Management science for Health

Boston, MA, United States

Management science for Health

Boston, MA, United States
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'T Hoen E.F.M.,Independent Consultant | Hogerzeil H.V.,University of Groningen | Quick J.D.,Management science for Health | Sillo H.B.,Tanzania Food and Drugs Authority TFDA
Journal of Public Health Policy | Year: 2014

Problems with the quality of medicines abound in countries where regulatory and legal oversight are weak, where medicines are unaffordable to most, and where the official supply often fails to reach patients. Quality is important to ensure effective treatment, to maintain patient and health-care worker confidence in treatment, and to prevent the development of resistance. In 2001, the WHO established the Prequalification of Medicines Programme in response to the need to select good-quality medicines for UN procurement. Member States of the WHO had requested its assistance in assessing the quality of low-cost generic medicines that were becoming increasingly available especially in treatments for HIV/AIDS. From a public health perspective, WHO PQP's greatest achievement is improved quality of life-saving medicines used today by millions of people in developing countries. Prequalification has made it possible to believe that everyone in the world will have access to safe, effective, and affordable medicines. Yet despite its track record and recognized importance to health, funding for the programme remains uncertain. © 2014 Macmillan Publishers Ltd.


Sherr L.,University College London | Cluver L.D.,University of Oxford | Cluver L.D.,University of Cape Town | Betancourt T.S.,Harvard University | And 4 more authors.
AIDS | Year: 2014

There is a growing evidence base on the immediate and short-term effects of adult HIV on children. We provide an overview of this literature, highlighting the multiple risks and resultant negative consequences stemming from adult HIV infection on the children they care for on an individual and family basis. We trace these consequences from their origin in the health and wellbeing of adults on whom children depend, through multiple pathways to negative impacts for children. As effective treatment reduces vertical transmission, the needs of affected children will predominate. Pathways include exposure to HIV in utero, poor caregiver mental or physical health, the impact of illness, stigma and increased poverty. We summarize the evidence of negative consequences, including those affecting health, cognitive development, education, child mental health, exposure to abuse and adolescent risk behaviour, including sexual risk behaviour, which has obvious implications for HIV-prevention efforts. We also highlight the evidence of positive outcomes, despite adversity, considering the importance of recognizing and supporting the development of resilience. This study is the first in a series of three commissioned by President's Emergency Plan for AIDS Relief (PEPFAR)/United States Agency for International Development (USAID), the summary provided here was used to inform a second study which seeks to identify insights from the broader child development field which will help us predict what long-term negative consequences children affected by HIV and AIDS are likely to experience. The third study discusses the design of a model to estimate these consequences. Although comprehensive, the review is often hampered by poor-quality research, inadequate design, small sample sizes and single studies in some areas. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Harries A.D.,International Union Against Tuberculosis and Lung Disease | Harries A.D.,London School of Hygiene and Tropical Medicine | Makombe S.D.,Ministry of Health | Libamba E.,Ministry of Health | And 2 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2011

The national scale-up of antiretroviral therapy (ART) in Malawi is based on a public health approach, with principles and practices borrowed from the successful DOTS (directly observed treatment short course-the system used to successfully deliver antituberculosis treatment to people in some of the poorest countries of the world) tuberculosis control framework. During the first 6 years, the number of patients registered on treatment increased from 3000 to >350,000 in both the public and private sectors. The most important reasons for this success have been strong international and national leadership combined with adequate funds, a standardized approach to ART with practical guidelines, an approved national scale-up plan with clear, time-bound milestones; investment in an intensive program of training and accreditation of ART sites, quarterly supervision and monitoring of ART and operational research, rational drug forecasting and no stock-outs of drugs during the first few years, and involvement of the private sector. The looming challenges of human resources, guaranteed financial support, better but also more expensive ART regimens, use of electronic medical records to monitor response to therapy, and attention to HIV prevention need to be met head-on and solved if the momentum of the earlier years is to be maintained. © 2011 by Lippincott Williams & Wilkins.


