The People’s Republic of China has made great achievements in improving health status over the past six decades, mainly due to the government’s commitment to health, provision of cost effective public health programmes, growing coverage of health financial protection mechanisms and investments in an extensive health-care delivery network.
The Solomon Islands HiT determines that the country’s health system has significant weaknesses but also considerable strengths. Despite the range and difficulty of issues facing policy-makers in the Solomon Islands, there have been significant achievements in health, including considerable progress in advancing population health status. The performance of the health system is positive, achieving high coverage, high satisfaction levels, and steady progress on health outcomes. Nonetheless, the country faces important health challenges that could undermine development gains made to date
The Cambodia HiT reports that the national health sector reforms initiated two decades ago have had a positive impact on Cambodia’s health sector. The country’s health status has substantially improved since 1993 and is on track to achieve the Millennium Development Goal targets. Improving the quality of care is now the most pressing imperative in health-system strengthening.
This document provides an overview of health systems and their development and strengthening. It defines a health system and its key goals of good health outcomes, responsiveness, and fairness in financing. The six building blocks of a health system are described as service delivery, health workforce, information, medical products/vaccines/technologies, financing, and leadership/governance. Health system strengthening is defined as initiatives that improve one or more of these functions to enhance access, coverage, quality or efficiency. The document discusses challenges faced by health systems and some opportunities to address them.
Indonesia has a mixed health system with both public and private provision of care. Key achievements include increased life expectancy and reductions in communicable disease rates. However, challenges remain such as the dual burden of disease, natural disasters, weak health information systems, and high out-of-pocket expenditures. Future prospects include expanding the use of telemedicine, incentivizing an even workforce distribution, and passing more legislation to clarify the health system framework.
This second edition of the health system review of Philippines shows the major changes that have occurred over the 7 years since the last review. Channelling of funds from sin tax to Health has shown unprecedented levels of finances are now available for UHC. PhilHealth has dramatically increased coverage of people as well as service providers that it works with from both government and non-government sectors. However major challenges remain; regional and socioeconomic disparities in the availability and accessibility of resources are prominent and there is a need to improve regulation of service providers. Philippines HiT reports on the current health system reforms undertaken including challenges of incorporating primary health care as in the overall health architecture of the country.
Cambodia Health Researchers Forum 11 Nov 2015 combined presentationsReBUILD for Resilience
Combined presentations given at Cambodia Health Researchers' Forum 11th November 2015, Phnom Penh. Hosted by the National Institute of Public Health. Presentations given by Peter Annear, Barbara McPake, Sreytouch Vong and Ir Por
This is primarily based on a chapter from our most recent publication.
I want to acknowledge the authors of the chapter:
Melisa Tan, Victoria Haldane, Sue-Anne Toh & Helena Legido-Quigley from NUS
Martin McKee from LSHTM
Summary of the current 4 main NCDs situation in Asia including risk factors
Examples of health system response
Challenges
This report provides an overview of China's aging population, healthcare system, and wellbeing market from 2011 to 2015. It reviews achievements under China's 11th Five-Year Plan and analyzes opportunities and challenges under the 12th Five-Year Plan. Key points include: China's GDP and healthcare spending grew rapidly from 2006 to 2010 and are projected to continue growing to 2015. An aging population and increasing life expectancy are driving growth in healthcare needs. The report assesses foreign companies' performance and opportunities in China's pharmaceutical, medical device, and healthcare markets under the national economic development initiatives outlined in the Five-Year Plans.
Localization of Universal Health Coverage for Equitable Health Outcomes in NepalDeepak Karki
Presentation entitled "Localization of Universal Health Coverage for Equitable Health Outcomes in Nepal" by Dr Shiva Raj Adhikari on the 18th Anniversary of Nepalt Health Economics Association.
The document provides a review of Tonga's health system. It summarizes that Tonga has a decentralized health system managed through 4 districts, with the majority of primary care and 90% of hospital services provided by the public sector. Key achievements include control of infectious diseases, high immunization coverage, and prioritization of non-communicable diseases. However, challenges remain such as high rates of non-communicable diseases and their risk factors. The health workforce faces issues of limited education opportunities and brain drain overseas. Infrastructure and medical equipment also require significant upgrades.
Health access for all Thailand’s.The Thai citizens gain universal access to essential health services at zero cost, and reap significant benefits as babies get healthier, workers increase productivity, and households reduce financial risk.
The document provides a health profile of Benue State, Nigeria. It summarizes key health indices like tuberculosis prevalence (13,000+ affected), HIV prevalence (15.4%), and stakeholders involved in health. It describes USAID/HFG project interventions in the state like budget advocacy, capacity building, and establishing a Resource Mobilization Technical Working Group. The project achieved a 62% increased budget allocation and release of previously withheld funds. Challenges included limited time and insecurity, while recommendations focused on ownership, capacity building and longer timelines.
MRC/HIVAN KZN AIDS Forum - 30/10/12 - Challenges and Opportunities for HIV/AI...info4africa
This presentation was given on 30/10/12 at the MRC/HIVAN KZN AIDS Forum.
Co-presented by Kwazi Mbatha (CEGAA Researcher/Trainer) and Mlungisi Vila kasi (TAC Community Mobiliser - uMgungundlovu), this talk was facilitated by Judith King (CEGAA Communications and Advocacy Manager).
For more information on CEGAA please visit their website: http://www.cegaa.org/
The document provides an overview of South Korea's health system response to COVID-19. Key measures included transparent communication, social distancing guidelines, extensive testing and contact tracing, increasing hospital capacity, and maintaining access to healthcare. The country's universal health coverage system supported its efficient mobilization of resources to test, treat, and manage COVID-19 cases.
Japan was one of the first countries to be hit by COVID-19 and declared a state of emergency by April 2020. Japan’s response to COVID-19 included the imposition of context-specific measures and restrictions based on local need to contain the spread of the disease. Containment measures were enacted under the Act on Special Measures for Pandemic Influenza and New Infectious Diseases Preparedness and Response. Citizens were requested to abide by containment measures that focused on avoiding the 3C’s: Closed spaces with poor ventilation; Crowded places; Close‐contact settings. Health infrastructure, workforce, and supply chain were strengthened, alongside social security interventions including financial support for citizens. Primary health centers were strengthened and were at the forefront of Japan’s COVID-19 response at the local level.
