Minimum Package Research Articles

Minimum package of public health services: the adoption of core services in local public health agencies in Colorado.

We examined the effect of a state law in Colorado that required local public health agencies to deliver a minimum package of public health services. We used a longitudinal, pre-post study design, with baseline data collected in 2011 and follow-up data collected in 2013. We conducted means testing to analyze the change in service delivery and activities. We conducted linear regression to test for system structure effects on the implementation of core services. We observed statistically significant increases in several service areas within communicable disease, prevention and population health promotion, and environmental health. In addition to service and program areas, specific activities had significant increases. The significant activity increases were all in population- and systems-based services. This project provided insight into the likely effect of national adoption of a minimum package as recommended by the Institute of Medicine. The implementation of a minimum package showed significant changes in service delivery, with specific service delivery measurement over a short period of time. Our research sets up a research framework to further explore core service delivery measure development.

Vapers’ perspectives on electronic cigarette regulation in Australia

BackgroundThe use of electronic cigarettes (e-cigarettes), also known as personal vaporisers (PVs), has increased rapidly in Australia despite legal barriers to the sale, possession and use of nicotine for non-therapeutic purposes. Australia is one of many countries in the process of developing regulations for these devices yet knowledge of consumers’ views on e-cigarette regulation is lacking. MethodsAn online survey was completed by 705 e-cigarette users recruited online. Participants answered questions about their smoking history, e-cigarette use, as well as their opinions on appropriate regulation of e-cigarettes. ResultsMost participants were male (71%), employed (72%), and highly educated (68% held post-school qualification). They tended to be former heavy smokers who had stopped smoking entirely and were currently vaping. Participants generally agreed that the government should enforce minimum labelling and packaging standards and there was majority support for minimum quality standards. Most supported making e-cigarettes available for sale to anyone over the age of 18, but expressed concern about the government's motivation for regulating e-cigarettes. There was strong opposition to restricting sales to a medicines framework (prescription only or pharmacy only sales). ConclusionE-cigarette users in Australia are in favour of e-cigarettes being regulated as long as those regulations do not impede their ability to obtain devices and refill solutions, which they view as important for them to remain smoke free. These views align with some aspects of appropriate policy designed to maximise the public health potential of e-cigarettes in society, but conflict with some of the proposed regulatory models. Governments should consider how future regulation of e-cigarettes will affect current consumers while helping to maximise the number of smokers who switch to e-cigarettes and minimise the possibility of non-smokers becoming addicted to nicotine.

Cultural rights versus human rights: A critical analysis of the trokosi practice in Ghana and the role of civil society

In this article, I examine critically the culture versus human rights debate, and the crucial role and tactics of civil society organisations, drawing on insights from transnational advocacy networking, in the struggle to extend human rights to vulnerable people with reference to the trokosi practice in Ghana. This trokosi system turns virgin girls into slaves of the gods to atone for crimes committed by their family members. Theoretically, universal human rights must take precedence over any demand for cultural rights. In practice, however, the actual enforcement of human rights laws that conflict with other cultural values and practices can be more messy and complex than it is often conceptualised. Essentially, universal human rights accommodate, recognise and promote cultural rights; however, the latter ends at a point where its observance is likely to result in the violation of the fundamental human rights of others. I conclude that, although the call for cultural pluralism and the need to celebrate and respect the diversity of cultures sound legitimate, this demand cannot be allowed to trump the minimum package of the fundamental human rights that protect human dignity, wellbeing and integrity within the context of human rights protocols that state parties already have ratified. Yet, for this to materialise, stronger civil society organisations with a solid broad-based networking capacity and tenacity of purpose are crucial. This article helps to extend our current knowledge of human rights struggles and the implications these have for the furtherance of universal human rights. Key words: universal human rights; cultural relativism; trokosi; civil society; transnational advocacy networking; Ghana

Mental health services in Cambodia, challenges and opportunities in a post-conflict setting

