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Background: Infectious disease outbreaks like Ebola and Covid-19 are increasing in frequency. They may harm reproductive, maternal and newborn health (RMNH) directly and indirectly. Sierra Leone experienced a sharp deterioration of RMNH during the 2014–16 Ebola epidemic. One possible explanation is that donor funding may have been diverted away from RMNH to the Ebola response. Methods: We analysed donor-reported data from the Organisation for Economic Cooperation and Development (OECD)'s Creditor Reported System (CRS) data for Sierra Leone before, during and after the 2014–16 Ebola epidemic to understand whether aid flows for Ebola displaced aid for RMNH. We estimated aid for Ebola using key term searches and manual review of CRS records. We estimated aid for RMNH by applying the Muskoka-2 algorithm to the CRS and analysing CRS purpose codes. Results: We find substantial increases in aid to Sierra Leone (from $484 million in 2013 to $1 billion at the height of the epidemic in 2015), most of which was earmarked for the Ebola response. Overall, Ebola aid was additional to RMNH funding. RMNH aid was sustained during the epidemic (at $42 m per year) and peaked immediately after (at $77 m in 2016). There is some evidence of a small displacement of RMNH aid from the UK during the period when its Ebola funding increased. Conclusions: Modest changes to RMNH donor aid patterns are insufficient to explain the severe decline in RMNH indicators recorded during the outbreak. Our findings therefore suggest the need for substantial increases in routine aid to ensure that basic RMNH services and infrastructure are strong before an epidemic occurs, as well as increased aid for RMNH during epidemics like Ebola and Covid-19, if reproductive, maternal and newborn healthcare is to be maintained at pre-epidemic levels. [ABSTRACT FROM AUTHOR]

Many low- and middle-income countries facing high levels of antimicrobial resistance, and the associated morbidity from ineffective treatment, also have a high burden of tuberculosis. Over recent decades many countries have developed effective laboratory and information systems for tuberculosis control. In this paper we describe how existing tuberculosis laboratory systems can be expanded to accommodate antimicrobial resistance functions. We show how such expansion in services may benefit tuberculosis case-finding and laboratory capacity through integration of laboratory services. We further summarize the synergies between high-level strategies on tuberculosis and antimicrobial resistance control. These provide a potential platform for the integration of programmes and illustrate how integration at the health-service delivery level for diagnostic services could occur in practice in a low- and middle- income setting. Many potential mutual benefits of integration exist, in terms of accelerated scale-up of diagnostic testing towards rational use of antimicrobial drugs as well as optimal use of resources and sharing of experience. Integration of vertical disease programmes with separate funding streams is not without challenges, however, and we also discuss barriers to integration and identify opportunities and incentives to overcome these. De nombreux pays a revenu faible et intermediaire qui sont confrontes a une forte resistance aux antlmicrobiens ainsi qu'a la morbidite associee, due a l'inefficacite des traitements, sont aussi fortement touches par la tuberculose. Ces dernieres decennies, de nombreux pays ont mis au point des systemes efficaces d'information et de laboratoire afin de combattre la tuberculose. Dans cet article, nous decrivons la maniere dont les systemes existants des laboratoires specialises dans la tuberculose peuvent etre elargis afin d'integrer des fonctions applicables a la resistance auxantimicrobiens. Nous montrons comment cet elargissement des services pourrait contribuer au depistage de la tuberculose et aux capacites des laboratoires par l'integration de services de laboratoire. Nous faisons par ailleurs le point sur les synergies entre les strategies de haut niveau sur la tuberculose et la lutte contre la resistance aux antimicrobiens. Celles-ci offrent des possibilites pour l'integration de programmes et illustrent la maniere dont l'integration au niveau de la prestation des services de diagnostic pourrait se faire en pratique dans les regions a revenu faible et intermediaire. L'integration pourrait apporter de nombreux benefices mutuels, comme l'expansion plus rapide des tests de diagnostic en vue d'une utilisation rationnelle des medicaments antimicrobiens, d'une utilisation optimale des ressources et d'un partage d'experience. L'integration de programmes verticaux de lutte contre les maladies, qui ont des sources de financement differentes, n'est cependant pas chose simple. Nous evoquons egalement les obstacles a cette integration ainsi que les perspectives et les mesures incitatives pour les surmonter. Muchos paises de ingresos bajosy medianos que enfrentan altos niveles de resistencia a los antimicrobianos, asi como la morbilidad asociada por un tratamiento Ineficaz, tambien presentan una alta incidencia de tuberculosis. En las ultimas decadas, muchos paises han desarrollado sistemas efectivos de laboratorio e informacion para el control de la tuberculosis. En este documento describimos como los sistemas de laboratorio de tuberculosis existentes pueden ampliarse para dar cabida a las funciones de resistencia a los antimicrobianos. Mostramos como dicha expansion en los servicios puede beneficiar la busqueda de casos de tuberculosis y la capacidad de laboratorio a traves de la integracion de los servicios de laboratorio. Resumimos las sinergias entre las estrategias de alto nivel sobre la tuberculosis y el control de la resistencia a los antimicrobianos. Estos proporcionan una plataforma potencial para la integracion de programas e ilustran como la integracion en el nivel de prestacion de servicios de salud para los servicios de diagnostico podria ocurrir en la practica en un entorno de ingresos bajosy medianos. Existen muchos beneficios mutuos potenciales de la integracion, en terminos de una mejora acelerada de las pruebas de diagnostico hacia el uso racional de los medicamentos antimicrobianos, asi como el uso optimo de los recursos y el intercambio de experiencias. Sin embargo, la integracion de programas de enfermedades verticales con flujos de financiacion separados no esta exenta de desafios, y tambien examinamos los obstaculos a la integracion e identificamos oportunidades e incentivos para superarlas. [phrase omitted], Introduction Public health programmes that address the threats of antimicrobial resistance and of tuberculosis are major contributors towards gains in global health. (1,2) Unlike tuberculosis, antimicrobial resistance is not specifically [...]

