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Many global health institutions, including the World Health Organization, consider primary health care as the path towards achieving universal health coverage (UHC). However, there remain concerns about the feasibility and effectiveness of this approach in low-resource countries. Ethiopia has been implementing the primary health-care approach since the mid-1970s, with primary health care at the core of the health system since 1993. Nevertheless, comprehensive and systemic evidence on the practice and role of primary health care towards UHC is lacking in Ethiopia. We made a document review of publicly available qualitative and quantitative data. Using the framework of the Primary Health Care Performance Initiative we describe and analyse the practice of primary health care and identify successes and challenges. Implementation of the primary health-care approach in Ethiopia has been possible through policies, strategies and programmes that are aligned with country priorities. There has been a diagonal approach to disease control programmes along with health-systems strengthening, community empowerment and multisectoral action. These strategies have enabled the country to increase health services coverage and improve the population's health status. However, key challenges remain to be addressed, including inadequate coverage of services, inequity of access, slow health-systems transition to provide services for noncommunicable diseases, inadequate quality of care, and high out-of-pocket expenditure. To resolve gaps in the health system and beyond, the country needs to improve its domestic financing for health and target disadvantaged locations and populations through a precision public health approach. These challenges need to be addressed through the whole sustainable development agenda. De nombreux organismes sanitaires internationaux, dont Organisation mondiale de la Sante, considerent que les soins de sante primaires representent un jalon essentiel du cheminement vers une couverture maladie universelle (CMU). Neanmoins, des inquietudes subsistent quant a la faisabilite et a l'efficacite de cette approche dans les pays a faible revenu. LEthiopie a adopte cette approche depuis le milieu des annees 1970, et les soins de sante primaires figurent au creur du systeme sanitaire depuis 1993. Pourtant, rares sont les preuves exhaustives et generalisees concernant la pratique et le role des soins de sante primaires dans l'evolution vers une CMU en Ethiopie. Nous avons donc procede a un examen des documents contenant des donnees qualitatives et quantitatives accessibles au public. A l'aide du cadre instaure par l'initiative PHCPI (Primary Health Care Performance Initiative), nous avons decrit et analyse la pratique des soins de sante primaires; nous avons egalement identifie les reussites et les defis. C'est grace a des politiques, strategies et programmes en adequation avec les priorites nationales que cette methode axee sur les soins de sante primaires a pu etre mise en reuvre en Ethiopie. Le pays a emprunte une approche diagonale vis-a-vis des programmes de controle des maladies, tout en renforqant les systemes de sante, l'autonomie des communautes et l'action multisectorielle. Ces strategies lui ont permis d'augmenter la prise en charge des services de sante et d'ameliorer l'etat de sante de la population. Il reste cependant d'importants defis a relever: couverture insuffisante des services, inegalites d'acces, lenteur de transition entre systemes sanitaires pour la fourniture de prestations liees aux maladies non transmissibles, qualite mediocre des soins et frais non remboursables eleves. Afin de combler les lacunes au sein et en dehors du systeme de sante, le pays doit revoir le montant du financement octroye aux soins de sante a la hausse, mais aussi cibler les regions et populations defavorisees par le biais d'une approche de precision en matiere de sante publique. Ces defis doivent etre abordes tout au long du programme de developpement durable. Varias instituciones sanitarias mundiales, incluida la Organizacion Mundial de la Salud, opinan que la atencion primaria de salud es la via hacia el logro de la cobertura sanitaria universal (CSU). Sin embargo, persisten las preocupaciones acerca de la viabilidad y la eficacia de este enfoque en los paises de bajos recursos. Etiopia aplica el enfoque de la atencion primaria de salud desde mediados del decenio de 1970, por lo que la atencion primaria de salud es el nucleo del sistema de salud desde 1993. No obstante, Etiopia carece de pruebas integrales y generales sobre la practica y la funcion de la atencion primaria de salud orientada a la CSU. Se realizo un analisis documental de los datos cualitativos y cuantitativos a disposicion del publico. Se describe y analiza la practica de la atencion primaria de salud y se determinan los exitos y los desafios por medio del marco de la Iniciativa sobre el desempeno de la atencion primaria de salud. La aplicacion del enfoque de la atencion primaria de salud en Etiopia fue posible gracias a las politicas, las estrategias y los programas que se adaptaron a las prioridades del pais. Existe un enfoque diagonal de los programas de control de enfermedades sumado al fortalecimiento de los sistemas sanitarios, a la participacion de la comunidad y a las medidas multisectoriales. Gracias a estas estrategias, el pais ha logrado aumentar la cobertura de los servicios sanitarios y mejorar el estado de salud de la poblacion. Sin embargo, aun quedan por resolver algunos desafios fundamentales, como la cobertura insuficiente de los servicios, la falta de equidad en el acceso, la lentitud de la transicion de los sistemas sanitarios para prestar los servicios correspondientes a las enfermedades no transmisibles, la calidad deficiente de la atencion y los elevados gastos de bolsillo. Para resolver las deficiencias del sistema sanitario y otros aspectos, el pais debe mejorar su financiamiento nacional para la salud y centrarse en los lugares y las poblaciones desfavorecidos a traves de un enfoque preciso de la salud publica. Se debe abordar estos desafios en todo el programa de desarrollo sostenible. [phrase omitted], Universal health coverage (UHC) is the main target of sustainable development goal (SDG) 3, i.e. to ensure healthy lives and promote well-being for all at all ages. UHC is about [...]

