E-commerce lags in South Africa‚ says expert

All indicators reflect that e-commerce in SA is still in its infancy compared to the rest of the world‚ says Dieter Febel‚ MD of leading ISP SA Gateway‚ sister company to broad-based distributor Esquire Technologies…..more

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Resource: HIV Clinical Guidelines App

Made by The Open Medicine Project, the free app allows health workers and patients to access the latest national HIV guidelines via smart phones or tablets. These guidelines are automatically updated to reflect the latest Department of Health policies. Guidelines appear alongside a Google Maps-enabled directory of HIV treatment clinics and a feedback mechanism allowing health workers to report problems such as a need for training or drug stock outs….more

Booklet: Handbook for District Clinical Specialist Teams

Part of the country’s move towards a National Health Insurance and aimed at reducing maternal and child deaths, teams teams are made up of a number of specialists who provide clinical mentorship and guidance to health facilities. According to the National Department of Health handbook, teams should dedicated a maximum 70 percent of their time to clinical governance, 20 percent to clinical work and 10 percent on teaching and research. The 78-page handbook outlines concepts such as clinical governance, how to track team effectiveness and key interventions for reducing maternal and child deaths….more

Africa’s retail market: Plenty in store

FOR formal retail, Africa is one of the world’s few remaining frontiers. It is one on which SA retailers are making their mark, with the combined footprint of the 13 main contenders now in excess of 1 400 stores.

Shoprite leads the pack, its 320 stores in 14 countries generating R19bn in annual sales, which is 16,4% of the group total. Shoprite CE Whitey Basson, who has long termed Africa “our future growth driver”, is just getting into his stride…..more

Cochrane issues statement on WHO guidelines development and governance

A statement (below) by the Cochrane Collaboration notes that WHO has substantially improved its processes for guideline development, but says there is still room for improvement. In particular, it points to the need for research on ‘how to create guidelines for urgent public health problems where evidence may be very scarce or of poor quality’.

As a personal comment, this latter point is clearly the responsibility of the entire health research (and publishing and information sciences) community, and not of WHO specifically. If one is to look specifically at how better to appraise and synthesise evidence that may be scarce of of poor quality, perhaps the first priority is to ensure that all relevant research is indeed identified, so as to avoid the possibility that guidelines fail to include existing research.

Looking more broadly, a holistic approach is needed that not only makes the best use of ‘scarce or poor quality’ research, but also addresses the many underlying *causes* of the scarcity of high quality research – to move progressively towards a global research agenda that aligns with global health priorities.

(This statement is all about the quality of WHO guidelines. The elephant in the room is, of course, not the quality of WHO guidelines but the gap between WHO guidelines and actual policy and practice.)

I look forward to hear from HIFA members on these important issues.

Cochrane issues statement on WHO guidelines development and governance

http://www.cochrane.org/news/cochrane-issues-statement-who-guidelines-development-and-governance

Cochrane is an international organization that produces high-quality, relevant, accessible systematic reviews and other synthesized research evidence, and promotes evidence-based decision-making.  Cochrane has been an NGO in official relations with the World Health Organization (WHO) since 2011 and an important part of our workplan involves support for the WHO guideline development process.

Cochrane contributors published some of the earliest critiques of the WHO guideline process (Oxman, 2007) which called for guidelines to use reliable, independent research summaries that are free of conflicts of interest (Boyd, 2006).  WHO responded to these criticisms by developing a uniform review process in developing guidelines. This included implementing procedures to manage conflicts of interest. Recent analyses of WHO guidelines (Sinclair, 2013; Burda, 2014) have shown that editorial independence and use of reliable evidence have increased markedly since WHO has implemented these reforms, and highlight that these high standards are essential for WHO’s credibility.

WHO guideline panels have implemented procedures to make the link between recommendations and the underlying evidence more transparent.  There is room for improvement (Alexander, 2013).  Further research is needed to improve methods to create guidelines for urgent public health problems where evidence may be very scarce or of poor quality. Cochrane will continue to offer methodological support and training to WHO as it tackles these challenges.