Lemay N.V.,Management science for Health | Sullivan T.,Center for Communication Programs | Jumbe B.,Management science for Health Malawi | Perry C.P.,Public Health Consultant
Journal of Health Communication | Year: 2012

mHealth has great potential to change the landscape of health service delivery in less developed countriesexpanding the reach of health information to frontline health workers in remote areas. Formative, process, and summative evaluation each play an important role in mHealth interventions. K4Health conducted a Health Information Needs Assessment in Malawi from July to September 2009 (formative evaluation) that found widespread use of cell phones among health workers offering new opportunities for knowledge exchange, especially in areas where access to health information is limited. K4Health subsequently designed an 18-month demonstration project (January 2010 to June 2011) to improve the exchange and use of family planning/reproductive health and HIV/AIDS knowledge among health workers, which included the introduction of a short message service (SMS) network. K4Health conducted a pretest of the mHealth intervention from June to October 2010. A baseline assessment was carried out in November 2010 before expanding the SMS network and included use of qualitative and quantitative measures and comparison groups (summative evaluation). Routinely collected statistics also guide the program (process evaluation). This article describes the approach and main findings of the SMS baseline study and contributes to a growing body of evidence measuring the effectiveness and efficiency of mHealth programs using a strong evaluation design. Copyright © Taylor & Francis Group, LLC.


Mansour M.,Management science for Health | Mansour J.B.,Management science for Health | Swesy A.H.E.,Aswan Health and Population Directorate
Human Resources for Health | Year: 2010

Introduction: In 2002, the Egypt Ministry of Health and Population faced the challenge of improving access to and quality of services in rural Upper Egypt in the face of low morale among health workers and managers.From 1992 to 2000, the Ministry, with donor support, had succeeded in reducing the nationwide maternal mortality rate by 52%. Nevertheless, a gap remained between urban and rural areas.Case description: In 2002, the Ministry, with funding from the United States Agency for International Development and assistance from Management Sciences for Health, introduced a Leadership Development Programme (LDP) in Aswan Governorate. The programme aimed to improve health services in three districts by increasing managers' ability to create high performing teams and lead them to achieve results.The programme introduced leadership and management practices and a methodology for identifying and addressing service delivery challenges. Ten teams of health workers participated.Discussion and evaluation: In 2003, after participation in the LDP, the districts of Aswan, Daraw and Kom Ombo increased the number of new family planning visits by 36%, 68% and 20%, respectively. The number of prenatal and postpartum visits also rose.After the United States funding ended, local doctors and nurses scaled up the programme to 184 health care facilities (training more than 1000 health workers). From 2005 to 2007, the Leadership Development Programme participants in Aswan Governorate focused on reducing the maternal mortality rate as their annual goal. They reduced it from 85.0 per 100,000 live births to 35.5 per 100,000. The reduction in maternal mortality rate was much greater than in similar governorates in Egypt. Managers and teams across Aswan demonstrated their ability to scale up effective public health interventions though their increased commitment and ownership of service challenges.Conclusions: When teams learn and apply empowering leadership and management practices, they can transform the way they work together and develop their own solutions to complex public health challenges. Committed health teams can use local resources to scale up effective public health interventions. © 2010 Mansour et al; licensee BioMed Central Ltd.


Lemay N.V.,Management science for Health | Bocock P.J.W.,Center for Communication Programs
Journal of Health Communication | Year: 2012

Getting the right information into the right hands at the right time is a challenge for many health systems in developing countries. Health workers need access to reliable and up-to-date health information in order to support their clients. This health information needs assessment, conducted in the capital city and 3 districts of Malawi from July 2009 to September 2009, aimed to determine access to, and need for, health information in HIV/AIDS and family planning/reproductive health at all levels of the health system. Using qualitative research methods, the study showed the need to (a) build the capacity of government technical working groups to collect and store information and to promote information exchange at all levels of the health system; (b) improve information synthesis and packaging, particularly for users at peripheral levels; (c) strengthen the district level to serve as an information hub for district- and community-level providers; and (d) explore mobile technologies to increase provider access to knowledge and information. © Taylor and Francis Group, LLC.


