Achievement Of Universal Access Research Articles

Relationship between Prices and Quality of Essential Medicines from Different Manufacturers Collected in Cameroon, the Democratic Republic of the Congo, and Nigeria.

Achieving universal access to affordable medicines and at the same time ensuring the quality of medicines presents a challenge, especially in low- and middle-income countries. Here, the relationship between medicine prices and medicine quality was investigated in three African countries. From different types of health facilities and medicine vendors, 711 samples of 18 different essential medicines were purchased and analyzed for quality (assay and dissolution) according to the United States Pharmacopeia. Without exception, all originator brand medicines and all SRA generics (generic medicines manufactured in countries with stringent regulatory authorities [SRAs]) complied with pharmacopeial specifications. In contrast, 21.1% of the non-SRA generics (manufactured in countries without SRAs) were substandard. The median prices of originator brands and SRA generics were three times and two times higher than those of non-SRA generics, respectively. Within the non-SRA generics, no positive correlation was observed between medicine quality and medicine price. Medicines manufactured in India, China, or African countries showed similar quality and similar prices. Only a single WHO-prequalified medicine sample was found among the 711 samples. Non-SRA generic medicines produced by manufacturers for which WHO had published Public Inspection Reports showed a significantly lower rate of substandard medicines (7.3%) and, at the same time, significantly lower prices (by 33%) than other non-SRA generics. Falsified medicines (total 2.0%) were found among all categories of medicines and had prices similar to those of non-SRA generics. Our findings indicate that adequate quality assurance does not necessarily imply an increase in medicine prices.

Evaluating centrifuged water treatment plant sludge as an adsorbent for nutrients, microorganisms, and heavy metals removal from wastewater

Achieving universal access to clean water, as mandated by SDG 6 – Clean Water and Sanitation, is crucial for supporting human health and environmental sustainability. Water treatment plants generate a by-product known as Water Treatment Plant Sludge (WTPS), comprising organic and inorganic substances. Traditionally, the disposal of WTPS poses environmental risks, including nutrient runoff and heavy metal contamination. This study investigates using centrifuged WTPS, without prior treatment, as an adsorbent to remove contaminants from treated wastewater, offering a sustainable waste management solution. Through comprehensive characterization using Scanning Electron Microscopy, Thermogravimetric Analysis, Fourier Transform Infrared Spectroscopy, and geo-environmental parameter assessment, the research evaluates the adsorption efficacy of WTPS. A factorial design methodology facilitated the systematic examination of adsorption tests. Findings indicate that WTPS exhibits adsorption capacities for phosphorus (q = 0.2 mg g-1), Chemical Oxygen Demand (q = 1.1 mg g-1), and metals under specific conditions. Maximum removal efficiencies for total coliforms and Escherichia coli were achieved with extended contact times, showcasing WTPS's potential as a robust adsorbent. The research demonstrates that centrifuged WTPS can significantly reduce concentrations of metals such as Pb, Co, and Ni (100%), Al (96%), Cu (95%), and Fe (93%) in treated wastewater, presenting a promising approach for enhancing wastewater quality. However, the interaction between WTPS and wastewater resulted in an increased concentration of Mn in the effluent, highlighting the complex dynamics of adsorption processes. In conclusion, centrifuged WTPS emerges as a viable, cost-effective adsorbent, aligning with sustainable waste management practices and circular economy principles.

Swarm electrification: Harnessing surplus energy in off-grid solar home systems for universal electricity access

Achieving universal access to electricity by 2030, as set out by the Sustainable Development Goals, presents a significant challenge given the current rate of progress. A recent promising concept is swarm electrification. Its central idea is the peer-to-peer energy sharing of surplus energy in solar home systems (SHSs) to connect additional neighbors and grow a bottom-up grid. This paper studies the surplus energy in SHSs and its underlying influencing factors as a basis for swarm electrification. An open-source multi-model-based techno-economic analysis of off-grid SHS including surplus energy as a value is presented. Three distinct household types from the tier 3 category in the Multi-tier framework are compared based on their unique ratios of peak-to-average demand and percentage of load consumption during sun hours. A statistical analysis of surplus energy for each household type is presented and energy sharing with additional households at tier 1–2 is simulated. Two economic analysis methods, including surplus energy, are presented and compared: single-objective cost minimization and multi-objective compromise programming. The study finds that a low ratio of demand during sun hours leads to higher surplus energy volumes, while a peak-to-average ratio alone cannot give such indications. Both economic methods suggest that optimizing the SHS design for tier 3 households involves a slight increase in solar power capacity when considering the expected revenue from selling surplus energy to 2–3 households in tiers 1–2. The total cost for the tier 3 households are reduced by 40%−64%, additionally to decreasing their own lost load by 4%−7%, and reducing the up-front cost to get electricity access for the tier 1–2 households by 50% compared to purchasing their own full SHS.