This publication presents the various measures that were put in place from the beginning of the outbreak until December 2020 to control COVID-19 transmission in the country. We aim to update this document as new policies and interventions are operationalized to respond to the outbreak.
The document discusses how population health is influenced by many factors beyond just the financing and structure of health systems, including social determinants like gender, economic security, and access to services. It analyzes Wilkinson and Pickett's research showing countries with higher income inequality have worse health outcomes. While Australia's system provides some universal access, it could be improved by increasing primary care services, reducing geographical inequalities, and lowering financial barriers through reducing out-of-pocket costs. Significant reforms would be needed to transform the system to better promote population health.
There are numerous changes taking place in South Africa, in the economy, politics and health. All these are interdependent and embedded in a social milieu which brings a number of pressures on health services and systems. The major event in the medium to long term is the impact of the National Health Insurance. Other contextual factors of importance include the range of social determinants of health and disease, with the provision of water, sanitation, electricity and housing being the key services. South Africa will also be influenced in the future by the major diseases it harbours at present. This seminar provided some insight into how these factors will impact on the South African Health Services.
People's Health Assembly 2012: Global Health Initiatives, Civil Society and t...GlobalHealthObserver
NGOs play an important role in helping provide antiretroviral therapy (ART) in South Africa where government services are limited. While NGOs are accountable to their donors for financial and service targets, their accountability to the communities they serve is less clear. The document examines different types of NGOs providing ART and finds gaps in how they define and engage with local constituents. It calls for NGOs to clarify who they are truly accountable to in order to better serve community needs.
The document summarizes Amanda Trac's experience in an online mobile/personal learning class. It describes her learning preferences as a sensual and verbal learner. It discusses the learning pathway and activities that helped her learn, including quizzes, predictions, and discussion questions. It highlights three mobile technologies she found most useful - iPods for studying, microblogs for current information, and multimedia for marketing lessons. It concludes by discussing how she will continue using reflection, sensing, and multimedia strategies and technologies in her work and studies going forward.
This document discusses different types of energy sources including renewable sources like solar, wind, and hydropower as well as non-renewable sources like coal, petroleum, and natural gas. It notes that while renewable sources are unlimited, they can be expensive to implement. Non-renewable sources cause environmental issues like increased greenhouse gases, acid rain, and pollution. The document also briefly describes how energy is produced at power stations through heating water to create steam that turns turbines to generate electricity.
The ant works hard every day without supervision. A cockroach is hired as a supervisor and introduces many new processes that waste the ant's time. Production decreases. An owl consultant is hired and finds the department is overstaffed. The ant is fired for a negative attitude.
This document discusses different types of energy sources including renewable sources like solar, wind, and hydropower as well as non-renewable sources like coal, oil, and natural gas. It notes that while renewable sources are unlimited, they can have drawbacks like high costs or dependence on weather conditions. In contrast, non-renewable sources cause environmental issues like increased greenhouse gases, acid rain, and pollution. The document also briefly describes how energy is produced at power stations.
PDHPE is important because it encourages students to live happy, healthy, responsible, and productive lives by enhancing their overall health and wellbeing. It teaches students to value themselves and others, make informed life decisions, and obtain lifelong involvement in physical activity. PDHPE covers different strands that link to being healthy across physical, mental, social, interpersonal, and spiritual dimensions.
This document discusses different types of energy sources including renewable sources like solar, wind, and hydropower as well as non-renewable sources like coal, petroleum, and natural gas. It notes that while renewable sources are unlimited, some have high costs or depend on specific climate conditions. Non-renewable sources cause environmental issues like increased greenhouse gases, acid rain, and pollution. The document also briefly describes how energy is produced at power stations through heating water to create steam that turns turbines to generate electricity.
1. The document discusses different approaches to healthcare systems and describes how a diagonal approach can effectively launch RHD control programs.
2. A diagonal approach focuses on specific diseases like RHD within the primary healthcare system by using existing infrastructure, resources, and personnel but upgrading them.
3. Integrating RHD control into primary care in this way strengthens the overall system while still allowing for disease-specific priorities and funding. This makes RHD programs more sustainable and effective compared to vertical or solely horizontal approaches.
This breakout session at the CCIH 2015 Annual Conference explores SANRU, on of the first major health systems building projects funded following Alma Ata, and perhaps the only, or one of the few to be managed through a faith-based network. The project brings healthcare to millions in the Democratic Republic of the Congo.
The Kingdom of Bhutan has made great achievement in establishing and sustaining public financed and managed health system in the past five and a half decades. As enshrined in the Constitution, health services are free in the integrated traditional and allopathic medicines. The report also notes the epidemiological and health system challenges and the way forward to overcome in line with achieving SDGs.
With this webinar, we invite you to join in the discussion on the post-Ebola strategy in West Africa. During the webinar four experts from different backgrounds will outline their view of the Ebola Crisis and most importantly share their vision on what needs to be done now, and post-Ebola, to ensure aversion of further food insecurity and social marginalization.
The spread of the Ebola virus disease has major consequences on the African countries it has hit the hardest: Guinea, Liberia, and Sierra Leone. The death toll from the disease and associated losses pose great economic consequences.
More than 2,600 people have died in West Africa. Transportation companies suspended their operations to the countries for fear of contamination even though the World Health Organisation advised against it. So far, the economies are experiencing adverse effects with escalating food insecurities.
Sierra Leone and Liberia, two of the most hit countries, recently came out of more than a decade of gruesome civil wars. Their institutions are still fragile and the deprivation from the Ebola crisis could trigger ever bigger problems.
The youth played a major role in both the Sierra Leone and Liberia conflicts as a result of economic and social marginalization. Without an effective strategy to assure young people a brighter future of economic and social stability, impact of the 2014 Ebola crisis on food insecurity and social livelihoods could trigger an even greater post-Ebola crises.
Agenda points:
Short term strategy: containment strategy & humanitarian aid
Long term strategy: improvement of (social) health care & international assistance
The importance of microprogrammes: Engagement, voicing the right people, AYM’s call for action**
HIV/AIDS prevalence in Sudan is estimated at 600,000 people, with the first case reported in 1986. The Sudan National AIDS Control Programme was established in 1987 to coordinate the national response. Key challenges include limited funding, poor surveillance, and low access to treatment, prevention, and HIV testing services due to stigma. Expansion of programs for mother-to-child transmission prevention, blood safety, and care for at-risk groups is needed to improve Sudan's national HIV/AIDS response.
