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Aquatic animal disease outbreaks affect both the public (represented by the government) and the private sector (represented by the aquaculture and fisheries industry). However, all too often, the responsibilities and costs of responding to an outbreak may not be shared. Without a mechanism for public and private sectors to work together, the outcomes of an emergency response may not be ideal, or of common benefit to all potentially affected parties. In Australia, a mechanism is being developed for public and private sectors to share the responsibilities and costs of responding to aquatic animal disease outbreaks, through an industry- government aquatic emergency animal disease response agreement. The agreement provides an approach for both public and private sectors to share the responsibilities and costs of responding to a disease outbreak and to coordinate disease prevention activities to reduce their shared risk. The key elements of the agreement include provisions to incentivise faster notification of disease outbreaks, facilitate a faster response, share decision-making and costs (including compensation for affected businesses), clarify the responsibilities of all parties and, most importantly, strengthen risk mitigation activities. This paper describes how the draft agreement has been developed among 18 industry and government parties, how key elements of the agreement may contribute to improved aquatic animal health outcomes, and the principles which could be applied by other OIE Member Countries.

Les foyers de maladies survenant chez les animaux aquatiques affectent aussi bien le secteur public (représenté par les services gouvernementaux) que le secteur privé (représenté par les entreprises de l'aquaculture et de la pêche). Néanmoins, trop souvent ces secteurs ne partagent ni les responsabilités ni les coûts afférents aux interventions consécutives à un foyer. À défaut d'un mécanisme permettant aux secteurs public et privé de travailler ensemble, les résultats de la réponse à une urgence sanitaire risquent de ne pas être optimaux et de ne pas apporter les mêmes bénéfices à l'ensemble des parties potentiellement affectées. L'Australie a mis en place un mécanisme pour que les secteurs public et privé puissent partager les responsabilités et les coûts de la réponse aux foyers de maladies affectant les animaux aquatiques à travers un accord spécifique conclu entre le secteur de l'aquaculture et les instances gouvernementales compétentes. C'est une première mondiale dans le domaine de la gestion de la santé des animaux aquatiques. L'accord porte sur les modalités du partage des responsabilités et des coûts liés à la réponse à un foyer entre les secteurs public et privé ainsi que sur la coordination des activités de prévention sanitaire destinées à réduire les risques communs. Parmi les aspects déterminants de l'accord figurent des dispositions visant à accélérer les notifications des foyers, à faciliter une réponse plus rapide, à partager les processus de décision et les coûts (y compris l'indemnisation des entreprises affectées), à clarifier les responsabilités de chaque partie et, plus important encore, à renforcer les activités d'atténuation du risque. Les auteurs décrivent la mise en œuvre de cet accord, auquel ont pris part 18 instances du secteur privé et gouvernemental ; ils expliquent le rôle des principaux aspects de cet accord dans l'amélioration attendue de la santé des animaux aquatiques et soulignent les principes que d'autres Pays membres de l'OIE pourraient avantageusement appliquer à cette même fin.

Los brotes de enfermedades de los animales acuáticos afectan por un igual al sector público (instancias gubernamentales) y al privado (industria acuícola y pesquera). Ocurre demasiado a menudo, sin embargo, que estos sectores no asuman conjuntamente las responsabilidades y los costos de responder a un brote. En ausencia de un mecanismo para que ambos sectores trabajen de consuno, los resultados de la respuesta a una emergencia quizá no sean los idóneos, o no vayan en beneficio de todas las partes que pueden verse afectadas. En Australia se está instituyendo un mecanismo para que el sector público y el privado compartan las responsabilidades y los costos de la lucha contra brotes infecciosos en los animales acuáticos, mecanismo que reposa en un acuerdo de respuesta de emergencia a enfermedades de los animales acuáticos suscrito entre la industria y el Gobierno. Se trata de una primicia mundial en el ámbito de la gestión de la sanidad acuícola. El acuerdo prevé un método para que ambos sectores asuman en común las responsabilidades y los costos de responder a un brote infeccioso y coordinen sus respectivas actividades de prevención de enfermedades a fin de reducir el riesgo común. Entre los principales elementos del acuerdo hay disposiciones destinadas a incentivar una notificación más rápida de los brotes de enfermedad, facilitar una respuesta más ágil, compartir decisiones y costos (incluidas las indemnizaciones a empresas afectadas), aclarar las responsabilidades que incumben a todas y cada una de las partes y también, aspecto este de suma importancia, potenciar las labores de mitigación del riesgo. Los autores describen el proceso de elaboración del acuerdo entre 18 instancias del mundo empresarial y el sector público, explican cómo sus principales elementos servirán para mejorar los resultados sanitarios en los animales acuáticos y exponen los principios que podrían aplicar otros Países Miembros de la OIE para lograr también mejores resultados en el ámbito de la sanidad acuícola.

