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The rapid rise in antimicrobial resistance (AMR) has increased global momentum to establish antimicrobial stewardship programs in health facilities, clinics, and hospitals. The overuse or misuse of antimicrobial medicines is a key driver of AMR and a growing global health problem.

The publication outlines the essential elements of managing supplies at the district and subdistrict levels and in nongovernmental organizations (NGOs), provides practical guidance in assessing and improving the supply system at that level, and offers a range of other technical and managerial resources and references that will enable you to improve your management skills and study the areas that i

Stewardship is the ethical use of common resources in pursuit of financially efficient outcomes. This Setting a Shared Strategic Direction for Health Systems Strengthening guide explores the nature of the practice of stewarding scarce resources (human, financial, political, and technological), and principles and activities that will strengthen organizations' capacity for such stewardship.

The Management of Medicines Benefit Programs in Low- and Middle-Income Settings manual serves as a primer for managers, government officials, or consultants who are tasked by a government, health insurance plan, or other institution with designing or implementing a medicines benefit program.

"Improving Medicines Access and Use for Child Health—A Guide to Developing Interventions" represents an up-to-date and practical resource for those developing interventions to improve access to and use of medicines for child illness. It targets groups working in community organizations, health facilities, and district health offices, or within larger health systems.

The In-service Leadership, Management and Governance Syllabus provides an action-oriented instructional pathway for health leaders, managers, and their teams to improve their leadership and management skills and the governance of health programs. It leverages reliable tools and processes for addressing challenges and producing measurable results through team projects.

The Pre-service Leadership, Management and Governance Syllabus assists pre-service training institutions to effectively and efficiently integrate leadership, management, and governance practices into existing curricula.

Half of the Ugandan population obtains medicines from the public sector. Yet, we found only 3/5 of 455 inspected public health facilities meet Good Pharmacy Practice (GPP) standards. Facilities using SPARS (the Supervision, Performance Assessment, and Recognition Strategy) tended to perform better than unsupervised facilities, substantiating the value of supporting supervision interventions in GPP areas that need strengthening. Non-compliant indicators can be improved through practices and behavioral changes; some require infrastructure investments. We conclude that regular National Drug Authority inspections of public sector pharmacies in conjunction with interventions to improve GPP adherence can revolutionize patient care in Uganda.

National Essential Medicines lists (EMLs) indicate medicines that meet the priority health needs of the population and often guide a government’s purchasing and distribution decisions for public health facilities.

This publication presents case studies from three countries — Bangladesh, Nepal, and Zambia — that have introduced and scaled up the use of misoprostol for postpartum hemorrhage (PPH).

Uganda introduced a multipronged intervention, the supervision, performance assessment, and recognition strategy (SPARS), to improve medicines management (MM) in public and not-for-profit health facilities. This paper, the first in a series, describes the SPARS intervention and reports on the MM situation in Uganda before SPARS (baseline).

The objective of this study was to compare the diagnostic yield of GeneXpert MTB/RIF with Ziehl-Neelson (ZN) sputum smear microscopy among index TB cases and their household contacts. A cross sectional study was conducted among sputum smear positive index TB cases and their household contacts in Northern Ethiopia. Results: Of 353 contacts screened, 41 (11%) were found to have presumptive TB. GeneXpert test done among 39 presumptive TB cases diagnosed 14 (35.9%) cases of TB (one being rifampicin resistant), whereas the number of TB cases diagnosed by microscopy was only 5 (12.8%): a 64.3% increased positivity rate by GeneXpert versus ZN microscopy. The number needed to screen and number needed to test to diagnose a single case of TB was significantly lower with the use of GeneXpert than ZN microscopy. Of 119 index TB cases, GeneXpert test revealed that 106 (89.1%) and 5 (4.2%) were positive for rifampicin sensitive and rifampicin resistant TB, respectively. GeneXpert test led to increased TB case detection among household contacts in addition to its advantage in the diagnosis of Rifampicin resistance among contacts and index TB cases. There should be a consideration in using GeneXpert MTB/RIF as a point of care TB testing tool among high risk groups.

Non-communicable diseases (NCDs) are a growing cause of death and disability in Africa, reducing individual and collective productivity and increasing health care costs. The African region is expected to experience the greatest increase in NCD deaths over the coming decade.

AbstractBackground: To ascertain equity in financing for essential medicines and health supplies (EMHS) in Uganda, this paper explores the relationships among government funding allocations for EMHS, patient load, and medicines availability across facilities at different levels of care.Methods: We collected data on EMHS allocations and availability of selected vital medicines from 43 purposively s

AbstractIntroduction: Active surveillance pharmacovigilance is a systematic approach to medicine safety assessment and health systems strengthening, but has not been widely implemented in low- and middle-income countries.

This guide provides national stakeholders and advocates with information and guidance to update the national EML to include a new commodity, a new indication, or a new formulation based on the available evidence and based on country need and disease burden.

