Below are the citation, abstract and key messages of a new paper in Health Policy and Planning, highly relevant to HIFA’s work on promoting the availability and use of reliable information for prescribers and users of medicines: http://www.hifa2015.org/prescribers-and-users-of-medicines/

It would be very interesting to hear from HIFA members in PNG and other countries about the role of Standard Treatment Guidelines, Essential Medicines Lists, and other resources to support rational prescribing.

The full text is freely available here:

http://heapol.oxfordjournals.org/content/early/2015/09/15/heapol.czv083.full?papetoc

CITATION: An evaluation of the Essential Medicines List, Standard Treatment Guidelines and prescribing restrictions, as an integrated strategy to enhance quality, efficacy and safety of and improve access to essential medicines in Papua New Guinea

Isaac B Joshu,   Phillip R Passmore and Bruce V Sunderland

Health Policy Plan. (2015)

doi: 10.1093/heapol/czv083

First published online: September 15, 2015

Corresponding author E-mail: i.joshua@postgrad.curtin.edu.au

ABSTRACT

The World Health Organization (WHO) has advocated the development and use of country specific Standard Treatment Guidelines (STGs) and Essential Medicines Lists (EML) as strategies to promote the rational use of medicines. When implemented effectively STGs offer many health advantages. Papua New Guinea (PNG) has official STGs and a Medical and Dental Catalogue (MDC) which serves as a national EML for use at different levels of health facilities. This study evaluated consistency between the PNG Adult STGs (2003 and 2012) and those for children (2005 and 2011) with respect to the MDCs (2002, 2012) for six chronic and/or acute diseases: asthma, arthritis, diabetes, hypertension, pneumonia and psychosis. Additionally, the potential impact of prescriber level restrictions on rational medicines use for patient’s living in rural areas, where no medical officer is present, was evaluated. Almost all drugs included in the STGs for each disease state evaluated were listed in the MDCs. However, significant discrepancies occurred between the recommended treatments in the STGs with the range of related medicines listed in the MDCs. Many medicines recommended in the STGs for chronic diseases had prescriber level restrictions hindering access for most of the PNG population who live in rural and remote areas. In addition many more medicines were listed in the MDCs which are commonly used to treat arthritis, high blood pressure and psychosis than were recommended in the STGs contributing to inappropriate prescribing. We recommend the public health and rational use of medicines deficiencies associated with these findings are addressed requiring: reviewing prescriber level restrictions; updating the STGs; aligning the MDC to reflect recommendations in the STGs; establishing the process where the MDC would automatically be updated based on any changes made to the STGs; and developing STGs for higher levels of care.

KEY MESSAGES

– Lack of integration of Essential Medicines Lists, Standard Treatment Guidelines and prescribing restrictions leads to potential inappropriate prescribing and restricted access to medicines.

– In Papua New Guinea (PNG) there is very limited public access to drugs for the management of chronic diseases.

– In PNG there are notable discrepancies between the Essential Medicines List and Standard Treatment Guidelines.

Best wishes, Neil

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

Thanks to everyone for the valuable insights to the CHW discussion each day.  I’d like to respond in one go – for which I apologize, but my thoughts are cross-cutting, stimulated every time I read another contribution.

There is clearly critical evidence that CHWs can provide missing care to people who often have no care at all. However, the care provided has to be consistent with the skills that CHWs have, and across countries and even within countries, there are different types and levels of training, hence different skills levels.  We have also seen that CHWs can safely and effectively provide parts of care chains in specialist areas – the treatment of TB for example, or the prevention and early detection of Malaria. This is laudable and cost-efficient, as studies point out – because CHWs are cheap.

Now I begin to worry a bit: are we saying then that what the world needs is CHWs rather than other types of health workers – because the world can afford CHWs and not health workers? No-one has actually articulated this actual sentence, but no-one has articulated either what the overall plan is. Are CHWs envisaged as  a temporary solution to the health workforce crisis- or a permanent one? If the solution is temporary then what may be required is a career path that enables the CHW to progress into well paid employment as a health worker.  Even well qualified health workers have difficulties progressing up the career ladder in low income settings – where are the jobs and where is the money?