Cambodia had suffered enormously due to war and internecine conflict during the latter half of the twentieth century, more so during the Vietnam War. Total collapse of education and health systems during the Pol Pot era continues to be a challenge for developing the necessary infrastructure and human resources to provide basic minimum mental health care which is compounded by the prevailing cultural belief and stigma over mental, neurological and substance abuse disorders (MNSDs). The mental health research and services in Cambodia had been predominantly ‘trauma focused’, a legacy of war, and there is a need to move toward epidemiologically sound public health oriented mental health policy and service development. Integrating mental health program with primary health care services with specifically stated minimum package of activities at primary level and complementary package of activities at secondary level is an opportunity to meet the needs and rights of persons with mental, neurological and substance abuse disorders (PWMNSDs) in Cambodia, provided there is mental health leadership, government commitment and political will.

Minimum initial service package (MISP) for sexual and reproductive health in disasters.

This paper is based on a presentation given at the Evidence Aid Symposium, on 20 September 2014, at Hyderabad, India. The paper provides background about how the sexual and reproductive health (SRH) got conceived as a humanitarian health response that adopts human right approach, based on core principles driven by needs of adolescent girls and women, and having respect for their values, ethics and morals. Good practices across nations documented by Inter-Agency Working Groups (IAWGs) on Reproductive Health in Humanitarian Crisis has supported the provision of essential SRH care services to adolescent girls and women in humanitarian crisis and in disasters. Secondary desk review is used to document the lessons learnt and good practices followed and documents for SRH. These essential SRH care services are to be provided as "Minimum Initial Service Package (MISP)" for implementation at the outset of disaster. The Sphere Humanitarian Charter and Minimum Standards in Disaster Response incorporated the MISP for SRH as a minimum standard of care in disaster response with a goal to reduce mortality, morbidity and disability among populations affected by crises, particularly women and girls. Disaster prone countries are expected to roll out MISP to improve humanitarian response and emergency preparedness systems. The East Europe and Central Asia (EECA) region including India have rolled out MISP starting from 2011 (EECA) and from 2013-2014 onwards in India across cities such as Chennai, Patna, Bhubaneshwar, Kolkata, Faridabad and Calcutta. Across India, through these national and state level trainings, nearly 600 people from NGOs, institutions, and government agencies were developed as national level trainers and resource persons for MISP who could advocate for RH in emergencies, apply core techniques provided in the MISP, apply coordination skills for the implementation of MISP and develop an action plan to integrate RH and Gender Based Violence (GBV) into Disaster Management Plans of respective agencies. The way forward includes focusing on MISP distance learning module, integration of MISP in Health action plans, and integration into national disaster preparedness and contingency planning of respective agencies and departments and building capacity at various levels.

Management of HIV-associated cryptococcal disease in South Africa

In routine-care settings, the 10-week mortality associated with cryptococcal meningitis (CM) is high, even with prompt, appropriate antifungal treatment and correctly timed initiation of antiretroviral therapy (ART). While early diagnosis of HIV infection and initiation of ART prior to the development of AIDS is the most important way to reduce the incidence of CM, a cryptococcal antigenaemia screen-and-treat intervention has the potential to reduce mortality by identifying patients prior to onset of CM. Antifungal treatment for HIV-associated CM is divided into three phases over a minimum period of 1 year: (i) a 2-week induction phase, including intravenous amphotericin B deoxycholate as a backbone; (ii) an 8-week consolidation phase with fluconazole 400 mg daily; and (iii) a maintenance phase with fluconazole 200 mg daily. Amphotericin B should be paired with another antifungal agent to maximise cerebrospinal fluid fungal clearance. World Health Organization guidelines emphasise that patients receiving amphotericin B-containing regimens should have access to a ‘minimum package of toxicity prevention, monitoring and management to minimise the serious amphotericin B-related toxicities particularly hypokalaemia and nephrotoxicity’. Raised intracranial pressure is a serious and often fatal complication of CM, which requires good pressure management with repeat lumbar punctures. ART should be initiated 4 - 6 weeks after starting antifungal therapy. In many cases, relapse CM among South African patients occurs because of suboptimal adherence to secondary prophylaxis with fluconazole and/or the antifungal not being prescribed.