Wagner A.K.,Harvard University | Quick J.D.,Management science for Health | Ross-Degnan D.,Harvard University
BMC Health Services Research | Year: 2014

Background: Medicines are a major driver of quality, safety, equity, and cost of care in low and middle-income country health systems. Universal health coverage implementers must explicitly address appropriate use of medicines to realize the health benefits of medicines, avoid wasting scarce resources, and sustain the financial viability of universal health coverage schemes. Discussion. Medicines are major contributors to the health and well-being of individuals and populations when used appropriately, and they waste resources and endanger health when used unnecessarily or incorrectly. Stakeholders need to balance inherently competing objectives in the pharmaceutical sector. Emerging and expanding UHC schemes provide potential levers to balance competing system objectives.To use these levers, sustainable universal coverage programs will require a) information systems that can track medicines utilization, expenditures, and quality of medicines use; b) routine monitoring of indicators of medicines availability, access, affordability, and use; c) policies and programs that facilitate appropriate medicines use by prescribers, dispensers, and patients; d) transparency in setting priorities for medicines coverage under resource constraints; and e) a system perspective to engage diverse actors.As they operationalize paths toward universal health coverage and include targeted medicines coverage policies and programs, systems can build on, and innovate, pharmaceutical policy frameworks and management tools from different countries' settings. Summary. Ensuring that medicines which achieve important health outcomes are available, accessible to all, used appropriately, and sustainably affordable is essential for realizing universal health coverage. Stakeholder cooperation and use of information and financing system levers provide opportunities to work toward this goal. © 2014 Wagner et al.; licensee BioMed Central Ltd.


Yang Y.,University of Washington | Lewis F.M.,University of Washington | Kraushaar D.L.,Management science for Health
Culture, Health and Sexuality | Year: 2013

HIV transmission in Cambodia has declined considerably in recent years, yet new incidents of HIV transmission within marital relationships have increased. Evidence suggests that the cause of this is transmission from HIV-positive men to their HIV-negative spouses. The objective of this paper is to develop an evidence-based model of HIV transmission from husbands to wives in Cambodia in a context of culture and society, drawing from the published literature. A critical analysis of peer reviewed literature, professional papers, policy reports and reference books identified four plausible factors influencing inter-spousal HIV transmission: (1) a hierarchical male-dominated society, (2) husbands' involvement with sex workers, (3) cultural values concerning the ideal Khmer woman and (4) unprotected sex between an HIV-infected husband and his uninfected wife. This evidence-based explanatory model can be used to inform future culturally appropriate HIV-education and prevention programmes. © 2013 Taylor & Francis.


Miller C.M.,Boston University | Tsoka M.,University of York | Reichert K.,Management science for Health
Development Policy Review | Year: 2010

Governments target transfers so that limited resources reach impoverished households; targeting errors therefore indicate inefficiency in resource use and inability to reach the poorest households. This article examines the Malawi Social Cash Transfer Scheme (SCTS), using mixed methods and multiple data sources, including examination of underlying assumptions, the operationalisation of key concepts, questions of implementation, and errors of inclusion and exclusion. Despite serious challenges, the scheme's error rates are within the range of global averages. Its impressive impacts provide strong motivation for improving the targeting process before it is scaled up to the national level. © 2010 No claim to original US governments works. Journal compilation © 2010 Overseas Development Institute.


Huber D.,Management science for Health | Saeedi N.,Early Recovery Team | Samadi A.K.,STEP Health and Development Organization
Bulletin of the World Health Organization | Year: 2010

Problem: Afghan women have one of the world's highest lifetime risks of maternal death. Years of conflict have devastated the country's health infrastructure. Total fertility was one of the world's highest, contraceptive use was low and there were no Afghan models of success for family planning. Approach: We worked closely with communities, providing information about the safety and non-harmful side-effects of contraceptives and improving access to injectable contraceptives, pills and condoms. Regular interaction with community leaders, mullahs (religious leaders), clinicians, community health workers and couples led to culturally acceptable innovations. A positive view of birth spacing was created by the messages that contraceptive use is 300 times safer than pregnancy in Afghanistan and that the Quran (the holy book of Islam) promotes two years of breastfeeding. Community health workers initiated the use of injectable contraceptives for the first time. Local setting: The non-for-profit organization, Management Sciences for Health, Afghan nongovernmental organizations and the Ministry of Public Health implemented the Accelerating Contraceptive Use project in three rural areas with different ethnic populations. Relevant changes: The contraceptive prevalence rate increased by 24-27% in 8 months in the project areas. Men supported modern contraceptives once they understood contraceptive safety, effectiveness and non-harmful side-effects. Injectable contraceptives contributed most to increases in contraceptive use. Lessons learnt: Community health workers can rapidly increase contraceptive use in rural areas when given responsibility and guidance. Project innovations were adopted as best practices for national scale-up.

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