This cross-sectional study examined health supply chain management in Rwanda through surveys of 103 respondents from 54 institutions, including government bodies, medical suppliers, pharmacies, and hospitals. Health commodity availability ranked highest (98.0%) among benefits, alongside improved infrastructure and cost-effectiveness. Major challenges included insufficient financial resources, skilled staff shortages, and limited information sharing. Participants recommended improving collaborative partnerships through political will, supply performance measurement, better financing policies, and increased transparency. Results emphasize the importance of strengthening stakeholder collaboration, staff capacity, and information sharing to enhance supply chain efficiency and client satisfaction.
Public-Private Mix
This pilot study evaluated HIV service uptake when private pharmacies offered free testing and referrals in Kisumu County, Kenya. Among 1,500 pharmacy clients tested, 1,178 were followed up after three months. Most participants were women (median age 26), testing HIV-negative and receiving pre-exposure prophylaxis (PrEP), or post-exposure prophylaxis (PEP) referrals. While antiretroviral therapy (ART) initiation and PEP uptake was high among those referred, PrEP uptake remained low at 9%, with prior PrEP use being the only significant predictor of initiation. Findings suggest the need for additional interventions to support PrEP referral follow-through or alternative delivery models like same-day pharmacy initiation.
The current Kenyan cigarette tax regime is reported to fail to control cigarette consumption efficiently, especially among young people. Kenya decentralized the implementation of the Tobacco Control Act to 47 county governments in 2010. However, this decentralization has created a need for more institutional coherence in implementing the act. The tobacco industry exploits these fragmented counties by targeting the young people with tobacco products, particularly in the eastern, central and coast counties, where less resources are available for governance and control of substance use. The central government is thus recommended to enforce measures that ensure homogeneous implementation of tobacco control in all counties. The lobbying power of the tobacco industry blunts the effectiveness of the cigarette excise tax policy. In 2017, the industry lobbied the Kenyan government to adopt a two-tier tax system, which caused differential taxes between cheap and premium cigarettes. Unfortunately, the current Kenyan tax does not help to reduce nicotine pouch consumption and fails to prevent young people from starting. Therefore, a case for reforming the excise tax policy on cigarettes and nicotine products is argued to exist: the government needs to coordinate robust and comprehensive operations to regulate the entire supply chain of the e-liquid market. These measures should be combined with targeted cessation support and awareness campaigns focusing on vulnerable young people. The authors propose that Kenya can do better by replicating Uganda’s approach, which taxes tobacco progressively, as well as to implement aggressive tobacco taxation in line with the WHO FCTC; introduce high taxation of or ban nicotine pouches and regulate e-liquids.
The Amandla! Radio Podcast presents a deep dive into public-private partnerships and the corporate takeover of development. This is the inaugural episode of the new podcast series hosted on CKUT McGill Radio and is the successor to a long-running radio show that broadcast for over three decades. The podcast documents discussions held earlier this year with several authors of the book Corporate Capture of Development. The authors discuss the disruptive and negative impacts of public private partnership development models in Kenya, Ghana, Sierra Leone and Mexico. The rich insights cover issues ranging from the role of the state, how to build resistance and what kind of alternatives could be considered. The accounts describe the learning and tell a story that demands action.
The RTS,S/AS01 malaria vaccine produced by GSK was recommended by the World Health Organization in 2021. In October 2023, WHO recommended the second malaria vaccine, R21/Matrix-M, developed by Oxford’s Jenner Institute and manufactured by the Serum Institute of India. Both the RTS,S and R21 vaccines have been shown to be effective and safe. Yet for months it was unclear how many doses of R21 would be ordered and delivered; and only recently just 10 million were reported as ordered and delivered at a time when the number of doses available stood at 25 million. The solution to this shortfall is argued to require African action, to prioritise these lifesaving vaccines and push Unicef and GAVI to procure supply. Respective countries aiming to roll out the vaccines also need to authorise R21 through their regulatory authorities, a process that can take about 6 months. So far, only Nigeria, Ghana and Burkina Faso have done so. Applications to GAVI go through the ministries of health and finance and can be submitted only once every three months. The authors propose allowing a rolling window for applications to be submitted as soon as they are ready to save time, but also see the situation as .a wake-up call to Africa to build its own capacity for pioneering research and development of countermeasures against endemic diseases.
