The Leprosy Post-Exposure Prophylaxis (LPEP) programme: update and interim analysis.

Innovative approaches are required to further enhance leprosy control, reduce the number of people developing leprosy, and curb transmission. Early case detection, contact screening, and chemoprophylaxis currently is the most promising approach to achieve this goal. The Leprosy Post-Exposure Prophylaxis (LPEP) programme generates evidence on the feasibility of integrating contact tracing and single-dose rifampicin (SDR) administration into routine leprosy control activities in different settings. The LPEP programme is implemented within the leprosy control programmes of Brazil, Cambodia, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. Focus is on three key interventions: tracing the contacts of newly diagnosed leprosy patients; screening the contacts for leprosy; and administering SDR to eligible contacts. Country-specific protocol adaptations refer to contact definition, minimal age for SDR, and staff involved. Central coordination, detailed documentation and rigorous supervision ensure quality evidence. Around 2 years of field work had been completed in seven countries by July 2017. The 5,941 enrolled index patients (89·4% of the registered) identified a total of 123,311 contacts, of which 99·1% were traced and screened. Among them, 406 new leprosy patients were identified (329/100,000), and 10,883 (8·9%) were excluded from SDR for various reasons. Also, 785 contacts (0·7%) refused the prophylactic treatment with SDR. Overall, SDR was administered to 89·0% of the listed contacts. Post-exposure prophylaxis with SDR is safe; can be integrated into the routines of different leprosy control programmes; and is generally well accepted by index patients, their contacts and the health workforce. The programme has also invigorated local leprosy control.

Validity of reported vaccination coverage in 45 countries.

BACKGROUND: Monitoring and assessment of coverage rates in national health programmes is becoming increasingly important. We aimed to assess the accuracy of officially reported coverage rates of vaccination with diphtheria-tetanus-pertussis vaccine (DTP3), which is commonly used to monitor child health interventions. METHODS: We compared officially reported national data for DTP3 coverage with those from the household Demographic and Health Surveys (DHS) in 45 countries between 1990 and 2000. We adjusted survey data to reflect the number of valid vaccinations (ie, those administered in accordance with the schedule recommended by WHO) using a probit model with sample selection. The model predicted the probability of valid vaccinations for children, including those without documented vaccinations, after correcting for bias from differences between the children with and without documented information on vaccination. We then assessed the extent of survey bias and differences between officially reported data and those from DHS estimates. FINDINGS: Our results suggest that officially reported DTP3 coverage is higher than that reported from household surveys. This size of the difference increases with the rate of reported coverage of DTP3. Results of time-trend analysis show that changes in reported coverage are not correlated with changes reported from household surveys. INTERPRETATION: Although reported data might be the most widely available information for assessment of vaccination coverage, their validity for measuring changes in coverage over time is highly questionable. Household surveys can be used to validate data collected by service providers. Strategies for measurement of the coverage of all health interventions should be grounded in careful assessments of the validity of data derived from various sources.

Access, utilization, quality, and effective coverage: an integrated conceptual framework and measurement strategy.

Health systems can primarily improve the health of individuals and populations by delivering high-quality interventions to those who may benefit from them. We propose a concept of effective coverage as the probability that individuals will receive health gain from an intervention if they need it. Understanding the extent to which health systems are delivering key interventions to those who will benefit from them and the factors that explain gaps in delivery are a critical input to decision-making at the local, national and global levels. We develop an integrated conceptual framework for monitoring and analyzing the delivery of high-quality interventions to those who need them. This framework can help clarify the inter-relationships between notions of access, demand for care, utilization, and coverage on the one hand and highlight the requirements for health information systems that can sustain this type of analysis. We discuss measurement strategies and demonstrate the concept by means of a simple simulation model.

Physician shortages in rural Vietnam: using a labor market approach to inform policy.

This paper investigates labor market dynamics for physicians in Vietnam, paying particular attention to geographic distribution and dual job holding. The analysis is based on a survey of a random sample of physicians in 3 regions in 2009-10. We found that the labor market for physicians in Vietnam is characterized by very little movement among both facility levels and geographic areas. Dual practice is also prominent, with over one-third of physicians holding a second job. After taking account of the various sources of income for physicians and controlling for key factors, there is a significant wage premium associated with locating in an urban area. This premium is driven by much higher earnings from dual job holding rather than official earnings in the primary job. There are important policy implications that emerge. With such low job turnover rates, policies to increase the number of physicians in rural areas could focus on initial recruitment. Once in place, physicians tend to remain in their jobs for a very long time. Lastly, findings from an innovative discrete choice experiment suggest that providing long-term education and improving equipment are the most effective instruments to recruit physicians to work in rural areas.