Towards regional access to medicines:the development of the East African Community pooled procurement mechanism

IntroductionThe East African Community (EAC) has been facing challenges in ensuring access to affordable and quality-assured medicines. To address these problems, the EAC Partner States have been working on implementing an inter-country pooled procurement mechanism since 2005. However, with limited progress to date. The aims of this study were to explore how the EAC pooled procurement mechanism has been developing over time, and to clarify the work and efforts made during this development process to draw lessons for enhancing such collaborative efforts.MethodsFor this study, we carried out a multi-method qualitative case study. We used the Pooled Procurement Guidance to collect and structure our data drawn from academic papers, grey literature documents, observations and field notes. For the analysis, we used an inductive thematic analysis approach.ResultsOver the past two decades of the EAC’s pooled procurement journey, we have identified two developmental stages so far: the promise stage and the creation stage. The promise stage was characterised by initial engagement and alignment efforts between Partner States. However, the lack of dedicated funding and ownership to drive the project forward led to stagnation of the process for some years. Following the establishment of a dedicated organisation, the pooled procurement mechanism entered the creation stage. This stage has been characterised by continuous alignment work consisting of project management, efforts to build inter-personal relationships, and facilitation of negotiations to harmonise goals, needs and operations. This process has been aided by broad and recurring involvement of regional experts.ConclusionTo successfully implement a pooled procurement mechanism, we suggest EAC Partner States to continue their alignment efforts, sustain political will and allocate sustainable funding using a phased implementation approach towards pooled procurement

Exploring the perception of the educational environment among health sciences students at the University of Rwanda: a mixed methods study

The educational environment (EE) plays a very important role in effective learning. However, information about the quality of the EE at the University of Rwanda (UR) is limited. We aimed to explore the perception of health sciences students about their EE at UR. We used a mixed methods design. Of 606 health sciences students in total, 241 participants were recruited for a quantitative survey using the Dundee Ready Education Environment Measure (DREEM) questionnaire. Additionally, we purposively recruited 10 participants for the qualitative data collection using an interview guide. We used descriptive statistics, independent samples t-test and analysis of variance (ANOVA) test to analyse the quantitative data. The interview verbatims were transcribed and analysed using a thematic approach. The overall mean score of DREEM was 133.74±20.00 which indicates a more positive environment. Female students had higher score than males in the academic (p = 0.005) and social (p = 0.001) self-perception sub-domains. There were also differences in academic selfperception (p = 0.008) and learning atmosphere (p = 0.002) across the departments. The qualitative interviews revealed some specific problems that need to be addressed such as the shortage of financial means during clinical placements; occasional lack of lecturers; insufficient time for hands-on-practice; insufficient chairs in classrooms; and delays in providing feedback to students. Health sciences students at the UR had a positive perception towards their EE. However, there is a need for more efforts to make the environment more positive

Exploring the perception of the educational environment among health sciences students at the University of Rwanda: a mixed methods study

The educational environment (EE) plays a very important role in effective learning. However, information about the quality of the EE at the University of Rwanda (UR) is limited. We aimed to explore the perception of health sciences students about their EE at UR. We used a mixed methods design. Of 606 health sciences students in total, 241 participants were recruited for a quantitative survey using the Dundee Ready Education Environment Measure (DREEM) questionnaire. Additionally, we purposively recruited 10 participants for the qualitative data collection using an interview guide. We used descriptive statistics, independent samples t-test and analysis of variance (ANOVA) test to analyse the quantitative data. The interview verbatims were transcribed and analysed using a thematic approach. The overall mean score of DREEM was 133.74±20.00 which indicates a more positive environment. Female students had higher score than males in the academic (p = 0.005) and social (p = 0.001) self-perception sub-domains. There were also differences in academic selfperception (p = 0.008) and learning atmosphere (p = 0.002) across the departments. The qualitative interviews revealed some specific problems that need to be addressed such as the shortage of financial means during clinical placements; occasional lack of lecturers; insufficient time for hands-on-practice; insufficient chairs in classrooms; and delays in providing feedback to students. Health sciences students at the UR had a positive perception towards their EE. However, there is a need for more efforts to make the environment more positive