Africa has one of the highest cancer death rates in the world, yet this could be markedly improved by better access to treatments already widely available in high-income countries for the continent’s biggest killers – breast, cervical, lung and prostate cancers and Kaposi sarcoma. This is according to a recent study by the Botswana-Rutgers Partnership for Health, which researched which cancer treatments that are effective in other regions could have an impact in sub-Saharan Africa (SSA) – but are not available or hard to get. The partnership propose a framework for how to improve access to the life-saving and life-altering medications that are proven to work that are available elsewhere but not in Africa. While cost-effectiveness concerns are noted to be important in realistically increasing availability of a broad range of oncology drug therapies in SSA, they propose advancing therapeutics would reduce the significantly high case-fatality rates from cancer in SSA as a global imperative, combined with investment in diagnostic and laboratory infrastructure and in the oncology workforce.
The South African Presidency released the ‘Third Final Report’ of its investigations into Covid-related corruption in December 2022, probing 5,513 contracts given to 3,058 service providers. Irregularities were identified in 2,965 contracts to the tune of R8.8bn. Although the Special Tribunal has played a pioneering role since it was established, its work has often been hampered by legal challenges to its authority, although now empowered by an important decision in its favour by the Constitutional Court. The authors note that although irregularities to the value of R8.8-billion have so far been found by the SIU, the value of matters enrolled at the Tribunal is less than R2.5-billion and the rand value of cash and/or assets actually recovered so far is a mere R36-million. This is noted to be a vast disjuncture, amounting to less than half a percent, and that there is a lot of work to be done.
In Africa, the Care Economy has long been unrecognised. At least since the last pandemic — HIV-AIDS — caring work has been severely undervalued in the continent, and the redistribution of caring work, from females in the home and communities, next to non-existent. The COVID-19 pandemic has renewed attention to the care economy globally. The Africa Care Economy Index offers a concrete evaluation of African state performance in the recognition, support and redistribution of caring work. Based on a definition of care economy and related concepts relevant in Africa, the Index uses ten metrics to evaluate the 54 states of the continent. Demonstrating longstanding neglect of the care economy by all states in Africa, recommendations are made around broad policy and in depth research required to begin supporting and redistributing caring work. Social recognition and state support for caring work are shown to be central to building holistic development that benefits the majority in Africa.
This paper documented public and private sector partnerships in the Democratic Republic of Congo, Nigeria, Senegal and Uganda between November 2020 and March 2021 in responses to the COVID-19 pandemic, using literature review and key informant interviews. Across the 4 countries, private sector strengthened laboratory systems, COVID-19 case management, risk communication and health service continuity. Across the 4 countries, the private sector supported expansion of access to COVID-19 testing services through establishing partnerships with the public health sector albeit at unregulated fees. In Senegal and Uganda, governments established partnerships with private sector to manufacture COVID-19 rapid diagnostic tests. In addition, private entities provided personal protective equipment, conducted risk communication to promote adherence to safety procedures and health promotion for health service continuity. However, there were concerns related to reporting, quality and cost of services, calling for quality and price regulation in service provision. The authors indicate that regulatory frameworks are needed in public–private engagements in pandemics, including of pricing, quality assurance and alignment with national plans and priorities.
Illicit financial flows are argued by the authors to punch holes in the public purse across the African continent. Over the past five decades Africa is reported to have lost in excess of US$ 1 trillion in illicit financial flows, dwarfing the continent's receipts of overseas development assistance during this period and the foreign direct investment into Africa. Based on research of national laws, policies and practice, each of the 70 countries included in the Corporate Tax Haven Index are given a score. African countries are found to contribute less to tax abuse than European Union and OECD member states and their dependencies, but have less robust transparency and anti-avoidance measures. The authors call for policy improvements in African countries to curb and protect against corporate tax abuse, and advocate for a UN Tax Convention.