To really address the health workforce crisis, what is needed is investment in the health system and especially the health workforce. CHWs have a vital role as a member of a dynamic health team with a range of competencies to deal with the total disease burden of a community.

For CHWs to be really clinically successful they have to have a reliable referral system, that ensures that people get seen quickly, when needed, at each level of the health care system. Yet where CHWs are envisaged as the solution to health workforce shortages, the referral systems are the weakest also. CHWs are important as one cadre in the health worker team, but they are definitely not the panacea for what ails health systems. There is no panacea. What is needed is for governments to choose to invest in healthy populations by developing stronger health systems and well paid, highly valued health workers, no matter what title they have.

Barbara Stilwell | Senior Director of Health Workforce Solutions

IntraHealth International | Because Health Workers Save Lives.

t. +1 (919) 313-9161| bstilwell@intrahealth.org

Skype. Barbara.stilwell

My MOOC (massive, open online course) on Coursera  entitled Health for All through Primary Health Care is now available for enrollment at your convenience, and you can take it at your own speed.

As before, the course consists of 4 modules. Each module contains 1 hour of lecture and 1 hour of readings. The course is free, but you can obtain a verified certificate of completion for $49 if you want (assuming you satisfactorily complete all the assignments). A statement of completion will be provided to those who complete all the assignments but who do not pay for a verified certificate of completion.

For those who want a statement or certificate of completion, there is a quiz after each module and, after the second module, a 2-page paper to write and after the fourth module, a 4-page paper to write.

So far, more than 50,000 people have enrolled in the eight previous course offerings, and I have received many comments from people who have found it to be a meaningful learning experience and even transformative.

To sign up, to to: https://www.coursera.org/course/healthforall.

Please share this with any of your colleagues and feel free to distribute it on any listservs you may have access to.

Thanks! Best wishes,

Henry B. Perry, MD, PhD, MPH

Senior Scientist, Department of International Health, Room E8537

Bloomberg School of Public Health, Johns Hopkins University

Baltimore, MD 21205, hperry2@jhu.edu, 443-797-5202

I think you make a very important point when you say “Sustainable Development is best achieved by having access to information, sharing and networking”. Indeed, it could be asserted that “Sustainable Development can only achieved by having access to information, sharing and networking”.

Over the past 10-20 years we are entering an unprecedented and exciting era with the technological potential to connect all stakeholders working for international development and the SDGs. Communities of practice like this one [sdgs-impact-access-information-societies] will have an increasing role and will become ever more capable of not only giving more and more people a voice, but also to harness these voices in ways that can help inform policy and practice.

This CoP – [sdgs-impact-access-information-societies] – is one of over 700 Communities of Practice supported by the Dgroups Foundation, a partnership of 23 international development organisations (including FAO, DFID and SDC) with a common vision: A world where every person is able to contribute to dialogue and decision-making for international development and social justice. We are currently expanding and we welcome new partners: www.dgroups.info

Best wishes, Neil

Neil Pakenham-Walsh

Chair, Dgroups Foundation

www.dgroups.info

Dgroups: Working for a world where every person is able to contribute to dialogue and decision-making for international development and social justice.

‘Little is known about the barriers, facilitators and interventions that impact on systematic review uptake.’  This systematic review recommends three approaches – targeted messaging, educational visits and summaries – to enhance systematic review uptake into policy and practice.

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CITATION: BMJ Open 2014;4:e005834 doi:10.1136/bmjopen-2014-005834

Medical education and training

Improving the uptake of systematic reviews: a systematic review of intervention effectiveness and relevance

John Wallace, Charles Byrne, Mike Clarke Author Affiliations

Correspondence to Dr John Wallace; john.wallace@wadh.oxon.org

ABSTRACT

Objective: Little is known about the barriers, facilitators and interventions that impact on systematic review uptake. The objective of this study was to identify how uptake of systematic reviews can be improved.

Selection criteria: Studies were included if they addressed interventions enhancing the uptake of systematic reviews. Reports in any language were included. All decisionmakers were eligible. Studies could be randomised trials, cluster-randomised trials, controlled-clinical trials and before-and-after studies.

