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Child-appropriate medicines are essential for the safe and effective treatment of children, yet we have observed a large gap in the data required to adequately monitor access to these medicines. We have examined data on the availability and pricing of child-appropriate medicines across 50 surveys. Child-appropriate medicines for nine out of 12 priority diseases in children were infrequently surveyed or not at all. A similar data deficit on age-appropriate medicines is detectable in the broader scientific literature. We also note that existing instruments for collecting data on the availability or prices of medicines are limited in their ability to generate the required data for children. We have identified four priorities as key for improved monitoring of access to medicines for children: (i) dedicated child medicine surveys are needed on availability and prices of child-appropriate medicines; (ii) standardized survey instruments should include age-appropriate medicines and dosages; (iii) health facility service readiness survey tools should include the collection of data on the price of child-appropriate medicines in addition to the availability of medicines; and (iv) sustainable development goal indicator 3.b.3 should be modified to enable the monitoring of access to medicines for children. These deficiencies need to be addressed to ensure the monitoring of access to child medicines as part of the sustainable development goal agenda for 2030 and to implement appropriate interventions for improving access for this vulnerable population. Disposer de medicaments adaptes aux enfants est essentiel a l'administration d'un traitement sur et efficace. Pourtant, nous avons observe de vastes lacunes dans les donnees requises pour evaluer l'acces a ces medicaments. Nous avons passe 50 enquetes au crible, a la recherche d'informations sur la disponibilite et le prix des medicaments pediatriques. Dans le cas de neufmaladies infantiles prioritaires sur douze, les medicaments adaptes aux enfants n'etaient pas ou peu etudies. Meme constat dans le contexte plus large de la litterature scientifique. Nous avons egalement remarque que les instruments servant a recolter des donnees sur la disponibilite ou le prix des medicaments avaient leurs limites et ne permettaient pas d'obtenir les informations requises concernant les enfants. Nous avons identifie quatre priorites majeures en vue d'ameliorer la surveillance de l'acces aux medicaments pediatriques: (i) la realisation d'enquetes sur les medicaments pediatriques afin d'en connaitre la disponibilite et le prix; (ii) l'integration des medicaments et dosages adequats dans les instruments d'enquete standard; (iii) outre la disponibilite, la prise en compte du prix des medicaments a usage pediatrique dans les outils d'evaluation de l'etat de preparation des services au sein des etablissements de sante; et enfin, (iv) la modification de l'indicateur 3.b.3 des objectifs de developpement durable, qui prevoirait des lors un controle de l'acces aux medicaments adaptes aux enfants. Ces lacunes doivent etre comblees pour assurer un suivi en matiere d'acces aux medicaments pediatriques dans le cadre du Programme de developpement durable a l'horizon 2030, mais aussi pour adopter les mesures correspondantes afin d'ameliorer la prise en charge de cette population vulnerable. Los medicamentos indicados para los ninos son esenciales para su tratamiento seguro y eficaz, pero se ha observado un gran vacio en los datos necesarios para supervisar de manera adecuada el acceso a estos medicamentos. Se han analizado los datos sobre la disponibilidad y el precio de los medicamentos indicados para los ninos en 50 encuestas. Estos medicamentos para nueve de las 12 enfermedades prioritarias infantiles se encuestaron con poca frecuencia o no se encuestaron en absoluto. En la literatura cientifica mas general, se detecta un deficit de datos similar sobre los medicamentos adecuados para la edad. Tambien se observa que los instrumentos existentes para recopilar los datos sobre la disponibilidad o los precios de los medicamentos son limitados en su capacidad para generar los datos necesarios en el caso de los ninos. Se han identificado cuatro prioridades para mejorar el seguimiento del acceso a los medicamentos pediatricos: (i) se necesitan encuestas especificas sobre la disponibilidad y los precios de los medicamentos indicados para los ninos; (ii) los instrumentos de encuesta estandarizados deben incluir medicamentos y dosis adecuados para la edad; (iii) las herramientas de encuesta sobre la disponibilidad de los servicios sanitarios deben incluir la recopilacion de los datos sobre el precio de los medicamentos indicados para los ninos, ademas de la disponibilidad de los medicamentos; y (iv) el indicador 3.b.3 del Objetivo de Desarrollo Sostenible se debe modificar para permitir el seguimiento del acceso a los medicamentos pediatricos. Es preciso solucionar estas deficiencias para garantizar el seguimiento del acceso a los medicamentos pediatricos como parte de la agenda de los objetivos de desarrollo sostenible para 2030 y aplicar las intervenciones adecuadas para mejorar el acceso de esta poblacion vulnerable., Introduction The importance of access to available and affordable essential medicines for all is embodied in targets 3.8 and 3.b of the sustainable development goals (SDGs) and remains a priority [...]

