Estimating the risk of declining funding for malaria in Ghana: the case for continued investment in the malaria response

Background Ghana has made impressive progress against malaria, decreasing mortality and morbidity by over 50% between 2005 and 2015. These gains have been facilitated in part, due to increased financial commitment from government and donors. Total resources for malaria increased from less than USD 25 million in 2006 to over USD 100 million in 2011. However, the country still faces a high burden of disease and is at risk of declining external financing due to its strong economic growth and the consequential donor requirements for increased government contributions. The resulting financial gap will need to be met domestically. The purpose of this study was to provide economic evidence of the potential risks of withdrawing financing to shape an advocacy strategy for resource mobilization. Methods A compartmental transmission model was developed to estimate the impact of a range of malaria interventions on the transmission of Plasmodium falciparum malaria between 2018 and 2030. The model projected scenarios of common interventions that allowed the attainment of elimination and those that predicted transmission if interventions were withheld. The outputs of this model were used to generate costs and economic benefits of each option. Results Elimination was predicted using the package of interventions outlined in the national strategy, particularly increased net usage and improved case management. Malaria elimination in Ghana is predicted to cost USD 961 million between 2020 and 2029. Compared to the baseline, elimination is estimated to prevent 85.5 million cases, save 4468 lives, and avert USD 2.2 billion in health system expenditures. The economic gain was estimated at USD 32 billion in reduced health system expenditure, increased household prosperity and productivity gains. Through malaria elimination, Ghana can expect to see a 32-fold return on their investment. Reducing interventions, predicted an additional 38.2 clinical cases, 2500 deaths and additional economic losses of USD 14.1 billion. Conclusions Malaria elimination provides robust epidemiological and economic benefits, however, sustained financing is need to accelerate the gains in Ghana. Although government financing has increased in the past decade, the amount is less than 25% of the total malaria financing. The evidence generated by this study can be used to develop a robust domestic strategy to overcome the financial barriers to achieving malaria elimination in Ghana

Understanding the gap between access and use: a qualitative study on barriers and facilitators to insecticide-treated net use in Ghana

Mass and continuous distribution channels have significantly increased access to insecticide-treated nets (ITNs) in Ghana since 2000. Despite these gains, a large gap remains between ITN access and use.; A qualitative research study was carried out to explore the individual and contextual factors influencing ITN use among those with access in three sites in Ghana. Eighteen focus group discussions, and free listing and ranking activities were carried out with 174 participants; seven of those participants were selected for in-depth case study. Focus group discussions and case study interviews were audio-recorded, transcribed verbatim, and analysed thematically.; ITN use, as described by study participants, was not binary; it varied throughout the night, across seasons, and over time. Heat was the most commonly cited barrier to consistent ITN use and contributed to low reported ITN use during the dry season. Barriers to ITN use throughout the year included skin irritation; lack of airflow in the sleeping space; and, in some cases, a lack of information on the connection between the use of ITNs and malaria prevention. Falling ill or losing a loved one to malaria was the most powerful motivator for consistent ITN use. Participants also discussed developing a habit of ITN use and the economic benefit of prevention over treatment as facilitating factors. Participants reported gender differences in ITN use, noting that men were more likely than women and children to stay outdoors late at night and more likely to sleep outdoors without an ITN.; The study results suggest the greatest gains in ITN use among those with access could be made by promoting consistent use throughout the year among occasional and seasonal users. Opportunities for improving communication messages, such as increasing the time ITNs are aired before first use, as well as structural approaches to enhance the usability of ITNs in challenging contexts, such as promoting solutions for outdoor ITN use, were identified from this work. The information from this study can be used to inform social and behaviour change messaging and innovative approaches to closing the ITN use gap in Ghana

Femineidad y masculinidad en la organización del trabajo

This paper is the result of a study in a crystal factory and a fruit storage and marketing company. Its aim was to examine how the notions of femininity and masculinity affect the distribution of work in these organizations. The results evidenced that although there is no sexual division of labor, and activities are still carried out only by men or women, featuring "working men" and "women's work", such activities do not separate the inherent characteristics of femininity and masculinity, the construction of which depends on the subjects that execute those activities.Este artigo resulta de um estudo em uma fábrica de cristais e uma empresa de armazenamento e comercialização de frutas. O objetivo foi analisar como as noções de feminilidade e masculinidade afetam a organização do trabalho nessas organizações. Os resultados demonstraram que embora exista a divisão sexual do trabalho, e atividades que são desenvolvidas apenas por homens ou por mulheres, caracterizando "trabalho de homens" e "trabalho de mulheres", tais atividades não separam as características inerentes à feminilidade e à masculinidade, cuja construção está no sujeito que desenvolve o trabalho.Este artículo se deriva de un estudio en una fábrica de cristal y en una empresa de almacenamiento y comercialización de frutas. El objetivo era examinar cómo las nociones de femineidad y masculinidad afectan la organización del trabajo en estas organizaciones. Los resultados mostraron que, aunque exista una división sexual del trabajo, y las actividades están siendo llevadas a cabo sólo por hombres o por mujeres, caracterizando "trabajo de hombres" y "trabajo de mujeres", estas actividades no separan las características propias de la feminidad y la masculinidad , cuya construcción está en el sujeto que desarrolla el trabajo

Using donor funding to catalyse investment in malaria prevention in Ghana: an analysis of the potential impact on public and private sector expenditure.