Data sources: We searched 19 databases including PubMed, EMBASE and The Cochrane Library, covering the full range of publication years from inception to December 2010. Two reviewers independently extracted data and assessed quality according to the Effective Practice and Organisation of Care criteria.

Results: 10 studies from 11 countries, containing 12 interventions met our criteria. Settings included a hospital, a government department and a medical school. Doctors, nurses, mid-wives, patients and programme managers were targeted. Six of the studies were geared to improving knowledge and attitudes while four targeted clinical practice.

Synthesis of results: Three studies of low-to-moderate risk of bias, identified interventions that showed a statistically significant improvement: educational visits, short summaries of systematic reviews and targeted messaging. Promising interventions include e-learning, computer-based learning, inactive workshops, use of knowledge brokers and an e-registry of reviews. Juxtaposing barriers and facilitators alongside the identified interventions, it was clear that the three effective approaches addressed a wide range of barriers and facilitators.

Discussion: A limited number of studies were found for inclusion. However, the extensive literature search is one of the strengths of this review.

Conclusions: Targeted messaging, educational visits and summaries are recommended to enhance systematic review uptake. Identified promising approaches need to be developed further. New strategies are required to encompass neglected barriers and facilitators. This review addressed effectiveness and also appropriateness of knowledge uptake strategies.

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Best wishes, Neil

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

ANTIBIOTIC RESISTANCE

A Growing Nightmare, Going Global

Antibiotic overuse is an alarming trend driving resistance – not justt in rich countries, but in countries like India, Kenya and Vietnam, as a new report from the Center for Disease Dynamics, Economics & Policy (CDDEP) reveals.

CDDEP also created a richly detailed map, illustrating antibiotic use in 69 countries and antibiotic resistance in 39 countries.

The bottom line: Inappropriate use?whether to treat colds (ineffecttively) or in animal feed?is a global issue, and it will take countrry-by-country education to bring down the problem. “It’s like climate change,” says Ramanan Laxminarayan, director of the Center and author of the report. “We’re all at risk.”

NPR Goats and Soda

http://www.cddep.org/blog/posts/cddep_maps_dangerous_trends_antibiotic_resistance_global_scale_first_time

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[The full article from CDDEP is shown below]

CDDEP Maps Dangerous Trends in Antibiotic Resistance on a Global Scale for the First Time

17 Sep 2015

Author: Andrea White

Online mapping tool and new CDDEP report show rise in drug-resistant infections and antibiotic use; CDDEP calls for prioritization of drug conservation over new R&D efforts

WASHINGTON, D.C. and NEW DELHI (17 September 2015) — Researchers at the Center for Disease Dynamics, Economics & Policy (CDDEP) released new data today documenting alarming rates of bacteria resistant to last-resort antibiotics that can lead to life-threatening infections across the world. Though wealthy countries still use far more antibiotics per capita, high rates in the low- and middle-income countries where surveillance data is now available—such as India, Kenya, and Vietnam—sound a warning to the world. For example, in India, 57 percent of the infections caused by Klebsiella pneumoniae, a dangerous superbug found in hospitals, were found to be resistant to one type of last-resort drug in 2014, up from 29 percent in 2008. For comparison, these drugs, known as carbapenems, are still effective against Klebsiella infections in 90 percent of cases in the United States and over 95 percent of cases in most of Europe.  

The findings were released via CDDEP’s ResistanceMap, an interactive online tool that allows users to track the latest global trends in drug resistance in 39 countries, and antibiotic use in 69 countries. It includes infections caused by 12 common and potentially deadly bacteria, including Escherichia coli (E. coli), Salmonella, and methicillin-resistant Staphylococcus aureus (MRSA). This is the first time data from a significant number of developing countries have been brought together publicly.

CDDEP also issued the first report to look comprehensively at the current state of global antibiotic use and drug resistance in humans, livestock and the environment. The report, The State of the World’s Antibiotics, 2015, lays out six strategies that belong in every national plan to halt the spread of resistance. Report authors say antibiotic stewardship is the key component of that action, and they challenge the frequently-cited notion that the problem with antibiotic resistance is a lack of new drugs in the antibiotic pipeline.