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OBJECTIVES: At the time when Nepal is on the verge of reaching the maintenance phase of the Visceral Leishmaniasis (VL) elimination program, the country is facing new challenges. The disease has expanded to 61 of the country's 75 districts including previously non-endemic areas where there is no control or patient management program in place. This study aimed to assess which elements of the surveillance and reporting systems need strengthening to identify cases at an early stage, prevent further transmission and ensure sustained VL elimination. METHODS: In a cross-sectional mixed-method study, we collected data from two study populations in VL program and non-program districts. From February to May 2016, structured interviews were conducted with 40 VL patients, and 14 in-depth and semi-structured interviews were conducted with health managers. RESULTS: The median total delay from onset of symptoms to successful reporting to the Ministry of Health was 68.5 days in the VL-program and 83 days in non-program districts. The difference in patient's delay from the onset of symptoms to seeking health care was 3 days in VL-program and 20 days in non-program districts. The diagnostic delay (38.5 days and 36 days, respectively), treatment delay (1 vs. 1 days) and reporting delay (45 vs. 36 days) were similar in program and non-program districts. The diagnostic delay increased three-fold from 2012, while treatment and reporting delay remained unchanged. The main barriers to surveillance were: (i) lack of access and awareness in non-program districts; (ii) growing private sector not included in and not participating to referral, treatment and reporting; (iii) lack of cooperation and coordination among stakeholders for training and deployment of interventions; (iv) insufficient validation, outreach and process optimisation of the reporting system. CONCLUSIONS: Corrective measures are needed to maintain the achievements of the VL elimination campaign and prevent resurgence of the disease in Nepal. A clear patient referral structure, reinforcement of report notification and validation and direct relay of data by local hospitals and the private sector to the district health offices are needed to ensure prompt treatment and timely and reliable information to facilitate a responsive system of interventions.

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BACKGROUND: The number of occupational therapists working in the private sector in British Columbia (BC) has risen steadily since 2008, employing approximately 25.7% of occupational therapists by 2012. Processes used to determine workforce needs for occupational therapists in BC have previously overlooked this growing sector. PURPOSE: This study aims to describe the supply, demand, and workforce needs for occupational therapists in BC's private sector. METHOD: This exploratory study used a sample of occupational therapists and employers of occupational therapists in BC's private sector. Data collection included an online survey that collected information about the workplace and supply and demand needs. Descriptive data analysis was conducted on the survey data, and thematic analysis was used to organize participants' comments into categories. FINDINGS: In addition to identifying current supply, this study identifies barriers, facilitators, projected movement in and out of the sector, and current and future demand for occupational therapists. IMPLICATIONS: This study supports the need for an increase in supply of occupational therapists in the private sector to fulfill the current and future workforce demands.

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The engagement of both scientists and veterinarians in strengthening biosecurity systems is of paramount importance to ensure resilience and sustainability. Such commitment from scientists and veterinarians begins during their university education, is nurtured by the examples set by their mentors, and continues into their careers through professional development and the wisdom gained from experience. Resilient and sustainable biosecurity systems also require an organisational culture that encourages, recognises and rewards scientists and veterinarians who are committed to biosecurity education, research, outreach and preparedness. At present, such involvement is complicated by the range of definitions of biosecurity used in the life sciences and veterinary medicine, and by the various international organisations with biosecurity responsibilities. Biosecurity represents both a public and a private good. However, the priority given to biosecurity education, research, outreach and implementation differs widely among the public, private and academic sectors. The public sector has the broadest engagement and the broadest mandate for biosecurity. The private sector's approach to biosecurity is governed by business decisions and whether or not they produce consumer goods. In the academic sector, although biosecurity education is gaining increased attention in universities, there are disincentives to research in this field. Strategies for encouraging greater involvement from scientists and veterinarians include agreeing on an inclusive definition of biosecurity, developing teaching materials and experiential learning approaches for use in undergraduate curricula and postgraduate professional development, train-the-trainer programmes, increased involvement of government scientists and veterinarians in university education and professional development, and the fostering of public-private-academic partnerships around shared interests in biosecurity education, research, outreach and implementation.

