• Caught in Colombia's crossfire.

      Reilley, B; Morote, S; Médecins sans Frontières, New York, USA. (The Massachusetts Medical Society, 2004-12-16)
    • Challenging traditional energy settings in the humanitarian aid: experiences from Doctors Without Borders

      Ten-Palomares, M; Motard, E (Taylor and Francis, 2019-03-21)
      Energy is essential to the provision of humanitarian aid, from operating medical and non-medical equipment, to storing vaccines and drugs. In the last decades, the contexts of intervention of humanitarian actors are getting more complex and volatile, sometimes leading to longer project lifespans. To respond to this evolving context, and at the same time to try to cope with the global ecological crisis, humanitarian actors are proposing new strategies toward more sustainable energy solutions in their operations. However, there is a lack of reflection regarding how energy is conceived and used in the humanitarian response. With the aim of shedding light on these issues, we take the case of Médecins Sans Frontières, a medical humanitarian organization who is rethinking its traditional logics of energy planning. The results reveal that even if some transformative approaches to energy are emerging in the humanitarian field, they face several challenges when putting them into practice. Challenges related to effectiveness and flexibility, core concerns of the humanitarian aid. The work invites to a deeper look at the plurality of those challenges, aiming to gain better understanding on the relationship between energy and society and its operational impact.
    • Clinical bacteriology in low-resource settings: today's solutions

      Ombelet, S; Ronat, JB; Walsh, T; Yansouni, CP; Cox, J; Vlieghe, E; Martiny, D; Semret, M; Vandenberg, O; Jacobs, J (Elsevier, 2018-03-05)
      Low-resource settings are disproportionately burdened by infectious diseases and antimicrobial resistance. Good quality clinical bacteriology through a well functioning reference laboratory network is necessary for effective resistance control, but low-resource settings face infrastructural, technical, and behavioural challenges in the implementation of clinical bacteriology. In this Personal View, we explore what constitutes successful implementation of clinical bacteriology in low-resource settings and describe a framework for implementation that is suitable for general referral hospitals in low-income and middle-income countries with a moderate infrastructure. Most microbiological techniques and equipment are not developed for the specific needs of such settings. Pending the arrival of a new generation diagnostics for these settings, we suggest focus on improving, adapting, and implementing conventional, culture-based techniques. Priorities in low-resource settings include harmonised, quality assured, and tropicalised equipment, consumables, and techniques, and rationalised bacterial identification and testing for antimicrobial resistance. Diagnostics should be integrated into clinical care and patient management; clinically relevant specimens must be appropriately selected and prioritised. Open-access training materials and information management tools should be developed. Also important is the need for onsite validation and field adoption of diagnostics in low-resource settings, with considerable shortening of the time between development and implementation of diagnostics. We argue that the implementation of clinical bacteriology in low-resource settings improves patient management, provides valuable surveillance for local antibiotic treatment guidelines and national policies, and supports containment of antimicrobial resistance and the prevention and control of hospital-acquired infections.
    • A Comparison of Cluster and Systematic Sampling Methods for Measuring Crude Mortality.

      Rose, A; Grais, R; Coulombier, D; Ritter, H; Epicentre, Paris, France. angela.rose@epicentre.msf.org (Published by WHO, 2006-04)
      OBJECTIVE: To compare the results of two different survey sampling techniques (cluster and systematic) used to measure retrospective mortality on the same population at about the same time. METHODS: Immediately following a cluster survey to assess mortality retrospectively in a town in North Darfur, Sudan in 2005, we conducted a systematic survey on the same population and again measured mortality retrospectively. This was only possible because the geographical layout of the town, and the availability of a good previous estimate of the population size and distribution, were conducive to the systematic survey design. RESULTS: Both the cluster and the systematic survey methods gave similar results below the emergency threshold for crude mortality (0.80 versus 0.77 per 10,000/day, respectively). The results for mortality in children under 5 years old (U5MR) were different (1.16 versus 0.71 per 10,000/day), although this difference was not statistically significant. The 95% confidence intervals were wider in each case for the cluster survey, especially for the U5MR (0.15-2.18 for the cluster versus 0.09-1.33 for the systematic survey). CONCLUSION: Both methods gave similar age and sex distributions. The systematic survey, however, allowed for an estimate of the town's population size, and a smaller sample could have been used. This study was conducted in a purely operational, rather than a research context. A research study into alternative methods for measuring retrospective mortality in areas with mortality significantly above the emergency threshold is needed, and is planned for 2006.
    • A Comparison of Liposomal Amphotericin B with Sodium Stibogluconate for the Treatment of Visceral Leishmaniasis in Pregnancy in Sudan.