“For the first time, we have data on low- and middle-income countries, where antibiotic resistance is a serious problem but rarely the focus of policy solutions,” said Ramanan Laxminarayan, CDDEP Director and report co-author. “We hope this report, together with the ResistanceMap online tool, will help empower these countries to understand the burden of antibiotic resistance in their region and then take coordinated, research-backed action to limit it.”

Other Findings on Drug-Resistant Infections and Antibiotic Use from ResistanceMap

E. coli resistance is high and rising for many drug types and in many world regions, according to ResistanceMap. But compared to all other countries, India has the highest rates of resistance to nearly every drug used to treat it; strains of E. coli are more than 80 percent resistant to three different classes of drugs, meaning treatment options are becoming increasingly limited.

“Carbapenem antibiotics are for use in the most dire circumstances—when someone’s life is in danger and no other drug will cure the infection,” said Sumanth Gandra, an infectious diseases physician and CDDEP Resident Scholar in New Delhi. “We’re seeing unprecedented resistance to these precious antibiotics globally, and especially in India. If these trends continue, infections that could once be treated in a week or two could become routinely life threatening and endanger millions of lives.”

Incidence of methicillin-resistant Staphylococcus aureus (MRSA), a highly dangerous pathogen that people can contract in the community and in hospitals, is rising in sub-Saharan Africa, India, Latin America, and Australia.  Incidence is highest in Latin America, where estimates published in the State of the World’s Antibiotics, 2015 report show that in 2013, about 90 percent of Staph aureus infections were resistant to multiple antibiotics. Where antibiotic stewardship programs are beginning to take hold—in South Africa, Europe, the UK, and the US—MRSA rates have begun to decline.

ResistanceMap also tracks rates of antibiotic use, and findings indicate that both human and animal antibiotic use is rising dramatically in middle-income countries—particularly China, India, Brazil and South Africa. Per capita use in these countries is still less than half what it is in the United States, but the increase, driven by increased prosperity, includes a great deal of unnecessary and inappropriate use—mainly self-prescribed for coughs and colds. In many countries, antibiotics are easily purchased in pharmacies and shops without prescription. “A rampant rise in antibiotic use poses a major threat to public health, especially when there’s no oversight on appropriate prescribing,” said Laxminarayan. “Antibiotic use drives antibiotic resistance.”

ResistanceMap’s data come from a variety of sources, from small private laboratories in India to large datasets from the European Centre for Disease Prevention and Control, covering 30 countries. ResistanceMap, supported by a grant from the Bill & Melinda Gates Foundation, includes data from South Africa, India, Thailand, Vietnam, Kenya, Australia and New Zealand among others and will continue to be expanded and updated. Data from China, Nepal, Mozambique and the Philippines will be added soon.

First-Ever Report on the State of the World’s Antibiotics

CDDEP’s State of the World’s Antibiotics, 2015 says limiting overuse and misuse of antibiotics are the only sustainable solutions. “We need to focus 80 percent of our global resources on stewardship and no more than 20 percent on drug development,” said Laxminarayan. “No matter how many new drugs come out, if we continue to misuse them, they might as well have never been discovered.”

One major drawback to focusing on drug development as a solution is that new antibiotics are significantly more expensive than those currently available—far more costly than people in low- and middle-income countries can afford. Dozens of new antibiotics have been developed in the last few years, but on a global scale, almost no one can afford them, say report authors. “When it comes to antibiotic-resistant infections, the rich pay with their wallets and the poor pay with their lives,” said Laxminarayan.

Still, much can be done to conserve antibiotic effectiveness for future generations. Though ResistanceMap’s findings indicate troubling trends in global antibiotic resistance rates, the State of the World report concludes that concerted action can help alleviate the problem.

The World Health Organization recently highlighted the need for country-level antibiotic resistance plans in May 2015 when it endorsed the Global Action Plan on Antimicrobial Resistance, which calls on all countries to adopt national strategies within two years. The new CDDEP report can help countries take action to achieve this goal.

