Faith-based Health Facilities Research Articles

Healthcare Providers’ Engagement in Strategic Purchasing of Outpatient Services: A Cross-sectional Analysis of the National Health Scheme in Kenya

Abstract Background: National Health Insurance Fund (NHIF) outpatient services operate under capitation, and are strategically designed to enhance quality, equity, and affordability. However, despite this strategy, providers often demand out-of-pocket payments. This study investigates provider participation in strategic purchasing and its impact on NHIF’s outpatient service delivery. Methods: A cross-sectional analytical study was conducted among 66 healthcare managers from facilities accredited to provide NHIF outpatient services in two counties in Kenya. The data were collected using structured questionnaires. Logistic regression analysis was performed to assess the association between study variables. Results: Most respondents were male (36, 55%). The provision of NHIF outpatient services was significantly correlated with the monitoring provider performance by NHIF and the county department of health (Pmultivariate=0.024). There was a 31-fold increase in the likelihood of provision for monitored facilities. A significant difference (p=0.005**) was observed in monitoring health facilities. Monitoring was more common among private healthcare providers than public and faith-based health facilities. Conclusion: The involvement of healthcare providers in strategic purchasing has not yet been achieved. County and NHIF quality assurance departments should regularly monitor providers’ performance to ensure the delivery of equitable and high-quality healthcare.

Responding to preventable causes of maternal and perinatal deaths in Homabay County

Background: The Kenya population and housing census (2019) ranked Homabay County among the 15 counties with the highest maternal mortality rate (MMR) of 516 deaths in 100,000 livebirths and neonatal mortality rate (NMR) of 26 in 1,000 livebirths. Baseline assessment reported gaps including dysfunctional maternal and perinatal death surveillance and response system, and untimely perinatal deaths audited. Other challenges contributing to near misses and mortality include erratic availability of blood/blood products, staff shortages affecting the offering of CEmONC services, interfacility referral challenges, not exploiting partnerships with private and faith-based health facilities in the county, and HCW knowledge and skills deficit, especially in management of common causes of death, such as postpartum hemorrhage and eclampsia Methods: MCGL’s objective was to work with the County’s leadership to revitalize the MPDSR system and work toward responding to the causes and avoidable factors contributing to the high burden of maternal and perinatal deaths in the County. MCGL trained HCWs on harvesting and handling of blood products, management of PPH and eclampsia, development of county referral strategy, linkage to private and faith-based HFs, capabilities, support weekly MPDSR committee meetings, develop, and roll out MPDSR of weekly monitoring tool, formation of QI teams, and support for social accountability activities. Results: Improved implementation of MPDSR action points included increased number of CEmONC health facilities, availability and access to blood during PPH emergencies, and point-of-care ultrasound machines in 13 health facilities. There was notable improvement of timely perinatal deaths of audits 47% (70/152). Conclusions: Deliberate and collective effort by the leadership with close follow-up can improve timely auditing and response , which improves the quality of care for mothers and newborns receiving HFs.

Assessment of prices, availability and affordability of essential medicines in Juba County, South Sudan

BackgroundAccess to safe, effective, affordable, and high-quality medications has been included in the Sustainable Development Goals (SDGs) of the United Nations as a crucial step towards attaining universal health coverage. Access to medicines is a fundamental human right. If medicines are accessible and affordable, they save lives by reducing mortality and morbidity associated with acute and chronic diseases. WHO recommends that all countries voluntarily reach the minimum target of 80% availability of medicines by 2025. The primary purpose of this research is to assess access to essential medicines in Juba County, South Sudan.MethodsThis study was undertaken using the standard World Health Organization/Health Action International Organization (WHO/HAI) approach for surveying the prices, availability, and affordability of medicines. A survey was conducted in six payams of Juba County, South Sudan, and 55 health facilities were assessed.ResultsPrices for generic medicines were better in faith-based health facilities with a median price ratio of 1.95. Private pharmacies and private clinics had MPRs of 4.64 and 4.32, respectively. Local prices were high compared to International referent prices. Availability of medicines was highest in the faith-based health facilities (65.5%) and slightly lower in private pharmacies (55.4%), private clinics (57.7%) and public (50.4%) sectors. Most of the surveyed medicines were unaffordable. The medicines needed to treat non-communicable diseases cost up to 33.7-day wages for one full course of treatment.ConclusionsIn South Sudan, medicines are poorly available in all sectors. Medicines are affordable in the public sector but Most medicines are unaffordable in private pharmacies, private clinics and faith-based health facilities. Poor medicines availability in the public sector contributes to the overall unaffordability of medicines in all the other sectors.

