Reforms for financial protection schemes towards universal health coverage, Senegal

Advancing the public health insurance system is one of the key strategies of the Senegalese government for achieving universal health coverage. In 2013, the government launched a universal health financial protection programme, la Couverture Maladie Universelle. One of the programme's aims was to establish a community-based health insurance scheme for the people in the informal sector, who were largely uninsured before 2013. The scheme provides coverage through non-profit community-based organizations and by the end of 2016, 676 organizations had been established across the country. However, the organizations are facing challenges, such as low enrolment rates and low portability of the benefit package. To address the challenges and to improve the governance and operations of the community-based health insurance scheme, the government has since 2018 planned and partly implemented two major reforms. The first reform involves a series of institutional reorganizations to raise the risk pool. These reorganizations consist of transferring the risk pooling and part of the insurance management from the individual organizations to the departmental unions, and transferring the operation and financial responsibility of the free health-care initiatives for vulnerable population to the community-based scheme. The second reform is the introduction of an integrated management information system for efficient and effective data management and operations of the scheme. Here we discuss the current progress and plans for future development of the community-based health insurance scheme, as well as discussing the challenges the government should address in striving towards universal health coverage in the country

Purchasing reforms and tracking health resources, Kenya

As low- and middle-income countries undertake health financing reforms to achieve universal health coverage, there is renewed interest in making allocation of pooled funds to health-care providers more strategic. To make purchasing more strategic, countries are testing different provider payment methods. They therefore need comprehensive data on funding flows to health-care providers from different purchasers to inform decision on payment methods. Tracking funding flow is the focus of several health resource tracking tools including the System of Health Accounts and public expenditure tracking surveys. This study explores whether these health resource tracking tools generate the type of information needed to inform strategic purchasing reforms, using Kenya as an example. Our qualitative assessment of three counties in Kenya shows that different public purchasers, that is, county health departments and the national health insurance agency, pay public facilities through a variety of payment methods. Some of these flows are in-kind while others are financial transfers. The nature of flows and financial autonomy of facilities to retain and spend funds varies considerably across counties and levels of care. The government routinely undertakes different health resource tracking activities to inform health policy and planning. However, a good source for comprehensive data on the flow of funds to public facilities is still lacking, because these activities were not originally designed to offer such insights. We therefore argue that the methods could be enhanced to track such information and hence improve strategic purchasing. We also offer suggestions how this enhancement can be achieved

A cross-sectional description of open access publication costs, policies and impact in emergency medicine and critical care journals

Introduction :Finding journal open access information alongside its global impact requires access to multiple databases. We describe a single, searchable database of all emergency medicine and critical care journals that include their open access policies, publication costs, and impact metrics.Methods:A list of emergency medicine and critical care journals (including citation metrics) was created using Scopus (Citescore) and the Web of Science (Impact Factor). Cost of gold/hybrid open access and article process charges (open access fees) were collected from journal websites. Self-archiving policies were collected from the Sherpa/RoMEO database. Relative cost of access in different regions were calculated using the World Bank Purchasing Power Parity index for authors from the United States, Germany, Turkey, China, Brazil, South Africa and Australia.Results:We identified 78 emergency medicine and 82 critical care journals. Median Citescore for emergency medicine was 0.73 (interquartile range, IQR 0.32­1.27). Median impact factor was 1.68 (IQR 1.00­2.39). Median Citescore for critical care was 0.95 (IQR 0.25­2.06). Median impact factor was 2.18 (IQR 1.73­3.50). Mean article process charge for emergency medicine was $2243.04, SD = $1136.16 and for critical care $2201.64, SD = $1174.38. Article process charges were 2.24, 1.75, 2.28 and 1.56 times more expensive for South African, Chinese, Turkish and Brazilian authors respectively than United States authors, but neutral for German and Australian authors (1.02 and 0.81 respectively). The database can be accessed here: http://www.emct.info/publication-search.html.Conclusions:We present a single database that captures emergency medicine and critical care journal impact rankings alongside its respective open access cost and green open access policies