Implementing and measuring the level of laboratory service integration in a program setting in Nigeria.

BackgroundThe surge of donor funds to fight HIV&AIDS epidemic inadvertently resulted in the setup of laboratories as parallel structures to rapidly respond to the identified need. However these parallel structures are a threat to the existing fragile laboratory systems. Laboratory service integration is critical to remedy this situation. This paper describes an approach to quantitatively measure and track integration of HIV-related laboratory services into the mainstream laboratory services and highlight some key intervention steps taken, to enhance service integration.MethodA quantitative before-and-after study conducted in 122 Family Health International (FHI360) supported health facilities across Nigeria. A minimum service package was identified including management structure; trainings; equipment utilization and maintenance; information, commodity and quality management for laboratory integration. A check list was used to assess facilities at baseline and 3 months follow-up. Level of integration was assessed on an ordinal scale (0 = no integration, 1 = partial integration, 2 = full integration) for each service package. A composite score grading expressed as a percentage of total obtainable score of 14 was defined and used to classify facilities (≤80% FULL, 25% to 79% PARTIAL and <25% NO integration). Weaknesses were noted and addressed.ResultsWe analyzed 9 (7.4%) primary, 104 (85.2%) secondary and 9 (7.4%) tertiary level facilities. There were statistically significant differences in integration levels between baseline and 3 months follow-up period (p<0.01). Baseline median total integration score was 4 (IQR 3 to 5) compared to 7 (IQR 4 to 9) at 3 months follow-up (p = 0.000). Partial and fully integrated laboratory systems were 64 (52.5%) and 0 (0.0%) at baseline, compared to 100 (82.0%) and 3 (2.4%) respectively at 3 months follow-up (p = 0.000).DiscussionThis project showcases our novel approach to measure the status of each laboratory on the integration continuum.

Perspectives on reproductive healthcare delivered through a basic package of health services in Afghanistan: a qualitative study

BackgroundContracting-out non-state providers to deliver a minimum package of essential health services is an increasingly common health service delivery mechanism in conflict-affected settings, where government capacity and resources are particularly constrained. Afghanistan, the longest-running example of Basic Package of Health Services (BPHS) contracting in a conflict-affected setting, enables study of how implementation of a national intervention influences access to prioritised health services. This study explores stakeholder perspectives of sexual and reproductive health (SRH) services delivered through the BPHS in Afghanistan, using Bamyan Province as a case study.MethodsTwenty-six in-depth interviews were conducted with health-system practitioners (e.g. policy/regulatory, middle management, frontline providers) and four focus groups with service-users. Inductive thematic coding used the WHO Health System Framework categories (i.e. service delivery, workforce, medicines, information, financing, stewardship), while allowing for emergent themes.ResultsImprovements were noted by respondents in all health-system components discussed, with significant improvements identified in service coverage and workforce, particularly improved gender balance, numbers, training, and standardisation. Despite improvements, remaining weaknesses included service access and usage - especially in remote areas, staff retention, workload, and community accountability.ConclusionsBy including perspectives on SRH service provision and BPHS contracting across health-system components and levels, this study contributes to broader debates on the effects of contracting on perceptions and experiences among practitioners and service-users in conflict-affected countries.

Allocating responsibility for health care decisions under the United States Affordable Care Act

This article summarizes the major elements of the ACA's insurance reforms and how they affect responsibility for making decisions about the health care that people receive. A key example of the difficulty of allocating decision making responsibility is the effort to define a minimum benefit package for insurance plans, called essential health benefits. While the ACA should achieve its goal of near-universal access to care, it leaves in place a multiplicity of processes and decision-makers for determining individual treatment. As a result, decisions about what care is provided are likely to remain, much as they are today, divided among government agencies, private insurers, private employers, and the courts.