Burden of and factors associated with poor quality antibiotic, antimalarial, antihypertensive and antidiabetic medicines in Malawi.

To assess the prevalence and factors associated with substandard and falsified (SF) medicines among antibiotic, antimalarial, antihypertensive and antidiabetic medicines in Malawi. We conducted a cross-sectional study in 23 public, faith-based and private health facilities in Zomba, Machinga and Nsanje districts. We analyzed oral medicine samples of commonly used medicines among antibiotics, antimalarial, antihypertensive and antidiabetics in accordance with Malawi Essential Medicines List and local treatment guidelines. These medicines were subjected to visual inspection for any defects and screening for the content of active pharmaceutical ingredient and disintegration of dosage units. Samples that failed during screening and at least 10% of those that passed were subjected to pharmacopeia assay and dissolution test for confirmation. We used thin layer chromatography and disintegration test methods provided in the Global Pharma Health Fund minilab® for the screening purposes. We conducted confirmatory test using High-Performance Liquid Chromatography (HPLC) or ultra-violet/visible spectrophotometer and dissolution. Of the 293 medicine samples collected, 14.3% were SF medicines. Among the SF medicines were 12.5% of Amlodipine (1/8), 19.2% of Amoxicillin (5/26), 72.2% of Atenolol (8/11), 21.2% of Ciprofloxacin (7/33), 14.3% of Enalapril (1/7), 44.4% of Flucloxacillin (4/9), and 35.7% of sulfadoxine/ pyrimethamine (10/28). Medicine quality was associated with therapeutic medicine class, stated origin of manufacturer, primary packaging material and geographical location. Antimalarial and antidiabetic medicines were of better quality as compared to antibiotics, odds ratio OR 4.2 (95% CI 1.7-9.49), p < 0.002 and OR 5.6 (95% CI 1.21-26.09), p < 0.028 respectively. In terms of stated country of origin, the prevalence of SF medicines was 30% (15/50), 33% (9/27), 26.7% (4/15) and 6.6% (8/122) for medicines stated to be manufactured in Malawi, China, Kenya and India respectively. This study presents the first findings on the assessment of quality of medicines since the establishment of the national pharmacovigilance center in 2019 in Malawi. It is revealed that the problem of SF medicines is not improving and hence the need for further strengthening of quality assurance systems in Malawi.

The Geographical Distribution of Gastrointestinal Endoscopy Services Within Government and Faith Based Hospitals in Ghana

Background: Gastrointestinal (GI) endoscopy is generally a very safe and effective diagnostic and interventional modality in the current practice of medicine. To plan a comprehensive equitable gastrointestinal endoscopy service, the geographical distribution of this essential facility needs to be mapped.Methods: This study was a cross sectional situational survey of gastrointestinal endoscopy services within government and faith based health facilities in Ghana. Information on the availability of GI endoscopy services as at December 2016 was obtained by interviewingdoctors from the various regions in Ghana. Five (5) doctors working in different hospitals were interviewed per region.Results: Gastrointestinal (GI) endoscopy service was available in 3 out of the 4 teaching hospitals and only one regional hospital (Sunyani) in Ghana. The upper east, Upper west and Volta regions have no GI endoscopy services within any government or faithbased facility. The Christian Health Association of Ghana (CHAG) complemented government effort with GI endoscopy units at 4 district hospitals located in the Eastern, Central, Brong Ahafo and Volta regions.Conclusion: The distribution of gastrointestinal endoscopy services within government and faith based facilities is uneven. There is an urgent need to establish these services equitably across Ghana.

