Regional Experts Research Articles

Problems and current directions of further medium-term strategic planning for the development of the health care system of the Moscow Region: expert survey results

BACKGROUND: Modern strategic planning for the development of the health care system in the region involves regular monitoring of problem areas for the timely identification of emerging problems, as well as monitoring the effectiveness of measures designed to eliminate the identified problems. Based on this, within the framework of the 5th level of medical and sociological monitoring of the results of strategic planning for the development of regional health care, which involves studying the opinions of regional experts, a study was conducted focused on studying the main problems and prospects for the development of the health care system in the Moscow Region on the most important ones from the standpoint of its strategic planning directions.
 AIM: To determine the degree of relevance of problems for the health care system of the Moscow Region and for the next medium-term strategic planning of measures for its development, as well as to evaluate the indicators from the standpoint of their significance, which will serve as the basis for compiling the archetype of the health care system in the territory of the municipal formation of the Moscow Region in order to adopt further management decisions, including taking into account municipal features.
 MATERIALS AND METHODS: A survey was conducted of experts from among the heads of regional medical organizations of the Moscow Region, their deputies for the medical profile of activity, as well as the main freelance specialists of the Ministry of Health of the Moscow Region. A total of 126 people were interviewed using formalized structured interviews and questionnaires.
 RESULTS: In the course of the study, a range of the most pressing problems of the health care system of the Moscow Region was determined today. In addition, activities were identified, the strategic planning of which is most relevant for the formation of the next medium-term program “Health of the Moscow Region”. The study also made it possible to streamline the list of indicators characterizing the archetype of the health care system in the territory of the municipality of the Moscow Region, according to the degree of their importance in making and implementing management decisions in the framework of medium-term strategic planning for health care development.
 CONCLUSION: The study demonstrated the sustainability of some problems in the health care system of the Moscow Region that currently need to be addressed.

A Dataset of Amphibian Species in U.S. National Parks

National parks and other protected areas are important for preserving landscapes and biodiversity worldwide. An essential component of the mission of the United States (U.S.) National Park Service (NPS) requires understanding and maintaining accurate inventories of species on protected lands. We describe a new, national-scale synthesis of amphibian species occurrence in the NPS system. Many park units have a list of amphibian species observed within their borders compiled from various sources and available publicly through the NPSpecies platform. However, many of the observations in NPSpecies remain unverified and the lists are often outdated. We updated the amphibian dataset for each park unit by collating old and new park-level records and had them verified by regional experts. The new dataset contains occurrence records for 292 of the 424 NPS units and includes updated taxonomy, international and state conservation rankings, hyperlinks to a supporting reference for each record, specific notes, and related fields which can be used to better understand and manage amphibian biodiversity within a single park or group of parks.

A 20-year evidence-based experience of the evolving medicine regulation in Zanzibar.

Access to medicine is crucial for the effective functioning of healthcare systems. A robust regulatory framework is necessary to ensure the safety, effectiveness, and availability. However, weak regulatory frameworks persist in many low- and middle-income countries, leasing to the circulation of falsified and substandard medicines as well as anti-competitive restrictions on registering poor-quality medicines, which poses a significant public health threat. This study evaluated the evolution of Zanzibar's medicine regulatory system over the past two decades and identified the key factors contributing to its success by elaborating on the Zanzibar Food and Drug Agency, seeking the expertise of regional, continental, and global experts to assess its regulatory capacity and maturity level. This study was conducted at the Zanzibar Food and Drug Agency (ZFDA) in Unguja, Zanzibar, using a retrospective cross-sectional review and qualitative approach. It thoroughly reviewed relevant regulatory documents, including Acts, policies, guidelines, and assessment reports. Data were collected using a standardised checklist and analysed to uncover patterns and insights regarding the evolution of Zanzibar's medicine regulatory system. This study revealed substantial legal provisions, organisational development, strategic planning, and resource allocation improvements. Notable achievements include establishing a structured organisational framework, developing a comprehensive strategic plan, and implementing a Quality Management System (ISO 9001:2015 certified). The ZFDA also addressed human resource limitations by creating job descriptions and a staff scheme of service, enhancing financial resources through revised fee regulations and government support, and improving infrastructure with new office and laboratory facilities. Zanzibar's medicine regulations have evolved significantly, with marked regulatory capacity and infrastructure improvements. Future efforts should address the remaining challenges and foster collaboration with regional and international bodies to ensure the continued evolution and effectiveness of Zanzibar's medicine regulatory framework.