The 21st century presents significant global health challenges that necessitate an integrated health workforce capable of delivering person-centered and integrated healthcare services. Interprofessional collaboration (IPC) plays a vital role in achieving integration and training an IPC-capable workforce in sub-Saharan Africa (SSA) has become imperative. This study aims to assess changes in IPC confidence among learners participating in a team-based, case-based HIV training programme across diverse settings in SSA. Additionally, it sought to examine the impact of different course formats (in-person, synchronous virtual, or blended learning) on IPC confidence. Data from 20 institutions across 18 SSA countries were collected between May 1 and December 31, 2021. Logistic regression analysis was conducted to estimate associations between variables of interest and the increases in IPC confidence. The analysis included 3,842 learners; nurses comprised 37.9% (n = 1,172) and physicians 26.7% (n = 825). The majority of learners (67.2%, n = 2,072) were pre-service learners, while 13.0% (n = 401) had graduated within the past year. Factors significantly associated with increased IPC confidence included female gender, physician cadre, completion of graduate training over 12 months ago, and participation in virtual or in-person synchronous workshops (p <.05). The insights from this analysis can inform future curriculum development to strengthen interprofessional healthcare delivery across SSA. [ABSTRACT FROM AUTHOR]

Introduction Tandem spinal stenosis (TSS) refers to the narrowing of the spinal canal at two distinct anatomic areas. Symptoms can present due to either cervical myelopathy or lumbar stenosis. Consequently, determining the symptomatic anatomical levels requiring surgery can pose a challenge. We sought to identify the surgical approach associated with better patient-reported outcomes. Materials and Methods The Information Management System was queried using the International Classification of Diseases Ninth and Tenth Edition codes to identify patients who underwent simultaneous or staged decompression surgery for TSS between 2011 and 2020. Patient records were reviewed to collect data on age, sex, comorbidities, surgical approach, modified Japanese Orthopedic Association (mJOA) score, and complications. The mJOA is a validated composite assessment used to quantify postoperative neurological status. Multivariable regression models were utilized to identify factors associated with better postoperative neurological recovery. Results Among 42 patients included in the analytical cohort, 33 (78.6%) underwent simultaneous cervical and lumbar decompression, while 9 (21.4%) underwent staged decompression (cervical followed by lumbar). The patient's age, sex, comorbid conditions, and American Society of Anesthesiologists level were similar between the two groups. Furthermore, simultaneous decompression was associated with higher blood loss (676.97 vs. 584.44 mL) and an increased need for transfusion (259.09 vs. 111.11 mL) compared with staged decompression. Moreover, patients who underwent simultaneous decompression experienced a higher number of postoperative complications (10 vs. 1; p = 0.024). Notably, postoperative mJOA scores improved in both groups; however, the improvement was more pronounced in the staged group (mJOA score: 15.16% [ ± 2.18] vs. 16.56% [ ± 1.59]). On follow-up visits, patients who underwent staged decompression showed better recovery rates (mJOA score: 78.20% [ ± 24.45] vs. 59.75% [ ± 25.05]). Conclusion The patient's clinical history and examination findings should be the main determinants of surgical decision-making. Our study showed a slightly higher postoperative mJOA score and a recovery rate with fewer complications in staged decompression of TSS. [ABSTRACT FROM AUTHOR]

Introduction: The large number of deaths among children with HIV is driven by poor antiretroviral treatment (ART) coverage among this cohort. The aim of the study was to assess the availability and stock‐outs of paediatric and adult ART formulations in Kenya and Uganda across various regions and types of health facilities. Methods: A survey on availability and stock‐outs of paediatric ART at health facilities was adapted from the standardized Health Action International–WHO Medicine Availability Monitoring Tool. All preferred and limited‐use formulations, and three phased‐out formulations according to the 2021 WHO optimal formulary list were included in the survey, as well as a selection of adult ART formulations suitable for older children, adolescents, and adults. Availability data were collected in June–July 2022 and stock‐out data were obtained over the previous year from randomly selected public and private‐not‐for‐profit (PNFP) facilities registered to dispense paediatric ART across six districts per country. All data were analysed descriptively. Results: In total, 144 health facilities were included (72 per country); 110 were public and 34 PNFP facilities. Overall availabilities of preferred