Citizen science for malaria control in Rwanda : Engagement, motivation, and behaviour change

Background: Malaria continues to be a major public health concern worldwide, with Sub-Saharan Africa carrying the largest global burden of malaria. Currently, the World Health Organization calls for malaria control interventions that leave no one behind with the aim to realize a malaria-free world. Consequently, engaging community members in malaria control interventions is crucial for malaria elimination in many countries including Rwanda. However, very little is known about how people can be engaged in malaria control, and how this engagement could, in turn, affect the consistent use of malaria control measures. Therefore, the overall objective of this thesis was to better understand the factors that influence the consistent use of malaria control measures, explore how citizens can be engaged through a citizen science program, and how this program could contribute to the use of malaria control measures. Methods: A mixed-methods approach was used in four different phases to design, implement, and evaluate the citizen science program for malaria control. A citizen science program was co-designed to collect and report mosquitoes using a hand made trap, and report mosquito nuisance experienced as well as confirmed malaria cases using a paper-based form. The first phase involved the development and testing of an integrated model of determinants of malaria preventive behaviour. The second phase involved a co-designing process that was employed to engage citizens in malaria control through a citizen science program. In this co-designing phase, participatory design workshops were used to discuss on how community members can report observations such as mosquitoes species, mosquito nuisance experienced, and confirmed malaria cases in case they are asked to; whether they think is something feasible;  how frequently they can do it in case they accept to do it; how they think they can receive feedback; and what could be the content of that feedback. The third and fourth phases involved monitoring and evaluation of this citizen science program by exploring motivational factors and barriers to participate in the program. Results: The model developed in the first phase proposes that the integration of factors at both individual and collective levels is required to address the malaria problem. By testing this integrated model, the results showed that individual perceptions as whole explain 50% of variance of behavioural intentions. The behavioural intentions were positively associated with the consistent use of LLINs, IRS, and draining of stagnant water.  The findings indicated three strategies that could be used to improve consistent use and acceptance of malaria control measures: (1) access to LLINs and regular spraying activities, (2) community mobilization and (3) citizen engagement in malaria prevention and control activities. The second phase elaborated on the co-design process that was employed to engage citizens in malaria control through a citizen science program. The results of the co-design process revealed that community members have their preferences and choices related to the tools (a hand made trap and paper based form) to collect citizen science data, as well as an organizational structure to report these data. These choices demonstrate that citizens have context-specific knowledge and skills. Consequently, involving them in the design of a program and considering their preferences facilitated the implementation of the program and retention of volunteers. A third phase included monitoring of the citizen science program and indicated that volunteers joined and participated in the program because of different motivations including curiosity, a desire to learn new things, recognition, and a desire to contribute to malaria control. Barriers encountered include the pressure to report observations (mostly mosquito species) and a perceived low efficacy of the trap. The monitoring of this program helped to understand the key elements necessary to maintain the program and retain volunteers. The motivational factors and barriers reported in this study should be considered in citizen science projects to know how to approach community members at what stage of participation to recruit and retain volunteers. Although the retention of volunteers is important, an assessment should also be conducted to monitor and explore the impact of the program on community members. In this thesis, phase four involved an evaluation to explore the benefits of the program to those who are directly involved in the collection and reporting of citizen science data and other community members who are not directly involved. The findings showed that the citizen science program has the potential to provide individual and collective benefits to volunteers and the community at large. Participation in citizen science raises awareness, increases knowledge and skills, improves perceptions, and expands social networks. Conclusion: Overall, the results of this thesis clearly showed that the achievement of malaria control needs consideration of both individual and collective factors. To facilitate this, citizens need to be engaged in malaria control interventions. A high participation and retention rate observed throughout the project (one year), clearly demonstrated that the implementation of a citizen science program in areas with limited technology is feasible. However, the citizens’ preferences should be considered during the design process, and their motivations and barriers should be identified and addressed during the program to enhance the retention rate. The benefits of the program are not only limited to those who are directly involved in the program, but there is diffusion of information and benefits of the program to other community members. The citizen science data submitted by the volunteers provide localized information about mosquito density and its relationship with mosquito nuisance. This may, in turn, foster localized and targeted malaria control interventions. Therefore, we can conclude that this citizen science program can complement the existing active surveillance and may be considered by the National Malaria Control Program

