Implementation of an insecticide-treated net subsidy scheme under a public-private partnership for malaria control in Tanzania – challenges in implementation

BACKGROUND: In the past decade there has been increasing visibility of malaria control efforts at the national and international levels. The factors that have enhanced this scenario are the availability of proven interventions such as artemisinin-based combination therapy, the wide scale use of insecticide-treated nets (ITNs) and a renewed emphasis in indoor residual house-spraying. Concurrently, there has been a window of opportunity of financial commitments from organizations such as the Global Fund for HIV/AIDS, Tuberculosis and Malaria (GFATM), the President's Malaria Initiative and the World Bank Booster programme. METHODS: The case study uses the health policy analysis framework to analyse the implementation of a public-private partnership approach embarked upon by the government of Tanzania in malaria control - 'The Tanzania National Voucher Scheme'- and in this synthesis, emphasis is on the challenges faced by the scheme during the pre-implementation (2001 - 2004) and implementation phases (2004 - 2005). Qualitative research tools used include: document review, interview with key informants, stakeholder's analysis, force-field analysis, time line of events, policy characteristic analysis and focus group discussions. The study is also complemented by a cross-sectional survey, which was conducted at the Rufiji Health Demographic Surveillance Site, where a cohort of women of child-bearing age were followed up regarding access and use of ITNs. RESULTS: The major challenges observed include: the re-introduction of taxes on mosquito nets and related products, procurement and tendering procedures in the implementation of the GFATM, and organizational arrangements and free delivery of mosquito nets through a Presidential initiative. CONCLUSION: The lessons gleaned from this synthesis include: (a) the consistency of the stakeholders with a common vision, was an important strength in overcoming obstacles, (b) senior politicians often steered the policy agenda when the policy in question was a 'crisis event', the stakes and the visibility were high, (c) national stakeholders in policy making have an advantage in strengthening alliances with international organizations, where the latter can become extremely influential in solving bottlenecks as the need arises, and (d) conflict can be turned into an opportunity, for example the Presidential initiative has inadvertently provided Tanzania with important lessons in the organization of 'catch-up' campaigns

Cross-Sector Review of Drivers and Available 3Rs Approaches for Acute Systemic Toxicity Testing

Acute systemic toxicity studies are carried out in many sectors in which synthetic chemicals are manufactured or used and are among the most criticized of all toxicology tests on both scientific and ethical grounds. A review of the drivers for acute toxicity testing within the pharmaceutical industry led to a paradigm shift whereby in vivo acute toxicity data are no longer routinely required in advance of human clinical trials. Based on this experience, the following review was undertaken to identify (1) regulatory and scientific drivers for acute toxicity testing in other industrial sectors, (2) activities aimed at replacing, reducing, or refining the use of animals, and (3) recommendations for future work in this area

Interest in medical health care for foreign residents among Japanese nursing students in areas of varying ethnic diversity

Background: Exposure of nursing students to foreign residents may improve cultural understanding. Nursing students are expected to have differing rates of contact with foreign residents, depending on how many foreign residents live in their municipality where they study in. Those in areas densely populated by foreign residents are more likely to encounter foreigners, and to have favorable views of them than students in areas with sparser foreign-resident populations. As of 2015, 2.23 million foreign residents lived in Japan, equaling 1.76% of the population; however, Japan still has fewer foreign-born residents compared to other countries. Therefore, interest in Medical Health Care for Foreign Residents (MHCFR) may be greater in students in ethnically diverse areas. While nursing students may have different levels of recognition of foreign nationals as potential clients and interest in MHCFR, no research validates this assumption. Objectives: This study aimed to clarify the association between proximity to foreign nationals and interest in MHCFR among Japanese nursing students. The secondary purpose was to describe knowledge and interest regarding MHCFR among students. To elucidate these topics, education and development of human resources in MHCFR should be considered. Research design and method: The study design was cross-sectional. A self-administered questionnaire survey was conducted with 143 nursing students. Results: Most students understood the likelihood of providing nursing care to foreigners; however, knowledge and interest were low, regardless of whether lectures on MHCFR were provided. Knowledge of MHCFR, recognition of providing care to foreign nationals, and level of contact experiences with foreign nationals were significantly associated with students\u27 level of interest in MHCFR. Discussion: Nursing students in ethnically diverse areas tend to show greater interest in MHCFR in Japan. To foster global health perspectives, including MHCFR, in nursing students studying in ethnically diverse areas, contact experiences with foreigners and acceptance of international students by universities might be effective