Healthcare providers’ attitude towards abortion service provision in Gulu city, Northern Uganda

Background: Although induced abortion is legally allowed on various grounds in several sub-Saharan African countries, health care providers in these countries often persist in viewing induced abortion as immoral. Providers’ attitudes may conflict with the national abortion law or their personal and or religious values. Abortion services are severely restricted and highly contentious in Uganda. This study, therefore, is aimed at determining attitudes among healthcare providers on induced abortion service provision in Gulu City. Procedures: A cross-section survey was conducted among health workers about attitudes toward induced abortion between September and November 2019 using a modified abortion attitudinal score. The study was conducted in the Hospitals and Health centers in Gulu City, in Northern Uganda, the participants were drawn from Public, Private non-for-profit faith-based, Private for Profit and, Private non-for-profit Non-Government Organisation health centers. Findings: A total of 252 health care providers were surveyed. The mean attitudinal score for generally in support, generally not in support, conditional in support, personal attitude, and beliefs against and toward abortion provision were 2.80, 2.71, 2.86, 3.239, and 3.35 respectively. Factors that were positively associated with general support included age 40 years and above; and being employed in private non-for-profit non-governmental health facilities, with coefficients of 0.85 and 0.67 respectively. Factors that were positively associated with conditional support were; age 40years or above; being employed in a non for profit non-governmental health facility; private for-profit and private not-for-profit faith-based health facilities coefficients 0.55, 0.54, 0.40, and 0.37 respectively. However, being a born-again Christian was negatively associated with general support for induced abortion provision. Conclusion: Healthcare providers’ attitude is an important element in the provision of quality stigma-free post-abortion care services. A clear national effort to improve post-abortion and comprehensive abortion care training should include value clarification and attitude transformation among all healthcare providers.

Readiness assessment: Implications for COVID-19 infection prevention and control (IPC) preparedness in health facilities

Background: Monitoring uptake of infection prevention and control (IPC) interventions is critical for the targeted and rational use of limited resources. A national facility readiness assessment conducted in August 2020 provided key information for targeted interventions to strengthen priority IPC areas. We assessed the level of COVID-19 preparedness in the facilities, identified priority COVID-19 IPC gaps, and generated a baseline report to further guide IPC investments at all levels. Methods: The Kenya Ministry of Health in collaboration with the CDC and International Training and Education Center for Health adapted a WHO Facility Readiness Assessment tool to include COVID-19–specific areas. In August 2020, data were collected using tablets through an Android-based electronic platform and were analyzed using descriptive statistics. Assessments were conducted in public, private, and faith-based health facilities nationally after 4 months of preparedness and investment in the healthcare system. Results: We assessed 684 facilities of the targeted 844 (81%). Overall facility readiness in Kenya was rated above average (61%), and the performance score significantly increased with the Kenya Essential Package for Health level, with level 5 and 6 facilities scoring an average of 83% and 79% respectively. Of the assessed facilities, 82% had an appointed IPC coordinator. Only 14% of the facilities had all the required guidelines, policies, and the appropriate COVID-19 case definitions. 67% of the facilities had updated supply inventories for past week. Only 50% of the facilities had adequate supplies of N95 masks. The assessment revealed that 52% of healthcare facilities had trained their healthcare workforce; morticians were the least trained (only 17% of facilities). Moreover, 41% of the facilities had clear work plans for monitoring healthcare workers exposures to COVID-19, but only 33% of the facilities had policies on the management of infected healthcare workers. Conclusions: The findings provided critical information for stakeholders at all levels to be used for policy decisions, to prioritize key intervention areas in leadership and governance of facility IPC programs, for guideline development, and for capacity building and targeted investment in IPC to improve COVID-19 facility preparedness.Funding: NoneDisclosures: None

Corporate Governance Practices and Performance of Faith Based Health Facilities in Nyanza Region

The study sought to find out the relationship between corporate governance practices and performance of faith based health facilities in Nyanza region. The objectives of the study was guided by the following corporate governance practices; board composition, size of the board, board sub-committees, CEO duality and the frequency of the meetings. The study employed a cross-sectional survey design to establish the relationship. The study found out that 93.5% of the faith-based health facilities in the Nyanza region had sub-committees, 67.7% of the facilities had a board size of 7-8 while 74.2% of the facilities had frequency of 4 This study adopted Balance scorecard developed by Kaplan and Norton to measure organizational performance. The study found out financial perspective of performance had high correlations with corporate governance practices (R=0.621) with 38% of financial performance influenced by the corporate governance practices. Internal business processes perspectives also had high correlations with corporate governance practices however both the customers’ perspectives and innovation, learning and growth perspectives had low correlations with corporate governance practices. The study therefore concluded that the corporate governance practices affected performance of the faith based health facilities although at a varied degree. The regression analysis showed that there was a positive influence of corporate governance practice on the performance of the faith based health facilities in Nyanza region. Thus the practice of good corporate governance enhances performance of faith based health facilities. The study recommended that the secretariats of the faith based health facilities should establish a clear policies on the terms of engagement of the directors, CEO and performance appraisal of the board to check on their effectiveness. The board should also be given inductions and continuous professional trainings to equip them with new technics. For further studies, the study suggests that another study be conducted to establish the corporate governance practices and performance of health sector in Kenya.

