Search

Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well–being for all at all ages” [1]. Unlike the Millennium Development Goals (MDGs), SDG 3 takes a comprehensive view of health and well–being by expanding its focus beyond a core set of diseases. Given the global prominence of the SDGs for driving the development agenda, it is important to consider whether SDG 3 and the indicators it tracks are well–designed to achieve this intended goal. In order to examine whether SDG 3 can actually help achieve this goal, this article considers whether it has an adequate theory of change (ToC) for improving health systems performance. Such an analysis rests on two core assumptions: 1) in order to achieve the SDG 3 goal, one must improve health systems performance, and 2) in order to achieve this goal, the approach must have a strong underlying ToC. Each assumption is considered below. Since the launch of the MDGs, experience has shown that without improvements in health systems performance, progress on the MDGS was both limited and potentially unsustainable [2]. Bottlenecks in the health system limited nations’ ability to achieve progress on combatting specific diseases. In addition, theoretical and empirical work has argued that providing services which are not only clinically effective but also affordable and acceptable has intrinsic and instrumental value. Recognizing the importance of overall health systems performance, numerous organizations including WHO, the World Bank, Global Fund, and GAVI have focused on health systems strengthening (HSS) as an important component of public health programming. Therefore, since SDG 3 aims to improve both health and well–being for all populations in a sustainable way, achieving this goal will likely require broad improvements in health systems performance. With regards to the second assumption, theories of change (ToC) are standard practice in public health and development [3,4]. They help guide priority–setting, decision–making, monitoring and evaluation, budgeting, and resource allocation, among other activities. A strong ToC can ensure that all stakeholders work toward the same goal(s). The SDGs aim to improve both the coherence of development policies and their implementation at the national level, and the United Nations has offered formal guidance on ways that nations can integrate and tailor the SDGs into their national policies [5]. This guidance explicitly advocates for horizontal policy coherence (ie, coherence across different programs and sectors), vertical policy coherence (ie, coherence between different stakeholders), and linking national policies based on the SDGs to budgets [6]. Given that the SDGs aim to improve policy coherence and drive implementation at the national level, it is instructive to consider whether they have internal coherence and a strong underlying logic themselves. The ToC approach provides a useful approach to explore this question. If the inputs and outputs tracked under SDG 3 have clear linkages to improving its impact indicators, then working toward SDG 3 will allow countries to pursue a comprehensive program for improving health systems performance. On the other hand, if the inputs and outputs tracked do not link to each other or do not have logical connections to impact indicators, then aiming to improve all indicators under SDG 3 could lead to a haphazard and uncoordinated set of public health programs.

Introduction Improving health systems performance, especially in low-resource settings facing complex disease burdens, can improve population health. Specifically, the efficiency and effectiveness of supply chains and procurement processes for pharmaceuticals, vaccines and other health products has important implications for health system performance. Pharmaceuticals, vaccines and other health products make up a large share of total health expenditure in low-income and middle-income countries (LMICs), and they are critical for delivering health services. Therefore, programmes which achieve cost savings on these expenditures may help improve a health system9s efficiency, whereas programmes that increase availability of health products may improve a health system9s effectiveness. This systematic review investigates whether changes to supply chains and procurement processes can achieve cost savings and/or improve the availability of drugs in LMICs. Methods Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL and the Health Economic Evaluation Database to identify. Results We identified 1264 articles, of which 38 were included in our study. We found evidence that centralised procurement and tendering can achieve direct cost savings, while supply chain management programmes can reduce drug stock outs and increase drug availability for populations. Conclusions This research identifies a broad set of programmes which can improve the ways that health systems purchase and delivery health products. On the basis of this evidence, policymakers and programme managers should examine the root causes of inefficiencies in pharmaceutical supply chain and procurement processes in order to determine how best to improve health systems performance in their specific contexts.

Kangaroo mother care (KMC) is an evidence-based approach to reducing mortality and morbidity in preterm infants. Although KMC is a key intervention package in newborn health initiatives, there is limited systematic information available on the barriers to KMC practice that mothers and other stakeholders face while practicing KMC. This systematic review sought to identify the most frequently reported barriers to KMC practice for mothers, fathers, and health practitioners, as well as the most frequently reported enablers to practice for mothers. We searched nine electronic databases and relevant reference lists for publications reporting barriers or enablers to KMC practice. We identified 1,264 unique publications, of which 103 were included based on pre-specified criteria. Publications were scanned for all barriers / enablers. Each publication was also categorized based on its approach to identification of barriers / enablers, and more weight was assigned to publications which had systematically sought to understand factors influencing KMC practice. Four of the top five ranked barriers to KMC practice for mothers were resource-related: "Issues with the facility environment / resources," "negative impressions of staff attitudes or interactions with staff," "lack of help with KMC practice or other obligations," and "low awareness of KMC / infant health." Considering only publications from low- and middle-income countries, "pain / fatigue" was ranked higher than when considering all publications. Top enablers to practice were included "mother-infant attachment" and "support from family, friends, and other mentors." Our findings suggest that mother can understand and enjoy KMC, and it has benefits for mothers, infants, and families. However, continuous KMC may be physically and emotionally difficult, and often requires support from family members, health practitioners, or other mothers. These findings can serve as a starting point for researchers and program implementers looking to improve KMC programs.

1. Radioactive sulfur (S35) was introduced into 3 sets of wheat plants grown hydroponically in the greenhouse. When mature, the grain was milled using micromilling procedures.

WHEN the effects of air pollutants on plants were investigated, the sensitivity of the plants to ozone or irradiated automobile exhaust was found to decrease during the winter months regardless of whether the plants were grown in the greenhouse or in controlled environmental conditions. Because the degree of stomatal opening may influence the degree of injury caused by air pollutants, a year's study of daytime stomatal movements was begun. Light, temperature, atmospheric pressure, relative humidity, time of day and month of year were the parameters studied.