에티오피아 농촌지도사업의 현재와 미래

에티오피아의 농촌지도사업은 다른 아프리카 국가들과 비교하여 긴 역사를 가지고 있으며 다양한 접근방법과 모델을 통하여 이루어져 왔다. 오랜 역사에도 불구하고, 농촌지도사업 시슨템은 사업영역, 커뮤니케이션, 제도적인 다원성 측면에서 초보단계에 머물고 있다. 농촌지도사업의 초점은 시험연구사업 결과에 대한 기술이전, 국가식량안보와 수출증가를 위한 농업생산성 증대에 있다. 최근 농촌지도사업 시스템에 대하여 많은 논의가 이루어지고 있으며, 다른 관점을 통하여 보다 지도사업 시스템이 엄밀성을 더해 가고 있다. 최근 에티오피아 농촌지도사업은 공공부문에 의하여 추진되고 있으며, 특히 district 단위에서 분권화된 방법으로 운영되고 있다. 그리고 제한된 수준이지만 NGO에 의하여 수행되고 있다. 에티오피아의 농촌지도사업은 1950년대에 연구개발 및 기술이전, 외국의 새로운 기술도입을 위하여 시작되었다. 초기에 농촌지도사업은 시험장 위주로 이루어졌다. 이후에 에티오피아 농촌지도사업은 다섯 가지 단계로 추진되었다. 대학학장시스템(the land grant extension system), 패키지 프로그램, 최소 팩키지 프로젝트, 농민 농업개발 프로그램, 참여민주주의와 훈련시스템(PADETS). 패키지 지도사업 프로그램은 시범지역에 최초로 수행되었으며, 15-20년내에 농촌지역의 90%까지 확대되었다. 이 프로그램은 개발기구에 의하여 관리되는 시범포를 사용하였으며, 조직화된 농민들을 훈련하였다. 그러나, 이 프로그램이 특정한 조그마한 지역에서 운영되어 다른 지역까지 확대되지 못하였다. 참여민주주의와 훈련시스템을 통하여 에티오피아의 농촌지도사업은 주목을 받게 되었으며 많은 논의가 있었으며, 외부의 관점들이 더 정교하게 만들었다. 긴 역사에도 불구하고, 이 시스템은 커뮤니케이션, 제도적인 다원주의적인 측면, 분권화 측면에서 걸음마 단계이다. Agricultural extension service in Ethiopia was started in early 1950s with mandate of transferring local research outputs and technologies to farmers, and importing technologies and improved practices from abroad. Extension service provided in this early time was limited to areas surrounding the experiment stations. Since then, Ethiopian Agricultural extension service has passed through at least five stages: the land grant extension system, the Comprehensive Package Programs, the Minimum Package Projects, the Peasant Agricultural Development Program, and the Participatory Demonstration and Training Extension System (PADETS). The comprehensive package extension program was initially implemented in selected pilot areas and eventually to be scaled up to cover about 90% of the farming community within 15-20 years time. The program used demonstration plots managed by development agents and used to train farmers organized through various field days. However, since all of these programs were operational in only small areas, the vast majority of the country was out of their reach. Through Participatory Demonstration and Training Extension System, the extension service in Ethiopia has come under the spotlight and government debates and external reviews are putting additional scrutiny on the system. Despite this long history, the system is still in its infancy in terms of coverage, communication and institutional pluralism. Currently in Ethiopia the Agricultural extension is provided primarily by the public sector, operating in a decentralized manner through which extension is implemented at the district level. Therefore, the main focus of this paper is to scrutinize the past, the present and the future Agricultural extension system in Ethiopia.