Nepal Health Sector Program Implementation Plan II (NHSP-IP2)Dip Narayan Thakur
The document summarizes Nepal's Health Sector Implementation Plan II (NHSP-IP II). NHSP-IP II aimed to strengthen Nepal's health system from 2010-2015 by improving access, equity, and utilization of essential health services. It reviewed achievements and shortcomings of NHSP-IP I and outlined NHSP-IP II's vision, goals, strategies, and financing plans. Key points included reducing morbidity and mortality through accessible, affordable, quality care; addressing sustainability issues in health financing; and achieving greater efficiency through health systems strengthening. Progress was made in areas like immunization and maternal health, but challenges remained around nutrition, non-communicable diseases, and equity gaps.
1. The document summarizes Nepal's Health Sector Implementation Plan 2 (NHSP-IP 2), which aimed to strengthen Nepal's health system from 2010-2015 by improving access, equity, and quality of essential health services.
2. Key goals of NHSP-IP 2 included reducing morbidity and mortality from common health problems by ensuring accessible, affordable, quality health care services.
3. The plan outlined strategies, programs and services, roles of non-state actors, and approaches to structure, financing, research and monitoring of Nepal's health system.
4. While progress was made in areas like immunization and reducing child and maternal mortality, challenges remained such as disparities in access, sustainability of financing
This document summarizes the presentation "Managing Social transitions for Health: The Experience from South Africa" by Charles Hongoro. It discusses how social changes globally and in South Africa have impacted health outcomes. It outlines the resulting demographic and epidemiological transitions in developing and developed countries. It then describes South Africa's experience in transforming its health system towards universal healthcare coverage, including establishing ward-based primary healthcare teams, integrated school health programs, and district clinical specialist support teams. The goals of universal health coverage in South Africa are also summarized.
1) India has a high burden of tuberculosis, accounting for nearly 1/4 of global TB cases. The social and economic costs of TB in India are also high, with estimated indirect costs of $3 billion and direct costs of $300 million annually.
2) The National Tuberculosis Program (NTP) was implemented in 1962 but had low treatment success rates of only 30%. The Revised National Tuberculosis Control Program (RNTCP) was launched in 1993 using the WHO-recommended DOTS strategy.
3) RNTCP has expanded coverage to the entire country and achieved targets of 70% case detection and 85% treatment success rates. It has contributed to reducing prevalence and mortality rates of TB in India
"Looking Ahead" Post-Ebola Strategy in West Africa is the first in a series of planned webinars, where we invite knowledgeable individuals and participants to join the post-Ebola strategy in West Africa discussion.
During the webinars, experts from different backgrounds, will outline their view on the Ebola Crisis and most importantly, share their vision on what needs to be done now, and post-Ebola, to ensure aversion of further political and economic disturbances.
The fast spread of the Ebola virus has major consequences on the African countries it has hit the hardest: Guinea, Liberia, and Sierra Leone.
Besides the death tolls and associate losses, the countries are also facing great danger because of the economic consequences the virus carries.
Sierra Leone and Liberia, two of the most hit countries, have both recently come out of more than a decade of gruesome civil wars and the set back of the disease does not help with the stabilization of the economies. Their democracies are fragile and the deprivation from the Ebola crisis could be a trigger for political disruption.
The youth played a major role in those conflicts as a result of economic and social marginalization. Without a post-Ebola strategy to ensure the youth a future of economic and social stability, there may be unforeseeable instabilities.
ABOUT THE ORGANIZER:
Twenty-First Century African Youth Movement, (AYM) empowers and mobilizes Africa’s youth through employment. The AYM is dedicated to developing new and exciting enterprise opportunities for young people in Sierra Leone, to help provide young people with the confidence, power and skills they need to get themselves into employment and out of poverty.
Mobilizing Africa’s unemployed and underemployed youth is the key to the continent’s economic growth and stability. AYM works to mobilize marginalized youth through education, training, and employment, creating entrepreneurial opportunities to help move communities away from poverty, disease, and hunger. AYM aims to establish personal empowerment and community resilience by energizing the continent’s youth population, its most critical resource in the reversal of social and economic stagnation.
For more information, visit:
http://www.aym-inc.org/ebola-looking-ahead/.
AYM’s call for action:
Dr David J Baumler’s AYM Pepper Challenge: http://youtu.be/iU1Ot60mT7I
Swot analysis of Safe motherhood, HIV & AIDS, ARI and Logistic Management Pro...Mohammad Aslam Shaiekh
The Acute Respiratory Tract Infection (ARI) program in Nepal aims to reduce childhood mortality from pneumonia through early diagnosis and treatment. The program trains female community health volunteers to diagnose pneumonia in children under 5 using an ARI timer and treat cases with antibiotics. It also educates mothers on the differences between cough/cold and pneumonia and the need for referral. While the program has increased access to care, analysis found low coverage of treatment at health facilities and by community health workers, suggesting the need for improved case management and coordination between levels of care.
Moving toward universal health coverage of Indonesia: where is the position?Ahmad Fuady
My final thesis about the Indonesian movement towards universal health coverage and its achievement in providing the right to health for Indonesian people.
Maximizing the Impact Of Global Fund Investments by Improving the Health of W...theglobalfight
Dr. Viviana Mangiaterra, Senior Technical Coordinator for Maternal, Newborn and Child Health and Health Systems Strengthening at the Global Fund to Fight AIDS, Tuberculosis and Malaria, discusses service delivery integration for the three diseases, Global Fund partnerships and strengthened training and representation of women in Country Coordinating Mechanisms.
Sustainability and transition - Nicolas Cantau, The Global FundOECD Governance
This presentation was made by Nicolas Cantau, The Global Fund, at the 2nd Health Systems Joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
Keynote address by Dr. Eric Goosby of UCSF, presented at CFAR HIV Research in International Settings (CHRIS) meeting in San Diego, October 1, 2014. Dr. Goosby discussed. "Global Health Delivery and Diplomacy: The Long Road to Sustainable Programs."