Assessment of Groundwater Recharge Using WetSpass-M and MODFLOW Coupling in Jedeb Watershed, Upper Blue Nile Basin, Ethiopia

Currently, the demand for water is rising, and as a result, the groundwater is declining. Water supplies are not sufficient for agricultural productivity, environmental preservation, or ecosystem services, resulting in an unbalanced water budget in the basin. The goal of this paper is to assess the groundwater recharge in the Jedeb sub-basin using WetSpass-MODFLOW coupling. A spatially distributed water balance model is developed to simulate long-term average recharge depending on land cover, soil texture, topography, and hydro meteorological parameters. The groundwater model is iteratively connected to the recharge model in order to simulate recharge. This means that the depth of the groundwater affects the recharge estimate and vice versa. The average yearly evapotranspiration, surface runoff, and groundwater recharge were determined using WetSpass-M to be 574, 898, and 99 mm, respectively. Groundwater recharge accounted for 6.3% of precipitation, while actual evapotranspiration and surface runoff accounted for 36.4% and 57% of precipitation, respectively. In such seasonal variations, the groundwater level in the Jedeb Sub-basin was studied under various stress conditions (dry season, wet season, and annually). The groundwater level distribution varied from 2,052.3 to 3,063.06 m in the summer stress period (recharge). While in the winter stress period (recharge), the groundwater level varied from 2,051.41 to 3,061.92 m, and the groundwater level due to the annual stress period (recharge) varied from 2,053.76 to 3,064.5 m. With a correlation coefficient of .89, which is an acceptable fit between the simulated and observed heads in steady state for all stress periods (summer, winter, and annual recharge). The contribution of this study could be used as baseline information for regional water resource experts, policymakers, and researchers for further investigation.

Pan American climate resilient health systems: a training course for health professionals.

To describe the development, implementation, and results of a training course designed to equip health professionals from the Pan American Health Organization region with the knowledge and tools needed to adapt health systems to current climate realities. The Pan American climate resilient health systems course was a 9-week live-virtual course in March-April 2023, which was delivered through Zoom and offered in English, Spanish, and French. All lectures were delivered by local and regional climate and health experts. The curricular foundation of this initiative was the Global Consortium on Climate and Health Education core competencies for health professionals. Participants completed pre- and post-course surveys. A total of 1212 participants attended at least one of the nine sessions and 489 (from 66 countries) attended at least six sessions. Of these, 291 participants completed both the pre- and post-course surveys which were used in the analysis. Longitudinal survey results suggested an improvement in participants' climate and health communication, an increased frequency of incorporating climate knowledge in professional practice, and improved confidence in engaging in climate initiatives. At the same time, many participants expressed a need for additional training. The results indicate that live-virtual courses have the potential to empower health professionals to contribute to climate resilience efforts by: increasing their communication skills; changing their professional practice; increasing their ability to lead climate and health activities; and preparing them to assess vulnerability and adaptation in health systems, measure and monitor environmental sustainability, and apply a health equity lens.

'Gezond Ge(s)maakt': a project in which vulnerable people learn skills and knowledge around healthy eating and cooking.

