• Acces aux soins de sante primaires Resultat d'une enquete epidemiologique. Le cercle de Bougouni, region de Sikasso-Mali

      Enyeque, Arsene; Latreille, Karin; Ponsar, Frederique; Bachy, Catherine; Van Herp, Michel; Philips, Mit (2006-05)
    • Access to health care in Burundi - Results of three epidemiological surveys

      Cetinoglu, Dalita; Delchevalerie, Pascale; Parque, Veronique; Philips, Mit; Van Herp, Michel (2004-03)
    • Access to health care in the community health unit of Petite Riviere, Verretes, la Chapelle, Haiti

      Ponsar, Frederique; Van Herp, Michel; Manzi, Marcel; Philips, Mit; MSF Haiti Team (2005-09)
    • Access to healthcare in post-war Sierra Leone

      MSF Amsterdam; MSF Brussels (2005-03)

      Karir, Veena; Bygrave, Helen; Cepuch, Christa; Davis, Brett; Elder, Greg; Jobanputra, Kiran; Reddy, Amulya; MSF (2018)
      This is a summary of work undertaken between March 2018 and May 2018 in order to increase understanding of accessibility to medicines for major non-communicable diseases (NCDs) among Jordanians and urban Syrian refugees. It includes multiple facets of accessibility - affordability, availability, price determinants, government and out-of-pocket expenditures, the pharmaceutical and health sectors, and prescriber and consumer behaviours. Overall accessibility to medicines in Jordan for the NCDs studied here is relatively high. However, a minority of the population does not access treatment, mainly due to affordability (predominantly provider costs, but also medicines and transportation costs); these factors are most likely linked to capacity to pay given that expenditures exceed income among Jordanians and urban refugees, the majority of whom report debt. It is imperative to understand that price of medicines cannot be examined in isolation but needs to be considered in relation to capacity to pay, as even very low-priced generic medicines remain out of reach for lower-income households. All World Health Organization (WHO) essential drugs (oral plus insulin) for the NCDs studied here were registered by the Jordan Food and Drug Administration, and procured by the government for the public sector. Based on the literature, public sector availability of medicines for NCDs is generally limited among lower income countries investigated. However, only a minority of urban Syrian refugees reported unavailability of medicines in the Jordanian public sector. From the literature, private sector NCD medication availability is higher and close to 80% among higher income countries and in urban settings; it is also higher in lower income countries, for medicines to treat cardiovascular disease. These findings should hold true for Jordan. Jordan has sufficient healthcare resources. Government expenditure on health exceeds that of many Middle East North Africa (MENA) countries of the same income group, while the population has lower out-of-pocket expenditure compared to the same group of countries. Government purchases of medicines (availability) are likely sufficient for cardiovascular disease, hypertension and non-insulin-dependent diabetes if 65% or fewer of the affected population access the public sector. Most medicines used to treat major NCDs are procured at competitive prices (comparable to the international reference price) by the Jordanian government. Public tendering as well as pricing of medicines is transparent in Jordan. In the private sector, prices are essentially fixed by law, but despite this pricing is heavily influenced by the pharmaceutical sector, whose priorities lie with profitability and in general, the predominant export market. The majority of medicines for major NCDs were determined to be affordable (less than one day’s wage to purchase a 30-day supply) in the public sector, even when multiple drugs were prescribed for hypertension, cardiovascular disease and/or diabetes. Affordability in the private sector is predominantly the case for medicines for hypertension, cardiovascular disease and oral medicines for diabetes; notable exceptions include insulin, fixed-dose combination (FDC) inhalers and statins. Across both sectors, higher costs can be attributable to prescriber practices, consumer preferences and predominance of brand drugs, especially for insulin and FDC inhalers. Risk factors for NCDs among Jordanians and Syrians surpass global averages, driving disability and death. While affordability comes through as the main obstacle in accessing health care, annually Jordanians are spending more on tobacco than medical expenses. Considerations for humanitarian and other implementing organizations: - Prior to engaging in NCD interventions, evaluation of the existing health system is key to determining how to plan (if at all), where along the continuum of NCD care the focus of the response should be and whom to target. - Programming details and operational costs need to factor procurement options, as there may be governmental requirements for local and/or international sourcing. - Prevention possibilities should be reviewed in relation to NCDs given known impact on reducing death and disability.
    • Akonolinga - Buruli Ulcer Project, Cameroon, 2002 - 2014

