ABSTRACT
In 2013, the Government of Japan issued “Japan Revitalization Strategy”, in which facilitation of overseas expansion of Japanese drugs, medical equipment, health services, and health system through Public Private Partnership (PPP) is included. In alignment with this strategy, ministries and agencies have initiated on various health project, one of which is “Project for global growth of medical technologies, systems and services through human resource development”funded by the Japan Ministry of Health, Labour, and Welfare from 2015. As an administrative organization of this project, National Center for Global Health and Medicine (NCGM) has organized 119 project for 4 years from 2015 to 2018. This report summarizes the experiences and the results of evaluation in terms of program management, expansion of introduced health technologies and the health impact. As the results, the overall project management was satisfactory from the viewpoints of varieties of project, the execution rates. Then, health technologies were adopted in the national guidelines or policies and 17 introduced medical products were purchased by local governments. When it comes to health impacts, 19646 health staffs were trained through this program for 4 years and 912334 persons were estimated as beneficiaries by 29 project in 2017. Based on data shown as above, the overall achievement of this program should be considered satisfactory. Since this program is unique among other PPP program in Japan as well as other countries as the program scheme to promote expansion of medical products through human resource development, the experiences should provide some insights about the ways to facilitate PPP in health sector. In order to extract the Tips of good practices for future activities, further analysis on each project is necessary.
ABSTRACT
Introduction Electronic health information systems (HISs) are believed to improve access to health information. The District Health Information System Version 2 (DHIS2) is used widely in developing countries. While numerous successful cases highlighting the introduction of DHIS in facility-based settings have been reported, it remains unclear how similarly effective results can be obtained in developing countries. Methods We conducted a literature review to clarify the achievements and challenges regarding the use of DHIS2, and extracted 62 papers from PubMed and Google Scholar using the search term ‘District Health Information Software System’. Eleven papers that described the process of introducing DHIS2 were selected for analysis.Results We categorized the achievements into two groups: ‘Improvement of the reporting system’ and ‘Human resources development’. The challenges were categorized into eight groups, of which most commonly reported were human resources-related issues, followed by system complexity and data collection inadequacy. Conclusions The introduction of DHIS2 contributed to the improvement of the timeliness and completeness of data reporting, as well as human resources development, while utilization of data should be further strengthened. The most common challenges reported consisted of human resources-related issues. The HISs should be simple and easy to understand, even for individuals with low computer literacy.
ABSTRACT
The way of Public Private Partnerships in development including Global Health has been changing dramatically. Japan is also making efforts to promote Public-Private Partnership to promote the Japanese medical technology and services globally. Since the program schemes are varied, we collect the information mainly through WEB at July 2017 to compare the features of each program and policy. We made a list of programs conducted by Ministries and responsible organizations. The programs are categorized in two directions, inbound which means inviting foreign patients to Japan for treatment, and outbound which means exporting Japanese medical devices, medicines, system, and services. Those are also categorized in two groups by objective and content, support for establishing foundation/core facilities, and support for the system and human-resource development. We created the correlation diagram based on these categorizations to show the relationship between each scheme/program. Programs undertaken by different agencies such as the Cabinet Secretariat, Ministry of Economy, Trade and Industry, Ministry of Health, Labor and Welfare, Ministry of Foreign Affairs, Japan International Cooperation Agency seems comprehensive and exhaustive. Therefore, we can expect a bigger impact if the appropriate support through those programs were provided in right time, especially for the outbound support. There is a need for developing overarching strategy among each program to the target country based on the needs assessment, local adaptability of the technology and services. From the fact that it has become clear that issues related to developing private funds for development by public funds as priming water such as the motivation for investment behavior and the different results are different in the public and private sectors, it is necessary to clarify the guidelines in Japan in order to strengthen such Public-Private Partnership.