We work with a group of vulnerable women in a local community. Once a month, they come together to socialize and learn. The women want to increase their knowledge and skills concerning healthy nutrition. We experience that the existing methods and materials are insufficiently adapted to their specific needs. Can you help us translate evidence based methodologies into a practical tool we can implement during our group activities?’ This question was submitted by a social development organisation to Logo Limburg. It became the start for the project ‘Gezond Ge(s)maakt’.
 ‘Gezond Ge(s)maakt’ or ‘Healthy Tasted’ shows the added value of cooperation between a public health organisation (Logo Limburg) and a social development organisation (SAAMO Limburg). By working together, each from their own expertise, and with a clear focus on the targeted people, the impact of their actions is enhanced. Also, the focus on proportional universalism is always top of mind for both organisations. SAAMO Limburg is an expert in enforcing vulnerable people through a community based approach. The social workers are in close contact with their clients, they know the best way to reach and enforce them. Logo Limburg is a regional expert in health promotion. As a network organisation, they have a clear overview on state of the art methodologies and projects developed by expert organisations. This collaboration and the participation of the target group itself, had a synergistic effect. ‘Healthy tasted’ combines previously developed instruments to a tool that is adjusted, easy to implement and fun. 
 'Healthy tasted' comes in a large box containing ten folders. Each folder represents one specific theme (healthy snacks, picnic, healthy nutrition for children and parenting, healthy holidays, Flemish dishes, … ). These subject were all suggested by the target group itself. During 10 months, our pilotgroup covered one theme a month. The methodology contains all necessary materials for the teacher. It consists of basic theoretical background information, questions to start the conversation on the topic, an exercise or game, and 9 recipes. Each session starts with an educational part, than they prepare a healthy meal (one of the recipes) and enjoy eating together.
 A great advantage is that anyone can use the tool, no prior knowledge on healthy nutrition is needed. Based on their own experience with a specific target group, instructors will be able to translate the content to the needs of the target group.
 The project was evaluated several times by the health promotors of Logo Limburg, the social workers of SAAMO Limburg and the target group. It turned out to be a success. The women indicated they learned a lot about healthy food and applied it in their own families. Their knowledge and skills on healthy nutrition and cooking were enhanced. The integrated collaboration between Logo Limburg and SAAMO was a prerequisite for this success. . This positive evaluation and the existing needs for this theme among the target groups has ensured ‘Healthy Tasted’ was up-scaled and made available for other organisations, starting in Limburg and soon all over Flanders.

Regional expert meeting on policy action for healthy diets, with a focus on the Gulf Cooperation Council countries

Regional expert meeting on policy action for healthy diets, with a focus on the Gulf Cooperation Council countries

Applying Human-Centered Design to Replicate an Adolescent Sexual and Reproductive Health Intervention: A Case Study of Binti Shupavu in Kenya.

We present a case study describing the use of human-centered design (HCD) to determine how to adapt intervention components from an existing contraceptive uptake program for adolescent girls in 4 geographical contexts (Ethiopia, northern Nigeria, southern Nigeria, and Tanzania) for use in Kenya. First, we prioritized existing intervention components to be tested in Kenya using sacrificial concepts. Through these concepts, we identified key insights and behavioral archetypes from which to build higher-fidelity prototypes, leveraging existing program knowledge and resources while responding to unique opportunities for Kenyan adolescent girls. After 2 rounds of prototyping, we launched a high-fidelity intervention designed to improve contraceptive uptake among girls. We used program experience to identify strategies for improvement during early implementation. The resulting model, Binti Shupavu, is designed to tap into girls' aspirations and connect them with contraceptive use, build their trust in the health system, and work with influencers to build support for adolescent contraceptive use, following the global user journey. In the first year of implementation (January-December 2022), the intervention was scaled from 90 facilities to 360 facilities and reached 60,111 adolescent girls aged 10-19 years. Of these, 21,698 were new voluntary contraceptive users (36%) and an additional 3,873 (19%) were continuing users.Our design process suggests that HCD is a promising tool for navigating replication. The emphasis on users' perspectives, testing to learn, and collaboration facilitated a deep understanding of the new user population, thus guiding program designers to balance using existing components with developing new ones based on the population's unique needs. Finally, HCD has potential to support the localization agenda if design teams are supported by national, regional, and global experts to be aware of and use the evidence and implementation experience from earlier work.

