Rethinking health sector procurement as developmental linkages in East Africa

Health care forms a large economic sector in all countries, and procurement of medicines and other essential commodities necessarily creates economic linkages between a country's health sector and local and international industrial development. These procurement processes may be positive or negative in their effects on populations' access to appropriate treatment and on local industrial development, yet procurement in low and middle income countries (LMICs) remains under-studied: generally analysed, when addressed at all, as a public sector technical and organisational challenge rather than a social and economic element of health system governance shaping its links to the wider economy. This article uses fieldwork in Tanzania and Kenya in 2012–15 to analyse procurement of essential medicines and supplies as a governance process for the health system and its industrial links, drawing on aspects of global value chain theory. We describe procurement work processes as experienced by front line staff in public, faith-based and private sectors, linking these experiences to wholesale funding sources and purchasing practices, and examining their implications for medicines access and for local industrial development within these East African countries. We show that in a context of poor access to reliable medicines, extensive reliance on private medicines purchase, and increasing globalisation of procurement systems, domestic linkages between health and industrial sectors have been weakened, especially in Tanzania. We argue in consequence for a more developmental perspective on health sector procurement design, including closer policy attention to strengthening vertical and horizontal relational working within local health-industry value chains, in the interests of both wider access to treatment and improved industrial development in Africa

Evaluation and use of surveillance system data toward the identification of high-risk areas for potential cholera vaccination: a case study from Niger.

In 2008, Africa accounted for 94% of the cholera cases reported worldwide. Although the World Health Organization currently recommends the oral cholera vaccine in endemic areas for high-risk populations, its use in Sub-Saharan Africa has been limited. Here, we provide the principal results of an evaluation of the cholera surveillance system in the region of Maradi in Niger and an analysis of its data towards identifying high-risk areas for cholera

ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia.

Hypertensive disease of pregnancy affects up to 10% of pregnant women1 and the pooled global incidence of pre-eclampsia (PE) is approximately 3%2. Significant variations between developed and developing countries can be attributed to true differences or differences arising from data acquisition. PE and its complications are a major contributor to maternal and perinatal morbidity and mortality worldwide1, 3. Given that timely and effective care can improve the outcome of PE3, the development of effective prediction and prevention strategies has been a major objective of prenatal care and of research.Full Tex

A method for evaluating transport energy consumption in suburban areas

peer reviewedUrban sprawl is a major issue for sustainable development. It represents a significant contribution to energy consumption of a territory especially due to transportation requirements. However, transport energy consumption is rarely taken into account when the sustainability of suburban structures is studied. In this context, the paper presents a method to estimate transport energy consumption in residential suburban areas. The study aimed, on this basis, at highlighting the most efficient strategies needed to promote awareness and to give practical hints on how to reduce transport energy consumption linked to urban sprawl in existing and future suburban neighborhoods. The method uses data collected by using empirical surveys and GIS. An application of this method is presented concerning the comparison of four suburban districts located in Belgium to demonstrate the advantages of the approach. The influence of several parameters, such as distance to work places and services, use of public transport and performance of the vehicles, are then discussed to allow a range of different development situations to be explored. The results of the case studies highlight that travelled distances, and thus a good mix between activities at the living area scale, are of primordial importance for the energy performance, whereas means of transport used is only of little impact. Improving the performance of the vehicles and favoring home-work give also significant energy savings. The method can be used when planning new areas or retrofitting existing ones, as well as promoting more sustainable life styles regarding transport habits.SAFE (Suburban Areas Favoring Energy efficiency

Benefits and barriers among volunteer teaching faculty: comparison between those who precept and those who do not in the core pediatrics clerkship

Background: Community-based outpatient experiences are a core component of the clinical years in medical school. Central to the success of this experience is the recruitment and retention of volunteer faculty from the community. Prior studies have identified reasons why some preceptors volunteer their time however, there is a paucity of data comparing those who volunteer from those who do not. Methods: A survey was developed following a review of previous studies addressing perceptions of community-based preceptors. A non-parametric, Mann–Whitney U test was used to compare active preceptors (APs) and inactive preceptors (IPs) and all data were analyzed in SPSS 20.0. Results: There was a 28% response rate. Preceptors showed similar demographic characteristics, valued intrinsic over extrinsic benefits, and appreciated Continuing Medical Education (CME)/Maintenance of Certification (MOC) opportunities as the highest extrinsic reward. APs were more likely to also precept at the M1/M2 level and value recognition and faculty development opportunities (p<0.05). IPs denoted time as the most significant barrier and, in comparison to APs, rated financial compensation as more important (p<0.05). Conclusions: Community preceptors are motivated by intrinsic benefits of teaching. Efforts to recruit should initially focus on promoting awareness of teaching opportunities and offering CME/MOC opportunities. Increasing the pool of preceptors may require financial compensation

Anomalous J/ψJ/\psi suppression in Pb-Pb interactions at 158 GeV per nucleon

The Drell-Yan and J/psi cross-sections measured in Pb-Pb collisions are compared with the values extrapolated from the results obtained in proton and light ion induced reactions. While the Drell-Yan production exhibits the normal expected behaviour, the yield of J/psi in Pb-Pb interactions is abnormally low, as it lies 9 standard deviations below the expected value. Moreover, the departure from the expected behaviour increases significantly from peripheral to central collisions. (C) 1997 Elsevier Science B.V

Charmonium production in Pb-Pb collisions

NA50The elaboration of specific media-planning is necessary to communicate with an opinion leader. Opinion leaders in 27 product categories are selected from a 10,000 sample of French representative consumers. Magazine is the favorite media of opinion leaders; the more important is the number of product categories in which a consumer is leaders, the greater the media consumption. Leaders do not systematically prefer the Internet, their preference appears to be category specific. However, a second study conducted among 600 brand website visitors shows that brand sites represent a major information source for the leaders