1
|
Zeng Z, Yu X, Tao W, Feng W, Zhang W. Efficiency evaluation and promoter identification of primary health care system in China: an enhanced DEA-Tobit approach. BMC Health Serv Res 2024; 24:777. [PMID: 38961461 PMCID: PMC11223419 DOI: 10.1186/s12913-024-11244-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND With Primary Health Care (PHC) being a cornerstone of accessible, affordable, and effective healthcare worldwide, its efficiency, especially in developing countries like China, is crucial for achieving Universal Health Coverage (UHC). This study evaluates the efficiency of PHC systems in a southwest China municipality post-healthcare reform, identifying factors influencing efficiency and proposing strategies for improvement. METHODS Utilising a 10-year provincial panel dataset, this study employs an enhanced Data Envelopment Analysis (DEA) model integrating Slack-Based Measure (SBM) and Directional Distance Function (DDF) with the Global Malmquist-Luenberger (GML) index for efficiency evaluation. Tobit regression analysis identifies efficiency determinants within the context of China's healthcare reforms, focusing on horizontal integration, fiscal spending, urbanisation rates, and workforce optimisation. RESULTS The study reveals a slight decline in PHC system efficiency across the municipality from 2009 to 2018. However, the highest-performing county achieved a 2.36% increase in Total Factor Productivity (TFP), demonstrating the potential of horizontal integration reforms and strategic fiscal investments in enhancing PHC efficiency. However, an increase in nurse density per 1,000 population negatively correlated with efficiency, indicating the need for a balanced approach to workforce expansion. CONCLUSIONS Horizontal integration reforms, along with targeted fiscal inputs and urbanisation, are key to improving PHC efficiency in underdeveloped regions. The study underscores the importance of optimising workforce allocation and skillsets over mere expansion, providing valuable insights for policymakers aiming to strengthen PHC systems toward achieving UHC in China and similar contexts.
Collapse
Affiliation(s)
- Zhi Zeng
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- Office of Policy Research, Chinese Center for Disease Control and Prevention & Chinese Academy of Preventive Medicine, Beijing, China
| | - Xiru Yu
- Institute for Hospital Management, Tsinghua University, Shenzhen, Guangdong, 518055, China
| | - Wenjuan Tao
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Wei Feng
- West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
- Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, 610041, China.
| |
Collapse
|
2
|
Zanga R. Regulation and participation of the private sector in the pursuit of universal health coverage: Challenges and strategies for health systems. J Family Med Prim Care 2024; 13:2123-2129. [PMID: 38948620 PMCID: PMC11213391 DOI: 10.4103/jfmpc.jfmpc_1697_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 07/02/2024] Open
Abstract
The 1978 Alma Ata Declaration established recommendations for health systems, which significantly impacted low-income countries. These guidelines marked improvements in access to health, coverage and financial equity, especially in Latin American countries. Objectives This paper focuses on the role of the private sector (including for-profit and non-profit organizations) in achieving Universal Health Coverage (UHC). It examines their involvement in the management, service delivery, resource investment and financing of primary health care (PHC) within the sustainable development goals (SDGs). Methods The study covers a review of health systems, emphasizing the influence of private institutions on public health, and evaluates how private sector experiences contribute to system functions and progress towards UHC. Results The findings indicate the crucial role of the private sector in global health systems, notably expanded in several countries. Private actors are essential to improve access and coverage, particularly in countries with low health indicators. The article highlights the importance of primary care physicians understanding these dynamics since their management is vital in implementing public policies for UHC.