Women’s Satisfaction with the Quality of Antenatal Care Services Being Offered in Bamenda Health District

<i>Background:</i> Antenatal care is the care women receive while pregnant. It is an important health service which detects and sometimes curbs the risk of complications among pregnant women (PW). The way women perceive the quality-of-care render during ANC influences utilization and consequently the outcome of pregnancy. This study investigated women’s satisfaction with the quality of antenatal care in the BHD. Women presenting for antenatal care for their second or subsequent visits at 14 health facilities in the Bamenda health district were interviewed in a cross-sectional designed study, using a semi-structured questionnaire. The questionnaire included sociodemographic and obstetric variables, and level of satisfaction with various aspects of antenatal care. Data analysis was done using EPI info. The p-value was set at P<0.05. 396 women participated in the study. 70% of the women were between 20 and 30yrs of age. 81.8% of them were married while. 49.2% had secondary education, 49.7% were self- employed while 10.4% were unemployed. Parity mean of 1.55 ± 1.357. 73.2% began ANC after the first trimester of pregnancy, mean number of ANC visits was 3.82 ±1.721. 84.6% of women were satisfied with elements of quality ANC services, 81.3% with the health education they received and only 41.0% were satisfied interventions for physiological problems of pregnancy. Women who attended faith-based health facilities (FBHF) were more satisfied with elements of quality ANC than those who attended public health facilities the reverse was true for health education messages received where women were more satisfied with public health facilities. There was no significant difference in the interventions during pregnancy for both faith-based and public health facilities (PHF). We concluded that apart from the physiological interventions during pregnancy, women were satisfied with the ANC services they receive in the BHD although there were gaps to be filled to improve on the quality of ANC. The use of antenatal care guidelines was recommended to enable a comprehensive delivery of antenatal care for an optimum satisfaction.

Equity in the Perceived Quality of Care Received by Malaria Patients Under National Health Insurance Scheme in Ghana.

The Ghana National Health Insurance Scheme (NHIS) seeks to provide access to quality healthcare to its members regardless of the health facility in which they receive care. However, it is unclear if all members of the Scheme receive quality care. The objective of the study is to examine the equity of perceived healthcare quality received by NHIS members depending on the type of facility in which care was provided. The study purposively sampled 2000 NHIS members who sought malaria treatment in the study areas. Only patients who had visited the health facilities at least twice not more than 12 months, before the data collection, were sampled. The SERVQUAL model was used to examine perceived quality of healthcare services in 5 quality dimensions: Reliability, Assurance, Tangibility, Empathy, and Responsiveness. These quality dimensions were compared in health facilities according to ownership (public, private, and faith-based facilities), capacity (hospital vs health centers), and finally location (urban vs rural health facilities). Instrumental variable estimation method was used to analyze data to address health facility selection bias problem. The results showed that faith-based health facilities scored the highest in all 5 perceived quality dimensions followed by public and private. Hospitals had higher score in perceived quality than health centers just as urban facilities scored higher in quality than rural facilities. These results represent high inequality in the perceived quality of care received by NHIS members.

How much healthcare is wasted? A cross-sectional study of outpatient overprovision in private-for-profit and faith-based health facilities in Tanzania.

