designed and piloted this methodology and tool in Malawi and Sierra Leone, countries that were selected given the important role that community health workers play within each of the countries' health systems.

MSH-Peru builds on the success of the Healthy Communities and Municipalities I-II projects (2006-2015).  This program, and others managed by MSH in Peru, provided access to thousands of individuals, families, and communities in various regions of Peru to live healthy lives, while changing paradigms in health care and local development.  

Afghanistan faces a burden of tuberculosis (TB) among the highest in the world, according to the World Health Organization (WHO).

Through the Challenge TB project, MSH’s work contributes to USAID’s goal of a world free of TB as part of its End TB Strategy, which seeks to reduce TB mortality by 35 percent and reduce incidence levels by 20 percent by 2019.

This brief provides details on the achievements, challenges, and lessons learned from the TRACK TB project's Urban DOTS component. TRACK TB works to strengthen the capacity of the National TB/Leprosy Programme in Uganda, to provide leadership for TB response, and deliver quality, well-organized, and efficient services in close collaboration with other USAID programs.   

This collection of stories represents some of the lifesaving work of USAID, Ethiopia's federal ministry of health, and the HEAL TB project.

Last year, tuberculosis (TB) killed more people than did HIV and AIDS—becoming the world's deadliest single infectious agent. More than 95 percent of TB deaths occur in low- and middle-income countries, especially those with weak health systems.

Twelve Stories of How MSH Is Advancing Health around the World

This editorial introduces the Lancet series on maternal health.

The purpose of this study was to investigate the quality of a select group of medicines sold in accredited drug dispensing outlets (ADDOs) and pharmacies in different regions of Tanzania as part of an in-depth cross-sectional assessment of community access to medicines and community use of medicines. We collected 242 samples of amoxicillin trihydrate, artemether-lumefantrine (ALu), co-trimoxazole, ergometrine maleate, paracetamol, and quinine from selected ADDOs and pharmacies in Mbeya, Morogoro, Singida, and Tanga regions. The analysis included physical examination and testing with validated analytical techniques. The physical examination of samples revealed no defects in the solid and oral liquid dosage forms, but unusual discoloration in an injectable solution, ergometrine maleate. Over 90% of the medicines sold in ADDOs and pharmacies met quality standards. Policy makers need to reconsider ergometrine maleate’s place on the list of medicines that ADDOs are allowed to dispense, by either substituting a more temperature-stable therapeutically equivalent product or requiring those sites to have refrigerators, which is not a feasible option for rural Tanzania.

In Tanzania, a public-private partnership launched in 2003 used an accreditation approach to improve access to quality medicines and pharmaceutical services in underserved areas. The government scaled up the accredited drug dispensing outlet (ADDO) program nationally, with over 9,000 shops now accredited. This study assessed the relationships between community members and their sources of health care and medicines, particularly antimicrobials, with a specific focus on the role ADDOs play in the health care system. We surveyed 1,185 households and audited 96 ADDOs and 84 public/nongovernmental health facilities using a list of 17 tracer drugs. To determine practices in health facilities, we interviewed 1,365 exiting patients. To assess dispensing practices, mystery shoppers visited 306 ADDOs presenting one of three scenarios (102 each) about a child’s respiratory symptoms. Of 614 household members with a recent acute illness, 73% sought outside care-30% at a public facility and 31% at an ADDO. However, people bought medicines more often at ADDOs no matter who recommended the treatment; of the 581 medicines that people had received, 49% came from an ADDO. ADDO dispensers are trained to refer complicated cases to a health facility, and notably, 99% of mystery shoppers presenting a pneumonia scenario received an antimicrobial (54%), a referral (90%), or both (45%), which are recommended practices for managing pediatric pneumonia. However, one-third of the dispensers needlessly sold antibiotics for cold symptoms, and 85% sold an antibiotic on request. In addition, the pneumonia scenario elicited more advice on handling the illness than the cold symptoms scenario (61% vs. 15%; p<0.0001), but overall, only 44% of the dispensers asked any of the shoppers about danger signs potentially associated with pneumonia in a child. Poor prescribing in health facilities, poor dispensing at ADDOs, and inappropriate patient demand continue to contribute to inappropriate medicines use. Therefore, while accreditation has attempted to address the quality of pharmaceutical services in private sector drug outlets, efforts to improve access to and use of medicines in Tanzania need to target ADDOs, public/nongovernmental health facilities, and the public to be effective.

