Keeping health facilities safe: one way of strengthening the interaction between disease-specific programmes and health systems.

The debate on the interaction between disease-specific programmes and health system strengthening in the last few years has intensified as experts seek to tease out common ground and find solutions and synergies to bridge the divide. Unfortunately, the debate continues to be largely academic and devoid of specificity, resulting in the issues being irrelevant to health care workers on the ground. Taking the theme 'What would entice HIV- and tuberculosis (TB)-programme managers to sit around the table on a Monday morning with health system experts', this viewpoint focuses on infection control and health facility safety as an important and highly relevant practical topic for both disease-specific programmes and health system strengthening. Our attentions, and the examples and lessons we draw on, are largely aimed at sub-Saharan Africa where the great burden of TB and HIV ⁄ AIDS resides, although the principles we outline would apply to other parts of the world as well. Health care infections, caused for example by poor hand hygiene, inadequate testing of donated blood, unsafe disposal of needles and syringes, poorly sterilized medical and surgical equipment and lack of adequate airborne infection control procedures, are responsible for a considerable burden of illness amongst patients and health care personnel, especially in resource-poor countries. Effective infection control in a district hospital requires that all the components of a health system function well: governance and stewardship, financing,infrastructure, procurement and supply chain management, human resources, health information systems, service delivery and finally supervision. We argue in this article that proper attention to infection control and an emphasis on safe health facilities is a concrete first step towards strengthening the interaction between disease-specific programmes and health systems where it really matters – for patients who are sick and for the health care workforce who provide the care and treatment

Tuberculosis diagnostics and biomarkers: needs, challenges, recent advances, and opportunities

Tuberculosis is unique among the major infectious diseases in that it lacks accurate rapid point-of-care diagnostic tests. Failure to control the spread of tuberculosis is largely due to our inability to detect and treat all infectious cases of pulmonary tuberculosis in a timely fashion, allowing continued Mycobacterium tuberculosis transmission within communities. Currently recommended gold-standard diagnostic tests for tuberculosis are laboratory based, and multiple investigations may be necessary over a period of weeks or months before a diagnosis is made. Several new diagnostic tests have recently become available for detecting active tuberculosis disease, screening for latent M. tuberculosis infection, and identifying drug-resistant strains of M. tuberculosis. However, progress toward a robust point-of-care test has been limited, and novel biomarker discovery remains challenging. In the absence of effective prevention strategies, high rates of early case detection and subsequent cure are required for global tuberculosis control. Early case detection is dependent on test accuracy, accessibility, cost, and complexity, but also depends on the political will and funder investment to deliver optimal, sustainable care to those worst affected by the tuberculosis and human immunodeficiency virus epidemics. This review highlights unanswered questions, challenges, recent advances, unresolved operational and technical issues, needs, and opportunities related to tuberculosis diagnostics

Viewpoint: Why do we need a point-of-care CD4 test for low-income countries?

In this paper, we discuss the reasons why we urgently need a point-of-care (POC) CD4 test, elaborate the problems we have experienced with the current technology which hampers CD4-count coverage and highlight the ideal characteristics of a universal CD4 POC test. It is high-time that CD4 technology is simplified and adapted for wider use in low-income countries to change the current paradigm of restricted access once and for all

Laboratory capacity building for the International Health Regulations (IHR[2005]) in resource-poor countries: the experience of the African Field Epidemiology Network (AFENET)

Laboratory is one of the core capacities that countries must develop for the implementation of the International Health Regulations (IHR[2005]) since laboratory services play a major role in all the key processes of detection, assessment, response, notification, and monitoring of events. While developed countries easily adapt their well-organized routine laboratory services, resource-limited countries need considerable capacity building as many gaps still exist. In this paper, we discuss some of the efforts made by the African Field Epidemiology Network (AFENET) in supporting laboratory capacity development in the Africa region. The efforts range from promoting graduate level training programs to building advanced technical, managerial and leadership skills to in-service short course training for peripheral laboratory staff. A number of specific projects focus on external quality assurance, basic laboratory information systems, strengthening laboratory management towards accreditation, equipment calibration, harmonization of training materials, networking and provision of pre-packaged laboratory kits to support outbreak investigation. Available evidence indicates a positive effect of these efforts on laboratory capacity in the region. However, many opportunities exist, especially to support the roll-out of these projects as well as attending to some additional critical areas such as biosafety and biosecuity. We conclude that AFENET’s approach of strengthening national and sub-national systems provide a model that could be adopted in resource-limited settings such as sub-Saharan Africa