Overprovision-healthcare whose harm exceeds its benefit-is of increasing concern in low- and middle-income countries, where the growth of the private-for-profit sector may amplify incentives for providing unnecessary care, and achieving universal health coverage will require efficient resource use. Measurement of overprovision has conceptual and practical challenges. We present a framework to conceptualize and measure overprovision, comparing for-profit and not-for-profit private outpatient facilities across 18 of mainland Tanzania's 22 regions. We developed a novel conceptualization of three harms of overprovision: economic (waste of resources), public health (unnecessary use of antimicrobial agents risking development of resistant organisms) and clinical (high risk of harm to individual patients). Standardized patients (SPs) visited 227 health facilities (99 for-profit and 128 not-for-profit) between May 3 and June 12, 2018, completing 909 visits and presenting 4 cases: asthma, non-malarial febrile illness, tuberculosis and upper respiratory tract infection. Tests and treatments prescribed were categorized as necessary or unnecessary, and unnecessary care was classified by type of harm(s). Fifty-three percent of 1995 drugs prescribed and 43% of 891 tests ordered were unnecessary. At the patient-visit level, 81% of SPs received unnecessary care, 67% received care harmful to public health (prescription of unnecessary antibiotics or antimalarials) and 6% received clinically harmful care. Thirteen percent of SPs were prescribed an antibiotic defined by WHO as 'Watch' (high priority for antimicrobial stewardship). Although overprovision was common in all sectors and geographical regions, clinically harmful care was more likely in for-profit than faith-based facilities and less common in urban than rural areas. Overprovision was widespread in both for-profit and not-for-profit facilities, suggesting considerable waste in the private sector, not solely driven by profit. Unnecessary antibiotic or antimalarial prescriptions are of concern for the development of antimicrobial resistance. Option for policymakers to address overprovision includes the use of strategic purchasing arrangements, provider training and patient education.

Clients' satisfaction with HIV care and treatment centres in Dar es Salaam, Tanzania: A cross-sectional study.

BackgroundHIV is a major global public health challenge, claiming the lives of over 32 million people so far. The satisfaction of HIV-affected clients with the quality of their HIV services at treatment centres is crucial for quality improvement. This article assesses clients’ satisfaction with different aspects of the overall care experience and seeks to determine if the type of health facility ownership is a predictor of satisfaction.MethodsA cross-sectional study involving 430 respondents was conducted between September and October 2019. Purposeful and convenient sampling techniques were used to select health facilities and potential respondents, respectively. A pre-tested, interviewer-administered questionnaire was used to collect data. Binary logistic regression was used to assess the association between type of health facility and clients’ satisfaction based on the six assessed aspects of care, and p˂0.05 was considered statistically significant.ResultsThe general clients’ satisfaction with HIV/AIDS services at care and treatment centres was 92.3%. Respondents from public health facilities were most satisfied with privacy and confidentiality (100%), physical environment (100%), counseling (99.5%) and drug availability (99.5%); respondents from private health facilities were most satisfied with the time spent in the facility (95.9%); while respondents from faith-based health facilities were most satisfied with staff-patient communication (99.2%). However, after adjusting for confounders, only one aspect of care, that of “time spent in the facility,” showed significant association with the type of health facility.ConclusionGenerally, clients’ satisfaction with HIV/AIDS services at care and treatment centres in the Ubungo District, Dar es Salaam was high. This finding should encourage health care providers to maintain high-quality services to sustain clients’ satisfaction.

Towards the scale and menace of unregulated sonography practice in Ghana

Background There is a high demand for medical sonographers, mainly due to high antenatal and other ultrasound examinations. Ghana has 334 registered radiographers and sonographers for a population of 30 million. The non-existence of strict enforcement of mandatory credentialization and licensure for the practice of ultrasonography has made the proliferation by quacks very pervasive in Ghana. However, there is inadequate knowledge about the activities of these unlicensed sonographers. This paper looks at the scale, creation, proliferation, and patronage of unlicensed Sonographers and discusses the impact on Ghana’s health care delivery. Methods The study was a qualitative study using well-structured pretested questionnaires administered to unlicensed sonographers – multiple techniques were used in data collection. Sonographic reports emanating from unlicensed sonographers brought by referred patients to a tertiary hospital were also collated and analyzed. Results A total of 207 unlicensed sonographers were recruited for the survey. The results showed 90% (186) response rates out of which 128 (69%) were males and 58 (31%) were females. All participants were above 25 years. 46.8% of unlicensed sonographers had senior high school (SHS) or tertiary (41.4%) education. Four pathways identified for their proliferation, 32.8% trained by attending sonography short courses, 32.2% by Peer-to-peer hands-on training, 32.2% by unaccredited training schools, 3.8% attended sonography workshop, and 1.0% had no form of training. Radiologists 33%, Licensed Sonographers 29%, Medical Doctors 20%, unlicensed sonographer 16%, and midwives 2% were responsible for their training. The majority (67.2%) worked in hospitals, and 29.6% in diagnostic centers. The facilities’ ownership structure showed 66.7% privately owned, 15.8% government-owned, 14.2% owned by the Christian Health Association of Ghana (CHAG), faith-based health facilities, and 3.3% of respondents set up their personal ultrasound scan center. The majority (82.2%) of respondents believed sonography practice must be rigorously regulated. The overwhelming majority (95.5%) wanted practicing unlicensed sonographers to be allowed to upgrade at accredited ultrasonography schools leading up to their appropriate licensing. Conclusions Regulators must stringently implement guidelines regulating the practice of ultrasound to safeguard patients. However, the 334 licensed sonographers in Ghana is woefully inadequate; therefore, unlicensed sonographers must be persuaded and supported to upgrade. Policy direction is to increase accredited ultrasonography training institutions to facilitate the training of more medical sonographers.