Difficulties of unit managers in selected district hospitals in Cameroon

Background: Being appointed to a managerial position because of one's clinical skills seems to be prestigious, even powerful. However, being a unit manager in a resource-constrained district hospital can be a daunting task. Also, managing a ward unit with no previous training in leadership and management can be very challenging.Objectives: The purpose of this study was to describe the difficulties, in the day-to-day activities, of unit managers in selected Cameroonian district hospitals.Method: A constructionist, descriptive Husserlian phenomenological inquiry was conducted to describe the difficulties of unit managers in two district hospitals. Ten unit managers were selected through a purposive sampling scheme, and then interviewed using semi-structured interviews. Coliazzi's qualitative data analysis method was used for analysis.Results: This study revealed that unit managers looked for assistance because it is not easy to be in their position. Their role implied facing difficulties and making sacrifices for something that is not even worth the trouble. Therefore, as a way to overcome their difficulties, they asked for assistance from the organisation, from their families and from God as strategies to face their difficulties.Conclusion: The difficulties faced by unit managers in the selected district hospitals revealed the need to prepare nurses for managerial positions by ensuring they are trained as managers before commencing employment as a manager

Factors affecting treatment practices of patent medicine vendors for malaria in under-five children: implications for malaria control in Nigeria

Background: Patent medicine vendors (PMVs) are the most common source of antimalarial drugs and treatment for majority of Nigerians. The quality of their practice could have implications for malaria control. This study sought to explore the factors influencing the malaria treatment practices of PMVs for under-five children in Akwa Ibom State. Methods: A cross-sectional survey using an interviewer-administered questionnaire was conducted among 176 PMVs selected by simple random sampling from two local government areas (LGAs). In addition, four focus group discussions (FGD) were conducted to generate qualitative data. Quantitative data was analysed using SPSS version 20 while content analysis was done on the qualitative data. Results: Artemisinin Combination Therapy (ACT) was the most frequently recommended antimalarial treatment by PMVs (75.6%) for children as against chloroquine (17%) and Sulphadoxine/Pyrimethamine (2.8%). However, only 39.2% of PMVs recommended the appropriate antimalarial treatment (ACTs at the right dose for age), while 71% recommended referral for severe malaria. Factors found to be associated with appropriate management of malaria from quantitative analysis included Educational qualification, attending malaria training and their knowledge of malaria. The FGDs showed that severity of child's illness, parents/caregivers drug request and perceived ability of the parents/caregiver to afford the drugs influenced PMVs malaria treatment practices. Conclusion: Knowledge of malaria, severity of child's illness and parents' drug request influenced the treatment practices of PMVs. Training PMVs on appropriate malaria management and community health education/sensitization to leverage on the influence of client-demand on ACT use is recommended to improve PMVs treatment practice

Costs incurred by caregivers of under-five inpatients with community-acquired pneumonia at a university hospital in south-western Ethiopia

Background: Pneumonia is one of the commonest diseases among children in Ethiopia resulting in deaths and hospitalisations. The objective of the current study was to determine the cost incurred by caregivers of under-five children with community-acquired pneumonia admitted to the paediatric ward of Jimma University Specialized Hospital, south-western Ethiopia.Methods: An institution-based cross-sectional study was conducted from 01 January to 28 February 2017, through interviews with caregivers. Data on costs incurred before hospital visit, direct medical and non-medical costs, and indirect costs incurred by caregivers of the children were collected. The collected data were analysed using Statistical Package for Social Sciences version 23.Results: Among the 120 caregivers in the study, a median total cost of 304.5 Ethiopian birr (13.22 USD) was reported. This was mostly contributed by indirect costs associated with earnings lost by caregivers related to travel and stay at hospital with the children. Factors, including permanent residence, family size, hospital stay, wealth index, education and major occupation, were found to have statistically significant association with the level of cost incurred by caregivers.Conclusion: This study identified that a significant level of cost is incurred by caregivers of the children in the hospital, a majority of which was contributed by the lost earnings because of the time spent at the hospital with the children

Recent predictive parameters for successful weaning from mechanical ventilation in critically Ill patients