Safe Injection in the Context of IPC – Changing Landscape in Nigeria

Background: Unsafe injection leads to an increased disease burden and deaths from transmission of infection. Cost effective injection safety (IS) interventions encourage best practices especially in low resource countries where the burden is highest. Infection prevention and control (IPC) among health workers, waste handlers, and communities has been documented to decrease the burden over time. Intervention: AIDSTAR-One, a PEPFAR funded project through USAID, adopted the World Health Organization technical approach that promotes sustainability by working with and through government structures and relevant stakeholders for policy development and implementation. Training and capacity building, provision of seed stock of IS commodities, behavioral communication and changes to effect new skills, appropriate healthcare waste management (HCWM), and supportive monitoring and evaluation guide interventions for effective impact. Investors are encouraged to manufacture IS commodities in-country to support the intervention. Community interventions, through existing credible structures, aim to reduce unnecessary injections, and HCWM interventions focus on a minimum package of best practice standards at the health facility level and through community involvement. Challenges: The Nigerian health system is generally weak, attrition of trained personnel due to brain drain is a continuing challenge, and health worker behavioral change is gradual. Conclusion: Injection safety interventions in countries with low resources, such as Nigeria, are generally making steady progress over time as stakeholders appreciate its importance as a key IPC measure to ensure the safety of the health workforce, patients, and communities.

An Improved Congestion Control Mechanism Based on Mobile Agent for Wireless Sensor Networks

An improved congestion control mechanism based on mobile agent for wireless sensor networks is proposed, which includes node-level congestion and link-level congestion control. The formers congestion information is collected and distributed by mobile agents (MA). When mobile agent travels through the networks, it can select a less-loaded neighbor node as its next hop and update the routing table according to the nodes congestion status. Minimum package of node outgoing traffic was preferentially transmitted in the link-level congestion. Simulation result shows that proposed mechanism attains high delivery ratio and throughput with reduced delay when compared with the existing technique.

An Improved Congestion Control Mechanism Based on Mobile Agent for Wireless Sensor Networks

An improved congestion control mechanism based on mobile agent for wireless sensor networks is proposed, which includes node-level congestion and link-level congestion control. The formers congestion information is collected and distributed by mobile agents (MA). When mobile agent travels through the networks, it can select a less-loaded neighbor node as its next hop and update the routing table according to the nodes congestion status. Minimum package of node outgoing traffic was preferentially transmitted in the link-level congestion. Simulation result shows that proposed mechanism attains high delivery ratio and throughput with reduced delay when compared with the existing technique.

Adequacy of resources for provision of maternal health services at the primary health care level in Nnewi, Nigeria.

Background:To determine the adequacy of resources (human and material) for provision of maternal health services at the primary health care (PHC) level in Nnewi, Nigeria.Materials and Methods:A cross-sectional study of women utilising maternal health services in four public PHC facilities in Nnewi selected using multistage sampling technique was done. Data was collected using a mix of quantitative and qualitative methods. Quantitative data was analysed using statistical package for social sciences (SPSS) version 16, while qualitative data was reported verbatim, analysed thematically and necessary quotes presented.Results:Two hundred and eighty women were studied. The mean age of respondents was 29.2 ± 5.9 years, while 231 (82.5%) were married. Most of them (82.5%) and 184 (66.1%), had their blood pressure and body weight respectively measured, while 196 (70.0%) had tetanus toxoid vaccination. Less than half of the respondents (41.4%) had urine test for sugar, and protein, while 94 (33.8%) had blood test for anaemia. The four facilities studied had most of the equipment and drugs available but in insufficient quantities. In three out of the four facilities, the physical structures were mostly good. None of them is equipped to provide an essential obstetric care (EOC) services, while one medical doctor covered all the facilities studied.Conclusions:This study showed that none of the health facilities is equipped with the minimum equipment package, essential drugs nor staff complement required to enable them offer quality maternal health services. With advocacy, technical support and funding, strategies could be implemented to provide quality maternal health services.

P6.011 Sure Start in Pune, India: The Convergence Model of Maternal and Newborn Health and HIV

BackgroundThe Sure Start project is a seven year initiative implemented by PATH to improve maternal and newborn health and save lives in India. In Pune, Maharashtra, Sure Start focused on...