      Michèle Mercier; Javier Gabaldon; Médecins Sans Frontiéres (2014-11-18)
      The primary objective of the evaluation was to identify the lessons learned throughout the period that the BU Project was in operation in Akonolinga, from its launch in 2002 until its conclusion in late June 2014. To accomplish this, the assessors relied on existing documentation, interviews with persons directly or indirectly involved with the project, and on any observations that they made during their time in the field. The findings presented in the evaluation deal essentially with the study of the project phases, its strategic evolution, its management, the partnerships entered into by MSF, decentralisation, awareness-raising campaigns and advocacy activities. One major chapter is devoted to an analysis and an appreciation of medical activities, with their therapeutic choices, performance, support elements and the research carried out in and around the project. The evaluation also looked at planning for the disengagement phase and on the legacy left by MSF after twelve years of engagement. A total of 1231 patients with ulcers, including 435 confirmed cases of BU, were diagnosed. They received institutional care, based on quality standards and methods which were unknown in Cameroon until now. Numerous research papers, training courses and a multi-disciplinary approach were also part of the care given over the years. A modest advocacy action was carried out. All these activities were developed against a background that highlighted a reduction in the incidence and number of new BU cases detected, not only on the national level, but also on the international level. Also, with time, there was a growing threat to the sustainability of activities after MSF had left.

      MSF Mali; MSF Bruxelles; MSF Luxembourg (2008-04)
    • Antiretroviral Therapy in Primary Health Care: Experience of the Khayelitsha Programme in South Africa

      MSF South Africa; Dept of Public Health, University of Cape Town; Provincial Administration of Western Cape (WHO, 2003)
    • Assessing the quality of teleconsultations in a store-and-forward telemedicine network

      Wootton, Richard; Liu, Joanne; Bonnardot, Laurent (Frontiers Media, 2014-07-01)
      Store and forward telemedicine in resource-limited settings is becoming a relatively mature activity. However, there are few published reports about quality measurement in telemedicine, except in image-based specialties, and they mainly relate to high- and middle-income countries. In 2010, Medecins Sans Frontieres (MSF) began to use a store-and-forward telemedicine network to assist its field staff in obtaining specialist advice. To date, more than 1000 cases have been managed with the support of telemedicine, from a total of 40 different countries. We propose a method for assessing the overall quality of the teleconsultations provided in a store-and-forward telemedicine network. The assessment is performed at regular intervals by a panel of observers, who-independently-respond to a questionnaire relating to a randomly-chosen past case. The answers to the questionnaire allow two different dimensions of quality to be assessed: the quality of the process itself and the outcome, defined as the value of the response to three of the four parties concerned, i.e. the patient, the referring doctor and the organisation. It is not practicable to estimate the value to society by this technique. The feasibility of the method was demonstrated by using it in the MSF telemedicine network, where process-quality scores, and user-value scores, appeared to be stable over a nine-month trial period. This was confirmed by plotting the cusum of a portmanteau statistic (the sum of the four scores) over the study period. The proposed quality assessment method appears feasible in practice, and will form one element of a quality assurance programme for MSF's telemedicine network in future. The method is a generally applicable one, which can be used in many forms of medical interaction.
    • Assessing the Quality of Teleconsultations in a Store-And-Forward Telemedicine Network - Long-Term Monitoring Taking into Account Differences between Cases

      Wootton, Richard; Liu, Joanne; Bonnardot, Laurent (Frontiers Media, 2014-10-28)
      We have previously proposed a method for assessing the quality of individual teleconsultation cases; this paper proposes an additional step to allow the long-term monitoring of quality. The basic scenario is a teleconsultation system (aka an e-referral system or a tele-expertise system) where the referrer posts a question about a clinical case, the question is relayed to an appropriate expert, and the chosen expert provides an answer. The people running this system want assurances that it is stable, i.e., they want routine quality assurance information about the "output" from the "process." This requires two things. It needs a method of assessing the quality of individual patient consultations. And it needs a method for taking into account differences between patients, so that these quality assessments can be compared longitudinally. Building on the previously proposed methodology, the present paper proposes two techniques for measuring the difficulty posed by a particular teleconsultation. The first is an indirect method, similar to a willingness to pay economic estimation. The second is a direct method. Using these two methods with real data from a telemedicine network showed that the first method was feasible, but did not produce useful results in a pilot trial. The second method, while more laborious, was also feasible and did produce useful results. Thus, when output quality is measured, an allowance can be made for the characteristics of the case submitted. This means that fluctuations in output quality can be attributed to variations in the process (network) or to variations in the raw materials (queries submitted to the network). Long-term quality assurance should assist those providing telemedicine services in low-resource settings to ensure that the services are operated effectively and efficiently, despite the constraints and complexities of the environment.