ECONOMIC ASSESSMENT OF THE LEVEL OF EFFECTIVENESS OF PRIMARY HEALTHCARE SERVI...JobOpue1
his study examined the level of effectiveness of primary healthcare services in Cross River State (CRS). The data generated were analyzed using the t-test of mean difference and the confidence interval analysis. The results showed that there was a disparity in access to healthcare services between the Northern and Central senatorial districts, while there was no disparity in the level of accessibility to healthcare services between the Northern and Southern and the Central and Southern districts. There was no disparity in the level of government funding and management of healthcare services between the three senatorial districts, but there was a disparity in the level of infrastructural amenities distributed among the three senatorial districts. The government should increase its budgetary allocation for healthcare in line with the World Health Organisation’s 15 per cent of the total budget benchmark to boost the effectiveness of primary healthcare services, among others was recommended.
Greece: Primary Care in a time of crisis. 2nd VdGM Forum, Dublin 2015Evangelos Fragkoulis
2nd Vasco Da Gama Movement Forum, Dublin 2015
The Effect of the Economic Crisis on the Health Systems of the peripheral countries: Greece, Ireland, Spain, Portugal and Italy.
Principle, Scope, Nature and Administration of Health Services in Nigeria
(block posting lecture presented to final year medical class of University of Port Harcourt on thursday 31/05/18)
NHM Overview of Gov of Bharat. The presentation is very helpful.pritoshitconsultant
The National Health Mission (NHM) aims to provide universal access to equitable, affordable, and quality healthcare services. It seeks to strengthen primary healthcare through initiatives like Health and Wellness Centers and increasing public expenditure on healthcare. The NHM addresses issues such as low access to healthcare, fragmented programs, and shortages in human resources. It focuses on improving healthcare management through measures like community involvement, decentralization, and flexible financing. The ultimate goal is to support states in providing comprehensive and high-quality healthcare that meets people's needs.
This document analyzes the emergence and evolution of global health initiatives (GHIs) such as GAVI, the Global Fund, PEPFAR, and the World Bank MAP. It focuses on how individuals, organizations, and networks have influenced the design and policy priorities of these institutions. Through documentary reviews and interviews with stakeholders, the study examines how GHIs were formed and how they have changed over time. While GHIs have had some success in addressing health issues, consensus has been lacking around supporting health systems strengthening, and GHIs have had an uncomfortable relationship with prioritizing broader health systems goals.
This document summarizes research on the influence of global health initiatives (GHIs) on Mozambique's public health system. It finds that while GHIs increased services for HIV, malaria, and TB, they also negatively impacted health worker performance and retention by making partner organizations more attractive. GHIs placed additional stress on weak financial and monitoring systems without sufficiently strengthening the overall health system. The document concludes that health outcomes could be improved if GHIs targeted strengthening the entire health system in a coherent manner rather than specific disease programs.
People's Health Assembly 2012: Global Health Initiatives, Civil Society and t...GlobalHealthObserver
This document discusses NGO accountability and provides context around global health initiatives. It begins with definitions of accountability and describes key features of civil society and NGOs. It then discusses the history of NGO accountability and challenges related to accountability requirements and mechanisms. The document outlines accountability to various stakeholders and provides references for further reading on the topic.
Gorik Ooms at Aids2012: Future Global Priorities or Beyond 2015GlobalHealthObserver
The document discusses potential global health priorities beyond 2015, with the author's prediction that universal health coverage (UHC) may become the single overarching goal. This could negatively impact efforts against AIDS if UHC is not properly defined and implemented. However, UHC could also benefit the fight against AIDS if the "right to health" perspective is taken, with clarification of national and global responsibilities. The author argues that UHC will only help AIDS efforts if advocates actively work to ensure UHC protects the right to health for all diseases.
GHIs operating in Mozambique include the Global Fund, PEPFAR, President's Malaria Initiative, and others focused on specific diseases. While GHIs have increased funding and scale-up of targeted health services, their vertical nature has stressed harmonization efforts and negatively impacted health workers. Overall, GHIs could have achieved better health outcomes by jointly strengthening the overall health system in a more coherent manner.
This document summarizes research on the impact of global health initiatives (GHIs) on Angola's health system. It finds that GHIs have both positive and negative effects. Positively, they have increased resources, knowledge transfer, and strategic planning. However, they also compete for skilled workers and use parallel monitoring systems. The research calls for continued harmonization between GHIs and the government to jointly strengthen the health system and ensure sustainability.
This document summarizes research conducted by the Institute of Tropical Medicine, Antwerp on various topics related to Global Health Initiatives (GHIs) and global health governance. The research examines: 1) GHIs and global health governance, focusing on complexity, health systems strengthening, and health exceptionalism; 2) the impact of GHIs on financing and sustainability, including crowding out of domestic health expenditure and human resources for health; and 3) the impact of GHIs on legal obligations to provide health assistance. The research uses literature reviews, stakeholder interviews, and data analysis to understand these issues from a complex adaptive systems perspective and to evaluate the normative effects of GHIs on moving states towards compliance with health assistance obligations under
कायाकल्प क्लिनिक: पटना के अग्रणी सेक्सोलॉजिस्ट और स्किन केयर विशेषज्ञ
पटना का एक शानदार स्वास्थ्य सेवा प्रदाता, कायाकल्प क्लिनिक, आपके स्वास्थ्य और त्वचा की देखभाल में विशेषज्ञता प्रदान करता है। हमारे नवीनतम तकनीकी समाधानों और अनुभवी विशेषज्ञों के साथ, हम पुरुष और महिलाओं के स्वास्थ्य सम्बंधित मुद्दों को हल करते हैं। यहां पर हम प्रदान करते हैं:
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Discover the Best Sexologist in Patna: Expert Care at Kayakalp Clinic
Kayakalp Clinic - Best Sexologist in Patna
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Co-Chairs, Hussein Tawbi, MD, PhD, and Prof. Christian Blank, MD, PhD, discuss melanoma in this CME activity titled “Deploying the Immune GAMBIT Against Melanoma: Guidance on Advances and Medical Breakthroughs With ImmunoTherapy.” For the full presentation, downloadable Practice Aids, and complete CME information, and to apply for credit, please visit us at https://bit.ly/4edfNpE. CME credit will be available until July 5, 2025.
Human blood has a hydrogen ion concentration [H+ ] of 35 to 45 nmol/L and it is essential that its concentration is maintained within this narrow range.
Hydrogen ions are nothing but protons which can bind to proteins and alter their characteristics.
All the enzymes present in the body are proteins and an alteration in these enzyme systems can change the homeostatic mechanisms of the body.
