• Understanding health care in the south Caucasus: examples from Armenia.

      von Schoen-Angerer, T; Médecins Sans Frontières, Manushyan St 48, 375012 Yerevan, Armenia. tavschoen@yahoo.com (2004-09-04)
    • Universal health coverage in a regional Nepali hospital: who is exempted from payment? [Short communication]

      Basnet, R.; Shrestha, B. R.; Nagaraja, S. B.; Basnet, B.; Satyanarayana, S.; Zachariah, R.; Nepal Health Sector Support Programme, Mid-Western Regional Health Directorate, Surkhet, Nepal (International Union Against Tuberculosis and Lung Disease, 2013-03-21)
      This study assessed the characteristics of beneficiaries of a government-led policy of exemption for payment being provided in a regional hospital in Nepal. In January and February 2012, 9547 patients sought services at the out-patient clinic, the majority (83%) of whom were from the same district although this was a referral hospital for 15 districts. Only 10.8% received exemption from payment; 66% of the individuals aged >60 years and eligible for exemption were missed. These shortcomings highlight intrinsic weaknesses in the current implementing mechanisms for payment exemption, which may not be providing financial protection. This hampers efforts towards achieving universal health coverage.
    • User Fees or Equity Funds in Low-Income Countries.

      Brikci, N; Philips, M; Programmes' Unit, Médecins Sans Frontières, London EC1N 8QX, UK. nouria.brikci@london.msf.org (Published by: Elsevier, 2007-01-06)
    • Violence Against Civilians and Access to Health Care in North Kivu, Democratic Republic of Congo: Three Cross-Sectional Surveys

      Alberti, Kathryn P; Grellety, Emmanuel; Lin, Ya-Ching; Polonsky, Jonathan; Coppens, Katrien; Encinas, Luis; Rodrigue, Marie-Noëlle; Pedalino, Biagio; Mondonge, Vital; Epicentre, France; Médecins Sans Frontières, Amsterdam; Médecins Sans Frontières, Belgium; Médecins Sans Frontières, France; Ministry of Health, Democratic Republic of Congo (2010-11-08)
      ABSTRACT:
    • Vital Registration in Rural Africa: Is There a Way Forward to Report on Health Targets of the Millennium Development Goals?

      Zachariah, R; Mwagomba, B; Misinde, D; Mandere, B C; Bemeyani, A; Ginindza, T; Cortier, H; Bissel, K; Jahn, A; Harries, A D; et al. (2011-04-19)
      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.
    • The vital signs of chronic disease management.

      Harries, A D; Zachariah, R; Kapur, A; Jahn, A; Enarson, D A; International Union against Tuberculosis and Lung Disease, Paris, France. adharries@theunion.org (2009-06)
      The vital signs of pulse rate, blood pressure, temperature and respiratory rate are the 'nub' of individual patient management. At the programmatic level, vital signs could also be used to monitor the burden and treatment outcome of chronic disease. Case detection and treatment outcome constitute the vital signs of tuberculosis control within the WHO's 'DOTS' framework, and similar vital signs could be adapted and used for management of chronic diseases. The numbers of new patients started on therapy in each month or quarter (new incident cases) are sensitive indicators for programme performance and access to services. Using similar reporting cycles, treatment outcomes for all patients can be assessed, the vital signs being: alive and retained on therapy at the respective facility; died; stopped therapy; lost to follow-up; and transferred out to another facility. Retention on treatment constitutes the prevalent number of cases, the burden of disease, and this provides important strategic information for rational drug forecasting and logistic planning. If case numbers and outcomes of chronic diseases were measured reliably and consistently as part of an integrated programmatic approach, this would strengthen the ability of resource-poor countries to monitor and assess their response to these growing epidemics.
    • What is a Hotspot Anyway?