Weight changes in overweight children enrolled in a therapeutic education program

BackgroundBetween 2016 and 2018, overweight children in the Midi-Pyrénées region of France were invited to participate in the Tout sur l'EQuilibre Alimentaire et l'Activité Physique (TEQAAP; All About Balanced Eating and Physical Activity) education program offered by the Structure d'Expertise Régionale Obésité Occitanie (SEROO; Regional Expert Center for Obesity in Occitanie). ObjectivesTo describe the patient population and evaluate the program efficacy. The primary criterion was the body mass index (BMI) Z-score of the patients at the end of the program compared to the beginning. MethodsThis retrospective, descriptive, and analytical study included 262 children (mean age: 10 years+10 months; 64% female) between 1 January 2016 and 31 December 2018. Data from 138 patients (52.7%) were accessible and analyzed. The mean study duration was 9 months. ResultsThe mean BMI at inclusion was 23.3 kg/m² with a mean Z-score of 2.8 ± 0.6; 82% were overweight, 11.1% were obese, and 6.1% were normal weight. Socioeconomic categories were well-balanced (35% high, 28% intermediate, 37% low). At the end of the study, 87% of the children had improved or stabilized their BMI, and Z-scores were lower by 9%±2 (p<0.001). ConclusionThe TEQAAP program led to an improvement in the BMI of overweight children.

Exploring participatory communication implemented to improve the livelihood of rural Ethiopia

The study aimed to explore how participatory communication can be used as an instrument for interventions enhancing agricultural production to improve the livelihoods of rural people. Specifically, it was designed to explore the nature of participatory approaches in the Ethiopian agricultural sector. The top-down approach that prevailed in the past lost its faith, and consequently, stakeholders practiced a participatory communication approach. Thus, explorative qualitative research was applied through focus group discussions and in-depth interviews to collect data. Data were transcribed, documented, coded, and thematically analyzed based on recurring themes. The findings show that if properly implemented, development agents and agricultural experts believe that participatory communication is instrumental in mobilizing the community. However, the routine does not allow development agents and experts to use the participatory approach. Besides, farmers are not given sufficient time due to insufficient interaction and communication on agricultural issues. Farmers and development agents have no ongoing, programmed, and frequent contact. The communication between development agents and higher-level agricultural experts is mainly top-down. Provincial and regional experts do not regularly visit and observe farm sites; they depend on the monthly paper report to execute modifications to the annual plan. There is no practical obligation with the consensus that demands farmers, development agents, and experts accomplish their tasks and duties on time with maximum effort. No dialogical session is available for the community to discuss their matters. Therefore, we suggest stakeholders use a multilevel and inclusive intervention in rural agriculture.

Анализ финансирования государственной и территориальной программ по оказанию бесплатной медицинской помощи

The article analyzes and compares the financing of expenditures of various types of medical care within the framework of the “Program of state guarantees of free provision of medical care to citizens for 2022 and for the planning period of 2023 and 2024” and the “Territorial program of state guarantees of free provision of medical care to citizens in the Rostov region” for the same periods. Some types of costs for the implementation of state programs in the field of healthcare are considered, due to the implementation of the national project “Healthcare” in the Rostov region and shortcomings in the healthcare system of this region. The growth rates of expenditures of the federal and regional budgets of the Rostov region, as well as the health insurance fund for financing various types of medical care have been determined. The most significant problems in the region that hinder the implementation of state programs included in the national project “Healthcare” have been identified. The budget for healthcare in the region according to regional experts, is not getting bigger, which is an incentive to search for other financing models, in particular, the perspective of the experience of the Rostov region in the field of organization of medical management is noted. In recent years, the municipal authorities have made a decision and transferred all municipal medical institutions to the ownership of the regional government, explaining this by the need to centralize management. The transition of municipal medical institutions to the category of state ones will simplify the routing of patients, make medical care more qualitative and affordable, and also provide an opportunity for more efficient use of all types of resources directed to the field of health care in the region. The results obtained can serve as a basis for adjusting the health policy of the Rostov region.