Background: Removal of patients from mechanical ventilation (MV) has been termed liberation, discontinuation, withdrawal and most commonly weaning. Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. Although weaning from MV is successful in most cases, the first attempt fails in 20% of patients. In addition, weaning accounts for over 40% of the total MV time, the proportion varying in function of the etiology of respiratory failure. Objective: The aim of this study was to evaluate the recent protocols of successful weaning from mechanical ventilation of critically ill patients, depending on central venous oxygen saturation, ultrasonographic assessment of diaphragmatic movement, and serial arterial blood gases to assess failure rate 48 hours after weaning. Patients and methods: This prospective randomized study included a total of 90 mechanically ventilated Egyptian patients of both sexes, ASA (I-II) attending at least for 48 hours at intensive care unit, AlAzhar University Hospitals. The included subjects were divided into three groups depending on method of monitoring; group A: serial arterial blood gases, group B: Central venous oxygen saturation and group C: Ultrasonographic assessment of diaphragmatic movement pre and post spontaneous breathing trial. All patients were subjected to daily monitoring of the following weaning parameters: static and dynamic compliances and inspiratory resistance, intrinsic positive end expiratory pressure (Auto PEEP) and Maximum inspiratory pressure (MIP). Results: There is highly statistically significant difference between patients as regard weaning outcome. As the group depended on normal ultrasonographic assessment of diaphragmatic movement, had the largest number of patients with successful weaning. Conclusion: Normal ultrasonographic assessment of diaphragmatic movement proved to be the most important criteria for successful weaning from mechanical ventilation

Community based health insurance as a viable option for health financing: An assessment of household willingness to pay in Lagos, Nigeria

The high cost and effect of out of pocket payments for health care on households in developing countries have led to the use of community-based health insurance (CBHI) as a viable alternative for health care funding. The overall objective of the study was to assess the perception and determinants of willingness-to-pay (WTP) for a proposed community based health insurance scheme in urban and rural households in Lagos State. The multi-stage sampling technique was used with 960 household heads enrolled in the study. A pre-tested, semi-structured, interviewer administered questionnaire was used to collect data from the respondents. The contingent valuation method was used to elicit household willingness to enrol and pay for a proposed community based health insurance scheme. Data was analysed using Statistical Package for Social Sciences software (SPSS) version 17. This study revealed that 86.3% of the households in the rural LGA and 78.6% of the households in the urban LGA were willing to pay for the proposed community based health insurance scheme (p=<0.001). The households were willing to pay a mean amount of ₦957.56 and ₦754.83/ household/ month in the urban and rural area respectively (p<0.001). The paper concludes by emphasizing the high willingness among households to participate in the proposed hypothetical CHBI scheme. This highlights its prospects of increasing access to quality health care in Lagos especially amongst vulnerable low-income households

Coûts médicaux des accouchements et des césariennes au Burkina Faso: une évaluation nationale

Dans le cadre des politiques publiques d'accès aux soins de santé maternelle, les centres de santé offrent des prestations aux populations et sont ensuite remboursés par l'État sans qu'on sache ce que représentent ces coûts. Les objectifs de cette étude étaient de déterminer les coûts réels des accouchements au Burkina Faso. C'est une enquête transversale conduite entre juin et août 2014 dans tous les hôpitaux, centres médicaux et deux centres de santé de base par commune. Les coûts médicaux réels incluaient l'acte, les médicaments et consommables, les examens paracliniques et l'hospitalisation. Au total 949 femmes de 544 centres de santé publics ont été analysées. L'échantillon comprenait 579 accouchements eutociques, 202 dystociques et 168 césariennes. Au niveau national, le coût médical réel moyen était de 3 180 (±1 255), 13 305 (± 6 865) et 55 830 (±14 800) FCFA respectivement pour un accouchement eutocique, dystocique et une césarienne. Quel que soit le type d'accouchement, les médicaments et consommables représentaient plus de la moitié des coûts. Le coût médical moyen variait selon la région sanitaire, le type d'accouchement et le type de formation sanitaire (p<0,001). Ces résultats suggèrent qu'un remboursement forfaitaire, selon le type de prestation, doit tenir compte du niveau de soins

Tobacco growing and the sustainable development goals, Malawi

Negative impacts of tobacco result from human consumption and from tobacco-growing activities, most of which now occur in low- and middle-income countries. Malawi is the world's largest producer of burley tobacco and its population is affected by the negative consequences of both tobacco consumption and production. In countries like Malawi, tobacco control refers to control of the tobacco supply chain, rather than control of consumption. We review the impact of tobacco cultivation, using Malawi as an example, to illustrate the economic, environmental, health and social issues faced by low- and middle-income countries that still produce significant tobacco crops. We place these issues in the context of the sustainable development goals (SDGs), particularly 3a which calls on all governments to strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control. Other goals address the negative effects that tobacco cultivation has on development. The SDGs offer an opportunity for low- and middle-income countries that are dependent on tobacco production and that are not yet parties to the Convention, to reconsider joining the FCTC

