Cost and unit cost calculations using step-down accounting

There is paucity of unit cost data from low- and middle-income countries, although recent initiatives have emerged to help rectify this. The limited budgets assigned to health care facilities mean that health planners and managers must be able to account for the resources used in health facilities as well as use them efficiently. Step-down cost accounting (SDCA) offers a relatively simple method for generating cost and unit cost data at the facility level. However, to the best of our knowledge, there is a lack of clear and concise guidance on how to undertake SDCA. Therefore, this paper, using a worked example, illustrates the different steps involved to generate cost and unit costs for a small hospital.     

A comparison of bottle tops,teaspoons and WHO glucose-electrolyte packets for home made oral rehydration solutions in The Gambia

Three methods of preparation of oral rehydration solution were taught to Gambian mothers and the sodium concentration and osmolality of the solutions prepared were estimated. Most of the solutions made up using WHO glucose-electrolyte mix had a satisfactory sodium content (70 to 120 mmol/l) and osmolality (200 to 350 mosmoles/kg). Of the sugar and salt mixtures using a teaspoon as a measure, 17% were hypertonic (>120 mmol sodium/l) and 24% were hyperosmolar (>350 mosmol/kg). Nearly all the sugar and salt solutions prepared using a soft drink bottle top as a measure had sodium contents of 30–88 mmol/l and none was hyperosmolar. We suggest that wider trials of this simple, widely available measure are indicated.     

Understanding why HIV-infected persons disengaged from pre-ART care in Freetown,Sierra Leone: a qualitative study*

In countries that have not implemented universal antiretroviral treatment (ART), loss to follow-up (LTFU) during pre-ART care remains a problem. We conducted semi-structured interviews with 41 HIV-infected persons who were LTFU during pre-ART care from a prospective cohort of persons newly diagnosed with HIV infection in Freetown, Sierra Leone, in 2012–2013. Interviews determined whether the participant disengaged or transferred care and explored the reasons for being LTFU. Of the 41 participants, 34 (83%) disengaged from care. For persons who disengaged from care, socioeconomic barriers emerged as a dominant theme in both ART-eligible and -ineligible groups while psychosocial barriers emerged as a dominant theme in the ART-ineligible group. Structural barriers emerged as a dominant theme for participants who transferred care. Interventions designed to address socioeconomic and psychosocial barriers may help reduce disengagement from pre-ART care.     

Perceptions and acceptability of an experimental Ebola vaccine among health care workers,frontline staff,and the general public during the 2014–2015 Ebola outbreak in Sierra Leone

Introduction

Experimental Ebola vaccines were introduced during the 2014–2015 Ebola outbreak in West Africa. Planning for the Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE) was underway in late 2014. We examined hypothetical acceptability and perceptions of experimental Ebola vaccines among health care workers (HCWs), frontline workers, and the general public to guide ethical communication of risks and benefits of any experimental Ebola vaccine.

A national system for monitoring the performance of hospitals in Ethiopia

Many countries struggle to develop and implement strategies to monitor hospitals nationally. The challenge is particularly acute in low-income countries where resources for measurement and reporting are scarce. We examined the experience of developing and implementing a national system for monitoring the performance of 130 government hospitals in Ethiopia. Using participatory observation, we found that the monitoring system resulted in more consistent hospital reporting of performance data to regional health bureaus and the federal government, increased transparency about hospital performance and the development of multiple quality-improvement projects. The development and implementation of the system, which required technical and political investment and support, would not have been possible without strong hospital-level management capacity. Thorough assessment of the health sector’s readiness to change and desire to prioritize hospital quality can be helpful in the early stages of design and implementation. This assessment may include interviews with key informants, collection of data about health facilities and human resources and discussion with academic partners. Aligning partners and donors with the government’s vision for quality improvement can enhance acceptability and political support. Such alignment can enable resources to be focused strategically towards one national effort – rather than be diluted across dozens of potentially competing projects. Initial stages benefit from having modest goals and the flexibility for continuous modification and improvement, through active engagement with all stakeholders.