paediatric ART formulations were 52.2% and 63.5% in Kenya and Uganda, respectively, with dolutegravir (DTG) 10 mg dispersible tablets being available in 70.2% and 77.4% of facilities, respectively, and abacavir/lamivudine dispersible tablets in 89.8% and 98.2% of facilities. Of note, availability of both formulations was low (37.5% and 62.5%, respectively) in Kenyan PNFP facilities. Overall availabilities of paediatric limited‐use products were 1.1% in Kenya and 1.9% in Uganda. At least one stock‐out of a preferred paediatric ART formulation was reported in 40.0% of Kenyan and 74.7% of Ugandan facilities. Nevirapine solution stock‐outs were reported in 43.1% of Ugandan facilities, while alternative formulations for postnatal HIV prophylaxis were not available. Conclusions: Recommended DTG‐based first‐line ART for children across all ages was reasonably available at health facilities in Kenya and Uganda, with the exception of Kenyan PNFP facilities. Availability of paediatric ART formulations on the limited‐use list was extremely low across both countries. Stock‐outs were reported regularly, with the high number of reported stock‐outs of neonatal ART formulations in Uganda being most concerning. [ABSTRACT FROM AUTHOR]

To ensure equitable access to medicines and vaccines, organizational efforts and purchase volumes have been pooled in joint procurements and negotiations for decades in some regions of the world, as well as globally through supranational procurement mechanisms. In Europe, countries started to collaborate on procurement and negotiations recently when it became increasingly difficult to ensure access to high-priced medicines, even in high-income countries. Two European country collaborations (the Nordic Pharmaceutical Forum and the Baltic Procurement Initiative) have successfully concluded at least one joint tender process for medicines and vaccines and the Beneluxa Initiative has concluded its first successful joint price negotiation. This article describes the experiences of these country collaborations. Challenges observed included: legal barriers; institutional and organizational differences between health-care systems in member countries; and the risk that suppliers will be reluctant to cooperate with country collaborations. Although these collaborations helped improve access to medicines and vaccines for the countries involved, in situations such as a global health crisis, larger-scale, more-inclusive initiatives are needed. In the current coronavirus disease 2019 (COVID-19) pandemic, COVID-19 Vaccines Global Access (COVAX) initiative established a global procurement mechanism to ensure the equitable distribution of COVID-19 vaccines globally. Despite differences in organization and scale, the European country collaborations and COVAX have some similarities: (i) their success depends on the increased purchasing power associated with pooled order volumes; (ii) expert knowledge and previous procurement experience is pooled; (iii) they perform other collaborative activities that go beyond procurement alone; and (iv) they actively involve external partners and stakeholders. Depuis des decennies, certaines regions du monde ont uni leurs efforts pour s'organiser, negocier et effectuer des achats groupes de grandes quantites afin d'assurer un acces equitable aux medicaments et vaccins. Des mecanismes d'acquisition supranationaux ont fait de meme a l'echelle planetaire. En Europe, des Etats ont recemment commence a collaborer en matiere d'achat et de negociation lorsqu'il est devenu de plus en plus difficile de garantir l'acces a des medicaments couteux, y compris dans les pays a haut revenu. Deux collaborations entre pays europeens (le Forum pharmaceutique nordique et l'Initiative d'acquisition de la Baltique) ont mene a bien au moins un processus d'offre conjoint pour des medicaments et vaccins, tandis que l'Initiative Beneluxa a conclu sa premiere negociation tarifaire conjointe. Cet article decrit les experiences liees a ces collaborations entre nations. Plusieurs defis se sont poses, notamment des obstacles juridiques; des differences institutionnelles et organisationnelles entre les systemes de sante des Etats membres; et enfin, le risque que les fournisseurs soient peu enclins a accepter ces collaborations entre pays. Bien que ces collaborations aient ameliore l'acces aux medicaments et vaccins pour les pays impliques, des initiatives plus globales et a plus grande echelle sont necessaires dans des situations telles qu'une crise sanitaire mondiale. Durant l'actuelle pandemie de maladie a coronavirus 2019 (COVID-19), l'initiative COVAX (COVID-19 Vaccines Global Access) a abouti a un dispositif d'approvisionnement mondial pour veiller a distribuer equitablement des vaccins contre la COVID-19 dans le monde. Malgre des variations d'organisation et d'echelle, les collaborations entre Etats europeens partagent des similitudes avec le COVAX: (i) le succes de ces deux demarches depend d'un accroissement du pouvoir d'achat combine a des volumes de commande groupes; (ii) elles