http://hdl.handle.net/10144/11184 Search the Channel search http://fieldresearch.msf.org/msf/simple-search http://hdl.handle.net/10144/141431 Title: Vital Registration in Rural Africa: Is There a Way Forward to Report on Health Targets of the Millennium Development Goals?<br/><br/>Authors: Zachariah, R; Mwagomba, B; Misinde, D; Mandere, B C; Bemeyani, A; Ginindza, T; Cortier, H; Bissel, K; Jahn, A; Harries, A D<br/><br/>Abstract: Vital registration - the systematic recording of births and deaths - has both legal and health significance. In particular, accurate recording and reporting of vital statistics are public goods to enable the monitoring of progress towards achieving health related targets of the 2015 United Nations Millennium Development Goals (MDG). The reality in Africa is that most births and deaths cannot be traced in legal records or official statistics and as such, there is currently no way of assessing progress towards achieving MDG targets and this applies particularly to rural settings in Africa. From the context of a rural district in Malawi, we describe an informal traditional system for the reporting of deaths at village level, and discuss the potential opportunities, challenges and ways forward in the wider implementation and interpretation of vital data generated by such a system. Such a system might provide an interim solution for accelerating the production and use of district level vital statistics for legal, administrative, statistical purposes and to report on the MDG in rural Africa while waiting for more comprehensive national systems to become a reality. http://hdl.handle.net/10144/141436 Title: Operational research in malawi: making a difference with cotrimoxazole preventive therapy in patients with tuberculosis and HIV.<br/><br/>Authors: Harries, Anthony D; Zachariah, Rony; Chimzizi, Rhehab; Salaniponi, Felix; Gausi, Francis; Kanyerere, Henry; Schouten, Erik J; Jahn, Andreas; Makombe, Simon D; Chimbwandira, Frank M; Mpunga, James<br/><br/>Abstract: ABSTRACT: http://hdl.handle.net/10144/118766 Title: Keeping health facilities safe: one way of strengthening the interaction between disease-specific programmes and health systems.<br/><br/>Authors: Harries, Anthony D; Zachariah, Rony; Tayler-Smith, Katie; Schouten, Erik J; Chimbwandira, Frank; Van Damme, Wim; El-Sadr, Wafaa M<br/><br/>Abstract: 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. http://hdl.handle.net/10144/127588 Title: Violence Against Civilians and Access to Health Care in North Kivu, Democratic Republic of Congo: Three Cross-Sectional Surveys<br/><br/>Authors: Alberti, Kathryn P; Grellety, Emmanuel; Lin, Ya-Ching; Polonsky, Jonathan; Coppens, Katrien; Encinas, Luis; Rodrigue, Marie-Noëlle; Pedalino, Biagio; Mondonge, Vital<br/><br/>Abstract: ABSTRACT: http://hdl.handle.net/10144/110116 Title: A systematic review of task- shifting for HIV treatment and care in Africa.<br/><br/>Authors: Callaghan, Mike; Ford, Nathan; Schneider, Helen<br/><br/>Abstract: BACKGROUND: Shortages of human resources for health (HRH) have severely hampered the rollout of antiretroviral therapy (ART) in sub-Saharan Africa. Current rollout models are hospital- and physician-intensive. Task shifting, or delegating tasks performed by physicians to staff with lower-level qualifications, is considered a means of expanding rollout in resource-poor or HRH-limited settings. METHODS: We conducted a systematic literature review. Medline, the Cochrane library, the Social Science Citation Index, and the South African National Health Research Database were searched with the following terms: task shift*, balance of care, non-physician clinicians, substitute health care worker, community care givers, primary healthcare teams, cadres, and nurs* HIV. We mined bibliographies and corresponded with authors for further results. Grey literature was searched online, and conference proceedings searched for abstracts. RESULTS: We found 2960 articles, of which 84 were included in the core review. 51 reported outcomes, including research from 10 countries in sub-Saharan Africa. The most common intervention studied was the delegation of tasks (especially initiating and monitoring HAART) from doctors to nurses and other non-physician clinicians. Five studies showed increased access to HAART through expanded clinical capacity; two concluded task shifting is cost effective; 9 showed staff equal or better quality of care; studies on non-physician clinician agreement with physician decisions was mixed, with the majority showing good agreement. CONCLUSIONS: Task shifting is an effective strategy for addressing shortages of HRH in HIV treatment and care. Task shifting offers high-quality, cost-effective care to more patients than a physician-centered model. The main challenges to implementation include adequate and sustainable training, support and pay for staff in new roles, the integration of new members into healthcare teams, and the compliance of regulatory bodies. Task shifting should be considered for careful implementation where HRH shortages threaten rollout programmes. http://hdl.handle.net/10144/112077 Title: Defining the limits of emergency humanitarian action: where and how to draw the line?