Collapse
Affiliation(s)
- Rosendo Zanga
- Policies and System of Health Program, School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
3
|
Lagarde M, Papanicolas I, Stacey N. The demand for private telehealth services in low- and middle-income countries: Evidence from South Africa. Soc Sci Med 2024; 354:116570. [PMID: 39002397 DOI: 10.1016/j.socscimed.2024.116570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/19/2023] [Accepted: 01/04/2024] [Indexed: 07/15/2024]
Abstract
In low- and middle-income countries, many believe that telehealth services could significantly expand access to doctors by offering remote access at low cost. Yet, despite its convenience, telehealth care is limited by the absence of physical examination, point-of-care testing, or immediate treatment. Hence it is unclear how individuals value such options compared to standard face-to-face care. We study this issue in South Africa with general practitioners who today mostly practice in the private sector and are geographically located in wealthier areas with higher health insurance coverage. We use an incentive-compatible method to elicit robust measures of willingness-to-pay (WTP) for telehealth and face-to-face consultations with general practitioners in a sample of uninsured individuals. We find that only 36% of respondents are willing to pay the prevailing market price for a telehealth consultation. We find average WTP for in-person consultations is only 10% higher than that of telehealth. Additionally, individuals with higher health needs are willing to pay a premium for face-to-face consultations, while others are indifferent. Our findings suggest that private telehealth services are better suited for more minor health needs, but are unlikely to expand access to a majority unless cheaper models are introduced.
Collapse
Affiliation(s)
- Mylene Lagarde
- Department of Health Policy, London School of Economics and Political Science, United Kingdom
| | - Irene Papanicolas
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, United Kingdom
| | - Nicholas Stacey
- Department of Health Policy, London School of Economics and Political Science, United Kingdom.
| |
Collapse
|
4
|
Lee JT, McPake B, Putri LP, Anindya K, Puspandari DA, Marthias T. The effect of health insurance and socioeconomic status on women's choice in birth attendant and place of delivery across regions in Indonesia: a multinomial logit analysis. BMJ Glob Health 2023; 8:bmjgh-2021-007758. [PMID: 36650018 PMCID: PMC9853138 DOI: 10.1136/bmjgh-2021-007758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/07/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Evidence suggests that women gave birth in diverse types of health facilities and were assisted by various types of health providers. This study examines how these choices are influenced by the Indonesia national health insurance programme (Jaminan Kesehatan Nasional (JKN)), which aimed to provide equitable access to health services, including maternal health. METHODS Using multinomial logit regression models, we examined patterns and determinants of women's choice for childbirth, focusing on health insurance coverage, geographical location and socioeconomic disparities. We used the 2018 nationally representative household survey dataset consisting of 41 460 women (15-49 years) with a recent live birth. RESULTS JKN coverage was associated with increased use of higher-level health providers and facilities and reduced the likelihood of deliveries at primary health facilities and attendance by midwives/nurses. Women with JKN coverage were 13.1% and 17.0% (p<0.05) more likely to be attended by OBGYN/general practitioner (GP) and to deliver at hospitals, respectively, compared with uninsured women. We found notable synergistic effects of insurance status, place of residence and economic status on women's choice of type of birth attendant and place of delivery. Insured women living in Java-Bali and in the richest wealth quintile were 6.4 times more likely to be attended by OBGYN/GP and 4.2 times more likely to deliver at a hospital compared with those without health insurance, living in Eastern Indonesia, and in the poorest income quantile. CONCLUSION There are large variations in the choice of birth attendant and place of delivery by population groups in Indonesia. Evaluation of health systems reform initiatives, including the JKN programme and the primary healthcare strengthening, is essential to determine their impact on disparities in maternal health services.