Hence, a disturbance in acid-base balance can result in malfunction of the various organ systems.
The normal pH of blood is 7.35-7.45.
Acidosis is defined as a pH Less than 7.35.
Conversely, when the pH is more than 7.45, alkalosis is said to exist.
Acidosis and alkalosis are of two types each: respiratory and metabolic.
An increase in carbon dioxide (CO2 ) levels increases the plasma [H+ ] and decreases the pH (respiratory acidosis).
Similarly, a decrease in plasma carbon dioxide levels reduces the [H+ ] and increases the pH (respiratory alkalosis).
A decrease in [HC03 -] reduces the pH and is called metabolic acidosis.
Similarly, an increase in [HC03 -] increases the pH and produces metabolic alkalosis.
The pH is regulated in the human body mainly by two organs: the respiratory system and the renal system.
The arterial carbon dioxide levels are regulated by the respiratory system.
Any increase in carbon dioxide levels stimulates the respiratory centre in the medulla thus augmenting respiration, alveolar ventilation and elimination of extra CO2 levels.
A decrease in CO2 levels may reduce the stimulus to breathe and cause hypoventilation.
This response is limited by hypoxia as the hypoxic drive stimulates the patient to maintain respiration.
Respiratory response to changes in CO2 level occurs very fast.
The plasma bicarbonate levels are regulated by the kidneys.
Any decrease in [HC03 -] stimulates the kidney to retain and synthesise bicarbonate.
High [HC03 -] results in elimination of more bicarbonate in urine.
In general, the pulmonary response to a change in acid-base status is faster and occurs immediately.
However, renal regulation takes time, a few hours to days.
Kidneys filter and reabsorb all the bicarbonate in the urine.
When necessary, kidneys can also produce extra bicarbonate through the glutamine pathway.
When an acid-base disorder occurs, the initial disturbance that occurs is termed the primary disorder.
The body attempts to normaliZe the pH by certain compensatory mechanisms resulting in a secondary disorder, e.g. primary metabolic acidosis results in an increase in hydrogen ions and a consequent decrease in bicarbonate ions.
To compensate for this, the patient hyperventilates and reduces the arterial carbon dioxide levels, thus moving the pH back to normal ( compensatory respiratory alkalosis )
These are the class of Drugs that are used to treat and prevent cardiac arrhythmias by blocking ion channels involved in cardiac impulse generation and conduction. Class I drugs like quinidine and procainamide block sodium channels to prolong the action potential duration, while Class IB drugs like lignocaine shorten repolarization. Class III drugs like amiodarone block potassium channels to prolong the action potential. Calcium channel blockers like verapamil inhibit calcium influx. Other drugs include adenosine for paroxysmal supraventricular tachycardia, beta blockers for supraventricular arrhythmias, and atropine for bradycardias. Adverse effects vary between drugs but include arrhythmias, heart block and QT prolong
Factors influencing growth & development:
Growth & development depend upon multiple factors or determinants. They influence directly or indirectly by promoting or hindering the process.
The determinants can be grouped as Heredity & environment..
Heredity or genetic factors are also related to sex, race, & nationality. Environment includes both pre natal & post natal factors.
Introduction to Dental Implant for undergraduate studentShamsuddin Mahmud
Introduction to Dental Implant
Dr Shamsuddin Mahmud
Assistant Professor, Department of Prosthodontics
Nortth East Medical College (Dental Unit)
Definition of Dental Implant
A prosthetic device
made of alloplastic material(s)
implanted into the oral tissues beneath the mucosal and/or periosteal layer and
on or within the bone
to provide retention and support for a fixed or removable dental prosthesis.
Classification of Dental Implant
According to placement within the tissue
Blade/Plate form implant
According to Material Used
A) METALLIC IMPLANTS
Commercially pure Titanium
Cobalt chromium molybdenum
Titanium aluminum vanadium
Stainless steel
B) NON-METALLIC IMPLANT
Zirconium
Ceramic
Carbon
According to the ability of implant to stimulate bone formation
A) Bio active
Hydroxyapatite
Tri Calcium Phosphate
B) Bio inert
Metals
Parts of Dental Implant
Implant fixture
Implant mount
Cover screw
Gingival former/healing screw/healing abutment/permucosal extension
Impression post/impression transfer abutment
Implant analogue
Abutment
Fixation screw
Implant Fixture
Implant Mount
Connected to the fixture
Function: used to carry implant from its vital to the prepared osteotomy site either by hand or with a ratchet/ handpiece adaption
Cover Screw
component that is used to cover the implant connection during the submerged healing of the implant
Function: preserves the patency of the connection by preventing any soft tissue ingrowth in the connection
Gingival former/ Healing Abutment/ Healing screw
Screw/ abutment used to create the soft tissue emergence profile around the implant.
Time of placement:
During 1st surgery – One step surgery
After Osseointegration – Two step/stage surgery
Gingival former/ Healing Abutment/ Healing screw
Placed in the site 2-3 weeks for soft tissue healing
Function:
Create gingival emergence profile
Formation of biological width
Impression post/impression transfer abutment
component that is used to trans- fer the implant Hex position and orientation from the mouth to the working cast.
Types
Closed tray
Open tray
Implant analogue/
component which has a different body but its platform and connection are exactly similar to the implant. The analogue is used to replicate the implant platform and connection in the laboratory mode.
Abutment
Abutments
Advantages of Dental Implant Retained Prosthesis
Maintain bone height and width by preventing bone resorption
Maintain facial esthetics
Improve masticatory performance
Improve stability and retention of prosthesis
More esthetics
Increase survival times of prostheses
There is no need to alter adjacent teeth
Improve psychological health
Disadvantages of Dental Implant Retained Prosthesis
Very expensive.
Cannot be used in medically compromised patients who cannot undergo surgery.
Longer duration of treatment
Requires a lot of patient co-operation because of repeated recall visits are essential
INDICATION OF DENTAL IMPLANT
Dental implants can successfully restore all
THE MANAGEMENT OF PENILE CANCER. PowerPointBright Chipili
This PowerPoint includes all the relevant information and science about penile cancer and its management. Information is based on Campbell 12th edition and EAU 2024 updated guidelines.
As a leading rheumatologist in Chandigarh, Dr. Aseem specializes in the diagnosis and management of a wide range of rheumatic conditions, including but not limited to:
Rheumatoid Arthritis: An autoimmune disorder that causes chronic inflammation of the joints.