Cochrane urges WHO to continue strengthening the use of evidence following a rigorous methodology in guideline development.  We recognize that panels should be cognizant of public and member state commentary on the issues, but the guidelines process needs to remain independent and separate from any individual or body with potential conflicts of interest. Involving participants with conflicts of interest in guideline development is likely to influence recommendations, make them less evidence based and impact on their credibility (Cosgrove, 2013).  Cochrane urges the WHO to protect against the influence of conflicts of interest in the guideline development process to ensure that the identification and evaluation of the best available evidence remains at its core.

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

New DFID Fund: Improving Communication of Research and Evidence for Development (ICRED)

Yesterday I went to a meeting at DFID to hear about a new programme: ˜Improving Communication of Research and EvEvidence for DevelopmentÃ.

Here is a description: ‘Having the ability to make evidence-informed policy and practice decisions is vital to support efforts to eradicate extreme poverty. DFID has designed the Improving Communication of Research Evidence for development programme (ICRED) to increase the impact of investments in development research, by supporting improved capacity of researchers and intermediaries in DFID priority countries to access, appraise and communicate evidence and rigorous research. Results of this programme are expected to include enhanced capacity of researchers (e.g. academics) and intermediaries (e.g. the media; civil society organisations) in DFID priority countries to routinely gather, appraise and communicate research evidence to inform the public, and increase the use of rigorous evidence for more effective development policy and practice.’

‘DFID will be seeking proposals for a range of projects that aim to build capacity of researchers and intermediaries to access, appraise and communicate evidence and rigorous research to inform development policy and practice. DFID has committed £12 million to this programme, which is expected to become operational during 2015/16, and a further 500,000 for an evaluation stream which will be commissioned following project selection. This programme will help inform DFID and other development research funders on what types of research uptake capacity building approaches are cost effective and have the greatest impact. It is anticipated that project contracts will run for 5 years.’

At the meeting, DFID said they were planning to distribute the 12 million pounds to 3 large projects only. In the Q&A session, I asked if they had considered making part of the money available for smaller organisations/projects, and unfortunately they are not planning to do this. However, they welcome applications from consortia.

HIFA could have a role to play in this programme. We not have the capacity to lead an application, but perhaps if a HIFA Supporting Organisation has the capacity to do this, you may like to consider HIFA as a budget line in a larger proposal. As a DFID representative said yesterday, “If the applicant is tapping into existing networks, that would be a strength”.

If you are interested, please let me know.

Further information here:

https://supplierportal.dfid.gov.uk/selfservice/pages/public/viewPublicNotice.cmd?bm90aWNlSWQ9NjM0NjA=

With best wishes,

Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Global Health Science & Practice: Successful mLearning Pilot in Senegal: Delivering Family Planning Refresher Training Using Interactive Voice Response and SMS

I was interested to read this paper in the open-access journal Global Health Science and Practice (isn’t it wonderful that papers relevant to HIFA seem to be increasingly, indeed mostly, open access?). The authors found that knowledge increased post-intervention. But perhaps what is more important is how the intervention compares with other interventions. Indeed, even if an intervention were ineffective, might one expect participants to acquire increased knowledge simply because they know they will be tested? I note that a few HIFA members are among the authors and look forward to their comments.

‘Health workers’ knowledge of contraceptive side effects increased substantially after the refresher training. The mobile phone approach was convenient and flexible and did not disrupt routine service

delivery. Clear limitations of the medium are participants can’t practice clinical skills or have interactive discussions. Also, some participants had trouble with network reception.’