La participation des chercheurs et des vétérinaires au renforcement des systèmes de biosûreté est d'une importance capitale pour garantir la résilience et la durabilité de ces systèmes. Les chercheurs et les vétérinaires qui s'engagent dans ce domaine le font dès leur formation universitaire, grâce à l'émulation de leurs mentors, et cet engagement se poursuit tout au long de leur carrière grâce au perfectionnement professionnel et à la sagesse acquise avec l'expérience. La durabilité et la résilience des systèmes de biosûreté nécessitent également une culture organisationnelle qui encourage, reconnaisse et récompense les chercheurs et les vétérinaires qui s'engagent dans des activités d'enseignement, de recherche, de vulgarisation et de préparation dans le domaine de la biosûreté. À l'heure actuelle, cette participation est rendue plus complexe par les nombreuses définitions données à la biosûreté dans les sciences du vivant et en médecine vétérinaire, ainsi que par le grand nombre d'organisations internationales compétentes en matière de biosûreté. La biosûreté constitue à la fois un bien public et un bien privé. Néanmoins, suivant que l'on se trouve dans le secteur public, privé ou universitaire, la priorité accordée à l'enseignement, à la recherche, à la vulgarisation et à la mise en œuvre de la biosûreté varie considérablement. Le secteur public compte avec la participation la plus large et détient le mandat le plus vaste en matière de biosûreté. L'approche du secteur privé est gouvernée par des décisions commerciales et dépend de la possibilité ou non de produire des biens commercialisables relevant de la biosûreté. Dans le secteur universitaire, l'enseignement de la biosûreté prend de l'ampleur mais certains facteurs découragent la recherche dans ce domaine. Parmi les stratégies permettant d'accroître la participation des chercheurs et des vétérinaires, l'auteur cite la mise au point d'une définition concertée et inclusive de la biosûreté ; le développement de matériels didactiques et de méthodes d'apprentissage par l'expérience destinés à l'enseignement supérieur et à la formation professionnelle ; la mise en place d'une offre de formation des formateurs ; une meilleure participation des chercheurs et des vétérinaires du service public dans l'enseignement supérieur et la formation professionnelle ; enfin, la promotion de partenariats de recherche public-privé autour de sujets d'intérêt commun relatifs à la biosûreté et à l'enseignement, la recherche, la vulgarisation et la mise en œuvre dans ce domaine.

La participación de científicos y veterinarios en el refuerzo de los sistemas de seguridad biológica reviste cardinal importancia para asegurar la resiliencia y la sostenibilidad. Esta participación, que empieza en el momento de la formación universitaria, se ve impulsada por los ejemplos que ofrece el profesorado y continúa a lo largo de toda la carrera gracias al perfeccionamiento profesional y a las enseñanzas que depara la experiencia. Para que los sistemas de seguridad biológica sean duraderos y resilientes se precisa también una cultura organizativa que aliente, reconozca y recompense a los científicos y veterinarios que intervienen en labores de pedagogía, investigación, difusión y preparación en relación con la seguridad biológica. A día de hoy, esta participación se ve complicada por las dispares definiciones que se dan de «seguridad biológica¼ en las ciencias de la vida y la medicina veterinaria y por la existencia de varias organizaciones internacionales con responsabilidades en la materia. La seguridad biológica representa un bien de interés a la vez público y privado. No obstante, los sectores público, privado y universitario no coinciden ni de lejos en el grado de prioridad que otorgan a la enseñanza, la investigación, la difusión y la aplicación de la seguridad biológica. El sector público exhibe la participación y el mandato más amplios en la materia. Los planteamientos del sector privado al respecto responden a decisiones empresariales y a su utilidad, o no, para traducirse en bienes de consumo. En los medios universitarios, si bien se presta cada vez más atención a la enseñanza de la seguridad biológica, hay factores que desincentivan la investigación en la materia. Las estrategias para alentar una mayor participación de científicos y veterinarios pasan especialmente por consensuar una definición integradora de «seguridad biológica¼, elaborar material pedagógico y métodos de aprendizaje experimental e introducirlos en los programas de estudios universitarios y de perfeccionamiento profesional de posgrado, instituir programas de formación del profesorado, impulsar una mayor intervención de científicos y veterinarios del sector público en la enseñanza universitaria y de perfeccionamiento profesional y potenciar la colaboración público-privada en la universidad en torno a temas de interés común relacionados con la enseñanza, la investigación, la difusión y la aplicación de la seguridad biológica.

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OBJECTIVE: The objective of this study was to assess the role of the private sector in low- and middle-income countries (LMICs). We used Demographic and Health Surveys for 57 countries (2000-2013) to evaluate the private sector's share in providing three reproductive and maternal/newborn health services (family planning, antenatal and delivery care), in total and by socio-economic position. METHODS: We used data from 865 547 women aged 15-49, representing a total of 3 billion people. We defined 'met and unmet need for services' and 'use of appropriate service types' clearly and developed explicit classifications of source and sector of provision. RESULTS: Across the four regions (sub-Saharan Africa, Middle East/Europe, Asia and Latin America), unmet need ranged from 28% to 61% for family planning, 8% to 22% for ANC and 21% to 51% for delivery care. The private-sector share among users of family planning services was 37-39% across regions (overall mean: 37%; median across countries: 41%). The private-sector market share among users of ANC was 13-61% across regions (overall mean: 44%; median across countries: 15%). The private-sector share among appropriate deliveries was 9-56% across regions (overall mean: 40%; median across countries: 14%). For all three healthcare services, women in the richest wealth quintile used private services more than the poorest. Wealth gaps in met need for services were smallest for family planning and largest for delivery care. CONCLUSIONS: The private sector serves substantial numbers of women in LMICs, particularly the richest. To achieve universal health coverage, including adequate quality care, it is imperative to understand this sector, starting with improved data collection on healthcare provision.