Key aspects defining the development and implementation of a regional genomic surveillance strategy for the Eastern Mediterranean Region.

The COVID-19 pandemic highlighted the critical role of pathogen sequencing in making informed public health decisions. Initially, the Eastern Mediterranean Region faced limitations in sequencing capacity. However, with robust WHO and stakeholder support, the situation significantly improved. By 2022, COVID-19 sequencing was underway in 22 out of 23 regional countries, with varying throughput and capacity. Notably, three genomic hubs were established in Oman, UAE, and Morocco, playing a key role in providing expanded genomics training and support across the region. While primarily for COVID-19 surveillance, this sequencing capacity offers an opportunity to integrate genomic surveillance into existing networks. This integration can enable early detection and response to high-threat pathogens with pandemic potential. To advance this, WHO/EMRO collaborated with stakeholders to formulate the Eastern Mediterranean Regional Genomic Surveillance Strategy for Emerging Pathogens of Pandemic Concern. Consultative meetings with regional and international genomic surveillance experts identified strategy focal points, key partners, priority pathogens, and implementation steps. As the strategy awaits member states' ratification in Q4 2023, this manuscript outlines pivotal facets defined by member states and the strategic document's key deliverables and opportunities. These efforts aim to yield a substantial positive impact within the region.

수도권과 비수도권에서의 지역균형발전방안 인식연구

The purpose of this study is to analyze the status of balanced regional development policies at home and abroad, and to examine the public opinion of local experts in order to identify differences in perception of balanced regional development plans in metropolitan and non-metropolitan areas, and to present suitable balanced regional development plans. The balanced regional development plan was divided into policies, plans, projects, and systems through cross-analysis by conducting surveys of balanced regional development policies and experts at home and abroad. In the policy sector, local experts in large cities recognized industrial, population, capital, culture, and educational facilities as very important. On the other hand, local experts in small and medium-sized cities recognized the decentralization and localization of the regional policy promotion system as very important compared to other local experts. In the planning sector, local experts in small and medium-sized cities recognized the plan to revitalize the local economic zone as very important. In the project sector, local experts in large cities recognized the evaluation and monitoring of the performance of balanced regional development projects as very important. In the system sector, local experts in small and medium-sized cities recognized the easing of polarization and strengthening local government policy acceptance capacity as very important. Therefore, the government should establish a regional development system that is differentiated from the metropolitan area, in order to induce the influx of companies and residents. It is also necessary to establish a capacity building system for local governments to promote policies that reflect regional characteristics rather than uniform policies.

Hydrological Modelling to Inform Forest Management: Moving Beyond Equivalent Clearcut Area

Forest disturbance can alter the hydrologic conditions of a watershed, including the frequency, magnitude, and timing of peak and low flows. Equivalent Clearcut Area (ECA) has been routinely used in watershed assessments to estimate hydrologic alteration due to forest disturbance. ECA analyses typically rely on broad regional assumptions, qualitative observations, and/or expert judgement, making it difficult to provide accurate quantitative estimates of hydrologic change. Process-based hydrological models offer an improved approach since they replicate watershed processes, can simulate land cover and climate change scenarios, and provide quantitative estimates of hydrologic change, including at ungauged points of interest. A workflow using a regionally calibrated hydrological model to investigate forest disturbance and future climate change scenarios is demonstrated. Results are contrasted with ECA-based outputs and emphasize that in addition to the amount of forest disturbance, watershed physical characteristics and the location of disturbance within a watershed influence the hydrologic response. This approach provides forest managers with quantitative outputs that support risk-based forest management decisions and presents a substantial improvement over ECA-based methods. Keywords: hydrological modelling, ECA-based analysis, watershed assessment, forest disturbance, cumulative effects, risk-based forest management

Streaming forward: Adoption considerations for the major recorded music markets in CARICOM

