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Ethiopia is one of the most populous countries in Africa with a high TB burden across a wide geography. The national TB program has reached hundreds of thousands of cases and successfully treated them. However, health authorities believe that a third of cases have been missed in the community, development corridors, industries, and crowded settings, such as universities.

This 4-page brochure on health systems strengthening describes how Keanahikishime partners with countries to build strong, resilient, sustainable health systems that can deliver universal health coverage—equitable, affordable access to high-quality health services for all who need them.

Every year, 7,300 women die in Latin America and the Caribbean from causes related to childbirth. Although, the region has achieved significant advances in maternal health over the past few years, the majority of these tragedies continue to be preventable. Why do maternal deaths keep occuring? How can we prevent them?

Our objective was to assess the knowledge of health professionals on Xpert MTB/RIF assay and associated factors in detecting TB/TB drug resistance. An institution based cross–sectional study was conducted from April 4 to June 5, 2015, in Addis Ababa, that involved 209 healthcare providers working in TB clinics.The overall magnitude of knowledge of healthcare workers on Xpert was found to be low. Health workers above age 35 years and those who had read the guidelines on Xpert had greater knowledge of Xpert. Distribution of the national guidelines on Xpert and assigning experienced clinicians to TB DOTs clinics are recommended.

From 2006 to 2014, Supply Chain System (SCMS), the global procurement and distribution project for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), distributed over US$1.6 billion worth of antiretroviral drugs and other health commodities, with over US$263 million purchased from local vendors in 14 countries in sub-Saharan Africa. A simple framework was developed and 39 local suppliers from 4 countries were interviewed between 2013 and 2014 to understand how SCMS local sourcing impacted supplier development. SCMS local suppliers reported new contracts with other businesses (77%), new assets acquired (67%), increased access to capital from local lending institutions (75%), offering more products and services (92%), and ability to negotiate better prices from their principals (80%). Additionally, 70% (n=27) of the businesses hired between 1 and 30 new employees after receiving their first SCMS contract and 15% (n=6) hired between 30 and 100 new employees. This study offers preliminary guidance on how bilateral and multilateral agencies could design effective local sourcing programs to create sustainable local markets for selected pharmaceutical products, laboratory, and transport services.

Inadequate health-care provider performance is a major challenge to the delivery of high-quality health care in low-income and middle-income countries (LMICs). The Health Care Provider Performance Review (HCPPR) is a comprehensive systematic review of strategies to improve health-care provider performance in LMICs. We screened 216,477 citations and selected 670 reports from 337 studies of 118 strategies. For professional health-care providers (generally, facility-based health workers), the effects were near zero for only implementing a technology-based strategy or only providing printed information. For percentage outcomes, training or supervision alone typically had moderate effects (10·3–15·9 percentage points), whereas combining training and supervision had somewhat larger effects than use of either strategy alone. Group problem solving alone showed large improvements in percentage outcomes (28·0–37·5 percentage points), but, when the strategy definition was broadened to include group problem solving alone or other strategy components, moderate effects were more typical (12·1 percentage points).

Quality of tuberculosis (TB) microscopy diagnosis is not a guarantee despite implementation of external quality assurance (EQA) services in all laboratories of health facilities. Hence, we aimed at evaluating the technical quality and the findings of sputum smear microscopy for acid fast bacilli (AFB) at health centers in Hararge Zone, Oromia Region, Ethiopia. Of the total 55 health center laboratories assessed during the study period (July 2014-July 2015), 20 (36.4%) had major technical errors; 13 (23.6%) had 15 false negative results and 17 (30.9%) had 22 false positive results. The quality of AFB smear microscopy reading and smearing was low in most of the laboratories of the health centers. Therefore, it is essential to strength the EQA program through building the capacity of laboratory professionals.

This quasi-experimental study conducted in Afghanistan examines the causal impact of a provincial health governance intervention on the provincial health system’s performance. It compares health system performance indicators between 16 intervention provinces and 18 nonintervention provinces using a difference-in-differences analysis to draw inference. The intervention consisted of governance action planning, implementation of the governance action plan, and self-assessment of governance performance before and after the intervention. The intervention had a statistically and practically significant impact on six indicators.

Ethiopia has a high prevalence of tuberculosis (TB) and is one of the countries with the highest burden of multidrug-resistant TB (MDR-TB). This study's purpose was to understand the costs that patients incur in obtaining diagnosis and treatment for MDR-TB. In March 2013, interviews were conducted with 169 MDR-TB patients at three hospitals in Ethiopia to identify the cost to patients and the impact on employment and family income. The average MDR-TB patient incurred a total cost of US$1378, which represented 25 months of a mid-treatment household income of US$54. The impact on the patient's employment and on overall patient and family income was generally catastrophic: 74% of all respondents reported losing their jobs, 66% of patients lost household income, and household income was reduced by 38%. To help cover the costs, 38% of patients sold some type of property, while 7% leased out property and 41% took out loans, any of which could jeopardize their future financial situation even further. Despite services being officially free of charge, most patients incurred catastrophic costs and suffered significant income loss as a result of obtaining diagnosis and treatment for MDR-TB.