CDDEP’s Global Antibiotic Resistance Partnership (GARP) has worked in eight countries since 2008 to develop local capacity to analyze national conditions and propose locally-appropriate solutions to antibiotic resistance problems while sustaining antibiotic access. The State of the World’s Antibiotics, 2015 uses the experience and knowledge gained from GARP working groups in Asia and Africa to identify policies that work—from antibiotic stewardship campaigns and hospital infection control to improving vaccination coverage to limit infections and reduce the need for antibiotics.

“Our research shows that antibiotic resistance and misuse is a dire—and growing—problem in every country on earth,” said Laxminarayan. “The good news is that every country can work on solving it.”

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

Abstract

Background: Tuberculosis (TB) remains a major global public health problem and mobile health (mHealth) interventions have been identified as a modality to improve TB outcomes. TextTB, an interactive text-based intervention to promote adherence with TB medication, was pilot-tested in Argentina with results supporting the implementation of trials at a larger scale.

Objective: The objective of this research was to understand issues encountered during pilot-testing in order to inform future implementation in a larger-scale trial.

Methods: A descriptive, observational qualitative design guided by a sociotechnical framework was used. The setting was a clinic within a public pulmonary-specialized hospital in Argentina. Data were collected through workflow observation over 115 days, text messages (n=2286), review of the study log, and stakeholder input. Emerging issues were categorized as organizational, human, technical, or sociotechnical considerations.

Results: Issues related to the intervention included workflow issues (eg, human, training, security), technical challenges (eg, data errors, platform shortcomings), and message delivery issues (eg, unintentional sending of multiple messages, auto-confirmation problems). System/contextual issues included variable mobile network coverage, electrical and Internet outages, and medication shortages.

Conclusions: Intervention challenges were largely manageable during pilot-testing, but need to be addressed systematically before proceeding with a larger-scale trial. Potential solutions are outlined. Findings may help others considering implementing an mHealth intervention to anticipate and mitigate certain challenges. Although some of the issues may be context dependent, other issues such as electrical/Internet outages and limited resources are not unique issues to our setting. Release of new software versions did not result in solutions for certain issues, as specific features used were removed. Therefore, other software options will need to be considered before expanding into a larger-scale endeavor. Improved automation of some features will be necessary, however, a goal will be to retain the intervention capability to be interactive, user friendly, and patient focused. Continued collaboration with stakeholders will be required to conduct further research and to understand how such an mHealth intervention can be effectively integrated into larger health systems.

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Abstract

THE hand wringing can stop. Research shows education, not bling, is perceived by many of SA’s township youth as indicative of status. The perception that SA’s youth are materialistic is widespread, and underscored by subcultures such as izikhothane. Skhothane youths compete against each other in front of crowds to determine which of them is wealthier, often through the intentional destruction or wasting of expensive personal items, demonstrating indifference to their cost, with the implication that more are easily afforded. “We found that status is found in some material things,” says Piet Geustyn, research manager at BrandsLaduma…..more

This study assessed the feasibility and usefulness of combining electronic health record (EHR) data with federal cost report data for the purposes of: 1) quantifying the provision of enabling services; and 2) for use as the basis of community health center payment rate-setting. The study used EHR data derived from the Center for Primary Care Informatics to isolate enabling services and perform the end-to-end analysis that might be required to develop or evaluate reimbursement rates. The study revealed that data extracted from federal cost reports combined with data from the EHR fall short of providing the information required to reasonably develop new rate setting approaches or evaluate existing rates as they might be applied to community health centers. Specifically, key findings include:  Use of internal, center-specific codes (for example, in CPT fields) complicates the translation into relative value units (RVUs) and the aggregation of comparable data across health centers.  Enabling services are difficult to quantify.  Vague and inconsistent position titles lead to potential inaccuracies in the allocation of expenses.  The current funding environment deters capture of new information. This study raises fundamental questions about how to quantify (let alone how to reimburse) the true value associated with the community health center model of care. The study recommends tailoring EHR products to better capture the unique services provided by health centers and their effective management of high-risk patients. Fully moving to value-based reimbursement models will likely require that health centers adapt workflow to ensure that additional critical information (e.g., social determinants of health) is properly entered as structured data and not merely as scanned notes and other documentation.