Equipping Religious Leaders as Family Planning Champions

Abstract Faith-based organizations and faith-based health facilities are crucial providers of healthcare. They help ensure religious leaders (RLs) are equipped with the proper information and training to address barriers and myths about family planning (FP). A low-literacy booklet was adapted from “Facts for Family Planning” that religious leaders could use to talk about FP with community members with lower levels of formal education. They also included Biblical passages, definitions and reasons why it is important for Christians to discuss these issues. The English version was translated into seven languages. These guides have been shared with at least 1,000 faith leaders in Uganda and Kenya. Religious leaders in Uganda held 168 awareness-raising events and reached 4,335 people with this information and referred individuals to health facilities for further information about FP methods. These low-literacy booklets gave RLs the confidence to speak in churches, at weddings and markets, etc about this issue, partly due to their training and partly due to the confidence that these booklets were being distributed among RLs in multiple countries and languages. Taking the time to build a system to test translated materials is also important. CCIH worked with FHI360/APC to develop testing protocol, which was IRB approved. These materials were tested via Focus Groups and In-depth-Interviews and materials (we recommend translating all materials into the language being tested) are available for public use. Ensuring mother-tongue language and education level appropriate materials are available for community-based programs is critical for community ownership and application of training. In addition, ensuring such materials are not just available for one project in one place is key for information sharing digitally for anyone to use and translate the English version into further languages. Key messages Demonstrate the capacity of religious leaders to break down barriers and myths about family planning in their communities. Being responsive to community needs via low-literacy materials in local languages.

1-year impact of supervision, performance assessment, and recognition strategy (SPARS) on prescribing and dispensing quality in Ugandan health facilities

BackgroundTo strengthen appropriate medicine use (AMU) including the prescribing and dispensing quality at public sector health facilities in Uganda, the Ministry of Health introduced a multipronged approach known as the Supervision, Performance Assessment, and Recognition Strategy (SPARS). This paper assesses the impact of the first year of SPARS implementation on key AMU indicators.MethodsDistrict-based health workers trained as supervisors provide in-service training in medicines management complemented by indicator-based performance assessment and targeted supervision during each SPARS facility visit. From 2010 to 2013, health facilities that started the SPARS intervention were assessed during the first and last visit during a period of 12 months of implementing SPARS. This study examines 12 AMU indicators with 57 individual outcomes covering prescribing and dispensing quality. We also explored factors influencing 1-year improvement.ResultsWe found an overall increase in AMU indicators of 17 percentage points (p < 0.000) between the first and last visit during a period of 12 months of supervisions, which was significant in all levels of health care facilities and in both government and private not-for-profit faith-based sectors. Appropriate dispensing (25 percentage points, p < 0.005) improved more than appropriate prescribing (12 percentage points, p = 0.13). Specific facilities that reached an average score of over 75% across all AMU measures within the first year of supervision improved from 3 to 41% from the first visit (baseline). The greatest overall impact on AMU occurred in lower-level facilities; the level of improvement varied widely across indicators, with the greatest improvements seen for the lowest baseline measures. Supervision frequency had a significant impact on level of improvement in the first year, and private not-for-profit faith-based health facilities had notably higher increases in several dispensing and prescribing indicator scores than public sector facilities.ConclusionsThe multipronged SPARS approach was effective in building appropriate medicine use capacity, with statistically significant improvements in AMU overall and almost all prescribing and dispensing quality measures after 12 months of supervision. We recommend broad dissemination of the SPARS approach as an effective strategy to strengthen appropriate medicine use in low-income countries.

