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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.

To investigate the regulation of Drosophila melanogaster behavior by biogenic amines, we have exploited the broad requirement of the vesicular monoamine transporter (VMAT) for the vesicular storage and exocytotic release of all monoamine neurotransmitters. We used the Drosophila VMAT (dVMAT) null mutant to globally ablate exocytotic amine release and then restored DVMAT activity in either individual or multiple aminergic systems, using transgenic rescue techniques. We find that larval survival, larval locomotion, and female fertility rely predominantly on octopaminergic circuits with little apparent input from the vesicular release of serotonin or dopamine. In contrast, male courtship and fertility can be rescued by expressing DVMAT in octopaminergic or dopaminergic neurons, suggesting potentially redundant circuits. Rescue of major aspects of adult locomotion and startle behavior required octopamine, but a complementary role was observed for serotonin. Interestingly, adult circadian behavior could not be rescued by expression of DVMAT in a single subtype of aminergic neurons, but required at least two systems, suggesting the possibility of unexpected cooperative interactions. Further experiments using this model will help determine how multiple aminergic systems may contribute to the regulation of other behaviors. Our data also highlight potential differences between behaviors regulated by standard exocytotic release and those regulated by other mechanisms.

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.