P4.097 Is the Minimum Package of Prevention Intervention Working? Outcome of Combined Prevention Intervention Amongst In - School Youths in Kwara State, North Central, Nigeria

<h3>Background</h3> Adolescents are among the vulnerable groups at risk of HIV infection. In Nigeria,the high HIV prevalence and teenage pregnancies amongst in-school youths underscores the need to implement effective interventions that address risky sexual behaviours and ultimately reduces the transmission of HIV. This study examines the outcome of Combined Prevention Interventions (CPI) amongst in-school youths in Kwara state,Nigeria. <h3>Methods</h3> The MSH Nigeria USAID funded ProACT project supports the Kwara State Government to implement effective and sustainable HIV prevention intervention that promotes adoption of abstinence amongst in-school youths. At Government Secondary School, Bode Sa’adu, 30 (13Males, 17Females) students were trained as Peer Educators using the Family Life HIV Education (FLHE) training package. Information for planning effective HIV Prevention interventions for the target population was generated through questionnaires administration and Focus Group Discussions. The knowledge and skills acquired by the PEs were cascaded to other students using the Minimum Package of Prevention Intervention (MPPI),which addresses behaviour change through the combination of prevention interventions targeted at individuals and communities. Each PE formed a cohort group of 10–15 peers and conducted activities under the Abstinence and/or Be Faithful prevention strategies to promote adoption of positive sexual and reproductive health (SRH) behaviour among their peers. Outcome of the prevention intervention on teenage pregnancies pre and post interventions were analysed. <h3>Results</h3> Prior to this intervention, about 10–15 unintended teenage pregnancies were recorded annually (from 2005–2011) at the school resulting in school dropout, unsafe abortion and death. However,after 20 months of implementation,number of teenage pregnancies reduced from 11cases in April 2011 to zero in December 2012. In addition,students also acquired life building skills that resulted in their overall academic improvement and wellbeing. <h3>Conclusion</h3> Effective implementation of the CPI/MPPI that focuses on addressing individual and community behaviour can go a long way in achieving sustainable positive SRH behaviours among in school youths.

Appropriate clinical use of blood in Uganda

The Uganda Blood Transfusion Services, in line with the requirements for the minimum health care package of Uganda, has made tremendous strides in improving the adequacy and quality on blood supply to hospitals and health center that administer blood. This is mainly due to the extensive technical and financial support to the procurement and processing components of the transfusion chain. Unfortunately these efforts have not been reciprocated at the in‐hospital setting. This is characterized by underdeveloped administrative structures catering for blood transfusion like lack of a hospital transfusion policy which has lead to paucity of instructive procedures, monitoring and evaluation as well as defined persons responsible for in‐hospital transfusion quality assurance. Additionally, documentation of what is to be or what has been done is still under‐developed.As a way of improvement, a step‐by‐step quality improvement strategy should be developed. First, a small working group of clinicians, laboratory technicians and administrators should be created to design the policy and strategies (blood transfusion plan) for clinical use of blood. Second, start creating Hospital Transfusion Committees with appropriate terms of reference. These should be supported by the hospital high authority. Third, design simple education materials for the three major in‐hospital transfusion processes and identified procedures, with their respective standard operating procedures (SOPs) and related outcome documents like a Blood Request Form (ordering, component selection and administration). Disseminate these materials through continuous professional trainings for in‐service staff and curriculum reviews for medical and paramedical schools. Fifth, embark on updating the National Transfusion Policy to embrace and support the development of National clinical standards and guidelines. These steps will be achieved when the concept of quality assurance is formally and philosophically incorporated into the structure and functioning of Uganda's health systems, consistently implemented, and supported by a culture of quality, as reflected in organizational values and policies that advocate quality of care.