CITATION: Successful mLearning Pilot in Senegal: Delivering Family Planning Refresher Training Using Interactive Voice Response and SMS

Abdoulaye Diedhiou, Kate E. Gilroy, Carie Muntifering Cox, Luke Duncan, Djimadoum Koumtingue, Sara Pacque-Margolis, Alfredo Fort, Dykki Settle, Rebecca Bailey.

http://www.ghspjournal.org/content/early/2015/06/01/GHSP-D-14-00220.full.pdf+html

ABSTRACT

Background: In-service training of health workers plays a pivotal role in improving service quality. However, it is often expensive and requires providers to leave their posts. We developed and assessed a prototype mLearning system that used interactive voice response (IVR) and text messaging on simple mobile phones to provide in-service training without interrupting health services. IVR allows trainees to respond to audio recordings using their telephone keypad.

Methods: In 2013, the CapacityPlus project, funded by the US Agency for International Development, tested the mobile delivery of an 8-week refresher training course on management of contraceptive side effects and misconceptions to 20 public-sector nurses and midwives working in Me´khe´ and Tivaouane districts in the Thie`s region of Senegal. The course used a spaced-education approach in which questions and detailed explanations are spaced and repeated over time. We assessed the feasibility through the system’s administrative data, examined participants’ experiences using an endline survey, and employed a pre- and post-test survey to assess changes in provider knowledge.

Results: All participants completed the course within 9 weeks. The majority of participant prompts to interact with the mobile course were made outside normal working hours (median time, 5:16 pm); average call duration was about 13 minutes. Participants reported positive experiences: 60% liked the ability to determine the pace of the course and 55% liked the convenience. The largest criticism (35% of participants) was poor network reception, and 30% reported dropped IVR calls. Most (90%) participants thought they learned the same or more compared with a conventional course. Knowledge of contraceptive side effects increased significantly, from an average of 12.6/20 questions correct before training to 16.0/20 after, and remained significantly higher than at baseline 10 months after the end of training at 14.8/20, without any further reinforcement.

Conclusions: The mLearning system proved appropriate, feasible, and acceptable to trainees, and it was associated with sustained knowledge gains. IVR mLearning has potential to improve quality of care without disrupting routine service delivery. Monitoring and evaluation of larger-scale implementation could provide evidence of system effectiveness at scale.

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

BMJ Open: Patient information leaflets to reduce antibiotic use – a systematic review

Information leaflets for patients reduce antibiotic prescriptions and their use should be encouraged. This is the main conclusion of a systematic review in BMJ Open. Below is the citation, abstract and selected extract.

The authors used ‘a broad search strategy for a complete and inclusive search’, and yet they found not a single eligible study from a low-income or middle-income country.

CITATION: Patient information leaflets to reduce antibiotic use and reconsultation rates in general practice: a systematic review

Eefje G P M de Bont, Marleen Alink, Famke C J Falkenberg, Geert-Jan Dinant, Jochen W L Cals

Corresponding author: Eefje G P M de Bont – eefje.debont@maastrichtuniversity.nl

BMJ Open 2015;5:e007612 doi:10.1136/bmjopen-2015-007612

http://bmjopen.bmj.com/content/5/6/e007612.full

Published 3 June 2015

ABSTRACT

Objective: Patients’ knowledge and expectations may influence prescription of antibiotics. Therefore, providing evidence-based information on cause of symptoms, self-management and treatment is essential. However, providing information during consultations is challenging. Patient information leaflets could facilitate consultations by increasing patients’ knowledge, decrease unnecessary prescribing of antibiotics and decrease reconsultations for similar illnesses. Our objective was to systematically review effectiveness of information leaflets used for informing patients about common infections during consultations in general practice.

Design, setting and participants: We systematically searched PubMed/MEDLINE and EMBASE for studies evaluating information leaflets on common infections in general practice. Two reviewers extracted data and assessed article quality.

Primary and secondary outcome measures: Antibiotic use and reconsultation rates.