Powerful Influencers: Kenyan & Zambia Religious Leaders Advocate for Family Planning

Abstract Faith-based organizations (FBOs) provide approximately 40% of healthcare in Kenya and 30% in Zambia. Promoting healthy families is a value at the heart of faith communities. This intervention focused on equipping and encouraging religious leaders (RLs), whose churches own and operate faith-based health facilities, to advocate for family planning (FP) within their congregations, communities, governments. This project included baseline assessments, FP sensitization, and media trainings. Religious leaders were trained through an adaptation of the AFP SMART training by ensuring culturally appropriate messaging for religious audiences were included (i.e. using scripture to discuss and develop messages on families, planning, having children, etc.). Training RLs provides an entree into government fora as culturally respected leaders in positions of power. In order for external advocacy to take place outside of church settings, it is crucial to identify how each church defines FP before meeting with external stakeholders. Creation of low-literacy terms in English and local languages that equipped RLs to interact with community members in-person (i.e. church services, weddings, funerals, community barazas, etc.) and via TV and radio shows was key in addressing myths and misconceptions. Eighty-six religious leaders from 16 denominations in Kenya and Zambia were engaged to sensitize communities and advocate with their Ministries of Health on behalf of the faith community to ensure family planning services reach communities. Equipping RLs in culturally and language appropriate contexts builds stronger advocates for healthy families and communities. Key messages To demonstrate how religious leaders in Kenya and Zambia are equipped to advocate for family planning from a faith perspective. Words and definitions and messengers matter in Family Planning Advocacy from a faith perspective.

Prices, availability and affordability of medicines in Rwanda.

BackgroundAccess to affordable and good quality medicines is a key to meeting Sustainable Development Goal No. 3 by the year 2030. Prices, availability and affordability of essential medicines have been studied in many developing countries, but no such information has been published about Rwanda yet. This study aimed at providing data on prices, availability and affordability of medicines in different health facilities of Rwanda.MethodsA survey was carried out on availability, prices and affordability of 18 medicines in Kigali City and five districts of Rwanda. 44 health facilities were surveyed, including public and faith-based hospitals, public and faith-based health centers and private pharmacies. The standardized methodology developed by WHO and Health Action International (HAI) was used to collect and analyze the data.FindingsPrices for generic medicines in public and faith-based health facilities were remarkably low, with median price ratios (MPRs) of 1.0 in comparison to the international procurement prices published by Management Sciences for Health. In private pharmacies, prices were twice as high (MPR = 1.99 for generics). Availability of medicines fell short of the of 80% target set by WHO, but was better than reported from many other developing countries. Availability of medicines was highest in the private sector (71.3%) and slightly lower in the faith-based (62.8%) and public (59.6%) sectors. The government procurement agency was found to work efficiently, achieving prices 30% below the international procurement price given in the International Medical Product Price Guide. Affordability of medicines was better in the public and faith-based sectors than in the private sector.ConclusionIn Rwanda, medicines are affordable but poorly available in both the public and the faith-based sectors. Further improvements of the availability of medicines in the public and the faith-based health facilities represent the most important key to increase accessibility and affordability of medicines in Rwanda.

Substandard and Falsified Antibiotics and Medicines against Noncommunicable Diseases in Western Cameroon and Northeastern Democratic Republic of Congo.

.Falsified and substandard medicines may undermine the progress toward the Sustainable Development Goals. The present study investigated the quality of 13 essential medicines in Cameroon and the Democratic Republic of Congo (DR Congo). Five hundred six medicine samples were collected from the government and faith-based health facilities, private pharmacies, and informal vendors (total 60 facilities). Collected samples were analyzed according to the U.S. Pharmacopeia (USP) for identity, content, and dissolution of their active pharmaceutical ingredients (APIs) and for uniformity of dosage units. Three samples (0.6%) were identified as falsified. Overall, 8.5% of the samples failed USP specifications for the content of the API and 11.7% failed dissolution testing. Medicines from informal vendors showed a higher out-of-specification rate (28.2%) than other types of drug outlets (12.3%; P < 0.0001). All three falsified medicines had been sold by informal vendors. The failure rate of medicines stated to be produced in Europe (5.1%) was lower than that for medicines from Asia (17.7%; P = 0.0049) and Africa (22.2%; P = 0.0042). Medicines against noncommunicable diseases showed a higher failure rate than antibiotics (25.3% versus 12.1%; P = 0.0004). Four hundred fifty-one of the samples were analyzed in Cameroon and the DR Congo with the Global Pharma Health Fund Minilab (thin-layer chromatography and disintegration testing). The three falsified medicines were readily detected in Minilab analysis. However, substandard samples were detected with low sensitivity. A well-enforced ban of medicine sales by informal vendors and increased attention to supplier qualification in the procurement process may reduce the prevalence of substandard and falsified medicines.