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OBJECTIVES: To describe the state of the public and private malaria diagnostics market shortly after WHO updated its guidelines for testing all suspected malaria cases prior to treatment. METHODS: Ten nationally representative cross-sectional cluster surveys were conducted in 2011 among public and private health facilities, community health workers and retail outlets (pharmacies and drug shops) in nine countries (Tanzania mainland and Zanzibar surveyed separately). Eligible outlets had antimalarials in stock on the day of interview or had stocked antimalarials in the past 3 months. RESULTS: Three thousand four hundred and thirty-nine rapid diagnostic test (RDT) products from 39 manufacturers were audited among 12,197 outlets interviewed. Availability was typically highest in public health facilities, although availability in these facilities varied greatly across countries, from 15% in Nigeria to >90% in Madagascar and Cambodia. Private for-profit sector availability was 46% in Cambodia, 20% in Zambia, but low in other countries. Median retail prices for RDTs in the private for-profit sector ranged from $0.00 in Madagascar to $3.13 in Zambia. The reported number of RDTs used in the 7 days before the survey in public health facilities ranged from 3 (Benin) to 50 (Zambia). CONCLUSIONS: Eighteen months after WHO updated its case management guidelines, RDT availability remained poor in the private sector in sub-Saharan Africa. Given the ongoing importance of the private sector as a source of fever treatment, the goal of universal diagnosis will not be achievable under current circumstances. These results constitute national baselines against which progress in scaling-up diagnostic tests can be assessed.

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OBJECTIVE: The Demographic and Health Surveys (DHS) are a vital data resource for cross-country comparative analyses. This study is part of a set of analyses assessing the types of providers being used for reproductive and maternal health care across 57 countries. Here, we examine some of the challenges encountered using DHS data for this purpose, present the provider classification we used, and provide recommendations to enable more detailed and accurate cross-country comparisons of healthcare provision. METHODS: We used the most recent DHS surveys between 2000 and 2012; 57 countries had data on family planning and delivery care providers and 47 countries had data on antenatal care. Every possible response option across the 57 countries was listed and categorised. We then developed a classification to group provider response options according to two key dimensions: clinical nature and profit motive. RESULTS: We classified the different types of maternal and reproductive healthcare providers, and the individuals providing care. Documented challenges encountered during this process were limitations inherent in household survey data based on respondents' self-report; conflation of response options in the questionnaire or at the data processing stage; category errors of the place vs. professional for delivery; inability to determine whether care received at home is from the public or private sector; a large number of negligible response options; inconsistencies in coding and analysis of data sets; and the use of inconsistent headings. CONCLUSIONS: To improve clarity, we recommend addressing issues such as conflation of response options, data on public vs. private provider, inconsistent coding and obtaining metadata. More systematic and standardised collection of data would aid international comparisons of progress towards improved financial protection, and allow us to better characterise the incentives and commercial nature of different providers.

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OBJECTIVE: To describe and analyse the prescription patterns and treatment outcomes of MDR-TB patients managed within Green Light Committee (GLC) and outside (non-GLC) the National TB programme in Viet Nam. METHODS: Retrospective cohort study with two elements: (i) in-depth interviews and focus group discussions with clinical doctors, hospital pharmacists, and the non-GLC patients with MDR-TB; (ii) review of treatment cards and patients' charts of all GLC and non-GLC patients with MDR-TB put on treatment during 2010. RESULTS: Of 282 patients with MDR-TB, comprising 79 (28%) GLC patients MDR-TB and 203 (72%) non-GLC patients with MDR-TB, were enrolled in the study. Treatment delay was significantly higher in the GLC group (12.8 days) than the non-GLC group (2.3 days), (P = 0.004). The success rate was significantly better in GLC patients (84.8%) than in non-GLC patients (53.7%) (P < 0.001). The default rate was significantly higher in non-GLC patients than in GLC patients (25.6% vs. 6.3%), (P < 0.001). The risk of unsuccessful outcome was higher in non-GLC patients (Hazard ratio = 4.6, 95% CI: 1.8-11.8). CONCLUSIONS: The treatment outcomes of patients with MDR-TB in the GLC group were significantly better than in the non-GLC group. Reasons for the high default rate in non-GLC patients with MDR-TB must be further investigated.

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