Existing definitions and measurement approaches of quality of health care often fail to address the complexities involved in understanding quality of care. It is perceptions of quality, rather than clinical indicators of quality, that drive service utilization and are essential to increasing demand. Here we reflect on the nature of quality, how perceptions of quality influence health systems and what such perceptions indicate about measurement of quality within health systems. We discuss six specific challenges related to the conceptualization and measurement of the quality of care: perceived quality asa driver of service utilization; quality as a concept shaped overtime through experience; responsiveness as a key attribute of quality; the role of management and other so-called upstream factors; quality as a social construct co-produced by families, individuals, networks and providers; and the implications of our observations for measurement. Within the communities and societies where care is provided, quality of care cannot be understood outside social norms, relationships, trust and values. We need to improve not only technical quality but also acceptability, responsiveness and levels of patientprovider trust. Measurement approaches need to be reconsidered. An improved understanding of all the attributes of quality in health systems and their interrelationships could support the expansion of access to essential health interventions. Les definitions et approches devaluation existantes de la qualite des soins de sante ne couvrent souvent pas toutes les complexites en jeu pour correctement apprehender la qualite des soins. Ce sont les perceptions de la qualite, plutot que les indicateurs cliniques de la qualite, qui expllquent generalement le recours aux services de soins et determinent i'augmentation de la demande. Dans cet article, nous nous penchons sur la nature de la qualite, sur la maniere dont les perceptions de la qualite influent sur les systemes de sante et sur ce que ees perceptions indiquent en termes devaluation de la qualite au sein des systemes de sante. Nous y evoquons six defis specifiques, lies a la conceptualisation et a Evaluation de la qualite des soins: la qualite percue en tant que facteur determinant de l'utilisation des services; la qualite en tant que concept faconne au fil du temps par l'experience; la reactivite en tant que caracteristique cie de la qualite; le role des pratiques de gestion et d'autres facteurs <>; la qualite en tant que construction sociale coproduite par les families, les individus, les reseaux et les prestataires; et les implications de nos observations en termes d'evaluation. Dans les communautes et societes dans lesquelles les soins sont dispenses, la qualite des soins ne peut pas etre comprise independamment des normes, relations et valeurs sociales et du climat de confiance en presence. Nous devons ameliorer non seulement la qualite technique mais aussi l'acceptabillte, la reactivite et le climat de confiance entre les patients et les prestataires de soins. II est done necessaire de reconsiderer les approches d'evaluation. Une meilleure comprehension de toutes les facettes de la qualite dans les systemes de sante et de leurs correlations pourrait contribuer a etendre l'acces aux interventions sanitaires essentielles. Las definiciones y los enfoques de medicion existentes de la calidad de la atencion sanitaria no suelen abordar las complejidades involucradas en la comprension de la calidad de la atencion. Son las percepciones de la calidad, y no los indicadores clinicos de calidad, lo que Impulsa la utilizacion de los servicios y son esenciales para el aumento de la demanda. Este articulo se centra en la naturaleza de la calidad, la forma en que las percepciones de la calidad influencian los sistemas sanitarios y que indican dichas percepciones sobre la medicion de la calidad de los sistemas sanitarios. Se analizan seis desafios especificos relacionados con la conceptualization y la medicion de la calidad de la atencion: la calidad aparente como un impulsor de la utilizacion de los servicios; la calidad como un concepto formado con el tiempo a traves de la experiencia; la capacidad de respuesta como un atributo fundamental de la calidad; el papel de la gestion y otros factores denominados previos; la calidad como una construccion social coproducida por las familias, individuos, redes y profesionales; y las implicaciones de nuestras observaciones para la medicion. Dentro de las comunidades y sociedades en las que se ofrece atencion, la calidad de la misma no puede concebirse sin tener en cuenta las normas sociales, las relaciones, la confianza y los valores. Es necesario mejorar la calidad tecnica, asi como la aceptacion, la capacidad de respuesta y los niveles de confianza entre paciente y profesional. Conviene reconsiderar los enfoques de medicion. Una mejor comprension de todos los atributos de la calidad de los sistemas sanitarios y sus interrelaciones podria dar apoyo a la expansion del acceso a intervenciones sanitarias basicas., Introduction Policies to improve population health have often focused exclusively on the expansion of access to basic health services, to the neglect of quality of care. Efforts to increase the [...]