Increasing Family Planning Access in Kenya Through Engagement of Faith-Based Health Facilities, Religious Leaders, and Community Health Volunteers.

Health facilities managed by faith-based organizations (FBOs) are important providers of health care in Kenya but provide only a small proportion of family planning services in the country. From 2013 to 2017, the Christian Health Association of Kenya (CHAK) implemented a project with 6 FBO-managed health facilities to increase voluntary family planning services in western Kenya, in partnership with religious leaders and community health volunteers (CHVs). The project aimed to build capacity of FBO-managed health facilities, increase religious leaders' knowledge of family planning, mobilize communities, improve family planning access and referrals for services, and advocate for improved family planning commodity security from the public sector. Project impact was evaluated using facility-level service statistics, project records and reports, and feedback from religious leaders and CHVs who implemented the project. Facility service statistics showed large increases in family planning visits. Phase 1 (2013-2014) was implemented at 2 health facilities, where client visits for family planning increased sixfold (from 705 to 4,286 visits) with tenfold increases seen in client visits for pills, intrauterine devices, and implants. In Phase 2 (2015-2017), the project was expanded to an additional 4 health facilities and total client visits for family planning nearly doubled (from 7,925 to 14,832 visits). During Phase 2, new client visits for implants increased threefold, making implants the most popular family planning method. Religious leaders who implemented the project reported reaching nearly 700,000 people with family planning messages and referring more than 87,000 clients to health facilities for family planning services. The religious leaders expressed confidence in the effectiveness of the project and in their role in enhancing access to voluntary family planning. Health facilities, religious leaders, and CHVs also reported multiple challenges to implementation, including inconsistent supply of family planning commodities from county health departments. This project demonstrates the potential of FBO-managed facilities and faith leaders to increase family planning demand and service provision, as well as the importance of coordination with the public sector to ensure supply of commodities and support for FBO-managed facilities.

Preparedness of health facilities in managing hypertension & diabetes mellitus in Kilimanjaro, Tanzania: a cross sectional study

BackgroundHypertension and Diabetes mellitus are risk factors for cardiovascular diseases that cause 17 million deaths globally. Many of these deaths could have been prevented if hypertensive and diabetic patients had their blood pressure and glucose controlled. Less than 30% of hypertensive and diabetic patients on management have controlled their blood pressure and glucose respectively. This study aimed to determine the preparedness of health facilities in managing hypertensive and diabetic patients in terms of personnel; laboratory services provision, and local use of routinely collected data, and shows differences in preparedness between the levels of facilities.MethodsWe conducted a cross-sectional study in Government, faith-based and private health facilities in two districts in Kilimanjaro region in Tanzania from March to July 2017. We collected data through interviews and observations on the preparedness of the facilities for managing hypertension and DM.ResultsForty-three (43) health facilities and 62 healthcare workers (HCW) participated in the survey. Services for hypertension and DM were available in 37 (86%) and 34 (79%) health facilities respectively. Eighteen (53%) and five (15%) facilities had HCW trained on hypertension and DM management respectively within two years preceding the survey. Regular adherence to treatment guideline was reported in 18 (53%) of the health facilities. More than third of health facilities were without basic equipment for managing hypertension and DM. All the recommended laboratory tests were only available in four (15%) hospitals and one health center. Valid first line medicines for both hypertension and DM were available in six (50%) health centers, four (24%) dispensaries and in four (80.0%) hospitals. Health data collection, analysis and local use for planning were reported in all hospitals, nine (75%) health centers and four (24%) dispensaries.ConclusionsHealth facilities are not fully prepared to manage hypertension and DM. Health centers and dispensaries are mostly affected levels of health facilities. Government interventions to improve facility factors and collaborative approaches to build capacity to HCW are needed to enable health facilities be responsive to these diseases.