      Mueller, M; Balasegaram, M; Koummuki, Y; Ritmeijer, K; Santana, M R; Davidson, R N N; Médecins sans Frontières, 67-74 Saffron Hill, London EC1N 8QX, UK. (Published by Oxford University Press, 2006-10)
      OBJECTIVES: Little is known about the treatment of visceral leishmaniasis (VL) in pregnancy, especially in resource-poor settings. We present a series of pregnant women with VL treated with either sodium stibogluconate or liposomal amphotericin B (AmBisome), or both, in eastern Sudan over 16 months. METHODS: We did a retrospective analysis of all pregnant VL patients treated in the Médecins sans Frontières (MSF) Um el Kher centre between January 2004 and April 2005. We diagnosed VL with laboratory confirmation of clinical suspects, and recorded the outcomes of treatment for pregnant women and their foetuses. We carried out a manual search of relevant publications and a systematic search of the literature in the MEDLINE database. RESULTS: We treated 23 women with sodium stibogluconate, 4 with AmBisome and sodium stibogluconate and 12 with AmBisome alone. There were 13 (57%) spontaneous abortions in the sodium stibogluconate monotherapy group, and none in either of the other two groups. All spontaneous abortions occurred in the first two trimesters. All patients, except one in the sodium stibogluconate group who defaulted, were discharged as cured in good clinical condition. CONCLUSIONS: AmBisome treatment for VL appears to be safe and effective for pregnant women and their foetuses. We recommend the use of AmBisome as first-line treatment for these patients.
    • Conflict in Sri Lanka. Sri Lanka's Health Service is a Casualty of 20 Years of War.

      Reilley, B; Simpson, I; Ford, N; DuBois, M; Médecins Sans Frontières, Colombo, Sri Lanka. (Published by: BMJ Publishing Group Ltd, 2002-02-09)
    • The courage to change the rules: a proposal for an essential health R&D treaty.

      Dentico, N; Ford, N; nicolettadentico@libero.it (PLoS, 2005-02)
    • Data Sharing in a Humanitarian Organization: The Experience of Médecins Sans Frontières

      Karunakara, Unni (Public Library of Science, 2013-12-10)
      Open data and data sharing are essential for maximizing the benefits that can be obtained from institutional and research datasets [1]. In 2012, the medical humanitarian organization Me´decins Sans Frontieres (MSF) decided to adopt a data sharing policy for routinely collected clinical and research data (http://www.msf.org.uk/msf-data-sharing). Here we describe the policy’s principles, practicalities,and development process. We hope this paper will encourage and help other humanitarian and nongovernmental organizations to share their data with public health researchers for the benefit of the populations with which they work.
    • Demand Forecasting and Order Planning for Humanitarian Logistics: An Empirical Assessment

      van der Laan, E; van Dalen, J; Rohrmoser, M; Simpson, R (Elsevier, 2016-07-15)
      Humanitarian aid organizations are most known for their short-term emergency relief. While getting aid items to those in need can be challenging, long-term projects provide an opportunity for demand planning supported by forecasting methods. Based on standardized consumption data of the Operational Center Amsterdam of Médecins Sans Frontières (MSF-OCA) regarding nineteen longer-term aid projects and over 2000 medical items consumed in 2013, we describe and analyze the forecasting and order planning process. We find that several internal and external factors influence forecast and order planning performance, be it indirectly through demand volatility and safety markup. Moreover, we identify opportunities for further improvement for MSF-OCA, and for humanitarian logistics organizations in general.
    • DFID's health strategy.

      Ooms, G; Ford, N; MSF Brussels (Elsevier, 2007-08-25)
    • The 'diagonal' approach to Global Fund financing: a cure for the broader malaise of health systems?

      Ooms, G; Van Damme, W; Baker, B; Zeitz, P; Schrecker, T; Médecins Sans Frontières Belgium, Dupréstraat 94, 1090 Brussels, Belgium. gorik.ooms@brussels.msf.org. (2008)
      ABSTRACT: BACKGROUND: The potentially destructive polarisation between 'vertical' financing (aiming for disease-specific results) and 'horizontal' financing (aiming for improved health systems) of health services in developing countries has found its way to the pages of Foreign Affairs and the Financial Times. The opportunity offered by 'diagonal' financing (aiming for disease-specific results through improved health systems) seems to be obscured in this polarisation.In April 2007, the board of the Global Fund to fight AIDS, Tuberculosis and Malaria agreed to consider comprehensive country health programmes for financing. The new International Health Partnership Plus, launched in September 2007, will help low-income countries to develop such programmes. The combination could lead the Global Fund to fight AIDS, Tuberculosis and Malaria to a much broader financing scope. DISCUSSION: This evolution might be critical for the future of AIDS treatment in low-income countries, yet it is proposed at a time when the Global Fund to fight AIDS, Tuberculosis and Malaria is starved for resources. It might be unable to meet the needs of much broader and more expensive proposals. Furthermore, it might lose some of its exceptional features in the process: its aim for international sustainability, rather than in-country sustainability, and its capacity to circumvent spending restrictions imposed by the International Monetary Fund. SUMMARY: The authors believe that a transformation of the Global Fund to fight AIDS, Tuberculosis and Malaria into a Global Health Fund is feasible, but only if accompanied by a substantial increase of donor commitments to the Global Fund. The transformation of the Global Fund into a 'diagonal' and ultimately perhaps 'horizontal' financing approach should happen gradually and carefully, and be accompanied by measures to safeguard its exceptional features.
    • Dilemmas in Access to Medicines: a Humanitarian Perspective

      Smith, J; Aloudat, T (Elsevier, 2017-03-11)
    • Discrimination in the Discretionary Points Award Scheme: Comparison of White with Non-white Consultants and Men with Women.

