April 30, 2018

Burundi. Photo by Kristy Carlson | longmilescoffeeproject.com

At the end of every month, we highlight key readings—and other information sources such as podcasts and videos—that during the month have provided us with new knowledge about efforts to improve access to health technologies in low- and middle-income countries (LMICs). Though we are always eager to learn about exciting new technologies for health improvement, what really matters, in our view, is the process of getting these technologies to the people who need them. Therefore, the knowledge sources that we highlight here are not about the characteristics of health technologies or the processes behind their research and development, but instead are about the people and systems that make access happen. When we talk about access, we mean “people’s ability to obtain and appropriately use good quality health technologies when they are needed” and we conceive of the access process in terms of four sets of activities—related to architecture, availability, affordability, and adoption—that occur simultaneously at the global-level and within national health systems (click here for more about this access definition and framework). In curating these readings every month, we hope to spotlight emerging knowledge about new and ongoing efforts to address persistent barriers to access, the consequences (both intended and unintended) of these efforts, and information gaps in the access to health technologies field.

–World Immunization Week was this month (24-30 April) and this feature story highlights the current status of global efforts to eradicate polio. It describes how migrants and refugees from Afghanistan and Pakistan are a key focus of the final push towards eradication and how the Global Polio Eradication Initiative with the two governments have set up vaccine “transit stations” on roads where migrants and refugees travel, as well as in bus and train stations and in airports.

–Pakistan’s Lady Health Workers deliver primary healthcare to women and immunization campaigns to children—in so doing, they play a critical role in polio eradication efforts. Many of these workers, however, face difficult work conditions including threats of physical violence, sexual harassment, and irregular payment of salaries. Their experiences are a stark reminder of the personal sacrifices made by many health workers to keep services functioning and the necessity of providing adequate protection and support.

—Efforts to improve access to contraceptives and family planning services in conflict-affected areas of eastern DRC found the importance of several program strategies—clinical coaching and supervision of providers to improve skills and attitudes, training and supporting providers in immediate postpartum insertion of the IUD, introduction of the levonorgestrel-releasing intrauterine system to expand client choice, and behavior change communications campaigns to raise awareness about family planning. The authors argue that women and their partners in conflict areas want family planning and that delivery of these services is feasible as long as programs are adapted and sensitive to local context.

–And on the subject of context…while many of us working in global health agree that “context matters,” the authors of this PLOS blog post argue that context is insufficiently accounted for or examined in our approaches, and call for the inclusion of local values and local expertise as a routine practice in global health institutions and interventions.

—A qualitative study of a syphilis/yaws point of care diagnostic test in the Solomon Islands sought to understand broader issues in the health system that might influence the test’s rollout. The study identified four themes related to healthcare worker and patient perceptions—training and ease of use, time taken for test and ability to fit into the clinical workflow, perceived reliability of the test results, and access to the test in lower levels of the health system.

–Local pharmaceutical production is one access strategy that can improve the affordability and availability of medicines. An examination of Brazil’s experiences highlights the conditions necessary for building local production as an access-to-medicines strategy (unfortunately, this article is not open access).

–On World Malaria Day (April 25), the African Development Bank released a report about the financing of malaria control efforts, with a focus on the role of foreign aid. In the report, the AfDB notes that in September 2016, Sri Lanka was declared malaria free, and examines this country’s experiences to extract lessons learned for African countries. Related, a case study of a public-private partnership in Sri Lanka for malaria elimination, established at the end of the separatist conflict in 2009, shows how collaboration with the private sector from 2010-2014 in war-affected districts with weak health systems contributed to Sri Lanka’s achievements.

–In this podcast, Dr. Allan Pamba shares his story of his personal experiences with malaria as a child in Kenya, his medical training during the HIV/AIDS epidemic at a time when no treatment was available, his subsequent establishment of the first HIV care clinic on Kenya’s coast at a time when ARVs had become available but not affordable, and then taking a job with a pharmaceutical company as way to “get to the heart of the problem” and learn more about how to make these treatments more broadly available.

Do you have a knowledge source that you think should be included? Great! Please send suggestions to Laura at [email protected] or tweet to @laurajfrost.