Cold chain management practices of non-vaccine commodities in public health facilities of Rwenzori Region, Western Uganda

Abstract Background Despite the evidence that cold chain management practices affect the potency and effectiveness of both vaccines and non-vaccine commodities, most of the researches in Uganda focus on vaccines. This study assessed the cold chain management practices of non-vaccine cold chain commodities in public health facilities of the Rwenzori Region, Uganda. Methods A cross-sectional study was conducted in a random sample of 69 level III and IV health facilities. The respondents were store managers at health facilities. Data on stock and storage management practices and level of knowledge on cold chain management were assessed. Data were collected and entered into Microsoft excel 2017, cleaned, and later exported into IBM SPSS version 26 for analysis. The management practices were graded as poor ( 75% score). Results Results from the 69 facilities indicated that the stock management practices were graded as fair for lesser than half of the facilities 28 (40.6%). Few facilities were correctly filling stock cards 20 (29%) and conducting physical inventories 19 (27.5%). The refrigerator storage management practices were fair for nearly half of the facilities 32 (46.4%). Among the facilities that had a refrigerator 53 (76.8%), 39 (70.9%) utilized it for storing both vaccines and non-vaccine commodities. The cold chain management practices at service delivery points were fair for 32 (46.4%) health centers. A larger proportion of the participants 69 (65%) had knowledge of cold chain storage. Most of the participants 47 (67.8%) were knowledgeable about the heat sensitivity of the cold chain commodities, however, almost half (48.1%) of them lacked knowledge on refrigerator use. Conclusion The management practices for non-vaccine cold chain commodities in health centers were fair. More than a third of the facility store managers lacked knowledge on cold chain management practices for non-vaccine commodities. There is a need to strengthen the capacity of the facilities’ store managers and provide equipment specific for non-vaccine cold chain commodities

Why (not) participate in citizen science? Motivational factors and barriers to participate in a citizen science program for malaria control in Rwanda

This study explores the motivational factors and barriers to participate in a citizen science program for malaria control in Rwanda. It assesses the changes in motivational factors over time and compares these factors among age and gender groups. Using a qualitative approach, this study involved 44 participants. At the initial stage, people participated in the program because of curiosity, desire to learn new things, helping others, and willingness to contribute to malaria control. As the engagement continued, other factors including ease of use of materials to report observations, the usefulness of the program, and recognition also played a crucial role in the retention of volunteers. Lack of time and information about the recruitment process, perceived low efficacy of the mosquito trap, and difficulties in collecting observations were reported as barriers to get and stay involved. Some variations in the motivational factors were observed among age and gender groups. At the initial phase, young adults and adults, as well as men and women were almost equally motivated to contribute to malaria control. For the ongoing phase, for age, the two groups were almost equally motivated by recognition of their effort. Also, the opportunity for learning was an important factor among young adults while ease of use of the materials was central for adults. For gender, the usefulness of the project, ease of use of materials, and learning opportunities were important motivational factors among women, while men were more motivated by recognition of their efforts. A framework including motivational factors and barriers at each stage of participation is presented. This framework may be used to explore motivations and barriers in future citizen science projects and might help coordinators of citizen science programs to determine whom to target, by which message, and at what stage of participation to retain volunteers in citizen science project

Mentors’ perspectives on strengths and weaknesses of a novel clinical mentorship programme in Rwanda: a qualitative study