Osteoarthritis: A degenerative joint disease characterized by the breakdown of cartilage.
Lupus: A systemic autoimmune disease that can affect the skin, joints, kidneys, and other organs.
Ankylosing Spondylitis: A type of arthritis that primarily affects the spine, causing pain and stiffness.
Gout: A form of arthritis characterized by sudden, severe attacks of pain, redness, and tenderness in the joints.
Psoriatic Arthritis: A type of arthritis that affects some people with psoriasis.
Vasculitis: An inflammation of the blood vessels that can cause a variety of symptoms.
Sjogren’s Syndrome: An autoimmune disorder characterized by dry eyes and mouth.
Accurate diagnosis is crucial for effective treatment. Dr. Aseem Goyal utilizes advanced diagnostic techniques to identify the underlying causes of rheumatic conditions. Our state-of-the-art facility is equipped with the latest technology to provide comprehensive diagnostic services, including:
Blood Tests: To check for markers of inflammation and autoimmune activity.
Imaging Studies: Such as X-rays, MRI, and ultrasound to assess joint and soft tissue damage.
Joint Fluid Analysis: To examine the fluid in the joints for signs of inflammation or infection.
Biopsy: In certain cases, a small tissue sample may be taken for further examination.
Treatment Approaches
Dr. Aseem Goyal adopts a holistic and patient-centered approach to treatment. Depending on the specific condition and its severity, treatment options may include:
Medications
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): To reduce inflammation and relieve pain.
Disease-Modifying Antirheumatic Drugs (DMARDs): To slow the progression of rheumatic diseases.
Biologic Agents: Targeted therapies that block specific pathways in the immune system.
Corticosteroids: To control severe inflammation quickly.
Safety should always come first when it comes to medical operations involving the use of a Huber needle. Disposable safety Huber needles are useful in this situation. A secure and effective method of accessing and delivering medication to a patient's port is provided by these single-use devices. But it might be difficult to choose the best option when there are so many on the market. We've put up the best advice to selecting the ideal disposable safety Huber needle so you can make an educated choice.
Principles of Cleaning
Nonsurgical root canal treatment is a predictable method of retaining a tooth that otherwise would require extraction. Success of root canal treatment in a tooth with a vital pulp is higher than that of a tooth that is necrotic with periradicular pathosis. The difference is the persistent irritation of necrotic tissue remnants, and the inability to remove the microorganisms and their by-products. The most significant factors affecting this process are tooth anatomy and morphology, and the instruments and irrigants available for treatment. Instruments must contact and plane the canal walls to debride the canal.
Morphologic factors such as lateral and accessory canals, canal curvatures, canal wall irregularities, fins, cul-de-sacs, and isthmuses make total debridement virtually impossible. Therefore the goal of cleaning not total elimination of the irritants but it is to reduce the irritants.
Currently there are no reliable methods to assess cleaning. The presence of clean dentinal shavings, the color of the irrigant, and canal enlargement three file sizes beyond the first instrument to bind have been used to assess the adequacy; however, these do not correlate well with debridement. Obtaining glassy smooth walls is a preferred indicator. The properly prepared canals should feel smooth in all dimensions when the tip of a small file is pushed against the canal walls. This indicates that files have had contact and planed all accessible canal walls thereby maximizing debridement (recognizing that total debridement usually does not occur).
Principles of Shaping
The purpose of shaping is to
1) facilitate cleaning and
2) provide space for placing the obturating materials.
The main objective of shaping is to maintain or develop a continuously tapering funnel from the canal orifice to the apex. This decreases procedural errors when cleaning and enlarging apically. The degree of enlargement is often dictated by the method of obturation. For lateral compaction of gutta percha the canal should be enlarged sufficiently to permit placement of the spreader to within 1-2 millimeters of the corrected working length. There is a correlation between the depth of spreader penetration and the apical seal.5 For warm vertical compaction techniques the coronal enlargement must permit the placement of the pluggers to within 3 to 5 mm of the corrected working length.6
As dentin is removed from the canal walls the root is weakened.7 The degree of shaping is determined by the preoperative root dimension, the obturation technique, and the restorative treatment plan. Narrow thin roots such as the mandibular incisors cannot be enlarged to the same degree as more bulky roots such as the maxillary central incisors. Post placement is also a determining factor in the amount of coronal dentin removal.
This document contains an overview of different types of ocular neoplastic disorders or ocular tumors among pediatric patients. you can have a quick basic concept about ocular tumors among children and a basic management strategy. You will have perfect idea about almost 8 ocular tumors among pediatric patients .
Hemodialysis: Chapter 11, Venous Catheter - Basics, Insertion, Use and Care -...NephroTube - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/QeWTw_fYPlA
- Video recording of this lecture in Arabic language: https://youtu.be/fUWI9boFc7w
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
- Video recording of this lecture in English language: https://youtu.be/AWaobASkZM4
- Video recording of this lecture in Arabic language: https://youtu.be/1cQRmJ3SKWc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
This Presentation provides information on hyperlipidemic drugs. It begins with an introduction to hyperlipidemia and its causes. It then discusses various drug classes for treating hyperlipidemia, including their mechanisms of action, effects on lipid levels, pharmacokinetics, therapeutic uses, adverse effects and interactions. The major drug classes discussed are HMG-CoA reductase inhibitors (statins), bile acid sequestrants, fibrates, and niacin. For each class, specific drugs are highlighted and their properties compared.