Results: Of 2512 unique records, eight studies were eligible (7 randomised, controlled trials, 1 non-randomised study) accounting for 3407 patients. Study quality varied from reasonable to good. Five studies investigated effects of leaflets during consultations for respiratory tract infections; one concerned conjunctivitis, one urinary tract infections and one gastroenteritis and tonsillitis. Three of four studies presented data on antibiotic use and showed significant reductions of prescriptions in leaflet groups with a relative risk (RR) varying from 0.53 (0.40 to 0.69) to 0.96 (0.83 to 1.11). Effects on reconsultation varied widely. One large study showed lower reconsultation rates (RR 0.70 (0.53 to 0.91), two studies showed no effect, and one study showed increased reconsultation rates (RR 1.53 (1.03 to 2.27)). Studies were too heterogenic to perform a meta-analysis.

Conclusions: Patient information leaflets during general practitioners consultations for common infections are promising tools to reduce antibiotic prescriptions. Results on reconsultation rates for similar symptoms vary, with a tendency toward fewer reconsultations when patients are provided with a leaflet. Use of information leaflets in cases of common infections should be encouraged. Their contributing role in multifaceted interventions targeting management of common infections in primary care needs to further exploration.

SELECTED EXTRACTS (selected by Neil PW)

When asked, most patients appreciate written information10 and indicate they would be less likely to consult if they had more information about managing minor illnesses.11 ,12 In addition, the use of written information may improve information retention up to 50% and patient satisfaction may improve.13 ,14 Patients presenting with a common infection value information on self-management strategies and expected duration of illness. The use of information leaflets to assist a consultation may be a useful tool to convey information, increase patient knowledge and possibly restrict antibiotic prescriptions.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

Obsgyn training material freely available for providers and students in sub-Saharan Africa

Below are extracts of a news article in the May 2015 issue of Africa Health. The full article is freely available here:

http://www.africa-health.com/articles/may_2015/News.pdf

‘Providers and students in low-resource countries will now have access to high-quality academic learning and teaching materials to help reduce maternal and new-born deaths in sub-Saharan Africa.

‘High-quality, obstetric care is a critical factor in sub-Saharan Africa, but local barriers like the availability of training materials, licensing costs and unreliable Internet access can prevent incoming obstetricians and gynaecologists (Obgyns), and midwives from being trained with the best educational materials available. The materials are available through a new collection created by the University of Michigan’s 1000+ OBGYNs Project – a network of American and African universities preparing to train more than 1000 new Obgyns in the region in 10 years…

‘All materials are publicly available for free, and licensed for students, teachers and practitioners to copy and modify to suit their curricular context…’

Project website: www.1000obgyns.org

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Possible PDF sizes for free of charge new textbook and pocketbook of hospital care

The UK medical charity, Maternal and Childhealth Advocacy International (MCAI), has recently financed and produced two new books on the hospital care of pregnant women, new-born infants, and children with a special focus on resource-limited settings, where access to the internet is limited.

These two practical and evidence-based books (International Maternal and Child Health Care -A practical manual for hospitals worldwide and a Pocket Book of Hospital Care For Maternal Emergencies Including Trauma & Neonatal Resuscitation) have been written and peer reviewed by over 100 experts from around the world, all with experience in hospital settings where there are limited resources, who have freely given their time and expertise. Several authors and reviewers are HIFA and Child 2015 members.

Please see www.mcai.org.uk for more details on both books, including contents and authors.

MCAI is distributing printed copies of these two books free of charge to health workers in public hospitals in low-income countries that provide free care to pregnant women, babies, and children.  To date MCAI has sent 2,227 textbooks books free of charge to 33 countries, including 500 copies to Afghanistan, 500 copies to Somaliland, and 800 copies to The Gambia. We are also selling both books to those in wealthier countries, to help finance the free copies and their distribution.

In the near future, we plan to have the PDFs of both books on our website so that health workers who have access to the Internet can download them free of charge.  The PDF of each book is rather large, 20MB for textbook and 9MB for pocketbook, so download times, especially in settings with weak Internet strength, may be prohibitive. So we also plan to divide the books into smaller sections to aid downloading, especially for those in rural, resource-limited settings.