Collapse
Affiliation(s)
- John Tayu Lee
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia,Department of Primary Care and Public Health, Imperial College London, London, London, UK,College of Health and Medicine, Australian National University, Canberra, Canberra, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Likke Prawidya Putri
- Department of Health Policy & Management, Faculty of Medicine Public Health and Nursing, Gadjah Mada University, Yogyakarta, DI Yogyakarta, Indonesia
| | - Kanya Anindya
- School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Gothenburg, Sweden
| | - Diah Ayu Puspandari
- Department of Health Policy & Management, Faculty of Medicine Public Health and Nursing, Gadjah Mada University, Yogyakarta, DI Yogyakarta, Indonesia
| | - Tiara Marthias
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia .,Department of Health Policy & Management, Faculty of Medicine Public Health and Nursing, Gadjah Mada University, Yogyakarta, DI Yogyakarta, Indonesia
| |
Collapse
|
5
|
Improving Primary Care Quality Through Supportive Supervision and Mentoring: Lessons From the African Health Initiative in Ethiopia, Ghana, and Mozambique. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00667. [PMID: 36109059 PMCID: PMC9476486 DOI: 10.9745/ghsp-d-21-00667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/07/2022] [Indexed: 11/15/2022]
Abstract
Systematic approaches to positioning technical support, enhancing systems, and promoting sustainment are crucial to strengthening supportive supervision and mentoring in primary health care systems. The African Health Initiative projects in Ethiopia, Ghana, and Mozambique have lessons to share from such experiences that stakeholders can apply to similar efforts in other countries. Introduction: Supportive supervision and mentoring (SSM) is crucial to primary care quality and effectiveness. Yet, there is little clarity on how to design and implement SSM and make it sustainable in primary health care (PHC) systems. The 3 African Health Initiative partnership projects introduced strategies to do this in Ethiopia, Ghana, and Mozambique. We describe: (1) how each partnership adapted SSM implementation strategies, (2) the dynamics of implementation and change that ensued after intervening within PHC systems, and (3) insights on the SSM sustainability as a mainstay of PHC. Methods: Researchers from each project collaboratively wrote a cross-country protocol based on those objectives. For this, they adapted implementation science frameworks—the Exploration, Preparation, Implementation, and Sustainment model and the Consolidated Framework for Implementation Research—through a qualitative theme reduction process. This resulted in harmonized lines of inquiry on the design, implementation, and potential sustainability of each project’s SSM strategy. In-depth interviews and focus group discussions were conducted with stakeholders from PHC systems in each country and thematic analyses ensued. Results: Across the projects, SSM strategies acquired multiple components to address individual, systems, and process-related determinants. Benefits arose from efforts that addressed worker-level attitudes and barriers, promoted a wider learning environment, and enhanced collaborative structures and tools for monitoring performance. Peer exchanges and embedded implementation research were critical to the perceived effectiveness of SSM strategies. Discussion: Despite differences in their approach to SSM implementation, there are common crucial ingredients across the SSM strategies of the 3 AHI partner projects from which important lessons arise: (1) positioning learning and adaptation opportunities within the routine workings of PHC systems, facilitation, and technical support to reflect and utilize new knowledge; (2) multisectoral collaboration, particularly with academic organizations; and (3) building PHC decision-makers’ and implementation teams’ capacity for evidence-informed change.
Collapse
|
6
|
Horizontal Integration and Financing Reform of Rural Primary Care in China: A Model for Low-Resource and Remote Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148356. [PMID: 35886206 PMCID: PMC9323543 DOI: 10.3390/ijerph19148356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 02/06/2023]
Abstract
Primary health care (PHC) systems are compromised by under-resourcing and inadequate governance, and fail to provide high-quality health care services in most low- and middle-income countries (LMICs). As a response to solve the problems of underfunding and understaffing, Pengshui County, an impoverished area in rural Chongqing, China, implemented a profound reform of its PHC delivery system in 2009, focusing on horizontal integration and financing mechanisms. This paper aims to present new evidence from the Pengshui model, and to assess the relevant changes over the past 10 years (2009–2018). An inductive approach was adopted, based on analysis of national and local policy documents and administrative data. From 2009 to 2018, the proportion of outpatients who sought first-contact care in rural community or township health centers increased from 29% (522,700 of 1,817,600) in 2009, to 40% (849,900 of 2,147,800) in 2018 (the national average in 2018 was 23%). Our findings suggest that many positive results have been achieved through the reform, and that innovations in financial governance and incentive mechanisms are the main driving forces behind the improvement. Pengshui County’s experience has proven to be a successful experiment, particularly in rural and low-income areas.