A Comprehensive Approach to the Governance of Universal Access to Sustainable Energy

Achieving universal access to energy by 2030 (Sustainable Development Goal 7.1) hinges on significantly scaling up and accelerating electrification efforts in developing countries. Governing the ecosystem of government agencies, energy utilities, practitioners, development and finance institutions, banks, NGOs, academia, and, most importantly, beneficiary communities to accelerate the pace of electrification requires the interweaving of technological innovation, disruptive business models, improved institutional frameworks, and inclusive multi-stakeholder decision-making, to ensure that no one is left behind. The foundation of this article is based on extensive insider research, including 14 national electrification plans, numerous visits, field studies, and semi-structured interviews with these actors conducted over ten years in 25 countries. This article presents a novel comprehensive conceptual approach that integrates both macro (national and global) and micro (local and individual) level mechanisms and the role of cultural factors and shared values within the ecosystem in driving and accelerating action within a harmonized regulatory, policy, and planning framework. It outlines the essential mechanisms for effectively engaging and empowering governments, utilities, donors, and local actors to accelerate the path to universal electrification through the most cost-effective articulation of diverse technologies and business models.

Impact Financing for Clean Cooking Energy Transitions: Reviews and Prospects

Achieving universal access to clean cooking requires a significant mobilization of capital to close the current funding gap of around US$7 bn per year. The clean cooking landscape has changed considerably with substantial innovation in terms of technology, business models, and services. The transition towards higher-tier, modern energy cooking (MEC) solutions provides key opportunities for innovative financing models to scale MEC globally. Transitions from cooking with polluting fuels to MEC have significant positive impacts on the environment, gender equality, and health. Impact Finance to monetize these co-benefits for MEC solutions is widely seen as an outstanding opportunity to channel funding into MEC transitions. However, except for climate funding, opportunities to channel finance for wider impact SDG benefits arising from MEC have proved challenging to realize in practice. This article explores in detail two new approaches which are taking advantage of features of digital technology to overcome some of these obstacles. It adds to the recent debate around climate finance for clean cooking and presents key learning lessons from developing and piloting the ‘Metered Methodology for Clean Cooking Devices’ as the current most accurate approach to estimate carbon savings for MEC and the ‘Clean Impact Bond (CIB)’ which aims at monetizing health and gender-co-benefits. The paper demonstrates how robust methodologies can help to accelerate funding for MEC and calls for joint approaches to standardize and streamline climate and outcome finance approaches to enhance their impact by making them more accessible for a wider range of MEC technologies, geographies, and projects.

Reaching Universal Coverage of Water and Sanitation Services: Is Regionalization a Sustainable Path for Developing Countries?

Achieving universal access to water and sanitation services in developing countries requires a coherent legal, political, and institutional environment, along with a clear financial strategy. Regionalizing utilities may be crucial for addressing disparities, economic inequalities, and governance challenges. Regionalization offers economies of scale, resource efficiency, knowledge sharing, and collaboration. The cornerstone will be ensuring the financial-economic viability of regional utilities, considering their social impacts in terms of affordability. A case study of the state of Santa Catarina (Brazil) is assessed. In the case of Santa Catarina, only four regional utilities currently generate sufficient revenue, without factoring in necessary investments, indicating the need to review design parameters to improve operational efficiency and increase revenues. Additional financial support may be required to ensure universal access. Tariff adjustments must strike a balance between cost effectiveness and affordability for families.

Leaving No One Behind: Prospects for User-Owned Urban Water Utilities in Kenya

Achieving universal access to basic services and safe and affordable water and sanitation to all by 2030, as targeted in Sustainable Development Goals 1 and 6, is of utmost importance in improving people’s well-being. In Kenya, this means fulfilling a significant water services gap. This study analyzed the viability of user-owned urban water utilities there from managers’ perspectives. It found that the high performance of the few licensed private utilities, high ownership and control, small size, robust public participation, and regulatory policies favor their performance. Yet, the costliness of water services production limits their viability in the most sidelined low-income areas. The article recommends (i) diversifying service production models, (ii) establishing a revolving fund to finance major capital investments, (iii) making full cost recovery a key policy objective, (iv) mobilizing financing from local users, including low-income earners, and (v) setting pricing structures that imply cross-subsidizing between the rich and poor.