To upgrade from an older version of QuanTB download and read these instructions. QuanTB 4.1 QuanTB E-Course An e-course for health professionals on how to use QuanTB, a downloadable forecasting, quantification and early warning tool for TB medicines. Version 4.1 available as of August 24, 2017.

Once thought nearly conquered, tuberculosis (TB) is now a global epidemic. With the combined threats of HIV, diabetes, and other chronic diseases, as well as the emergence of multidrug-resistant TB, the challenges of the disease are overwhelming national health systems.

Tuberculosis remains one of the world’s top infectious killers. Keanahikishime works in 22 countries with international, national, and local partners to strengthen the capacity of health systems to prevent the spread of TB and improve the lives of those affected by it.

Using a people-centered approach, Keanahikishime works with local partners to develop health systems solutions that meet the needs of communities affected by TB. Strengthening national, regional, district, and local health managers and their institutions to provide quality health services is a core strategy to support health systems resilience and sustainability.

The 49th Union World Conference on Lung Health, October 24-27, brings together over 3,000 researchers, global advocates, scientists, healthcare professionals, students and community members working on all aspects of lung health. 

As Keanahikishime has shown, innovations in TB prevention and treatment are needed throughout health systems.

To build capacity in medicines management, the Uganda Ministry of Health introduced a nationwide supervision, performance assessment and recognition strategy (SPARS) in 2012. Medicines management supervisors (MMS) assess performance using 25 indicators to identify problems, focus supervision, and monitor improvement in medicines stock and storage management, ordering and reporting, and prescribing and dispensing. Although the indicators are well-recognized and used internationally, little was known about the reliability of these indicators. An initial assessment of inter-rater reliability (IRR), which measures agreement among raters (i.e., MMS), showed poor IRR; subsequently, we implemented efforts to improve IRR. The aim of this study was to assess IRR for SPARS indicators at two subsequent time points to determine whether IRR increased following efforts to improve reproducibility. Initially only five (21%) indicators had acceptable reproducibility, defined as an IRR score ≥ 75%. At the initial assessment, prescribing quality indicators had the lowest and stock management indicators had the highest IRR. By the third IRR assessment, 12 (50%) indicators had acceptable reproducibility, and the overall IRR score improved from 57% to 72%. The IRR of simple indicators was consistently higher than that of complex indicators in the three assessment periods. We found no correlation between IRR scores and MMS experience or professional background.

A follow up study among 735 new TB cases registered at health facilities in districts of southwest Ethiopia was conducted from January 2015 to June 2016. Patients reported days elapsed between onset of illness and treatment commencement. The overall treatment success among the treatment cohort was 89.7% respectively among those initiated treatment beyond and within of 30 days of onset of illness. Higher risk of unsuccessful outcome was predicted by treatment initiation beyond 30 days of onset, HIV co-infection, and received treatment at hospital. On the other hand, lower risk of unsuccessful outcome was predicted by weight gain and sputum smear negative conversion the end of second month treatment. Higher risk of unsuccessful outcome is associated with prolonged days elapsed between onset of illness and treatment commencement. Hence, promotion of early care seeking, improving diagnostic and case holding efficiencies of health facilities and TB/HIV collaborative interventions can reduce risk of unsuccessful outcome.

A longitudinal study among 735 new TB cases was conducted from January 2015 through June 2016 in 10 woredas (districts) of southwestern Ethiopia. Between onset of illness and anti-TB treatment course, patients incurred a median of US$201.48. Of the total cost, the indirect and direct costs respectively constituted 70.6 and 29.4%. TB patients incurred a median of US$97.62 and US$93.75 during the pre- and post-diagnosis periods, respectively. Thus, patients incurred 53.6% of the total cost during the pre-diagnosis period. Direct out-of-pocket expenses during the pre- and post-diagnosis periods respectively amount to median of US$21.64 and US$35.02. Patient delay days, provider delay days, number of healthcare facilities visited until TB diagnosis, and TB diagnosis at private facilities independently predicted increased pre-diagnosis cost. Similarly, rural residence, hospitalization during anti-TB treatment, patient delay days, and provider delay days predicted increased post-diagnosis costs. TB patients incur substantial cost for care seeking and treatment despite “free service” for TB. Therefore, promoting early care seeking, decentralizing efficient diagnosis, and treatment services within reach of peoples, and introducing reimbursement system for direct costs can help minimize financial burden to the patient.

In late 2010, Uganda introduced a supervision, performance assessment, and recognition strategy (SPARS) to improve staff capacity in medicines management in government and private not-for-profit health facilities. This paper assesses the impact of SPARS in health facilities during their first year of supervision. SPARS was effective in building health facility capacity in medicines management, with a median overall improvement of almost 70% during the first year. The greatest improvements occurred in prescribing quality and at lower levels of care, although the highest level of performance was achieved in storage management. We recommend broad dissemination of the SPARS approach in all Ugandan health facilities as well as in other countries seeking a practical strategy to improve medicines management performance.

In response to the HIV and tuberculosis (TB) epidemics, we build the capacity of our public- and private-sector partners to prevent TB and HIV and improve diagnosis and management of co-infected patients.

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