ABSTRACT
<B>Objectives</B><BR>The objective of this study is to identify barriers and facilitators of anti-retroviral treatment (ART) continuation among ART patients in Zambia. It also aims to explore ART scale-up approach while reducing defaulters.<BR><B>Methods</B><BR>In October 2009, we obtained ART statistics, interviewed District Health Management Team (DHMT) in Livingstone, Zambia, and conducted Focus Group Discussion (FGD) with 27 ART defaulters who were traceable, where participants shared experience in relation to why they gave up and how they resumed treatment.<BR><B>Results</B><BR>Although ART facilities have been increased in Livingstone, half of the facilities are not equipped with CD4 count machine, which affects timely commencement of treatment. Anti-retrovirals (ARV) and consultation are basically offered free of charge to ART patients, yet patients have to pay X-ray and co-morbidity treatment. On average, 22.7% of ART patients stopped visiting ART facilities. Especially in large-scale ART centre, defaulters were not followed up. FGD revealed the process of how defaulters developed hopelessness and pill burden, which were triggered and influenced by several factors including hunger, poverty, stigma, side-effects and co-morbidities. Some stopped medication as they thought being cured after condition recovered. Others attributed discontinuation to the accessibility of service and the attitude of ART centre staff. Default was attributed by internal (inadequate knowledge, weak motivation) and also external (hunger, medical service system) factors. It is inevitable to empower patients with adherence management by strong motivation to treatment and supportive environment.<BR><B>Conclusion</B><BR>Financial empowerment of patients, free-service of co-morbidity treatment and side effect mitigation are desirable for sustainable ART scale-up. Defaulter follow-up, continuous regular adherence counseling and ART roll-out to small-scale clinics are inevitable to reduce defaulters.
ABSTRACT
Zambia is one of the HIV high burden countries in Sub Saharan Africa. Government of Zambia has been expanding Antiretroviral Therapy (ART) service nationwide at district level. However, it is still hard to access to ART service for PLHIVs who live in rural. In terms of accessibility, the service must be expanded to rural health centre level, but there are many challenges to expand the quality services into such resource limited setting, especially in the shortage of health providers.<br> JICA's “Integrated HIV and AIDS Care Implementation Project at District Level” launched at April 2006 to improve the quality and accessibility of HIV and AIDS care services in rural Zambia. Two districts in rural area, namely Mumbwa and Chongwe, were selected as project sites. The Project introduced the “mobile ART service” at rural health centre level using the existing health system. Mobile ART services enable a rural health centre that cannot offer ART by itself to provide ART services through the human resource and technical support/assistance of the District Hospital. Mumbwa and Chongwe District Health Management Team (DHMT) started mobile ART services in the first Quarter of 2007, therefore access to ART service in districts has been improved and contributed to increase of ART clients and reduce the defaulter rate within first 6 months of treatment. The project also tried to introduce the community involvement to overcome the shortage of human resources. <br> We found that Mobile ART services involving the community are beneficial and effective, and help ART services expansion to rural health facilities where resources are limited, and as close as possible to places where clients live. The strategies we experienced were cited in “the National Mobile HIV Services Guidelines” published by the MoH and will be able to be duplicated in other resource-limited areas of not only Zambia but also other developing countries.
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<b>Objective</b><br> In recent years, antiretroviral therapy (ART) has been significantly expanded in developing countries, while drug resistance to HIV caused by low adherence is becoming a grave concern. As a member of the international community, Japan is expected to expand its cooperation for supporting the expansion of ART. However, the evaluation of ART adherence remains a challenge since the definition and the methods of its measurement are not standardized. In this regard, the articles of studies on ART adherence are reviewed to investigate available methodologies that can be used for measurement.<br><b>Method</b><br> Articles were searched and extracted through Ovid Full Text database for the period between Jan. 2002 and Aug. 2006 by using keywords of “adherence” and “HIV”. Among 81 extracted original articles, 50 articles were selected based on the inventory and clear identification of the methodologies used to measure adherence.<br><b>Result</b><br> The studies were conducted in the US (28 articles: 56%), Canada (5 articles: 10%), UK (3 articles: 6%), Africa and South America (10 articles: 20%) and no articles were extracted from Asia. The mean sample size of the studies was 581.2 (range: 24-6288). Measurements of adherence that were used in the articles as follows; patient's self-report (31 articles: 62%), electric drug monitoring (14 articles: 28%), pharmacy's refill record (12 articles: 24%), pill-count (9 articles: 18%), laboratory testing (6 articles: 12%) and combination of these (14 articles: 28%). Of the 31 articles using patient's self-report, 25 articles asked for the participant's frequency of missed dose.<br><b>Conclusion</b><br> Studies concerned with ART adherence have been mainly undertaken in industrialized countries, and it was found that inquiries on missed doses were the most frequently used method to measure ART adherence. We strongly suggest the development of more simplified methods for measuring ART adherence, especially for resource-limited settings.