Both books have several sections and many chapters and it may not be convenient for users to have to download single chapters but the sections may still be too big.

So we would welcome feedback on the best size of downloadable sections so that those most in need can download them within a reasonable time. For example, would 3MB, 2MB or 1MB etc. be feasible?

It would be really helpful if HIFA and Child 2015 members, especially those working in rural hospitals in low-income countries where the Internet is most likely to be weak, could advise us on this matter so that we ensure that PDFs of both books are as useful as possible.

Very many thanks for your advice and we will inform members when the PDFs of both books are available.

David Southall and Rhona MacDonald

Honorary Medical and Honorary Executive Directors

Maternal and Childhealth Advocacy International (MCAI)

www.mcai.org.uk

HIFA profile: David Southall is a retired Professor of Paediatrics and Honorary Medical Director of Maternal and Childhealth Advocacy International (MCAI)    http://www.mcai.org.uk    He is also on the board of the International Child Health Group email: director AT mcai.org.uk

__________

Public consultation on the WHO global strategy on people-centred and integrated health services (PCIHS)

Dear all,

Please find below an email from World Health Organization inviting you to participate in a global survey about the new WHO global strategy on people-centred and integrated health services.

Looking forward to your feedback!

With kind regards,

Mart Leys

HIFA profile – Mart Leys is a Consultant for WHO in Geneva, Switzerland. leysm AT who.int

From KELLEY, Edward Talbott

Sent 05 June 2015 17:44

Subject Public consultation on the WHO global strategy on people-centred and integrated health services (PCIHS)

Dear Madam, Dear Sir,

As you may know, the World Health Organization launched the WHO global strategy on people-centred and integrated health services at the 15th International Conference for Integrated Care that took place in Edinburgh in March 2015 as an interim report. The Strategy promotes a paradigm shift in the way health services are funded, managed and delivered, and responds to the need to put people at the centre of service delivery and to foster integration across the care continuum. As we all know, this is urgently needed to meet the challenges being faced by health systems around the world, whether in high, middle or low income countries.

The final version of the Strategy will be submitted for discussion at the 138th meeting of the Executive Board to the 69th World Health Assembly in 2016. Before this official submission, we are expecting additional contributions from the WHO Regional Offices and experts in the field to enrich and revise the current interim documents.

It is with great pleasure that I announce that the Strategy is now ready for public consultation. We would like to engage individuals and organizations who have an interest in people-centred and integrated health services, with the aim of undertaking a critical review of the Strategy’s strengths and weaknesses and receiving valuable inputs to help inform its implementation. For this purpose, we have designed an online survey that deals with different sections of the Strategy. The survey will close on 15 July 2015, and the results will be compiled in a report to be published in the coming months. You can find all the information regarding this initiative and the online survey via the following link http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/

On behalf of the Service Delivery and Safety department, I am pleased to invite you to contribute to this public consultation process.

We look forward to your active and enthusiastic involvement and encourage you to spread the message widely in your network.

We thank you very much for your collaboration.

Yours faithfully,

Dr. Edward Kelley

Director

Service Delivery and Safety

World Health Organization

20 Avenue Appia

1211 Geneva 27, Switzerland

+41 22 791 2472 (phone)

+41 22 791 4769 (fax)

kelleye@who.int

__________

To send a message to the HIFA forum, simply send an email to: HIFA2015@dgroups.org

BMJ article: The knowledge system underpinning healthcare is not fit for purpose and must change

Please see below. I look forward to your thoughts. The key messages are valid, but I would argue for a different perspective: The knowledge system underpinning healthcare is not fit for purpose and *must be strengthened* (not ‘must change’). The authors point to well-known issues regarding quality of research, failure to publish, publishing bias, and reliability of systematic reviews. They suggest that ‘including only prospectively registered trials in systematic reviews will improve validity and readability’. It seems to me that a review is more likely to be valid if it takes into account all available evidence, and then uses criteria (including registration among many others) to assess the validity of each piece of research in the systematic review process, as is currently the norm.