      Lessler, J; Azman, A; McKay, H; Moore, S (American Society of Tropical Medicine and Hygiene, 2017-06)
      AbstractThe importance of spatial clusters, or "hotspots," in infectious disease epidemiology has been increasingly recognized, and targeting hotspots is often seen as an important component of disease-control strategies. However, the precise meaning of "hotspot" varies widely in current research and policy documents. Hotspots have been variously described as areas of elevated incidence or prevalence, higher transmission efficiency or risk, or higher probability of disease emergence. This ambiguity has led to confusion and may result in mistaken inferences regarding the best way to target interventions. We surveyed the literature on epidemiologic hotspots, examining the multitude of ways in which the term is used; and highlight the difference in the geographic scale of hotspots and the properties they are supposed to have. In response to the diversity in the term's usage, we advocate the use of more precise terms, such as "burden hotspot," "transmission hotspot," and "emergence hotspot," as well as explicit specification of the spatiotemporal scale of interest. Increased precision in terminology is needed to ensure clear and effective policies for disease control.
    • What's coming for health science and policy in 2018? Global experts look ahead in their field

      Swaminathan, S; Room, RS; Ivers, LC; Hillis, G; Grais, RF; Bhutta, ZA; Byass, P (Public Library of Science, 2018-01-30)
      In PLOS Medicine's first editorial of 2018, editorial board members and other leading researchers share their hopes, pleas, concerns, and expectations for this year in health research and policy.
    • When best practice is bad medicine: a new approach to rationing tertiary health services in South Africa.

      Kenyon, C; Ford, N; Boulle, A; Division of Infectious Diseases and HIV Medicine at Groote Schuur Hospital, Cape Town. chriskenyon1@absamail.co.za (South African Medical Society, 2008-05)
    • Who is telling the story? A systematic review of authorship for infectious disease research conducted in Africa, 1980-2016

      2019-10-18
      Introduction Africa contributes little to the biomedical literature despite its high burden of infectious diseases. Global health research partnerships aimed at addressing Africa-endemic disease may be polarised. Therefore, we assessed the contribution of researchers in Africa to research on six infectious diseases. METHODS: We reviewed publications on HIV and malaria (2013-2016), tuberculosis (2014-2016), salmonellosis, Ebola haemorrhagic fever and Buruli ulcer disease (1980-2016) conducted in Africa and indexed in the PubMed database using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Papers reporting original research done in Africa with at least one laboratory test performed on biological samples were included. We studied African author proportion and placement per study type, disease, funding, study country and lingua franca. RESULTS: We included 1182 of 2871 retrieved articles that met the inclusion criteria. Of these, 1109 (93.2%) had at least one Africa-based author, 552 (49.8%) had an African first author and 41.3% (n=458) an African last author. Papers on salmonellosis and tuberculosis had a higher proportion of African last authors (p<0.001) compared with the other diseases. Most of African first and last authors had an affiliation from an Anglophone country. HIV, malaria, tuberculosis and Ebola had the most extramurally funded studies (≥70%), but less than 10% of the acknowledged funding was from an African funder. CONCLUSION: African researchers are under-represented in first and last authorship positions in papers published from research done in Africa. This calls for greater investment in capacity building and equitable research partnerships at every level of the global health community.
    • Who is telling the story? A systematic review of authorship for infectious disease research conducted in Africa, 1980–2016

      Mbaye, R; Gebeyehu, R; Hossmann, S; Mbarga, N; Bih-Neh, E; Eteki, L; Thelma, OA; Oyerinde, A; Kiti, G; Mburu, Y; et al. (BMJ Publishing Group, 2019-10-01)
      Introduction Africa contributes little to the biomedical literature despite its high burden of infectious diseases. Global health research partnerships aimed at addressing Africa-endemic disease may be polarised. Therefore, we assessed the contribution of researchers in Africa to research on six infectious diseases. Methods We reviewed publications on HIV and malaria (2013–2016), tuberculosis (2014–2016), salmonellosis, Ebola haemorrhagic fever and Buruli ulcer disease (1980–2016) conducted in Africa and indexed in the PubMed database using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Papers reporting original research done in Africa with at least one laboratory test performed on biological samples were included. We studied African author proportion and placement per study type, disease, funding, study country and lingua franca. Results We included 1182 of 2871 retrieved articles that met the inclusion criteria. Of these, 1109 (93.2%) had at least one Africa-based author, 552 (49.8%) had an African first author and 41.3% (n=458) an African last author. Papers on salmonellosis and tuberculosis had a higher proportion of African last authors (p<0.001) compared with the other diseases. Most of African first and last authors had an affiliation from an Anglophone country. HIV, malaria, tuberculosis and Ebola had the most extramurally funded studies (≥70%), but less than 10% of the acknowledged funding was from an African funder. Conclusion African researchers are under-represented in first and last authorship positions in papers published from research done in Africa. This calls for greater investment in capacity building and equitable research partnerships at every level of the global health community.
    • WHO must continue its work on access to medicines in developing countries.