Integrated morbidity management for lymphatic filariasis and podoconiosis, Ethiopia

Problem Lymphatic filariasis and podoconiosis are the major causes of tropical lymphoedema in Ethiopia. The diseases require a similar provision of care, but until recently the Ethiopian health system did not integrate the morbidity management. Approach To establish health-care services for integrated lymphoedema morbidity management, the health ministry and partners used existing governmental structures. Integrated disease mapping was done in 659 out of the 817 districts, to identify endemic districts. To inform resource allocation, trained health extension workers carried out integrated disease burden assessments in 56 districts with a high clinical burden. To ensure standard provision of care, the health ministry developed an integrated lymphatic filariasis and podoconiosis morbidity management guideline, containing a treatment algorithm and a defined package of care. Experienced professionals on lymphoedema management trained government-employed health workers on integrated morbidity management. To monitor the integration, an indicator on the number of lymphoedema-treated patients was included in the national health management information system.Local setting In 2014, only 24% (87) of the 363 health facilities surveyed provided lymphatic filariasis services, while 12% (44) provided podoconiosis services.Relevant changes To date, 542 health workers from 53 health centres in 24 districts have been trained on integrated morbidity management. Between July 2013 and June 2016, the national health management information system has recorded 46 487 treated patients from 189 districts.Lessons learnt In Ethiopia, an integrated approach for lymphatic filariasis and podoconiosis morbidity management was feasible. The processes used could be applicable in other settings where these diseases are co-endemic

Cost of a human papillomavirus vaccination project, Zimbabwe

Objective To determine the cost of Zimbabwe's human papillomavirus (HPV) vaccination demonstration project. Methods The government of Zimbabwe conducted the project from 2014­2015, delivering two doses of HPV vaccine to 10-year-old girls in two districts. School delivery was the primary vaccination strategy, with health facilities and outreach as secondary strategies. A retrospective cost analysis was conducted from the provider perspective. Financial costs (government expenditure) and economic costs (financial plus the value of existing or donated resources including vaccines) were calculated by activity, per dose and per fully immunized girl. Results The project delivered 11 599 vaccine doses, resulting in 5724 fully immunized girls (5540 at schools, 168 at health facilities and 16 at outreach points). The financial cost for service delivery per fully immunized girl was United States dollars (US$) 5.34 in schools, US$ 34.90 at health facilities and US$ 288.63 at outreach; the economic costs were US$ 17.39, US$ 41.25 and US$ 635.84, respectively. The mean financial cost per dose was US$ 19.76 and per fully immunized girl was US$ 40.03 (economic costs were US$ 45.00 and US$ 91.19, respectively).The largest number of doses delivered (5788) occurred during the second vaccination round (the second group's first dose concurrently delivered with the first group's second dose), resulting in the lowest financial and economic service delivery costs per dose: US$ 1.97 and US$ 6.79, respectively. Conclusion The mean service delivery cost was lower in schools (primary strategy) and when more girls were vaccinated in each round, demonstrating scale efficiency

Cost-Effectiveness analysis of family planning services offered by mobile clinics versus static clinics in Assiut, Egypt

Cost effectiveness studies of family planning (FP) services are very valuable in providing evidence-based data for decision makers in Egypt. Cost data came from record reviews for all 15 mobile clinics and a matched set of 15 static clinics and interviews with staff members of the selected clinics at Assiut Governorate. Effectiveness measures included couple years of protection (CYPs) and FP visits. Incremental cost-effectiveness ratios (ICER) and sensitivity analyses were calculated. Mobile clinics cost more per facility, produced more CYPs but had fewer FP visits. Sensitivity analysis was done using: total costs, CYP and FP visits of mobile and static clinics and showed that variations in CYP of mobile and static clinics altered the ICER for CYP from $2 -$6. Mobile clinics with their high emphasis on IUDs offer a reasonable cost effectiveness of $4.46 per additional CYP compared to static clinics. The ability of mobile clinics to reach more vulnerable women and to offer more long acting methods might affect a policy decision between these options. Static clinics should consider whether emphasizing IUDs may make their services more cost-effective

Peptic ulcer Disease drugs usage patterns and its economic burden in a tertiary health institution in Niger Delta, Nigeria