Collapse
|
7
|
Soares Filho AM, Vasconcelos CH, Dias AC, Souza ACCD, Merchan-Hamann E, Silva MRFD. Atenção Primária à Saúde no Norte e Nordeste do Brasil: mapeando disparidades na distribuição de equipes. CIENCIA & SAUDE COLETIVA 2022; 27:377-386. [DOI: 10.1590/1413-81232022271.39342020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 11/20/2020] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetiva-se analisar o padrão espacial de implantação de equipes da Atenção Primária à Saúde (APS) no Norte e Nordeste do Brasil em 2017. Estudo ecológico das taxas de Agentes Comunitários de Saúde (ACS), equipes Saúde da Família (eSF), equipes Saúde Bucal (eSB) e Núcleo Ampliado de Saúde da Família (NASF), a partir de dados do Ministério da saúde (MS). A análise dos dados de área permitiu a identificação de padrões de dependência espacial dos municípios para as taxas, utilizando os índices e mapas de Moran para visualizar clusters de áreas críticas (95% de confiança). Os municípios do Norte (n=450) e Nordeste (n=1.794) apresentaram 132,2 mil ACS, 18,4 mil eSF, 13 mil eSB e 2,2 mil NASF. A proporção de municípios com taxas dentro do preconizado pelo MS: ACS (>1,33/mil) 96% no Norte e 98,5% no Nordeste; eSF (>2,9/10 mil) 54% e 80% nas respectivas regiões; eSB (>2,9/10 mil) 28% e 59% nestas respectivas regiões. Equipes NASF foram implantadas em 70% do Norte e 89% do Nordeste. Exceto ACS, a região Norte constituiu-se em área crítica de equipes, principalmente no Pará, Rondônia, Amazonas e Amapá. No Nordeste, essas áreas foram menores e concentradas a oeste da Bahia e leste do Maranhão. O Nordeste exibiu melhor composição de equipes e menor extensão de áreas críticas.
Collapse
|
8
|
Narwal S, Jain S. Building Resilient Health Systems: Patient Safety during COVID-19 and Lessons for the Future. JOURNAL OF HEALTH MANAGEMENT 2021. [DOI: 10.1177/0972063421994935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: The COVID-19 pandemic has profoundly impacted the country’s health systems and diminished its capability to provide safe and effective healthcare. This article attempts to review patient safety issues during COVID-19 pandemic in India, and derive lessons from national and international experiences to inform policy actions for building a ‘resilient health system’. Methods: Systematic review of existing published articles, government and media reports was undertaken. Online databases were searched using key terms related to patient safety during COVID-19 and health systems resilience. Seventy-three papers were included dependent on their relevance to research objectives. Findings: Patient safety was impacted during COVID-19, owing to sub-optimal infection prevention and control measures coupled with reduced access to essential health services. This was largely due to inadequate infrastructure, human and material resources resulting from chronic underinvestment in public health systems, paucity of reliable data for evidence-based actions and limited leadership and regulatory capacity. Conclusions: India’s health systems were found ill prepared to tackle large-scale pandemic, which has major implications for patient safety. The shortcomings observed in the COVID-19 response must be rectified and comprehensive health sector reforms should be initiated for building agile and resilient health systems that can withstand future pandemics.
Collapse
Affiliation(s)
| | - Susmit Jain
- Associate Professor, IIHMR University, Jaipur, India
| |
Collapse
|
9
|
Ranzi DVM, Nachif MCA, Soranz DR, Marcheti PM, Santos MLDMD, Carli ADD. Laboratory for innovation in Primary Health Care: implementation and results. CIENCIA & SAUDE COLETIVA 2021; 26:1999-2011. [PMID: 34231714 DOI: 10.1590/1413-81232021266.02922021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/02/2021] [Indexed: 11/21/2022] Open
Abstract
This article presents and problematizes innovation actions aimed at improving the quality of Primary Health Care (PHC), describing an experience that can be adapted to different contexts, considering diverse sociodemographic, economic, cultural and epidemiological realities. We conducted an exploratory study using documentary sources referring to the implementation of the Campo Grande Laboratory for Innovation in Primary Health Care (INOVAAPS). The project proposes the reorientation of the care model adopted in the municipality's public primary care services, redefining work processes and improving the quality of practice. We identified product, process and organizational innovations that have the potential to transform and tailor health care practices to the population's health needs. It is concluded that the proposals implemented by the project focus on the consolidation and expansion of access to primary care, recruitment and training of adequately qualified health professionals, adoption of resolutive technologies, regulatory improvement, and strengthening the mediating role of primary health care.