In Tanzania, a public-private partnership launched in 2003 used an accreditation approach to improve access to quality medicines and pharmaceutical services in underserved areas. The government scaled up the accredited drug dispensing outlet (ADDO) program nationally, with over 9,000 shops now accredited. This study assessed the relationships between community members and their sources of health care and medicines, particularly antimicrobials, with a specific focus on the role ADDOs play in the health care system. We surveyed 1,185 households and audited 96 ADDOs and 84 public/nongovernmental health facilities using a list of 17 tracer drugs. To determine practices in health facilities, we interviewed 1,365 exiting patients. To assess dispensing practices, mystery shoppers visited 306 ADDOs presenting one of three scenarios (102 each) about a child’s respiratory symptoms. Of 614 household members with a recent acute illness, 73% sought outside care-30% at a public facility and 31% at an ADDO. However, people bought medicines more often at ADDOs no matter who recommended the treatment; of the 581 medicines that people had received, 49% came from an ADDO. ADDO dispensers are trained to refer complicated cases to a health facility, and notably, 99% of mystery shoppers presenting a pneumonia scenario received an antimicrobial (54%), a referral (90%), or both (45%), which are recommended practices for managing pediatric pneumonia. However, one-third of the dispensers needlessly sold antibiotics for cold symptoms, and 85% sold an antibiotic on request. In addition, the pneumonia scenario elicited more advice on handling the illness than the cold symptoms scenario (61% vs. 15%; p<0.0001), but overall, only 44% of the dispensers asked any of the shoppers about danger signs potentially associated with pneumonia in a child. Poor prescribing in health facilities, poor dispensing at ADDOs, and inappropriate patient demand continue to contribute to inappropriate medicines use. Therefore, while accreditation has attempted to address the quality of pharmaceutical services in private sector drug outlets, efforts to improve access to and use of medicines in Tanzania need to target ADDOs, public/nongovernmental health facilities, and the public to be effective.

Over the past two decades, Ethiopia has improved its delivery of primary health care services and begun to make great progress toward meeting the Millennium Development Goals, particularly with regard to maternal, newborn, and child health and the prevention and control of HIV and tuberculosis.

An extensive body of work on access to and use of medicines has resulted in an assortment of tools measuring various elements of pharmaceutical systems. Until now however, there has been little attempt to conceptualize a pharmaceutical system as an entity and define its strengthening in a way that allows for measuring systems strengthening. The narrow focus of available tools limits their value in ascertaining which interventions result in stronger, more resilient systems. We sought to address this shortcoming by revisiting the current definitions, frameworks and assessment tools related to pharmaceutical systems. We conducted a comprehensive literature review and consulted with select pharmaceutical experts. On the basis of our review, we propose that a pharmaceutical system consists of all structures, people, resources, processes, and their interactions within the broader health system that aim to ensure equitable and timely access to safe, effective, quality pharmaceutical products and related services that promote their appropriate and cost-effective use to improve health outcomes. We further propose that pharmaceutical systems strengthening is the process of identifying and implementing strategies and actions that achieve coordinated and sustainable improvements in the critical components of a pharmaceutical system to make it more responsive and resilient and to enhance its performance for achieving better health outcomes. Finally, we established that, in addition to system performance and resilience, seven components of the pharmaceutical system are critical for measuring pharmaceutical systems strengthening: pharmaceutical products and related services; policy, laws and governance; regulatory systems; innovation, research and development, manufacturing, and trade; financing; human resources; and information.

The ongoing conflicts in Syria have had a major impact on the health of the population and have also reduced the capacity of health care service delivery to a minimum.

Uganda’s Ministry of Health in 2012 implemented a comprehensive strategy (SPARS) to build medicines management capacity in public sector health facilities. The approach includes supportive supervision. This structured observational study assesses supportive supervision competency among medicines management supervisors (MMS). The study used structured observations of two groups of five purposely selected MMS—one group supervising facilities with greater medicines management improvement during one year of SPARS and one group with less improvement, based on quantitative metrics. Our results suggest that MMS’ supportive supervision competency is positively related to the SPARS effectiveness scores of the facilities they supervise. We recommend strategies to strengthen supportive supervision behaviors and skills.

MSH authors have published a number of journal articles describing the accredited drug seller implementation experience and lessons learned in Tanzania—home of the flagship ADDO program. A new compendium reviews highlights ranging from robust multi-method quantitative to informative qualitative research. 

Antimicrobial resistance (AMR) is one of the world’s most pressing and urgent global health threats —one that could erode gains against tuberculosis (TB), malaria, HIV/AIDS, and many other infectious diseases. While AMR has emerged as a critical issue at the global level, current efforts to address AMR are insufficient to curb its spread.

Antimicrobial resistance (AMR) occurs when disease-causing pathogens are able to withstand the killing or suppressing power of antimicrobial medicines. This phenomenon increases the global burden of infectious diseases and strains health systems. Parts 1 and 2 of the online course are offered at the Global Health Learning Center. Part 1

The UN adoption of the SDGs in 2015 signaled a strong commitment of member countries to the expanded access to essential health service agenda and definitively recognized the critical role of medicines in achieving UHC.

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