      Ford, N; Piédagnel, J M; Médecins Sans Frontières. (Elsevier, 2003-01-04)
    • WHO Must Defend Patients' Interests, Not Industry.

      Cawthorne, P; Ford, N; Limpananont, J; Tienudom, N; Purahong, W; Médecins Sans Frontières, Bangkok 10240, Thailand. msfb-bangkok@brussels.msf.org (Published by: Elsevier, 2007-03-24)
    • A win-win solution?: A critical analysis of tiered pricing to improve access to medicines in developing countries

      Moon, Suerie; Jambert, Elodie; Childs, Michelle; von Schoen-Angerer, Tido; Harvard Kennedy School and School of Public Health, Boston, USA; Médecins Sans Frontières, Campaign for Access to Essential Medicines, Geneva, Switzerland (BioMed Central, 2011-10-12)
      Background: Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialized countries - has received widespread support from industry, policymakers, civil society, and academics as a way to improve access to medicines for the poor. We carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines. Discussion: We found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers vis-à-vis consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that “de-link” the financing of R&D from the price of medicines merit further attention, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices. However, in special cases - such as when market volumes are very small or multi-source production capacity is lacking - tiered pricing may offer the only practical option to meet short-term needs for access to a product. In such cases, steps should be taken to ensure affordability and availability in the longer-term. Summary: To ensure access to medicines for populations in need, alternate strategies should be explored that harness the power of competition, avoid arbitrary market segmentation, and/or recognize government responsibilities. Competition should generally be the default option for achieving affordability, as it has proven superior to tiered pricing for reliably achieving the lowest sustainable prices.
    • 'Working to stay healthy', health-seeking behaviour in Bangladesh's urban slums: a qualitative study.

      van der Heijden, J; Gray, N; Stringer, B; Rahman, A; Akhter, S; Kalon, S; Dada, M; Biswas, A (BioMed Central, 2019-05-17)
      BACKGROUND: Kamrangirchar and Hazaribagh are the largest slum areas in Dhaka, Bangladesh. In 2013, Médecins Sans Frontières initiated an urban healthcare programme in these areas providing services for factory workers and responding to the sexual and reproductive health needs of young women. Little in-depth information is available on perceptions of health and health seeking behaviour in this population. We aimed to provide a better understanding of community perceptions toward health and health care in order to inform programme strategies. METHODS: In-depth interviews were conducted with women (n = 13); factory workers (n = 14); and key informants (n = 13). Participants were selected using purposive maximum variation sampling and voluntarily consented to take part. Topic guides steered participant-led interviews, which were audio-recorded, translated and transcribed from Bangla into English. By comparing cases, we identified emerging themes, patterns and relationships in the data. NVivo11© was used to sort and code the data. RESULTS: Emerging themes indicated that in Kamrangirchar and Hazaribagh, health is seen as an asset necessary for work and, thus, for survival. Residents navigate a highly fragmented health system looking for 'quick fixes' to avoid time off work, with the local pharmacy deemed 'good enough' for 'common' health issues. Health care seeking for 'serious' conditions is characterised by uncertainty, confusion, and unsatisfactory results. Decisions are made communally and shaped by collective perceptions of quality care. People with limited socio-economic capital have few options for care. 'Quality care' is perceived as comprehensive care 'under one roof,' including predictive biomedical diagnostics and effective medication, delivered through a trusting relationship with the care provider. CONCLUSIONS: Health seeking behaviour of slum dwellers of Kamrangirchar and Hazaribagh is based on competing priorities, where quick and effective care is key, focussed on the ability to work and generate income. This takes place in a fragmented healthcare system characterised by mistrust of providers, and where navigation is informed by word-of-mouth experiences of peers. Improving health in this context demands a comprehensive and integrated approach to health care delivery, with an emphasis on rapid diagnosis, effective treatment and referral, and improved trust in care providers. Health education must be developed in collaboration with the community to identify knowledge gaps, support decision-making, and be channelled through existing networks. Further research should consider the effectiveness of interventions aiming to improve the practice of pharmacists.