mettent en commun les connaissances approfondies et experiences passees; (iii) elles menent d'autres activites collectives qui depassent le simple cadre de l'acquisition; et enfin, (iv) elles impliquent activement une serie d'intervenants et de partenaires externes. Para garantizar un acceso equitativo a los medicamentos y las vacunas, los esfuerzos organizativos y los volumenes de compra se han unido en adquisiciones y negociaciones conjuntas durante decadas en algunas regiones del mundo, asi como a nivel mundial a traves de mecanismos de adquisicion supranacionales. En Europa, los paises empezaron a colaborar en las adquisiciones y negociaciones recientemente, cuando se hizo cada vez mas dificil garantizar el acceso a los medicamentos con precios altos, incluso en los paises de renta alta. Dos colaboraciones de paises europeos (el Foro Farmaceutico Nordico y la Iniciativa de Adquisicion del Baltico) han concluido con exito al menos un proceso de licitacion conjunta de medicamentos y vacunas, y la Iniciativa Beneluxa ha concluido con exito su primera negociacion conjunta de precios. Este articulo describe las experiencias de estas colaboraciones entre paises. Entre los retos observados se encuentran: las barreras legales, las diferencias institucionales y organizativas entre los sistemas sanitarios de los paises miembros y el riesgo de que los proveedores se muestren reacios a cooperar con las colaboraciones entre paises. Aunque estas colaboraciones ayudaron a mejorar el acceso a los medicamentos y las vacunas para los paises implicados, en situaciones como una crisis sanitaria mundial, se necesitan iniciativas a mayor escala y mas inclusivas. En la actual pandemia de la enfermedad por coronavirus (COVID-19), la iniciativa Acceso global a las vacunas de la COVID-19 (COVAX, por sus siglas en ingles) establecio un mecanismo de adquisicion mundial para garantizar la distribucion equitativa de las vacunas contra la COVID-19 en todo el mundo. A pesar de las diferencias de organizacion y escala, las colaboraciones de los paises europeos y COVAX tienen algunas similitudes: i) su exito depende del mayor poder adquisitivo asociado a los volumenes de pedidos mancomunados; ii) se ponen en comun los conocimientos de los expertos y la experiencia previa en materia de adquisiciones; iii) realizan otras actividades de colaboracion que van mas alla de la mera adquisicion; e iv) implican activamente a socios y partes interesadas externas. [phrase omitted], Introduction Access to essential medicines has become a major challenge globally. Even high-income countries with health-care systems based on social solidarity are increasingly struggling to afford the high price of [...]

The South African government is moving toward universal health coverage (UHC) with the passing of the National Health Insurance (NHI) Bill. Access to quality primary healthcare (PHC) is the cornerstone of UHC principles. The South African governmental health department have begun focusing efforts on improving the efficiency and functionality of this system; that includes the involvement of private healthcare professionals and medical insurance companies. This study sought to explore perceptions of medical insurance company personnel on PHC re-engineering as part of NHI restructuring. A qualitative research design was adopted in this study. Semi-structured interviewed were conducted on 10 participants. Their responses were audio recorded and transcribed utilizing Microsoft Word® documents. Nvivo® was used to facilitate the analysis of data. A thematical approach was used to categories codes into themes. Although participants were in agreement with the current healthcare reform in South Africa. The findings of this study have highlighted several gaps in the NHI Bill at the current point in time. In order to achieve standardized quality of care at a primary level; it is imperative that reimbursement frameworks with clearly detailed service provision and accountability guidelines are developed. [ABSTRACT FROM AUTHOR]

This article presents the results of research into the impact on individual skill levels of the variables traditionally represented by human capital. The discussion is centred around the way in which education and vocational experience contribute to the process of producing useful skills in the job market or, conversely, of making them obsolete. The data comes from a survey of five banks in which we asked supervisors to assess the skills of 600 employees (counter staff and customer managers). It is a hetero-assessment based on a list of skills and behaviours. The central theme of this article is to draw attention to the process of the invalidation of acquired knowledge which individuals can be faced with and the role which banks accord to the two sources of human capital. The complementarity or substitution of sources of skills acquisition is thus proposed on a case-by-case basis. (Contains 4 tables, 1 graph, 11 footnotes, and a Bibliography.) [Appended to this document is "The Skills Acquisition Model."]