BACKGROUND: An estimated 1.5 billion malaria cases and 7.6 million malaria deaths have been averted globally since 2000; long-lasting insecticidal nets (LLINs) have contributed an estimated 68% of this reduction. Insufficient funding at the international and domestic levels poses a significant threat to future progress and there is growing emphasis on the need for enhanced domestic resource mobilization. The Private Sector Malaria Prevention (PSMP) project was a 3-year intervention to catalyse private sector investment in malaria prevention in Ghana. METHODS: To assess value for money of the intervention, non-donor expenditure in the 5 years post-project catalysed by the initial donor investment was predicted. Non-donor expenditure catalysed by this investment included: workplace partner costs of malaria prevention activities; household costs in purchasing LLINs from retail outlets; domestic resource mobilization (public sector financing and private investors). Annual ratios of projected non-donor expenditure to annualized donor costs were calculated for the 5 years post-project. Alternative scenarios were constructed to explore uncertainty around future consequences of the intervention. RESULTS: The total donor financial cost of the 3-year PSMP project was USD 4,418,996. The average annual economic donor cost per LLIN distributed through retail sector and workplace partners was USD 21.17 and USD 7.55, respectively. Taking a 5-year post-project time horizon, the annualized donor investment costs were USD 735,805. In the best-case scenario, each USD of annualized donor investment led to USD 4.82 in annual projected non-donor expenditure by the fifth-year post-project. With increasingly conservative assumptions around the project consequences, this ratio decreased to 3.58, 2.16, 1.07 and 0.93 in the "very good", "good", "poor" and "worst" case scenarios, respectively. This suggests that in all but the worst-case scenario, donor investment would be exceeded by the non-donor expenditure it catalysed. CONCLUSIONS: The unit cost per net delivered was high, reflecting considerable initial investment costs and relatively low volumes of LLINs sold during the short duration of the project. However, taking a longer time horizon and broader perspective on the consequences of this complex catalytic intervention suggests that considerable domestic resources for malaria control could be mobilized, exceeding the value of the initial donor investment

Arquivos Brasileiros de Psiquiatria, Neurologia e Ciências Afins: uma fonte com muita história Arquivos Brasileiros de Psiquiatria, Neurologia e Ciências Afins: a source rich in history

Surgido em 1905, o Arquivos Brasileiros de Psiquiatria, Neurologia e Ciências Afins foi o primeiro periódico brasileiro especializado na área. Com o nome de Arquivos Brasileiros de Psiquiatria, Neurologia e Medicina Legal, tornou-se, em 1908, veículo de divulgação da Sociedade com o mesmo nome. A partir de 1919 foi publicado como Arquivos Brasileiros de Neuriatria e Psiquiatria. O periódico traz as propostas para a psiquiatria brasileira lideradas por Juliano Moreira, diretor do Hospício Nacional e da Assistência a Alienados do Distrito Federal. Por veicular trabalhos de profissionais do Hospício Nacional, é fonte fundamental para a investigação dos processos diagnósticos e das práticas clínicas e terapêuticas do período. Apresenta-se aqui uma seleção de artigos publicados na revista entre 1905 e 1930, ano da aposentadoria de Moreira.<br>Launched in 1905, the Arquivos Brasileiros de Psiquiatria, Neurologia e Ciências Afins was the first Brazilian periodical specialized in psychiatry, neurology, and related sciences. In 1908, under the new name of Arquivos Brasileiros de Psiquiatria, Neurologia e Medicina Legal, it became the journal of the Society of Psychiatry, Neurology, and Forensic Medicine. Starting in 1919, it was published under the title Arquivos Brasileiros de Neuriatria e Psiquiatria. The periodical presents proposals put forward for this field in Brazil, under the leadership of Juliano Moreira, director of both the National Asylum and of Federal District Assistance for the Insane (Assistência a Alienados do Distrito Federal). Because the journal published articles by healthcare providers from the National Asylum, it is a vital source for researchers of the era's diagnostic processes and clinical and therapeutic practices. This selection of texts was published in its pages between 1905 and 1930, the year Moreira retired