Equitable health services

The objective of the East Africa Public Health Laboratory Networking Project for Africa is to establish a network of efficient, high quality, accessible public health laboratories for the diagnosis and surveillance of tuberculosis and other communicable diseases. There are three components to the project, the first component being regional diagnostic and surveillance capacity. This component will provide targeted support to create and render functional the regional laboratory network. Uganda, working in close collaboration with the East, Central and Southern African Health Community (ECSA-HC), will lead the establishment of the network. The second component is joint training and capacity building. The project will support training in a range of institutions in the four countries and across the region. Tanzania will provide leadership in this area and establish a regional training hub. It will provide practical training at its state-of-the-art national health laboratory quality assurance and training centre and in-service training and post-graduate mentorships at the Muhimbili University of Health and Allied Sciences. Finally, the third component includes joint operational research, knowledge sharing and regional co-ordination, and programme management.

The month-old Ebola outbreak in the Democratic Republic of Congo, which rose quickly to over 100 cases appears to be fading. More than 3,500 contacts of known cases are being followed, more than 4,000 doses of vaccine have been given and officials reported feeling hopeful enough to allow schools in the area — North Kivu Province, on the eastern border with Uganda — to open as usual. Although five experimental treatments for infected patients recently won approval for emergency use, the author reports that so far too few patients have received them to draw conclusions about how well they may work. One reason experts are reluctant to declare the outbreak contained is that some remote towns have not been visited because of armed groups in the area. Ebola experts also said they would not let down their guard because they remembered a brief, deceptive lull in the early days of the 2014 West African outbreak before it reached three capital cities and exploded, killing more than 11,000 people. Medically, the most exciting prospect on the horizon is that, as of Aug. 22, DRC has approved the emergency use of five potential treatments: two antiviral drugs, remdesivir and favipiravir; and three cocktails of antibodies originally found in recovered patients, including ZMapp, mAb114 and Regn3450-3471-3479. Previously, only about half of Ebola patients were saved if they got supportive treatment, including fluid replacement and fever control, in time. Being consistently able to cure most patients is reported to be an important advance.

In this study, an initial assessment of hospital management systems demonstrated weak functioning in several management areas. In response, the authors developed a novel Master of Hospital Administration (MHA) programme, a collaborative effort of the Ethiopian Ministry of Health (MoH), the Clinton HIV/AIDS Initiative, Jimma University and Yale University. The MHA is a two-year executive style educational programme to develop a new cadre of hospital leaders, consisting of 5% classroom learning and 85% executive practice. It has been implemented with 55 hospital leaders in the position of chief executive officer within the MoH, with courses taught in collaboration by faculty of the North and the South universities. The programme has enrolled two cohorts of hospital leaders and is working in more than half of the government hospitals in Ethiopia. Lessons learned include the need to: balance education in applied technical skills with more abstract thinking and problem solving; recognise the interplay between management education and policy reform; remain flexible as policy changes have direct impact on the project; be realistic about resource constraints in low-income settings, particularly information technology limitations; and manage the transfer of knowledge for long-term sustainability. The authors hope that this programme will set a precedent for other sub-Saharan countries wishing to improve their health sector management.

To date, no study has yet looked at the effect of incentives on the use of insecticide-treated nets (ITNs). This study aims to fill the research gap. It took the form of a cluster randomised controlled trial testing household-level incentives for ITN use following a free ITN distribution campaign in Madagascar. The study took place from July 2007 until February 2008. Twenty-one villages were randomised to either intervention or control clusters. At baseline, 8.5% of households owned an ITN and 6% were observed to have a net mounted over a bed in the household. At one month, there were no differences in ownership between the intervention and control groups, but net use was substantially higher in the intervention group (99% vs. 78%). After six months, net ownership had decreased in the intervention compared to the control group (96.7% vs. 99.7%). There was no difference between the groups in terms of ITN use at six months; however, intervention households were more likely to use a net that they owned (96% vs. 90%). The study concludes that providing incentives for behaviour change is a promising tool that can complement traditional ITN distribution programmes and improve the effectiveness of ITN programmes in protecting vulnerable populations, especially in the short-term.