In Malawi, health-system constraints meant that only a fraction of people infected with human immunodeficiency virus (HIV) and in immediate need of antiretroviral treatment (ART) received treatment. In 2004, the Malawian Ministry of Health launched plans to scale-up ART nationwide, adhering to the principle of equity to ensure fair geographical access to therapy. A public health approach was used with standardized training and treatment and regular supervision and monitoring of the programme. Before the scale-up, an estimated 930 000 people in Malawi were HIV-infected, with 170 000 in immediate need of ART. About 3000 patients were on ART in nine clinics. By December 2015, cumulatively 872 567 patients had been started on ART from 716 clinics, following national treatment protocols and using the standard monitoring system. Strong national leadership allowed the ministry of health to implement a uniform system for scaling-up ART and provided benchmarks for implementation on the ground. New systems of training staff and accrediting health facilities enabled task-sharing and decentralization to peripheral health centres and a standardized approach to starting and monitoring ART. A system of quarterly supervision and monitoring, into which operational research was embedded, ensured stocks of drug supplies at facilities and adherence to national treatment guidelines.

Priority digital health products will be profiled and developed to support the scale-up of WHO's End TB Strategy.

To determine the yield and determinants of retrospective TB contact investigation in selected zones in Ethiopia, we conducted a community-based cross-sectional study during June-October 2014.Trained lay providers performed symptom screening for close contacts of index cases with all types of TB registered for anti-TB treatment within the last three years. Of 272,441 close contacts of 47, 021 index cases screened, 13,886 and 2, 091 had presumptive and active TB respectively. The yield of active TB was thus 768/100, 000, contributing 25.4% of the 7,954 TB cases reported from the study zones over the study period. The yield of retrospective contact investigation was about six times the case notification in the study zones, contributing a fourth of all TB cases notified over the same period. The yield was highest among workplace contacts and in those with recent past history of contact. Retrospective contact screening can serve as additional strategy to identify high risk groups not addressed through currently recommended screening approaches.

Abstract HIV testing services (HTS) are an essential component of a national response to the HIV epidemic, and in lower and middle income countries, at least 150 million persons are tested annually. HIV testing is necessary to identify persons in need of antiretroviral treatment, which has been documented to be highly effective not only for treatment but also for prevention of HIV transmission to both adults and children. An assessment of the recent literature on sustainability of health and HIV services suggests that organizational performance, flexibility, and integration with other health interventions contribute to sustainability of HIV services and programs. This article describes the experiences of two HIV testing service providers in Uganda and Zambia as well as the track record of services to prevent mother-to-child HIV transmission to illustrate the factors of performance, flexibility, adaptability, and integration which are key to the sustainability of HIV testing services.

LQAS is intended for use by local health teams to collect data at the district and sub-district levels. Our question is whether local health staff produce biased results as they are responsible for implementing the programs they also assess. This test-retest study replicates on a larger scale an earlier LQAS reliability assessment in Uganda. We conducted in two districts an LQAS survey using 15 local health staff as data collectors. A week later, the data collectors swapped districts, where they acted as disinterested non-local data collectors, repeating the LQAS survey with the same respondents. We analysed the resulting two data sets for agreement using Cohen’s Kappa. The findings of this study are remarkably similar to those produced in the first reliability study. There is no evidence that using local healthcare staff to collect LQAS data biases data collection in an LQAS study. The bias observed in the knowledge indicators was most likely due to a ‘practice effect’, whereby respondents increased their knowledge as a result of completing the first survey; no corresponding effect was seen in the practice indicators.

Opioid agonist therapies (OAT) to treat opioid addiction in people who inject drugs (PWID) began in Ukraine in 2004. Scale-up of OAT, however, has been hampered by both low enrollment and high attrition. To better understand the factors influencing OAT retention among PWID in Ukraine, qualitative data from 199 PWIDs were collected during 25 focus groups conducted in five Ukrainian cities from February to April 2013. The experiences of PWID who were currently or previously on OAT or currently trying to access OAT were analyzed to identify entry and retention barriers encountered. Transcribed data were analyzed using a grounded theory approach. Individual beliefs about OAT, particularly misaligned treatment goals between clients and providers, influenced PWID's treatment seeking behaviors. Multiple programmatic and structural issues, including inconvenient hours and treatment site locations, complicated dosing regimens, inflexible medication dispensing guidelines, and mistreatment by clinic and medical staff also strongly influenced OAT retention. Findings suggest the need for both programmatic and policy-level structural changes such as revising legal regulations covering OAT dispensing, formalizing prescription dosing policies and making OAT more available through other sites, including primary care settings as a way to improve treatment retention. Quality improvement interventions that target treatment settings could also be deployed to overcome healthcare delivery barriers. Additional patient education and medical professional development around establishing realistic treatment goals as well as community awareness campaigns that address the myths and fears associated with OAT can be leveraged to overcome individual, family and community-level barriers.

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