Collapse
Affiliation(s)
- Dinaci Vieira Marques Ranzi
- Governo do Estado de Mato Grosso do Sul. Av. Poeta Manoel de Barros, Bloco 8, Parque dos Poderes Governador Pedro Pedrossian. 79031-350 Campo Grande MS Brasil
| | - Maria Cristina Abrão Nachif
- Governo do Estado de Mato Grosso do Sul. Av. Poeta Manoel de Barros, Bloco 8, Parque dos Poderes Governador Pedro Pedrossian. 79031-350 Campo Grande MS Brasil
| | | | - Priscila Maria Marcheti
- Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul (UFMS). Campo Grande MS Brasil
| | | | | |
Collapse
|
10
|
Annual Primary Care 2030 Convening: Creating an Enabling Ecosystem for Person-Centered Primary Healthcare Models to Achieve Universal Health Coverage in Low- and Middle-Income Countries. Ann Glob Health 2020; 86:106. [PMID: 32874937 PMCID: PMC7442168 DOI: 10.5334/aogh.2948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The 2019 United Nations General Assembly High-Level Meeting on Universal Health Coverage and the 2018 Declaration of Astana reaffirm the highest level of political commitment by United Nations Member States to achieve access to health services and primary healthcare for all. Both documents emphasize the importance of person-centered care in both healthcare services and systems design. However, there is limited consensus on how to build a strong primary healthcare system to achieve these goals. Methods: We convened a diverse group of global stakeholders for a high-level dialogue on how to create a person-centered primary healthcare system, using the country examples of the Republic of Kenya and the Socialist Republic of Vietnam. We focused our discussion on four themes to enable the creation of person-centered primary healthcare systems in Kenya and Vietnam: (1) strengthened community, person and patient engagement in subnational and national decision making; (2) improved service delivery; (3) impactful use of innovation and technology; and (4) meaningful and timely use of measurement and data. Findings: Here, we present a summary of our convening’s proceedings, with specific insights on how to enable a person-centered primary healthcare system within each of these four domains. Conclusions: Following the 2019 United Nations General Assembly High-Level Meeting on Universal Health Coverage and the 2018 Declaration of Astana, there is high-level commitment and global consensus that a person-centered approach is necessary to achieve high-quality primary healthcare and universal health coverage. We offer our recommendations to the global community to catalyze further discourse and inform policy-making and program development on the path to Universal Health Coverage by 2030.
Collapse
|
11
|
Ndlovu Z, Burton R, Stewart R, Bygrave H, Roberts T, Fajardo E, Mataka A, Szumilin E, Kerschberger B, Van Cutsem G, Ellman T. Framework for the implementation of advanced HIV disease diagnostics in sub-Saharan Africa: programmatic perspectives. Lancet HIV 2020; 7:e514-e520. [PMID: 32473102 DOI: 10.1016/s2352-3018(20)30101-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 01/21/2023]
Abstract
Patients with advanced HIV disease have a high risk of mortality, mainly from tuberculosis and cryptococcal meningitis. The advanced HIV disease management package recommended by WHO, which includes diagnostics, therapeutics, and patient psychosocial support, is barely implemented in many different countries. Here, we present a framework for the implementation of advanced HIV disease diagnostics. Laboratory and point-of-care-based reflex testing, coupled with provider-initiated requested testing, for cryptococcal antigen and urinary Mycobacterium tuberculosis lipoarabinomannan antigen, should be done for all patients with CD4+ cell counts of 200 cells per μL or less. Implementation of the advanced HIV disease package should be encouraged within primary health-care facilities and task shifting of testing to lay cadres could facilitate access to rapid results. Implementation of differentiated antiretroviral therapy delivery models can allow clinicians enough time to focus on the management of patients with advanced HIV disease. Efficient up-referral and post-discharge systems, including the development of patient-centric advanced HIV disease literacy, are also crucial. Implementation of the advanced HIV disease package is feasible at all health-care levels, and it should be part of the core of the global response towards ending AIDS as a public health threat.
Collapse
Affiliation(s)
- Zibusiso Ndlovu
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa.
| | - Rosie Burton
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa
| | | | - Helen Bygrave
- Médecins Sans Frontières, Access Campaign, Geneva, Switzerland
| | - Teri Roberts
- Médecins Sans Frontières, Access Campaign, Geneva, Switzerland
| | | | - Anafi Mataka
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | | | | | - Gilles Van Cutsem
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
| | - Tom Ellman
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa
| |
Collapse
|