Bulletin of the World Health Organization
Volume 93, Number 7, July 2015, 437-512
http://www.who.int/bulletin/volumes/93/7/en/

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Editorials
Technology, innovation and health equity
Hildy Fong a & Eva Harris a
a. Center for Global Public Health and Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, United States of America.
Bulletin of the World Health Organization 2015;93:438-438A. doi:
[Initial text]
Innovative technologies have enormous potential to improve human well-being. However, technological progress does not guarantee equitable health outcomes. As advances in technology redefine the ways people, systems and information interact, resource-poor communities are often excluded. Where technological fixes have been imposed on communities, the results have included abandoned equipment, incompatible computer programs and ineffective policies….

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Research
A comparative analysis of national HIV policies in six African countries with generalized epidemics
Kathryn Church, Francis Kiweewa, Aisha Dasgupta, Mary Mwangome, Edith Mpandaguta, Francesc Xavier Gómez-Olivé, Samuel Oti, Jim Todd, Alison Wringe, Eveline Geubbels, Amelia Crampin, Jessica Nakiyingi-Miiro, Chika Hayashi, Muthoni Njage, Ryan G Wagner, Alex Riolexus Ario, Simon D Makombe, Owen Mugurungi & Basia Zaba
Abstract
Objective
To compare national human immunodeficiency virus (HIV) policies influencing access to HIV testing and treatment services in six sub-Saharan African countries.
Methods
We reviewed HIV policies as part of a multi-country study on adult mortality in sub-Saharan Africa. A policy extraction tool was developed and used to review national HIV policy documents and guidelines published in Kenya, Malawi, South Africa, Uganda, the United Republic of Tanzania and Zimbabwe between 2003 and 2013. Key informant interviews helped to fill gaps in findings. National policies were categorized according to whether they explicitly or implicitly adhered to 54 policy indicators, identified through literature and expert reviews. We also compared the national policies with World Health Organization (WHO) guidance.
Findings
There was wide variation in policies between countries; each country was progressive in some areas and not in others. Malawi was particularly advanced in promoting rapid initiation of antiretroviral therapy. However, no country had a consistently enabling policy context expected to increase access to care and prevent attrition. Countries went beyond WHO guidance in certain areas and key informants reported that practice often surpassed policy.
Conclusion
Evaluating the impact of policy differences on access to care and health outcomes among people living with HIV is challenging. Certain policies will exert more influence than others and official policies are not always implemented. Future research should assess the extent of policy implementation and link these findings with HIV outcomes.

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Policy & Practice
The need to accelerate access to new drugs for multidrug-resistant tuberculosis
Helen S Cox, Jennifer J Furin, Carole D Mitnick, Colleen Daniels, Vivian Cox & Eric Goemaere
Abstract
Approximately half a million people are thought to develop multidrug-resistant tuberculosis annually. Barely 20% of these people currently receive recommended treatment and only about 10% are successfully treated. Poor access to treatment is probably driving the current epidemic, via ongoing transmission. Treatment scale-up is hampered by current treatment regimens, which are lengthy, expensive, poorly tolerated and difficult to administer in the settings where most patients reside. Although new drugs provide an opportunity to improve treatment regimens, current and planned clinical trials hold little promise for developing regimens that will facilitate prompt treatment scale-up. In this article we argue that clinical trials, while necessary, should be complemented by timely, large-scale, operational research that will provide programmatic data on the use of new drugs and regimens while simultaneously improving access to life-saving treatment. Perceived risks – such as the rapid development of resistance to new drugs – need to be balanced against the high levels of mortality and transmission that will otherwise persist. Doubling access to treatment and increasing treatment success could save approximately a million lives over the next decade.

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Perspectives
Redefining shared sanitation
Thilde Rheinländer a, Flemming Konradsen a, Bernard Keraita a, Patrick Apoya b & Margaret Gyapong c
a. Department of Public Health, University of Copenhagen, Øster Farigmagsgade 5, 1014 Copenhagen, Denmark.
b. Africa Sanitation Think Tank, 03 BP 7112, Ouagadougou 03, Burkina Faso.
c. Dodowa Health Research Center and School of Public Health, University of Ghana, Accra, Ghana.
(Submitted: 20 August 2014 – Revised version received: 09 February 2015 – Accepted: 16 February 2015 – Published online: 28 April 2015.)
Bulletin of the World Health Organization 2015;93:509-510. doi:
[Excerpt]
As the Millennium Development Goals reach their deadline, it is clear that the world is not on track to achieve global sanitation targets. With sanitation trends, global developments and local contexts in mind, it is time to adopt a more flexible approach to achieving universal functional sanitation. By functional sanitation, we mean toilet facilities that protect human health by preventing contamination of the environment with human faecal waste….
…Key sanitation stakeholders and donors should recognize the potential of household shared sanitation as an important driver behind sanitation progress in African and Asian high-density areas and low-income populations. Accepting household shared sanitation as a suitable toilet type could have major implications. This would legitimize innovative funding mechanisms, shared maintenance schemes and upgrading of large numbers of existing shared toilets to acceptable standards.
We argue that the focus for future sanitation programmes should be on improving the hygienic standards of shared facilities to a level that satisfies and protects sanitation users – irrespective of the toilet design. If well managed, household shared sanitation can be a feasible, economical, practical and socially acceptable choice for millions of sanitation users.