Music Streaming Services (MSS) have recently emerged as the main format for showcasing and monetizing sound recordings by record labels and artists in the international recorded music sector. In the Caribbean, however, stakeholders have been slow to adopt and integrate these digital music platforms into their overall recorded music strategies. Within this context, this paper explores the key economic opportunities and challenges associated with the late adoption of the platform-based streaming music model. Using self-administered structured interviews with nine regional experts from the three major music markets, as well as an analysis of audio-visual and digital materials and review of documents, the information is derived using a qualitative research approach, supported by a grounded theory strategy of inquiry. The findings illustrate that on one hand there is cautious optimism with respect to the potential for the re-construction of revenue streams, due to stronger royalty inflows associated with new uses of music in the digital arena. The extent to which this is realized contends with the quantum of royalty payouts actually received by rights-holders and their overall willingness to licence their rights to MSS. Additionally, MSS provides the platform for rights-owners to reach glocal audiences. However, this is reliant on the content and user-friendly features embedded in the platforms and the readiness of regional artists to be discovered and monetized via third party playlists.

Identification of appropriate tools to gauge brain functions in a clinical setup of a developing country: A pilot study.

To identify the most appropriate tools to measure functions of the brain that can be utilized in the clinical setups of developing countries. This qualitative research with a three-step approach was carried out from January 2022 to May 2022 at the Institute of Basic Medical Sciences, Khyber Medical University, Pakistan. Firstly, literature was searched to identify main brain faculties, then interviews were conducted with regional field experts to identify appropriate scales for the selected functions. Lastly a rubric was filled using interview transcripts and literature. The identified functions were vision, hearing, cognition, motor and emotions. Based on the rubric the best tests were visual fields (17/24), pure tone audiometry (16/24), Mini-Mental State Exam (20/24), Trait Emotional Intelligence Questionnaire (18/24), Romberg's test (19/24) and Manual Muscle Testing (18/24). The clinicians in developing countries can utilize the visual fields, pure tone audiometry, Mini-Mental State Exam, Trait Emotional Intelligence Questionnaire, Romberg's test and Manual Muscle Testing for most efficient, feasible, accurate and cost-effective measurement of brain functions.

Comments on Acosta-Velázquez et al. changes in mangrove coverage classification criteria could impact the conservation of mangroves in Mexico. Land Use Policy, 2023, 129, 106651

Accurate and up-to-date mapping of mangrove habitats is crucial for effective conservation and management strategies and policies. As a reply to the comparative assessment realized by Acosta et al. (2023) to the last map produced by the Mexican Mangrove Monitoring System (MMMS) and the conclusions resulting from it, we provide a comprehensive response addressing the concerns raised. We acknowledge that maps are not infallible and are subject to improvement, particularly in the rapidly advancing field of remote sensing technology used in long term monitoring system. The MMMS mapping efforts utilize state-of-the-art remote sensing technologies, such as high-resolution satellite imagery and advanced methodologies, to enhance precision and efficiency. Moreover, MMMS mapping integrates regional external expert knowledge to increase accuracy at uncertain locations. We emphasize the importance of accuracy and reliability in mangrove mapping due to the potential irreversible consequences of mangrove loss. The MMMS provides a valuable tool for monitoring deforestation rates, understanding spatial distribution, supporting management decisions, identifying conservation priorities, and facilitating targeted conservation actions. We highlight the application of the precautionary principle as an environmental imperative for the Mexican government. The inclusion of previously classified "Other wetlands" as mangroves in the MMMS mapping system implies the acknowledgment of their integral role in supporting biodiversity and climate change mitigation efforts. Technological progress and collaborative efforts have made this reclassification possible, enhancing our understanding and expertise in distinguishing mangroves from other wetland types. We conclude that our mapping efforts align with the objective of attaining high classification accuracy in remote sensing, and we remain committed to continuous improvement in our mangrove mapping endeavors.

Regional expert opinion: Management of heart failure with preserved ejection fraction in the Middle East, North Africa and Turkey.