Optimal Sizing and Techno-Economic Analysis of Minigrid Hybrid Renewable Energy System for Tourist Destination Islands of Lake Tana, Ethiopia

Achieving universal electricity access is a challenging goal for the governments of developing countries such as Ethiopia. Extending the national grid to the remotely located, scattered, and island populations demands a huge investment. This paper aims to show the techno-economic feasibility of minigrid renewable energy system to electrify Kibran Gabriel island in Ethiopia, through the execution of simulation, optimization and sensitivity analysis using Hybrid Optimization Models for Energy Resources (HOMER Pro) software. The minigrid systems were compared with both diesel generation (DG) and grid extension systems. The hybrid photovoltaic (PV)/DG/battery system is more economically feasible compared with other minigrid systems, and the best cost-effective option is the one including load flow (LF) strategy with 25 kW of PV, 10 kW of DG, 40 kWh of battery, and 5 kW of bi-directional convertor. The optimal PV/DG/Battery system, having levelized cost of energy (COE) of USD 0.175/kWh, net present cost (NPC) of USD 119,139 and renewable fraction (RF) of 86.4%, reduces the pollutant emissions by 33,102 kg/yr compared with the stand-alone DG system. The optimal minigrid sensitivity to the variations in global horizontal irradiance (GHI), diesel price and load consumption were considered in the sensitivity analysis, and the result shows that the system will operate reasonably well.

The role of regulatory, market and governance risk for electricity access investment in sub-Saharan Africa

Achieving universal electricity access in sub-Saharan Africa – a milestone of SDG 7 – requires about $30bn annually until 2030 on the top of baseline investment. The private sector plays a key role in supplying these investment flows, given the governmental budgetary constraints. Yet, private players face numerous sources of risk in their infrastructure investment decisions. This risk is usually factored in using a discount rate. To allow for a more realistic evaluation of the role of the investment environment in financing energy access, here we introduce the Electricity Access Governance Index (EAGI), a composite index of energy sector regulatory quality, energy sector governance, and market risk. The index is implemented through a discount rate conversion into a bottom-up integrated electricity planning model (IMAGE-TIMER) to evaluate the role of different sources of risk for electrification investment dynamics. Our results show that the adoption of decentralised systems for achieving universal energy access requires governance and institutional reform to lower discount rates faced by companies and households and mobilise private finance. Failure to reform investment environments will likely hamper the uptake of decentralised systems even in areas where they would be the techno-economically least-cost electrification option, and thus likely leave many without electricity.

A Retrospective Analysis of Energy Access with a Focus on the Role of Mini-Grids

Achieving universal access to electricity by 2030 is a key part of the Agenda for Sustainable Development, and has its own Sustainable Development Goal, SDG 7.1. This is because electricity services are required for almost all aspects of a modern economy, from the cooling of vaccines to irrigation pumping, to manufacturing and running a business. The achievement of SDG 7.1 will require a thoughtful mix of policy, finance, and technology to be designed and implemented at scale. Yet, the pressing need for an electrification ramp-up is not unprecedented. Many countries (now considered “industrialized”) faced similar challenges about a century ago. Although the existing literature covers a great deal of power systems evolution, there is a gap around the specific role and impact of small, isolated power systems in the early stages of electricity uptake. In this paper, we provide insights based on the review of the historical electrification efforts in four (now middle and high-income) countries. The drivers and context of electrification efforts in early stages are described. Those focus particularly on the role of dispersed, small-scale generation systems (mini-grids). Our analysis shows that electrification follows four loosely defined phases, namely: pilot projects, technological roll-out, economic expansion, and social scale-up. We report a selection of historical mistakes and advances that offer lessons of striking importance for today´s energy access efforts, particularly in regards to the development of mini-grids. We find that today, as historically, multi-stakeholder (e.g., planners, regulators, developers, investors, third party actors) collaboration is key and can help build locally adaptable, economically sustainable and community compatible mini-grids that can accelerate—and lower the societal costs of—universal access to electricity.