A further personal comment is that the healthcare knowledge system is about much more than research, publishing of research, and systematic reviews. HIFA uses a simple model for the global healthcare knowledge system, based on the Lancet article 2004 Can we achieve health information for all by 2015?

http://www.hifa2015.org/about/the-strategy-for-achieving-our-goal/

The BMJ have published an article critiquing the current healthcare knowledge system.

The full article can be read here (subscription required or a free 14 day subscription option is available).

http://www.bmj.com/content/350/bmj.h2463

Roberts Ian, Ker Katharine, Edwards Phil, Beecher Deirdre, Manno Daniela, Sydenham Emma et al. The knowledge system underpinning healthcare is not fit for purpose and must change BMJ 2015; 350 :h2463

Correspondence to: Ian Roberts: ian.roberts@lshtm.ac.uk

The authors argue that medical literature is biased and inundated with poor quality trials. The article explains how these problems affect systematic reviews and how they might be overcome.

It identifies problems with systematic reviews, including the bias created by unpublished trials, low quality – single centred trials, and the fact that most meta analysis – even when they cover 15 or more trials – actually only have a small number of overall trial participants.

The key messages identified in the article are:

Because the medical literature is biased, systematic reviews based on it are also biased. Many reviews are out of date and unreadably long

Including only prospectively registered trials in systematic reviews will improve validity and readability

Insisting that authors of doubtful trials provide the original trial data for statistical checking will improve validity

Requiring review authors to specify an estimated information size based on plausible treatment effects will reduce the risk of false positive conclusions and make reviews more reliable

Trial registries should include full protocols and datasets to facilitate the conduct of valid systematic reviews

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

A call to scale-up Community Health Workers

This post is co-authored with Sonia Sachs on behalf of the 1 Million CHW Campaign.

[Read online here: http://1millionhealthworkers.org/2015/06/15/a-call-to-scale-up-community-health-workers/ ]

Public health officials and practitioners from around Africa and from international public and private organizations, businesses, and universities, met in Accra, Ghana June 9-11 to consider ways to scale-up the coverage of high-quality community health worker (CHW) systems in our countries to achieve universal health coverage (UHC). In the meeting they pledged to work together to speed the scale-up of CHW systems in sub-Saharan Africa, and issued the following urgent appeal.

Joint Call to Action

We have reviewed the national experiences and the scholarly evidence demonstrating that CHW systems are a critical, integral, cost-effective, and long-term part of effective overall health systems. CHWs save lives, promote public health and wellbeing, bridge health system gaps, improve the quality of life, and help to prevent and end epidemics like Ebola. As members of the communities they serve, CHWs are the health workers closest to households. CHW systems offer high-quality, meaningful employment for young people.

We know that effective national-scale CHW systems start at home. We urge all African governments, including Ministers of Finance and Health, to recognize the indispensable role of CHWs in public health and epidemic control, by taking the following steps:

Making and implementing plans for national-scale CHW systems;

Expanding the domestic funding available for CHW systems;

Ensuring that CHWs are properly trained, remunerated, supported by cutting-edge information systems, and empowered with the proper supplies, equipment, and training needed to provide both preventive and curative care with professional skills and to empower communities in their own health;

Preparing CHW systems to address the non-communicable disease challenges that will be central to the new Sustainable Development Goals (SDGs);

Supporting CHW systems with state-of-the-art information and communications systems made possible by breakthroughs in mobile broadband, telemedicine, remote monitoring, remote diagnostics, and other recent ICT innovations of great promise and significance;

Empowering communities to work effectively with CHW systems;

On the international side, we underscore the urgent need to scale-up international support for CHW systems, and to convert the fragmented global CHW funding into pooled financing that supports national CHW systems. We are concerned about donors supporting parallel programs rather than national programs. Because of such parallel programs, CHW systems are scattered across many projects, each with its own protocols, ICT systems, if any, varied durations, and inconsistent approaches on training and the range of activities of the CHWs.