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Since 2007, PACK has been scaled up to reach 20,000 health workers across 2,000 government healthcare facilities in South Africa. BMJ is now promoting the global expansion of PACK, in partnership with KTU and other stakeholders including governments, universities and NGOs. The intention is to train and support doctors, nurses and pharmacists to improve primary care services in under-resourced regions.

BMJ has partnered with the University of Cape Town Lung Institute’s Knowledge Translation Unit (UCTLI KTU), to develop and distribute the Practical Approach to Care Kit (PACK) programme to healthcare workers in low to middle income countries.

The PACK programme is a comprehensive clinical practice aid that enables healthcare practitioners to diagnose and manage common conditions. It covers 40 common symptoms and 20 conditions including cardiovascular disease, respiratory diseases, tuberculosis, HIV/AIDS, women’s health, and end-of-life care.

PACK is updated annually to comply with local clinical policy, regulations and essential drug lists, and is translated where necessary. It incorporates regular evidence updates from BMJ and other credible sources including WHO, to ensure that it is relevant and provides the latest best practice guidance.

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Background: Action on the social determinants of health (SDH) is relevant for reducing health inequalities. This is particularly the case for South Africa (SA) with its very high level of income inequality and inequalities in health and health outcomes. This paper provides evidence on the key SDH for reducing health inequalities in the country using a framework initially developed by the World Health Organization. Objective: This paper assesses health inequalities in SA and explains the factors (i.e. SDH and other individual level factors) that account for large disparities in health. The relative contribution of different SDH to health inequality is also assessed.

Design: A cross-sectional design is used. Data come from the third wave of the nationally representative National Income Dynamics Study. A subsample of adults (18 years and older) is used. The main variable of interest is dichotomised good versus bad self-assessed health (SAH). Income-related health inequality is assessed using the standard concentration index (CI). A positive CI means that the rich report better health than the poor. A negative value signifies the opposite. The paper also decomposes the CI to assess its contributing factors.

Results: Good SAH is significantly concentrated among the rich rather than the poor (CI0.008; pB0.01). Decomposition of this result shows that social protection and employment (contribution0.012; pB0.01), knowledge and education (0.005; pB0.01), and housing and infrastructure (0.003; pB0.01) contribute significantly to the disparities in good SAH in SA. After accounting for these other variables, the contribution of income and poverty is negligible.

Conclusions: Addressing health inequalities inter alia requires an increased government commitment in terms of budgetary allocations to key sectors (i.e. employment, social protection, education, housing, and other appropriate infrastructure). Attention should also be paid to equity in benefits from government expenditure. In addition, the health sector needs to play its role in providing a broad range of health services to reduce the burden of disease.

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If a child were to build a hospital out of Legos it might look like the new Children’s Hospital of Michigan Specialty Center, an irregularly shaped, multicolored facility slated to open in February in the Detroit suburb of Troy, Mich. “Everybody drives by it and says, ‘I know that’s for kids, but I’m not sure what it is,’” said Ron Henry, chief facilities engineering and construction officer at Tenet Healthcare’s Detroit Medical Center, which is building the facility. ….more

ABSTRACT

Next week, the UN General Assembly will call on member states to bid farewell to the Millennium Development Goals and adopt 17 new Sustainable Development Goals. John Maurice reports….more