The Role of Open Access Data in Geospatial Electrification Planning and the Achievement of SDG7. An OnSSET-Based Case Study for Malawi

Achieving universal access to electricity is a development challenge many countries are currently battling with. The advancement of information technology has, among others, vastly improved the availability of geographic data and information. That, in turn, has had a considerable impact on tracking progress as well as better informing decision making in the field of electrification. This paper provides an overview of open access geospatial data and GIS based electrification models aiming to support SDG7, while discussing their role in answering difficult policy questions. Upon those, an updated version of the Open Source Spatial Electrification Toolkit (OnSSET-2018) is introduced and tested against the case study of Malawi. At a cost of $1.83 billion the baseline scenario indicates that off-grid PV is the least cost electrification option for 67.4% Malawians, while grid extension can connect about 32.6% of population in 2030. Sensitivity analysis however, indicates that the electricity demand projection determines significantly both the least cost technology mix and the investment required, with the latter ranging between $1.65–7.78 billion.

The Roles of Government and the Public Utility in Achieving Universal Access to Electricity

The Roles of Government and the Public Utility in Achieving Universal Access to Electricity

Interventions to increase the distribution of vaccines in Sub-Saharan Africa: a scoping review.

Achieving universal access to immunization, as envisioned in the global vaccine action plan continues to be a challenge for many countries in Sub-Saharan Africa. Weak immunization supply chain (iSC) has widely been recognized as a key barrier, hindering progress towards vaccination targets in this region. These iSCs, which were designed in the 1980s, have become increasing fragile and are now considered outdated. The objective of this review was to assess the effectiveness of system redesign and outsourcing to improve outdated iSC systems in sub-Saharan Africa. We searched the following electronic databases from January 2007 to December 2017: Medline, EMBASE (Excerpta Medica Database), the Cochrane Library, Google Scholar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), WHOLIS (World Health Organization Library Database), LILACS (Latin American and Caribbean Literature on Health Sciences) and contacted experts in the field. Our search strategy yielded 80 records and after assessment for eligibility, seven papers met the inclusion criteria. Five studies evaluated the experiences of system redesign in three countries (Nigeria, Benin and Mozambique), two assessed outsourcing vaccine logistics to the private sector in Nigeria and South Africa. According to these studies, system redesign improved vaccine availability at service delivery points and reduce the cost of distributing vaccines. Similarly, outsourcing vaccine logistics to the private sector reduced the cost of vaccines distribution and improve vaccine availability at service delivery points.

Health Care System Re-Design to Achieve Universal Access to Cardiac Rehabilitation Services: Implications for Population Health and Health Policy

The Gulf Cooperation Council Center for Infection Control (GCC-IC) has moved forward over the past several years on the antimicrobial resistance (AMR) agenda. Many of the GCC countries have now developed a national plan to combat AMR and have engaged the leadership of the involved sectors in the discussion on how to mitigate this threat. During the first meeting for the GCC-IC center on AMR, which took place early 2015, the roadmap for combating AMR was developed [1] and since then much more has been done. We present here the discussion that took place during the second GCC-IC center meeting on AMR where not only have the countries presented their progress, but we conducted 2 round table discussions inviting international and regional experts in the field to share their thoughts, progress and knowledge on this topic [2]. Within is the 2nd round table discussion at the 2017 GCC AMR meeting which took place in Riyadh, Saudi Arabia, April 2017. Where the 1st round table discussion during this meeting addressed the role of leadership in managing AMR [2].

Abstract 7: Health Care System Re-Design to Achieve Universal Access to Cardiac Rehabilitation Services: Implications for Population Health and Health Policy