TEST BANK Physical Examination and Health Assessment 9th Edition by Carolyn J...rightmanforbloodline
TEST BANK Physical Examination and Health Assessment 9th Edition by Carolyn Jarvis, All Chapters 1 - 32 Full Complete.pdf
TEST BANK Physical Examination and Health Assessment 9th Edition by Carolyn Jarvis, All Chapters 1 - 32 Full Complete.pdf
Introduction of mental health nursing, Perspective of mental health and mental health nursing, Evolution of mental health services, treatment and nursing practices Mental health team, Nature and scope of mental health nursing, Role & function of mental health nurse inn various settings and factors affecting the level of nursing practice, concept of normal and abnormal behavior
1. Global Health Initiatives and
the South African health system
Global Health Forum, 23 April 2012
School of Public Health
University of the Western Cape
Dr Thubelihle Mathole
Annie Neo Parsons
Dr Johann Cailhol
Prof David Sanders
2. Background
• Middle-income country but highest number of people living with
HIV in the world (around 5 million)
• History of inequitable distribution of resources
– Apartheid pre-1994, national economic policies post-1994
– Provincial autonomy in allocation of finances, policy implementation
• Denialist national government stance on HIV treatment: 1997-2008
• Public sector antiretroviral therapy (ART) introduced in 2003
– Ring-fenced national Conditional Grant HIV and AIDS since 2006 (ARVs, clinical
ART staff and laboratory tests)
• Public health expenditure as % of GDP in 2009 was 3.7%
• Two GHIs active in South Africa – focused on HIV programmes
– Global Fund for AIDS, Tuberculosis and Malaria (GFATM) since 2002
– US President’s Emergency Plan For AIDS Relief (PEPFAR) since 2004
2
4. Aims and objectives
• To assess the impact of GHIs on:
– Country-level and sub-national decision-making and planning
processes
– HR policies, planning, management, service delivery
– Development assistance for health practices.
• To identify useful lessons that improve the coherence of
development assistance and the co-ordination and efficacy
of the health system
• To understand how GHIs and other donors operate in South
Africa
5. Methodology
• Mostly relied on descriptive qualitative research (~230
interviews)
• Some quantitative research (Questionnaires and Document
Analysis), but limited by information availability
• Phased national (University of Pretoria) and sub-national level
research (2008-2010)
• Study relied on purposive sampling and snowballing of senior
government officials, GHI/ Donor country/ NGO
representatives
• 3 provinces were sampled according to GHI activity in the last
eight years, with a minimum of 2 districts and 2 facilities in
each district
• Data was thematically analysed
6. Sampled provinces
Eastern KwaZulu- Western National
Cape Natal Cape
Population, 2008 (DHIS) 7,084,923 9,894,761 4,945,733 48,272,35
Est. adult HIV prevalence, 18.5% 25.0% 6.2% 3
17.8%
2009 (UNAIDS)
Public sector ART 113,927 330,897 77,990 1,049,754
patients initiated as of
May 2010
TB cure rate, 2007 (DHB) 62.0% 55.4% 77.7% 64.0%
MMR per 100,000 live - - - 410
births, 2008 (UN)
Est. IMR per 1,000 live 60.3 60.0 25.3 46.1
births, 2007 (SAHR)
7. Findings
• Health system financing
• Selective Health System Strengthening
• HRH
• Accountability
• Financial sustainability
8. Flow of ART funding and GHIs
Global Fund to U.S. President’s
fight AIDS, TB Emergency Plan
and Malaria For AIDS Relief
Service
Government (national, provincial)
delivery
NGOs
Community-level ART services
9. Dependency on GHI funding?
• In 2007, donor funding accounted for 1% of all health system
expenditure and 26% of all HIV-related government spending
• National governments historically failed to acknowledge the
extent of GHI support for ART services: the general discourse
was donor funding is insignificant
• However, the project found GHI-supported service delivery
through government (KZN, WC) and service-delivery NGOs
(EC, KZN & WC) essential to ART roll-out
9
11. Distribution of PEPFAR-supported facilities in South
Africa, by province: October 2005, September 2009
Source:Larson et.al. 2012
12. Selective Approach to HSS
• Weak health system identified as major barrier to
success of programmes
– GHIs focus on disease specific interventions, e.g. vertical
TB, HIV (measurable short term outputs)
– HSS services a means to deliver targeted interventions e.g.
Improved HIS (NGO data capturer/software), drug supply,
seconded staff.
– Don’t address the root causes of the health system
weaknesses, but only constraints that impedes progress
e.g. use of expatriate staff to write proposals
13. HRH Supply
• On GHIs’ entry and ART initiation, South Africa faced HR
shortages and distribution challenges
– Vacancy rates in facilities ranged between 20-70%
– 39% of GPs & 44% of nurses served 80% of the population in the
public sector, vs 63% of GPs & 56% of nurses for 20% in the private
sector (2008)
• NGOs and government responded with:
– Task shifting (Nurse Initiated and Managed ART, training of
Pharmacist Assistants, increasing CHWs numbers)
– NGO secondment of staff to public sector facilities with a focus on
HR for ART services (as part of an emergency response),
• HR production did not match the increasing burden of
disease and demands of the ART roll out programme
14. HRH Training and Management
• Limited pre-service training on HIV/TB Management
– New graduates still require in-service training in HIV/TB management
– New PEPFAR Initiative on Strengthening Medical Schools (2011)
• NGOs supported short-term in-service training for
ART/PMTCT
• Government HR planning and forecasting affected by a lack of
information on NGO staff seconded staff
– Government HR management unable to track NGO seconded staff:
exposed existing weaknesses in government HR HIS
– HR planning not linked to disease profile e.g. ART scale up
14
15. HRH Sustainability
• HRH sustainability differed according to GHI funding
source
– GFATM: posts were created within the health service; only
the funds were external and posts themselves were
permanent
– PEPFAR: NGOs were told that health services would
absorb staff BUT usually without HR consultation
(recruitment did not meet HR criteria and posts not
created in system)
• Policy and practice gaps around HR initiatives mean
continual ART scale-up is problematic
– i.e. Task shifting not supported by regulation changes, e.g.
assistant pharmacists not allowed to prescribe some drugs
16. Scale-up sustainability
• Service integration of ART into general services constrained by general
health system capacity (M&E, HRH, pharmacy) and infrastructure
(buildings, funding)
– Expanded access to ARV treatment – 1163 512 people were enrolled ART by
August 2010, almost doubled its December 2008 total (NDOH, 2010)
– Service delivery NGO and government targets focus on the recruitment of new
patients, not the follow-up of ‘old’ patients
– ART as an emergency response justified building of vertical service: at what point
does an epidemic become endemic?
– National/provincial plans for sustainability tied to global economic changes
(i.e. Economic improvement? Access to cheaper 2nd/3rd line ARVs?)
