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

PurposeThe purpose of the Community Health Services Costing Tool is to help managers and planners estimate the costs of providing health services at the community level. It can be used for individual community services, packages of services, or for all community services.

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

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

The USAID-funded Integrated Health Services Activity (IHSA) supported the Ministry of Health of Benin and the National Malaria Control Program (NMCP) to launch an important seasonal malaria chemoprevention (SMC) campaign, where antimalarial medications are given monthly to treat and prevent the disease.

The Ouoré health center is an isolated facility in the commune of Kérou, department of Atacora, in Benin. Based on the volume of services provided by the health center, Ouoré received funding to build a new maternity ward from the Fond d’Appui au Développement des Communes (FaDeC) in 2017.

Building capacity for resource mobilization is at the center of the Government of Benin’s (GOB) decentralization strategy for improving the health and well-being of the people of Benin. The Fonds d’appui au développement des communes (FADeC) is a tool created by the GOB to support this strategy and attests to the government’s strong commitment.

Inside this issue:The Integrated Health Services ActivitySeasonal malaria chemoprevention campaignsVirtual One Stop GBV centerRevising the on-site training and supportive supervision approachStrengthening maternal, newborn, and child health through training sessionsEmpowering youth and women’s groups with income-generating activitiesEstablishing CommCare for improved patient follow-upCommuni

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%.

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.

Despite significant progress towards achieving its Millennium Development Goals, Madagascar was unable to meet many of its targets. The Government of Madagascar has identified community health as a priority for improving health outcomes and is therefore updating its National Community Health Policy and Strategy.

The National Community Health Strategy (SNSC) 2019-2023 for Burkina Faso, validated on December 28, 2018, seeks to set up a national health system which promotes preventative health and makes the community approach to primary health care the foundation for achieving universal health coverage.

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.

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