Background: Drug utilization evaluation for peptic ulcer disease and its cost implication are rare in Niger Delta. The objective of the study was to evaluate drug usage pattern in peptic ulcer diseases as well as its cost implications.Methods: The cross sectional drug use evaluation study involving the use of questionnaire and patient case notes was carried out in a tertiary health institution. The validated pretested questionnaire was interviewer administered to 300 patients sampled consecutively followed by a retrospective review of their respective case notes between April to November 2013. Information collected include risk factors, prescribed drugs, Helicobacter pylori assay test results among others. Cost of each drug and therapy were then computed appropriately. Data was analyzed using Statistical package for Social Sciences (SPSS) version 20, Microsoft Excel and Graph Pad Prism for windows Instat Version 3.Results: Out of the 300 patients, H. pylori test was conducted in 262 (87.3%) while the presence or absence of the organisms could not be confirmed in the remaining 38 subjects. Out of the 262 patients with H. pylori test results, only 166 representing 63.4% were positive. History of non-steroidal anti-inflammatory drugs (NSAID) usage was very high among the subjects (250; 83.3%) and highest for ibuprofen 146 (48.7%). The most prescribed drugs were antacids (268; 89.3%), amoxicillin (165; 55.0%), and a combined formulation of omeprazole, tinidazole, and clarithromycin in 140 (46.7%) subjects, followed by omeprazole alone (125; 41.7%).The national direct cost implication for the estimated 17.6 million is in the range of NGN186,849,000,000.00 ($958,200,000.00), out which NGN109,867,000,000.00($563,420,513.00) was for PUD drugs (50.9%) and NGN32,698,575,000.00 ($167,685,000.00) for H. pylori tests (17.5%), while the remaining 31.7% valued at NGN59,231,133,000.00 ($303,749,400.00) was for non-ulcer drugs, personnel and transportation.Conclusion: The pattern of drugs usage is consistent with standard treatment guidelines. Peptic ulcer drugs for the 300 subjects constituted NGN1,618,641 ($8300.72) which represents 73.0% of the total amount spent on drugs. The national direct cost of PUD is close to NGN200 billion ($1.04 billion). Updated information on drug usage and their costs is needed for improved usage and system efficiency

The legislative and regulatory framework governing herbal medicine use and practice in Kenya: a review

Complementary and alternative medicine is an integral component of primary healthcare in Kenya. This is because the infrastructural health setup in the country is inadequate in catering for all the medical needs of the population. This particularly holds true in the rural areas where many rural folk rely on products of herbal origin to offset their healthcare needs. More often than not these products are an elaborate cacophony of several different substances of biological origin and thus need personnel adept in their preparation. Sadly, due to loopholes in legislation and regulation, quacks have a field day in the practice. Moreover, the process of planting, harvesting, preparation and storage of herbs and related products dictates that a significant number of people will ultimately be involved in the whole process. This is likely to set the stage for manipulation and compromise of the safety, quality and efficacy of these products. This state of affairs appears unabated especially in the context of the current legal and regulatory framework governing herbal medicine use and practice in Kenya. Not only are these laws inadequate, they are shrouded in ambiguity, open to interpretation and the authorities mandated to implement them often end up performing duplicate roles. The aim of this review is to critique the legal and regulatory provisions governing herbal medicine use and practice in Kenya. In conclusion, laws and regulations meant to control herbal medicine use and practice in Kenya are wanting. Clear and definitive legislation on herbal medicine use and practice coupled with effective implementation by mandated institutions will go a long way in inspiring confidence to all stakeholders of herbal medicine

Expenditures on health research in sub-Saharan African countries: results of a questionnaire-based survey

Objective To estimate the sources of funds for health research (revenue) and the uses of these funds (expenditure). Design A structured questionnaire was used to solicit financial information from health research institutions. Setting Forty-two sub-Saharan African countries. Participants Key informants in 847 health research institutions in the 42 sub-Saharan African countries. Main outcome measures Expenditure on health research by institutions; funders and subject areas. Results An estimated total of US$ 302 million was spent on health research by institutions that responded to the survey in the World Health Organization (WHO) African Region for the biennium 2005-2006. The most notable funders for health research activities were external funding; ministries of health; other government ministries; own funds and non-profit institutions. Most types of health research performers spent significant portions of their resources on in-house research; with medical schools spending 82 and government agencies 62. Hospitals spent 38 of their resources on management; and other institutions (universities; firms; etc.) spent 87 of their resources on capital investment. Research on human immunodeficiency virus/tuberculosis and malaria accounted for 30 of funds; followed by research on other communicable diseases and maternal; perinatal and nutritional conditions (23). Conclusions Research on major health problems of the Region; such as communicable diseases; accounts for most of the research expenditures. However; the total expenditure is very low compared with other WHO regions