ABSTRACTIntroduction:  The establishment of the rural clinical schools funded through the Commonwealth Department of Health and Ageing (now Department of Health) Rural Clinical Training and Support program over a decade ago has been a significant policy initiative in Australian rural health. This article explores the impacts of this policy initiative and presents the wide range of educational innovations contextualised to each rural community they serve.
Methods:  This article reviews the achievements of the Australian rural clinical and regional medical schools (RCS/RMS) through semi-structured interviews with the program directors or other key informants. The questions and responses were analysed according to the funding parameters to ascertain the numbers of students, types of student placements and range of activities undertaken by each university program.
Results:  Sixteen university medical schools have established 18 rural programs, creating an extensive national network of RCS and RMS in every state and territory. The findings reveal extensive positive impacts on rural and regional communities, curriculum innovation in medical education programs and community engagement activities. Teaching facilities, information technology, video-conferencing and student accommodation have brought new infrastructure to small rural towns. Rural clinicians are thriving on new opportunities for education and research. Clinicians continue to deliver clinical services and some have taken on formal academic positions, reducing professional isolation, improving the quality of care and their job satisfaction. This strategy has created many new clinical academics in rural areas, which has retained and expanded the clinical workforce. A total of 1224 students are provided with high-quality learning experiences for long-term clinical placements. These placements consist of a year or more in primary care, community and hospital settings across hundreds of rural and remote areas. Many programs offer longitudinal integrated clerkships; others offer block rotations in general practice and specialist clinics. Nine universities established programs prior to 2004, and these well-established programs are finding graduates who are returning to rural practice. Universities are required to have 25% of the students from a rural background. University admission policies have changed to encourage more applications from rural students. This aspect of the policy implements the extensive research evidence that rural-origin students are more likely to become rural practitioners. Additional capacity for research in RCS has influenced the rural health agenda in fields including epidemiology, population health, Aboriginal health, aged care, mental health and suicide prevention, farming families and climate change. There are strong research partnerships with rural workforce agencies, research centres for early career researchers and PhD students.
Conclusions:  The RCS policy initiative has vastly increased opportunities for medical students to have long-term clinical placements in rural health services. Over a decade since the policy has been implemented, graduates are being attracted to rural practice because they have positive learning experiences, good infrastructure and support within rural areas. The study shows the RCS initiative sets the stage for a sustainable future Australian rural medical workforce now requiring the development of a seamless rural clinical training pipeline linking undergraduate and postgraduate medical education.

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The announcement of the discovery by the Rising Star Expedition team of a new species of human relative, Homo naledi, has attracted unprecedented global media attention and coverage.

Described as the “biggest single discovery of its kind in Africa”, the announcement on 10 September 2015 also took social media by storm and the hastags, #HomoNaledi and #NalediFossils, trended at number one locally and internationally on the day.

Here is a taste of some of the major local and international television, radio, print, wire services and online media coverage:

Some early statistics:

·         10 September 2015: 16 000 people watched the live web streaming of the launch on the Wits website. You can watch a replay at streaming.wits.ac.za. The event was also broadcast live on eNCA, SABC and 702, among others.

·         15 September 2015: 160 000 page views and 16 000 downloads of the Homo naledi scientific paper from the open access journal eLife.

·         16 September 2015: Download this pdf for a selection of the South African coverage. (Warning: This file is more than 1GB.)

·         16 September 2015: 5 000 views and nearly 1 700 downloads of 3D data from #Homonaledi on MorphoSource at http://morphosource.org/index.php.

If you want to learn more about the discovery, visit www.wits.ac.za/homonaledi, or want to know what the hype is all about, watch this short video on the launch.

The  Homo naledi fossils will be on display to the public at the Maropeng Visitors Centre until 11 October 2015 in celebration of Heritage Month at a 25% discounted entry fee.

Representatives of national governments are now coming together to set the next development agenda, under the umbrella of the Sustainable Development Goals (SDGs), as the era of the Millennium Development Goals (MDG) concludes. In order to attain the new goals, it may help to revisit what worked — and what didn’t — in achieving the successes of the MDGs over the past 15 years….more

When the United Nations summit for the adoption of the post-2015 development agenda begins on September 25, the attainment of universal health coverage (UHC) is expected to garner substantial attention. Bolstered by increasing evidence that UHC improves health outcomes,1 countries are seeking to build health-related goals around the concept of health care for all. Yet many lower- and middle-income countries (LMICs) have not created UHC systems (see mapCountries That Have Adopted Reforms toward Universal Health Coverage.). How can the global community translate vision into policy, especially in the face of complicated politics? ….more