• Financial support was selective – focused on GHI financed
programmes (HIV, TB, PMTCT)- while HIV disease affects all
services
17. Harmonization & Alignment
• NGOs’ reliance on performance based funding model meant
competition for limited resources and disincentive for
communication/collaboration
• The use of diverse Health Information Systems among NGOs/
GHIs increased problems of harmonization
• Denialism contributed to a lack of alignment
– GFATM worked directly with WC and KZN when they came in
– PEPFAR subcontracted NGOs, and in some areas by-passed
government institutions
• GFATM, PEPFAR increasingly demanding NGO/government
collaboration as part of growing sustainability drive
18. Acknowledgements
EU funding: INCO-DEV project
National and provincial health and treasury
departments
Municipal and district health authorities
All the Study Participants
19. Finding 2: Donor coordination (4)
• “Hmm, yeah, everyone got their own plans,
everyone wants to manage their own budgets,
everyone wants to have their own performance
indicators, everyone wants their own ‘in and outs’.
So it’s impossible to coordinate with that.” (NDOF2)
• Accountable to Funding institutions, not flexible
20. Financial accountability
• GHI funding emphasised financial accountability (linking
money spent to meeting targets)
• Tight financial accountability requirements led to vertical
systems and hierarchical management, BUT in turn:
– Facilitated the rapid rollout of ART
• Failure to align and consult ‘Beneficiaries’ by service-delivery
NGOs policy or planning process – a loophole
• Government lacked the authority to enforce decisions or
policy on NGOs as it did not control the finances and was
unwilling to sanction
– Related to reliance on service delivery NGOs for ART roll-out
21. Finding 2: Donor coordination (3)
Distribution of PEPFAR funded ART NGOs in KZN, 2008
Sources: National Department of Health HIV and Syphilis Survey 2009/2010, District Health Barometer 2008/2009, South African Health Review 2010
http://www.regency.org/news_may11_3.html http://www.iol.co.za/news/south-africa/ngos-feel-the-pinch-of-recession-1.437963 Delays in GFATM grant in 2008/9 exemplified problem: TAC forced to cut 20% of staff & ART literacy programme PEPFAR funding in particular is a main source of funding for service-delivery NGOs: though Treatment and Care funding not cut, in reality delays and flatlining in funding mean constraints on surveyed NGOs
Overall, GHI funding is a small percentage of South Africa’s health spending, but its influence on HIV and ART is disproportionate In FY2008, PEPFAR’s allocation for HIV treatment = 83% of the 2008/9 National Conditional Grant for HIV and AIDS and 57% of all expenditure on provincial health services HIV and AIDS sub programmes
Elysia Larson, Heidi O'Bra, J W Brown, Thobile Mbengashe, Jeffrey D Klausner: Supporting the massive scale-up of antiretroviral therapy: the evolution of PEPFAR-supported treatment facilities in South Africa, 2005-2009. BMC Public Health 2012, 12:173 doi:10.1186/1471-2458-12-173
Is this sustainable?? Get support to write good quality proposal but built capacity to implement and supervise.
NGO training on HIV increase staff mobility as they have skills in demand Figures from Sanders et al 2009 HR interventions reactive to HR challenges Staff patient ratio going down from 251nurses/100 000 in 1994 to 110/100 000 in 2007 Largest gaps are for pharmacy, lab specialist, doctors in public facilities
Training for clinical staff only in specific programme areas Rural nurses and doctors faced challenges in accessing training Found a lack of management/coordination of HR training (duplication of training, staff attended more than one course) NGOs ran the HIV-related trainings and lacked standardization (EC particularly) Built capacity among facility level programme staff and NGO staff (TB/HIV management and M&E) MEPI started recently. See Lancet article in about March/April 2011. I think that 2 SA med schools benefit, but am not sure. In Eastern Cape: Professional Nurses: 1996-2010 28%enrolled 59%, auxiliaries 23% 46% WF is >50yrs and 16% already reached 60 yrs 51, 200 PN need to qualify in the next 10 yrs Lack of HIV knowledge and skills among clinical staff: n= 215 providers in PHC facilities, ~>50% received training in clinical aspects of HIV/AIDS, 40% had been trained in counselling but only 10% had received training in both clinical aspects of HIV/AIDS and management (Modiba et al.,2003)
Presence of PEPFAR-funded NGO helped local government in EC and WC bypass internal bureaucratic employment processes for HR, but also meant lack of absorption/sustainability plans Lack of participation of other stakeholders in policy development (e.g. professional unions), resistance of labour unions Task shifting not supported by regulation changes, e.g. aasisstant pharmacists not allowed to prescribe some drugs
i.e. KZN consistently under-estimated ART uptake – health system does not have the capacity to sustain scale up If the NGO leaves, what happens? NGOs are a catalyst for service provision, but this is a problem in areas where government cannot sustain services Separate funding for HIV, HIV-related TB, PMTCT maintained by both government and GHIs/NGOs; PHC services continue to be underfunded though burden of "Some officials seem to believe government money from the budget ... and donor money are separate. Donor money was considered a luxury ... And we don't think that was correct.“ (Minister of Health, Reuters: 21/1/2011) http://mg.co.za/article/2011-01-21-motsoaledi-pursues-framework-to-harmonise-aid
It was unclear who should enforce the Paris Declaration There were fragmented coordination units among donors and NGOs e.g. EU Plus Forum, but few routine meetings etc Harmonization or alignment was particularly absent at the local level among service-delivery NGOs Different indicators were used by different NGOs/GHIs Was little sharing of reports, data among NGOs/GHIs Presence of PEPFAR-funded NGO helped local government in EC and WC bypass internal bureaucratic employment processes for HR, but also meant lack of absorption/sustainability plans GHI and NGO M&E requirements had knock-on effects on government practices, i.e. in WC with ART Government/NGO/GHI meetings were often reactive, not proactive (i.e. in reaction to unfunded mandate demands Exacerbated by lack of government management at local level Leadership, power dynamics Collaboration and management capacity was uneven across provinces
NGOs were only able to offer specific assistance to districts/facilities on the basis of the funding agreement with PEPFAR
Look at Umgungunlovu with highest ANC prevalence in 2008 – but fewer projects than Umkhanyakude, which also had about a third less uninsured population in 2007. Note that deprivation index does not include population density; not included for this presentation but even when taken into account there is disparity between that and number of projects (i.e. in 2007 Uthukela had almost a third more uninsured people accessing public health services in 2007 compared to Sisonke, a higher ANC HIV prevalence, but only 3 compared to 11 PEPFAR funded projects). Adding ANC prevalence suggests that projects should be concentrated on right, but still not quite right – look at Umgungunlovu with highest ANC prevalence in 2008