Although epidemiological data on heart failure (HF) with preserved ejection fraction (HFpEF) are scarce in the Middle East, North Africa and Turkey (MENAT) region, Lancet Global Burden of Disease estimated the prevalence of HF in the MENAT region in 2019 to be 0.78%, versus 0.71% globally. There is also a high incidence of HFpEF risk factors and co-morbidities in the region, including coronary artery disease, diabetes, obesity, hypertension, anaemia and chronic kidney disease. For instance, 14.5-16.2% of adults in the region reportedly have diabetes, versus 7.0% in Europe. Together with increasing life expectancy, this may contribute towards a higher burden of HFpEF in the region than currently reported. This paper aims to describe the epidemiology and burden of HFpEF in the MENAT region, including unique risk factors and co-morbidities. It highlights challenges with diagnosing HFpEF, such as the prioritization of HF with reduced ejection fraction (HFrEF), the specific profile of HFpEF patients in the region and barriers to effective management associated with the healthcare system. Guidance is given on the diagnosis, prevention and management of HFpEF, including the emerging role of sodium-glucose co-transporter-2 inhibitors. Given the high burden of HFpEF coupled with the fact that its prevalence is likely to be underestimated, healthcare professionals need to be alert to its signs and symptoms and to manage patients accordingly. Historically, HFpEF treatments have focused on managing co-morbidities and symptoms, but new agents are now available with proven effects on outcomes in patients with HFpEF.

Optimal location of remote dental units

Dental care, though critical, may not be accessible for many rural populations. Remote dental units (RDUs) can address the gap in access by providing basic services to rural areas, since recent digital health advancements enable close data integration between field RDUs and regional medical center clinical experts. Yet, the economic viability of this remote/hybrid care delivery effort has not been clearly established. We explore the economics of a major dental hospital operating RDUs in a distant rural area. Specifically, we characterize the optimal location of an RDU and examine the impact of operating this RDU on the hospital’s profit. We prove that the ideal scenario, from a patient-coverage perspective, is to put the RDU far enough away from the hospital such that patients accessing the RDU are distinct from patients accessing the hospital. This positioning avoids coverage overlap (market cannibalization). However, we show that such a placement may not always be optimal for the hospital’s profit, and we derive conditions under which the optimal patient coverage for the hospital and the RDU overlaps. Our results remain consistent for a hospital operating an RDU at different locations. The RDU will not be deployed in another location if the previous two locations have some coverage overlap. Our characterization of the profit-maximizing location provides hospitals with a practical guideline by quantifying the key trade-off between service expansion and the costs incurred by sending the provider team to remote, underserved locations. Our findings lead to important operational implications for regional dental care service by RDUs.

What is the appropriate antimicrobial use surveillance tool at the health facility level for Uganda and other low- and middle-income countries?

An appropriate antimicrobial use (AMU) surveillance system provides critical data and evidence on which antimicrobial stewardship interventions are based. However, Uganda and most other low- and middle-income countries (LMICs) lack efficient systems for monitoring AMU due to unique health system challenges. We reviewed the key tools available for AMU surveillance in health facilities. Based on our implementation experience, we present arguments on the need for country authorities to adapt a customized and standardized tool for national uses. Despite ongoing efforts to set up AMU surveillance programs in Uganda, AMU data remain sparse, with most of the available data collected through antimicrobial stewardship related continuous quality improvement efforts implemented by global AMR control programs. There is variability in the interpretation of available AMU surveillance tools and a need to identify the most appropriate AMU surveillance methodologies and tools for Uganda and other LMICs. Data fields for sex and gender are incorrectly categorized and there is no tool that records pregnancy variable. Based on the past four years of practical implementation experience since the launch of the World Health Organization's Point Prevalence Survey methodology in 2018 for inpatient settings, we believe that the tool should be modified in cognizance of existing capacity and priorities in resource-constrained settings. The World Health Organization, regional experts, ministry of health authorities, and other stakeholders should urgently review available tools with a view to adopting a customized and standardized facility AMU surveillance methodology suitable for national-level rollout in LMICs.