The promise andl imitations of cash transfer programs for HIV prevention

As the search for more effective HIV prevention strategies continues; increased attention is being paid to the potential role of cash transfers in prevention programming in sub-Saharan Africa. To date; studies testing the impact of both conditional and unconditional cash transfers on HIV-related behaviours and outcomes in sub-Saharan Africa have been relatively small-scale and their potential feasibility; costs and benefits at scale; among other things; remain largely unexplored. This article examines elements of a successful cash transfer program from Latin America and discusses challenges inherent in scaling-up such programs. The authors attempt a cost simulation of a cash transfer program for HIV prevention in South Africa comparing its cost and relative effectiveness - in number of HIV infections averted - against other prevention interventions. If a cash transfer program were to be taken to scale; the intervention would not have a substantial effect on decreasing the force of the epidemic in middle- and low-income countries. The integration of cash transfer programs into other sectors and linking them to a broader objective such as girls' educational attainment may be one way of addressing doubts raised by the authors regarding their value for HIV prevention

Determinants socio-economiques de l'automedication aux antimalariens a Kisangani/RD Congo

Objectif de l'etude : evaluer l'importance et les determinants socio-economiques de l'automedication aux anti-malariens dans la commune de la Tshopo a Kisangani Materiel et methodes : Nous avons realise une etude transversale utilisant un questionnaire d'enquete pour collecter les donnees. Par un echantillonnage systematique; 384 menages au minimum ont ete enquetes. Resultats : Au total 386 responsables de menage ont participe a l'enquete. 346 (89;6) de responsables avaient reconnu pratiquer l'automedication aux anti-malariens. Deux facteurs socio-economiques etaient significativement lies a l'automedication dans l'analyse classique : le revenu mensuel des responsables (p=0;0013) et la charge familiale en terme de nombre d'enfants (p=0;0034). L'age; le sexe; l'occupation des responsables; le niveau d'instruction et la religion des responsables n'etaient pas associes a la pratique. A l'analyse multi variee; les deux facteurs sont restes significatifs : les revenus superieurs a 100 dollars americains previennent la pratique [ORaj=0;25 (0;11-0;58); p=0;001] et le nombre eleve d'enfants dans le menage la favorise [ORaj=3;94(1;62-9;55); p=0;0024] entre 3-4 enfants et ORaj=3;34(1;067-10;46); p=0;038); a partir de 7 enfants) Conclusion : La prevalence de l'automedication aux anti-malariens est alarmante dans la commune de la Tshopo a Kisangani. La menace de la resistance; la circulation possible de medicaments de qualite douteuse et le contexte local de controle de qualite fait de cette pratique un probleme important de sante publique. Une evaluation serieuse de cette pratique serait donc utile dans le futur

Occupational therapy synergy between Comprehensive Community Based Rehabilitation Tanzania and Heifer International to reduce poverty

Background: This article describes a partnership between a community-based rehabilitation organisation and a non-governmental organisation (NGO) in Tanzania. The partnership focused on income-generating (IG) activities to tackle the problems of poverty faced by families with a child with a disability (CWD). Objectives: The aim of this case study was to describe the partnership between Comprehensive Community Based Rehabilitation Tanzania in Moshi (CCBRT-Moshi), a non-governmental organisation, and families to create an income-generating business, namely raising goats. Method: This was a team approach between CCBRT-Moshi and Heifer International, an organisation that focuses on IG activities to create a synergy or partnership between community-based rehabilitation and IG activities. Results: This partnership between occupational therapy rehabilitation services at CCBRT-Moshi and the NGO resulted in strengthening the effectiveness of occupational therapy services and leaving a more lasting impact on the people they served within the community by helping to reduce poverty in addition to providing rehabilitation and prevention interventions. Conclusion: This collaboration was successful as it provided a means for families to generate income from raising goats. Although the results have not been empirically verified, observational and anecdotal evidence suggests that families with CWDs have better quality of life and ultimately improved health through this synergistic partnership