Enhancing skills to promote the utilization of medical laboratory equipment in low resource settings

Objective This study was to demonstrate the efficacy of an intervention model involving on-going skills enhancement of users, Biomedical Engineers and Technicians (BMETs) in enhancing the utilization of medical laboratory equipment in low resource settings. Methods In an action research study, the condition of 202 pieces of medical equipment in seven regional blood banks in the Uganda Blood Transfusion Service (UBTS) were studied prospectively from January 2018 to December 2018. Of these, 160 pieces were included in the intervention group where users and BMETs were mentored and trained in the use and preventive maintenance for all equipment types. A second group of 42 pieces of medical equipment which were not involved in the intervention program, were assessed for comparison. Twenty-one participants were interviewed to obtain detailed information about their experiences and the impact of the training interventions. Results The percentage of equipment in good working condition and in use in the intervention group improved from 60% to 74%, while the improvement recorded in the second group was slower (48% to 55%) over the one-year period. Equipment in the intervention group were three times more likely to be in good working condition and in use at the end of the study period with an odds ratio of 3.2 (95% CI: 1.49 to 6.83) and P value < 0.001. Conclusion The model applied by Knowledge for Change (K4C) that involves co-learning and mentorship of users and BMETs was successful and should be implemented in other health facilities in Low- and Middle-Income Countries

The Economic Impact of Rheumatic Heart Disease (RHD) on the Health System of South Africa. A Cost of Illness Study.

Background Rheumatic Heart Disease (RHD) is a disease of poverty that is neglected in developing countries. The consequences of RHD are increasingly becoming huge economic burden to the health system and consecutively the government. Despite RHD being preventable, most of the RHD related deaths happen in children and working age adults where the economic burden of premature death is high. Several strategies have been suggested to advance the escalation of disease severity in order to avoid medical cost including cost of surgery. However, lack of adequate evidence regarding the cost of treating RHD has hindered the needed decisions and interventions to prevent RHD related death. The main objective of this study was to evaluate the utilization of resources and quantify the annual average total cost related to RHD in a tertiary hospital in the Western Cape, South Africa. Methods A mixture of ingredients and step-down costing approaches were used to estimate the annual cost of RHD care from health system perspective. All costs were estimated in 2017 (base year) South African Rand (ZAR) and 3% discount rate in order to allow depreciation and opportunity cost. Data on service utilization rates were collected using a randomly selected sample of 100 patient medical records from the Global Rheumatic Heart Disease Registry (the REMEDY study), a registry of individuals living with RHD. Patient-level clinical data, including, prices and quantities of medications and laboratory tests, were collected from Groote Schuur Hospital (GSH). Step-down costing was used to estimate provider time costs and all other facility costs such as overheads. REMEDY and GSH data were aggregated to estimate the total annual costs of RHD care at GSH and the average annual per-patient cost among REMEDY participants. One-way univariate sensitivity analysis was conducted to deal with uncertainty. Results The total cost of RHD care at GSH was estimated at $2, 238, 294 (ZAR 27 million) in 2017, with surgery costs accounting for 65$4, 311 (ZAR 52, 000) per-patient annually. The cost of medications and consumables related to cardiac catheterisation and heart valve surgery were the main cost drivers. Conclusions RHD care consumes a significant level of tertiary hospital resources in South Africa, with annual perpatient costs much higher than many other non-communicable and infectious diseases. This analysis supports the scaling up of primary and secondary prevention programmes at primary health centres in order to reduce the future burden on tertiary services. The study may also inform resource allocation efforts related to RHD at tertiary centres and provide cost estimates for future studies of intervention cost-effectiveness

WASH in Schools Empowers Girls' Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference 2013

This publication brings together the key elements of the 16 presentations made at the Second Annual Virtual MHM in WinS Conference at UNICEF Headquarters in New York City on 21 November 2013. Building on recommendations from the MHM 2012 virtual conference, the 2013 conference focused on the research tools and instruments being used to explore MHM barriers and practices and to evaluate the interventions being trialed or implemented in various contexts