Background: The efficacy of cardiac rehabilitation programs (CRP) is well established, and completion of such programs after an event is standard-of-care in guidelines worldwide. Despite universal recommendations, participation in CRP is alarmingly low: estimated at 14%-35% in the US, and <15% of eligible patients in the Canadian province of Ontario. The inability to achieve even 50% participation in CRP represents a failure of health care systems (HCS) to deliver effective, high-quality services. Such a failure is particularly vexing in Canada, where the central tenet and legal requirement of the HC-S is universal access to all medically necessary services. Objectives: A team of health care providers and administrators in Ontario used a systems integration approach to re-design the HCS in one health care region (HCR) to make an evidence-based CRP universally available. The key features of this HCS-integrated CRP (HCS-I-CRP), its adoption, and population health impact are reported here. Methods: By design, the HCS-I-CRP included harmonized criteria that triggered automatic referral to a HCR-wide coordinating center, which then directed eligible patients to a CRP provided in local, community-based setting (LCB-CRP). Fourteen LCB-CRP, available within a 30-minute drive from most all locations in the HCR, were trained to provide a standardized CRP. Detailed patient outcomes were tracked in a centralized database. Using administrative data, within-HCR participation rates were monitored, and population level health impacts between the HCR implementing the HCS-I-CRP and all other HCRs in Ontario were compared for the 2 years prior and 1 year after the HCS-I-CRP implementation. Results: More than 11,000 patients were referred through the HCS-I-CRP to a LCB-CRP. The estimated overall participation and completion rates were 31% and 67%, respectively. Population health impacts in the HCR implementing the HCS-I-CRP included (p<0.05): larger HCR-wide reduction in visits to family practitioners, cardiologists, and internists for any cardiac reason; larger HCR-wide reductions in hospitalizations, emergency department visits, and visits to cardiologist and internists for acute coronary syndrome; and larger HCR-wide reductions in visits to family practitioners and cardiologists for heart failure. Reductions in HCR-wide mortality for acute coronary syndrome approached significance (p=0.097). Conclusions: The adoption of a HCS-I-CRP was extremely successful: referrals actually exceeded the capacity of LCB-CRPs and enrollment, unfortunately, had to be capped. Despite this, statistically significant, population level health benefits were observed. We anticipate that adoption of a province-wide HCS-I-CRP, initiated and buttressed by provincial policy, would achieve near universal access to CRP and population health benefits similar to or greater than those reported here.

Ad-hoc numbers forming provision and policy: round and round of universal access in an Australian preschool

ABSTRACTAustralian early childhood education still labours with the achievement of universal access and the production of comprehensive and consistent data to underpin a national evidence base. In this article, we attend to the processes led by numbers whereby new practices of quantification, rationalization and reporting are introduced and mastered in a New South Wales preschool to reach universal access and effective data reporting following state initiatives. Provisional numbers, set by the state government, are instrumental in configuring and solidifying these processes through which preschools engage in creative strategizing, modelling and calculations to enact, inform and form policies. With the help of a preschool director’s biographical notes, we explore the complex entanglements of these new processes and the resulting ambivalent positions professionals find themselves in, the ethical dilemmas that emerge and the practical and material consequences and political possibilities that formalizing processes of universal access and data production bring forward.

Achieving Universal Access to Health Care in Africa: The Role of Primary Health Care

Following the expiration of the eight Millennium Development Goals (MDGs) that were used as frameworks for shaping progress in development between 2000 and 2015, seventeen new Sustainable Development Goals (SDGs) were adopted by governments at the UN General Assembly in September, 2015. SDG3 focuses on health i.e. to Ensure healthy lives and promote well-being for all at all ages. This goal is translated into 13 targets: three focus on reproductive and child health; three concern communicable diseases, non-communicable diseases, and addiction; two focus on environmental health; one relates to achieving universal health coverage (UHC); while four targets relate to tobacco control, vaccines and medicines, health financing and workforce, and global health risk preparedness. This brief commentary examines how universal health coverage (UHC) in African countries can be achieved through the strengthening of the primary health care system.

Understanding and confronting cultural complexities characterizing water, sanitation and hygiene in Sub-Saharan Africa

This article uses theoretical discourses on risk to engage in a review of cultural and religious concepts that challenge the achievement of universal access to water, sanitation and hygiene (WASH) in Sub-Saharan Africa. In the review, complex WASH behaviours evolve in relation to dominant situated experiences, often nested in cultural and religious beliefs and values, which tend to complicate risks and limit the attainment of universal WASH coverage in the subregion. The article argues that framing problems purely with respect to socio-economic limitations fails to account for the contextual triggers of WASH behaviours, making intervention programmes less likely to succeed.

One Goal, Two Paths: Achieving Universal Access to Modern Energy in East Asia and the Pacific - By World Bank

One Goal, Two Paths: Achieving Universal Access to Modern Energy in East Asia and the Pacific - By World Bank

Infrastructure Development: Public Private Partnership Path for Developing Rural Telecommunications in Africa

It is the quest of every government to achieve universal Access and service of telecommunication services and ICTs. Unfortunately due to the high cost of deploying infrastructure in rural areas of developing countries due to non-significant or no economic activity, this dream of achieving Universal access and service of telecommunications/ICTs have been stalled. This paper throws light on a possible Public Private Partnership framework as a development path that will enable affordable network technologies to be deployed in rural areas at a cost that will translate to what the rural dweller in a developing country in Africa can afford. The paper is a conceptual paper