      Esmail, A; Abel, P; Everington, S; Medical Practitioners Union, MSF Centre, London EC1V 8HA. aneez.esmail@man.ac.uk (Published by: BMJ Publishing Group Ltd, 2003-03-29)
    • Disparity in Market Prices for Hepatitis C Virus Direct-Acting Drugs

      Andrieux-Meyer, Isabelle; Cohn, Jennifer; de Araújo, Evaldo S Affonso; Hamid, Saeed S (Elsevier, 2015-11)
    • Do Aid Agencies Have an Ethical Duty to Comply with Researchers? A Response to Rennie.

      Zachariah, R; Janssens, V; Ford, N; Médecins sans Frontières, 68 Rue de Gasperich, L-1617, Gasperich, Luxembourg. rony.zachariah@brussels.msf.org (2006-05)
      Medical AID organisations such as Médecins Sans Frontières receive several requests from individuals and international academic institutions to conduct research at their implementation sites in Africa. Do AID agencies have an ethical duty to comply with research requests? In this paper we respond to the views and constructed theories (albeit unfounded) of one such researcher, whose request to conduct research at one of our sites in the Democratic Republic of Congo was turned down.
    • Do we need a world health insurance to realise the right to health?

      Ooms, G; Derderian, K; Melody, D; Médecins Sans Frontières, Brussels, Belgium. gorik.ooms@brussels.msf.org (Public Library of Science, 2006-12)
    • Does ratification of human-rights treaties have effects on population health?

      Palmer, Alexis; Tomkinson, Jocelyn; Phung, Charlene; Ford, Nathan; Joffres, Michel; Fernandes, Kimberly A; Zeng, Leilei; Lima, Viviane; Montaner, Julio S G; Guyatt, Gordon H; et al. (2009-06-06)
      Human-rights treaties indicate a country's commitment to human rights. Here, we assess whether ratification of human-rights treaties is associated with improved health and social indicators. Data for health (including HIV prevalence, and maternal, infant, and child [<5 years] mortalities) and social indicators (child labour, human development index, sex gap, and corruption index), gathered from 170 countries, showed no consistent associations between ratification of human-rights treaties and health or social outcomes. Established market economy states had consistently improved health compared with less wealthy settings, but this was not associated with treaty ratification. The status of treaty ratification alone is not a good indicator of the realisation of the right to health. We suggest the need for stringent requirements for ratification of treaties, improved accountability mechanisms to monitor compliance of states with treaty obligations, and financial assistance to support the realisation of the right to health.
    • Don't Spin the Pen: Two Alternative Methods for Second-Stage Sampling in Urban Cluster Surveys.

      Grais, R; Rose, A; Guthmann, J P P; Epicentre, 8, rue Saint Sabin, 75011 Paris, France. rebecca.grais@epicentre.msf.org (Published by BioMed Central, 2007)
      In two-stage cluster surveys, the traditional method used in second-stage sampling (in which the first household in a cluster is selected) is time-consuming and may result in biased estimates of the indicator of interest. Firstly, a random direction from the center of the cluster is selected, usually by spinning a pen. The houses along that direction are then counted out to the boundary of the cluster, and one is then selected at random to be the first household surveyed. This process favors households towards the center of the cluster, but it could easily be improved. During a recent meningitis vaccination coverage survey in Maradi, Niger, we compared this method of first household selection to two alternatives in urban zones: 1) using a superimposed grid on the map of the cluster area and randomly selecting an intersection; and 2) drawing the perimeter of the cluster area using a Global Positioning System (GPS) and randomly selecting one point within the perimeter. Although we only compared a limited number of clusters using each method, we found the sampling grid method to be the fastest and easiest for field survey teams, although it does require a map of the area. Selecting a random GPS point was also found to be a good method, once adequate training can be provided. Spinning the pen and counting households to the boundary was the most complicated and time-consuming. The two methods tested here represent simpler, quicker and potentially more robust alternatives to spinning the pen for cluster surveys in urban areas. However, in rural areas, these alternatives would favor initial household selection from lower density (or even potentially empty) areas. Bearing in mind these limitations, as well as available resources and feasibility, investigators should choose the most appropriate method for their particular survey context.