Readiness of health facilities to deliver safe male circumcision services in Tanzania: a descriptive study

Assessing the readiness of health facilities to deliver safe male circumcision services is more important in sub-Saharan Africa because of the inadequacy state of health facilities in many ways. The World Health Organization recommends that only facilities equipped with available trained staff, capable to perform at least minor surgery, able to offer minimum MC package and appropriate equipment for resuscitation, and compliant with requirements for sterilization and infection control should be allowed to deliver safe circumcision services. A cross-sectional study using quantitative data collection technique was conducted to assess the readiness of the health facilities to deliver safe circumcision services in selected districts of Tanzania. All hospitals, health centres and 30% of all dispensaries in these districts were selected to participate in the study. Face-toface questionnaires were administered to the heads of the health facilities and to health practitioners. Overall, 49/69 (59%) of the facilities visited provided circumcision services and only 46/203 (24%) of the health practitioners performed circumcision procedures. These were mainly assistant medical officers and clinical officers. The vast majority &amp;ndash; 190/203 (95%) &amp;ndash; of the health practitioners require additional training prior to providing circumcision services. Most facilities &amp;ndash; 63/69 (91%) &amp;ndash; had all basic supplies (gloves, basin, chlorine and waste disposal) necessary for infection prevention, 44/69 (65%) provided condoms, HIV counselling and testing, and sexuallytransmitted infections services, while 62/69 (90%) had the capability to perform at least minor surgery. However, only 25/69 (36%) and 15/69 (22%) of the facilities had functioning sterilization equipment and appropriate resuscitation equipment, respectively. There is readiness for roll out of circumcision services; however, more practitioners need to be trained on circumcision procedures, demand forecasting. Sterilization equipment for infection prevention and resuscitation equipment should also be made available.

Minimum Initial Service Package (MISP) for reproductive health during emergencies: Time for a new paradigm?

Reproductive health (RH) has historically received low priority in the hierarchy of humanitarian response. Awareness of RH needs in emergencies began in the mid-1990s and led to the formation of the Inter-Agency Working Group (IAWG) for RH. Subsequently, the Minimum Initial Service Package (MISP), a set of guidelines for RH service delivery in crisis settings, was created. The objectives of the MISP are to facilitate the coordination of RH services, prevent and manage the consequences of sexual violence, reduce HIV transmission, minimize maternal and neonatal morbidity and mortality, and plan for comprehensive RH services in the post-crisis phase. Available documentation on MISP implementation is minimal, and reveals mixed success. Challenges include low MISP awareness, inadequate RH training among humanitarian actors, logistical difficulties and poor coordination. Continued emphasis on advocacy and capacity building, a stronger focus on logistics and coordination and a greater commitment to monitoring and evaluation are essential for improving the MISP's effectiveness in the field.

The PrePex Device Is Unlikely to Achieve Cost-Savings Compared to the Forceps-Guided Method in Male Circumcision Programs in Sub-Saharan Africa

BackgroundMale circumcision (MC) reduces the risk of heterosexual HIV acquisition in men by approximately 60%. MC programs for HIV prevention are currently being scaled-up in fourteen countries in sub-Saharan Africa. The current standard surgical technique for MC in many sub-Saharan African countries is the forceps-guided male circumcision (FGMC) method. The PrePex male circumcision (PMC) method could replace FGMC and potentially reduce MC programming costs. We compared the potential costs of introducing the PrePex device into MC programming to the cost of the forceps-guided method.MethodsData were obtained from the Nyanza Reproductive Health Society (NRHS), an MC service delivery organization in Kenya, and from the Kenya Ministry of Health. Analyses are based on 48,265 MC procedures performed in four Districts in western Kenya from 2009 through 2011. Data were entered into the WHO/UNAIDS Decision Makers Program Planning Tool. The tool assesses direct and indirect costs of MC programming. Various sensitivity analyses were performed. Costs were discounted at an annual rate of 6% and are presented in United States Dollars.ResultsNot including the costs of the PrePex device or referral costs for men with phimosis/tight foreskin, the costs of one MC surgery were $44.54–$49.02 and $54.52–$55.29 for PMC and FGMC, respectively.ConclusionThe PrePex device is unlikely to result in significant cost-savings in comparison to the forceps-guided method. MC programmers should target other aspects of the male circumcision minimum package for improved cost efficiency.