<br/><br/>Authors: Ford N; Zachariah R; Mills E; Upshur R http://hdl.handle.net/10144/88051 Title: Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation.<br/><br/>Authors: Lambert-Evans, Sophie; Ponsar, Frederique; Reid, Tony; Bachy, Catherine; Van Herp, Michel; Philips, Mit<br/><br/>Abstract: ABSTRACT: BACKGROUND: In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households. METHODS: An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection was through a cross-sectional household survey of the catchment areas of 10 public health centres. A questionnaire was used to determine the accuracy of the community-identification method, households' access to health care, and costs of care. Household socioeconomic status was determined by reported expenditures and access to land. RESULTS: Financial access to care at the nearest health centre was ensured for 70% of the population. Of the remaining 30%, half experienced financial barriers to access and the other half chose alternative sites of care. The community-based assessment increased the number of people of the population who qualified for fee exemptions to 8.6% but many people who met the indigent criteria did not receive a card. Eighty-eight percent of the population lived under the poverty threshold. Referring to the last sickness episode, 87% of households reported having no money available and 25% risked further impoverishment because of healthcare costs even with the financial support system in place. CONCLUSION: The flat fee policy was found to reduce cost barriers for some households but, given the generalized poverty in the area, the fee still posed a significant financial burden. This report showed the limits of a programme of fee exemption for indigent households and a flat fee for others in a context of widespread poverty. http://hdl.handle.net/10144/83738 Title: Health leadership in sub-Saharan Africa.<br/><br/>Authors: Harries, Anthony D; Schouten, Erik J; Ben-Smith, Anne; Zachariah, Rony; Phiri, Sam; Sangala, Wesley O O; Jahn, Andreas http://hdl.handle.net/10144/85113 Title: How health systems in sub-Saharan Africa can benefit from tuberculosis and other infectious disease programmes.<br/><br/>Authors: Harries, A D; Jensen, P M; Zachariah, R; Rusen, I D; Enarson, D A<br/><br/>Abstract: Weak and dysfunctional health systems in low-income countries, particularly in sub-Saharan Africa, are recognised as major obstacles to attaining the health-related Millennium Development Goals by 2015. Some progress is being made towards achieving the targets of Millennium Development Goal 6 for tuberculosis (TB), HIV/AIDS and malaria, with the achievements largely resulting from clearly defined strategies and intervention delivery systems combined with large amounts of external funding. This article is divided into four main sections. The first highlights the crucial elements that are needed in low-income countries in sub-Saharan Africa to deliver good quality health care through general health systems. The second discusses the main characteristics of infectious disease and TB control programmes. The third illustrates how TB control and other infectious disease programmes can help to strengthen these components, particularly in human resources; infrastructure; procurement and distribution; monitoring, evaluation and supervision; leadership and stewardship. The fourth and final section looks at progress made to date at the international level in terms of policy and guidelines, with some specific suggestions about this might be moved forward at the national level. For TB and other infectious disease programmes to drive broad improvements in health care systems and patient care, the lessons that have been learnt must be consciously applied to the broader health system, and sufficient financial input and the engagement of all players are essential. http://hdl.handle.net/10144/75118 Title: An integrated approach of community health worker support for HIV/AIDS and TB care in Mozambique.<br/><br/>Authors: Simon, S; Chu, K; Frieden, M; Candrinho, B; Ford, N; Schneider, H; Biot, M<br/><br/>Abstract: ABSTRACT: BACKGROUND: The need to scale up treatment for HIV/AIDS has led to a revival in community health workers to help alleviate the health human resource crisis in sub-Saharan Africa. Community health workers have been employed in Mozambique since the 1970s, performing disparate and fragmented activities, with mixed results. METHODS: A participant-observer description of the evolution of community health worker support to the health services in Angonia district, Mozambique. RESULTS: An integrated community health team approach, established jointly by the Ministry of Health and Medecins Sans Frontieres in 2007, has improved accountability, relevance, and geographical access for basic health services. CONCLUSIONS: The community health team has several advantages over 'disease-specific' community health worker approaches in terms of accountability, acceptability, and expanded access to care.