In Africa, antiretroviral therapy (ART) is delivered with limited laboratory monitoring, often none. In 2003-2004, investigators in the Development of Antiretroviral Therapy in Africa (DART) Trial randomized persons initiating ART in Uganda and Zimbabwe to either laboratory and clinical monitoring (LCM) or clinically driven monitoring (CDM). CD4 cell counts were measured every 12 weeks in both groups but were only returned to treating clinicians for management in the LCM group. Follow-up continued through 2008. In observational analyses, dynamic marginal structural models on pooled randomized groups were used to estimate survival under different monitoring-frequency and clinical/immunological switching strategies. Assumptions included no direct effect of randomized group on mortality or confounders and no unmeasured confounders which influenced treatment switch and mortality or treatment switch and time-dependent covariates. After 48 weeks of first-line ART, 2,946 individuals contributed 11,351 person-years of follow-up, 625 switches, and 179 deaths. The estimated survival probability after a further 240 weeks for post-48-week switch at the first CD4 cell count less than 100 cells/mm(3) or non-Candida World Health Organization stage 4 event (with CD4 count

Background: The health and economic burden of antimicrobial resistance (in Australia is significant. Interventions that help guide and improve appropriate prescribing for acute respiratory tract infections in the community represent an opportunity to slow the spread of resistant bacteria. Clinicians who work in primary care are potentially the most influential health care professionals to address the problem of antimicrobial resistance, because this is where most antibiotics are prescribed. Methods: A cluster randomised trial was conducted comparing two parallel groups of 27 urban general practices in Queensland, Australia: 13 intervention and 14 control practices, with 56 and 54 general practitioners (GPs), respectively. This study evaluated an integrated, multifaceted evidence-based package of interventions implemented over a 6-month period. The evaluation included quantitative and qualitative components, and an economic analysis. Results: A multimodal package of interventions resulted in a reduction of 3.81 prescriptions per GP per month. This equates to 1280.16 prescriptions for the 56 GPs in the intervention practices over the 6-month period. The cost per prescription avoided was A$148. The qualitative feedback showed that the interventions were well received by the GPs and did not impact on consultation time. Providing GPs with a choice of tools might enhance their uptake and support for antimicrobial stewardship in the community. Conclusions: A multimodal package of interventions to enhance rational prescribing of antibiotics is effective, feasible and acceptable in general practice. Investment in antimicrobial stewardship strategies in primary care may ultimately provide the important returns for public health into the future. Clinicians who work in primary care are potentially the most influential health care professionals to address the problem of antimicrobial resistance, because this is where most antibiotics are prescribed. We demonstrated that the implementation of a multimodal package of interventions for acute respiratory tract infections in general practice resulted in a reduction of prescriptions and were well received. Providing GPs with a choice of tools might enhance their uptake and support for antimicrobial stewardship in the community. [ABSTRACT FROM AUTHOR]

Universal health coverage is essential for the progress to end threats of the acquired immunodeficiency syndrome epidemic. The current review assesses the publication rate, strategies and barriers for antiretroviral therapy (ART) coverage, equity, quality of care, and financial protection. We searched Web of Science, PubMed, and Google Scholar. Of the available articles, 43.13% were on ART coverage, 40.28% were on financial protection, 10.43% were on quality of care, and 6.16% were on equity. A lack of ART, fear of unwanted disclosure, lack of transportation, unaffordable health care costs, long waiting time to receive care, and poverty were barriers to ART coverage. Catastrophic health care costs were higher among individuals who were living in rural settings, walked greater distances to reach health care institutions, had a lower socioeconomic status, and were immunocompromised. There were challenges to the provision of quality of care, including health care providers' inadequate salary, high workload and inadequate health workforce, inappropriate infrastructure, lack of training opportunities, unclear division of responsibility, and the presence of strict auditing. In conclusion, ART coverage was below the global average, and key populations were disproportionally less covered with ART in most countries. Huge catastrophic health expenditures were observed. UHC contexts of ART will be improved by reaching people with poor socioeconomic status, delivering appropriate services, establishing a proper health workforce and service stewardship. [ABSTRACT FROM AUTHOR]