Objectives To identify mentors’ perspectives on strengths and weaknesses of the Training, Support and Access Model for Maternal, Newborn and Child Health (TSAM-MNCH) clinical mentorship programme in Rwandan district hospitals. Understanding the perspectives of mentors involved in this programme can aid in the improvement of its implementation.Design The study used a qualitative approach with in-depth interviews.Setting Mentors of TSAM-MNCH clinical mentorship programme mentoring health professionals at district hospitals of Rwanda.Participants 14 TSAM mentors who had at least completed six mentorship visits on a regular basis in three selected district hospitals.Results Mentors’ accounts demonstrated an appreciation of the two mentoring structures which are interprofessional collaboration and training. These structures are highlighted as the strengths of the mentoring programme and they play a significant role in the successful implementation of the mentorship model. Inconsistency of mentoring activities and lack of resources emerged as major weaknesses of the clinical mentorship programme which could hinder the effectiveness of the mentoring scheme.Conclusion The findings of this study highlight the strengths and weaknesses perceived by mentors of the TSAM-MNCH clinical mentorship programme, providing insights that can be used to improve its implementation. The study represents unique TSAM-MNCH structural settings, but its findings shed light on Rwandan health system issues that need to be further addressed to ensure better quality of care for mothers, newborns and children

Applying citizen science for malaria prevention in Rwanda : an integrated conceptual framework

Malaria remains a major threat to public health. Long-Lasting Insecticide-treated Nets (LLINs) and Indoor Residual Spraying (IRS) have been widely adopted as important malaria prevention and control interventions and have contributed to significant reduction in malaria incidence. However, recently malaria resurgence has been reported in different countries, including Rwanda, indicating that current attempts to control and eliminate malaria may be failing due to environmental changes and changes in human behaviour. Engaging citizens in malaria prevention and control would help them to identify and prioritize their own health concerns and be able to make appropriate decisions. A citizen science approach to monitor ecological changes by providing timely information is likely to support more effective and consistent use of malaria prevention and control interventions. However, the application of citizen science in malaria prevention and control has lagged behind when comparing with areas of disease diagnosis and treatment. In addition, the determinants of participation in such a citizen science program have not been fully analyzed. This paper presents a conceptual model of likely determinants of participation in connective action (sharing and exchange of malaria-related information), effective and consistent use of malaria preventive and control measures (LLINs and IRS) and collective action (participating in public goods for malaria prevention). The model will guide future research on behavioural and contextual factors and may enhance the effective and consistent use of malaria preventive and control interventions

Role of individual perceptions in the consistent use of malaria preventive measures: Mixed methods evidence from rural Rwanda

Background: Malaria preventive measures, including long-lasting insecticide-treated bet nets (LLINs), indoor residual spraying (IRS), and controlling mosquito breeding sites, are key measures to achieve malaria elimination. Still, compliance with these recommended measures remains a major challenge. By applying a novel and comprehensive model for determinants of malaria prevention behaviour, this study tests how individual perceptions influence the intentions to use malaria preventive measures and explores strategies that stimulate their consistent use. Methods: The study was carried out in the sectors of Ruhuha and Busoro, Rwanda during October and November 2017, and these were conducted into two phases. Phase one involved a questionnaire survey (N = 742), whereas Phase two employed a qualitative approach that included nine focus group discussions, seven key informant interviews, and three in-depth interviews. Results: The findings of the quantitative study showed that participants very often use LLINs (66.6%), accept IRS (73.9%), and drain stagnant water in case of presence (62%). The intentions to use malaria preventive measures were consistently driven by perceived severity, perceived self-efficacy, perceived response efficacy, and subjective norms, and hindered by perceived barriers. The intentions were also positively associated with the actual use of LLINs, acceptance of IRS, and drainage of stagnant water. There is no evidence that either not having enough LLINs (ownership of at least one bed net in the household, here referred to as availability) or having sufficient LLINs (having one LLIN per two people in the household, here referred to as accessibility) moderated the relationship between behavioural intentions and actual use of LLINs. The qualitative study indicated that participants believed malaria risk to be high and perceived a high mosquito density. They also believed that repetitive malaria episodes are caused by the perceived low effectiveness of anti-malaria medications. Lack of LLINs increased the perceived added value of LLINs, and together with the increased malaria burden increased the perceived response efficacy. Participants highlighted the need to continuously mobilize and engage community members especially those who do not use LLINs when having one, and those who do not accept the spraying activities. Conclusion: Malaria prevention interventions should target individual perceptions to enhance consistent use of malaria preventive measures. Three strategies to improve consistent use and acceptance of these measures are highlighted: (1) ensure access to LLINs and regular spraying activities, (2) community mobilization and (3) citizen engagement in malaria prevention activities.</p