We strongly urge donors to pool their CHW resources into a few pooled global funds, including the Global Fund to Fight AIDS, TB, and Malaria, GAVI, the new Global Finance Facility, and possibly a new Global Fund for Health Systems. These pooled funds should provide additional financing for CHWs in a flexible and timely manner. We call on the donor partners to end the donor fragmentation and the long delays in disbursements. The time for scale-up has arrived.

We note that two countries in Africa, Guinea and Sierra Leone, are still battling Ebola, while Liberia has succeeded in ending their Ebola epidemic in part through the successful deployment of community health workers. Ebola is a scourge that takes hold in places with under-financed and fragmented health systems that lack effective CHW system support. We call on the international community to support the Ebola-affected countries to scale-up their national health systems, including high-quality CHW systems, with full urgency.

We note that the world is on the verge of adopting the new SDGs, calling among other things for UHC as part of SDG 3. We also note that world leaders will assemble in Addis Ababa, Ethiopia next month to take steps to finance the new SDGs. We firmly believe and declare that success in universal health coverage will require the proper funding and scale-up of CHW systems in our countries and throughout Africa. We call on world leaders to heed the exciting opportunities at hand to save lives by the millions in the coming years through professionalized, high-quality CHW systems linked to overall high-quality health care systems.

We address this appeal to the leaders of national governments and the international health organizations. We kindly request the One Million Community Health Workers Campaign report back to the participating governments in advance of the UN SDG Summit in September 2015, so that we can move forward effectively and confidently together in an urgent and timely manner.

Accra

June 11, 2015

Adopted by acclamation with:

Government representatives from:

Ministry of Health, Burkina Faso

Ministry of Finance, Burkina Faso

Ministry of Health, Congo-Brazzaville

Government of Ghana

Ministry of Health, Ghana

Ministry of Finance, Ghana

Ghana Health Services

Ministry of Local Government and Rural Development, Ghana

Ministry of Health and Public Hygiene, Guinea

Ministry of Health, Kenya

Ministry of Health and Social Welfare, Liberia

Ministry of Finance, Liberia

Ministry of Health, Malawi

Ministry of Finance, Malawi

Ministry of Health, Mozambique

National Primary Health Care Development Agency, Nigeria

Ministry of Health, Rwanda

Ministry of Health and Social Action, Senegal

Ministry of the Economy, Finance, and Planning, Senegal

Ministry of Health and Sanitation, Sierra Leone

Ministry of Finance, Sierra Leone

Ministry of Health, Uganda

Ministry of Finance, Uganda

Ministry of Health and Social Welfare, Tanzania

Ministry of Finance, Tanzania

Ministry of Community Development, Zambia

Ministry of Health, Zambia

Representatives from:

BRAC

Brandeis University

Earth Institute at Columbia University

Moi University

Clinton Health Access Initiative, Zambia

Columbia Global Center East & Southern Africa

Columbia Global Center West & Central Africa

Global Health Workforce Alliance (GHWA)

Harvard University

Ifkara Health Institute

Johns Hopkins University

Last Mile Health

Living Goods

Management Sciences for Health, USA

Management Sciences for Health, Ghana

Management Sciences for Health, Rwanda

Millennium Development Goals Health Alliance

Millennium Promise Inc.

Millennium Villages Project, Ghana

CORE Group

National Health Insurance Fund, Ghana

Sanford International Clinics, USA

Sanford International Clinics, Ghana

Save the Children, Sierra Leone

Sustainable Development Solutions Network

University of Ghana School of Public Health

University of Washington

WHO AFRO

WHO Ghana

World Vision International

World Vision, Ghana

Follow Jeffrey Sachs on Twitter: www.twitter.com/JeffDSachs

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