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<title>Global Health: Science and Practice - Advance Access Articles</title>
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<description>Global Health: Science and Practice - Advance Access Articles</description>
<prism:eIssn>2169-575X</prism:eIssn>
<prism:publicationName>Global Health: Science and Practice</prism:publicationName>
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<title><![CDATA[Stakeholder Perceptions on Innovative Private Pharmacy Distribution Channels and Implications for Medicine Quality in Zambia: A Qualitative Study]]></title>
<link>http://ghspjournal.org/content/early/2026/02/24/GHSP-D-24-00248.short?rss=1</link>
<description><![CDATA[Introduction:Innovative private pharmacy distribution channels, including delivery services, telepharmacy, and e-pharmacies, have emerged as potential solutions to improve access to quality-assured medicine and pharmacy services in Zambia, but limited evidence exists regarding their impact on medicine quality and safety. This qualitative study provides the first comprehensive investigation of stakeholder perspectives on these channels, examining their implications for pharmaceutical quality assurance and distribution in Zambia’s health care system.Methods:A purposive sample of 15 stakeholders participated in the study, selected to represent key sectors of the pharmaceutical supply chain, including wholesalers, innovators, retailers, national medicine supply agencies, national medicine regulators, professional pharmacy bodies, and supply chain experts. Semi-structured interviews were conducted until data saturation was achieved. Interviews were recorded and transcribed, and a bottom-up thematic analysis was employed to derive themes directly from the data.Results:Themes that emerged from the analysis fell into 4 interconnected categories of issues: (1) current challenges in the pharmaceutical supply chain (including affordability barriers, transportation limitations, and regulatory constraints) affecting both traditional and innovative pharmacy services, (2) potential benefits of the innovative pharmacy approaches (such as enhanced traceability and improved quality assurance), (3) limitations and shortcomings (including technical and behavioral challenges), and (4) recommendations for improvement. Stakeholder perspectives varied notably by role, with regulators emphasizing quality control and innovators focusing on accessibility and efficiency.Conclusion:The findings suggest that innovative pharmacy distribution approaches will be constrained by some of the same regulatory and structural issues faced by traditional pharmacy systems, and thus cannot fully circumvent existing challenges of access to quality pharmacy services and medicines in Zambia and other countries. To successfully realize the potential of pharmacy innovations to improve accessibility to good-quality medicines, balanced attention is required to technological advancement, regulatory compliance, and the local context. These insights offer actionable guidance for policymakers and stakeholders seeking to strengthen medicine distribution systems, enriching the broader narrative of health care delivery in resource-limited settings.]]></description>
<dc:creator><![CDATA[Scott Kaba Matafwali, Virginia Bond, Sian E. Clarke, Harparkash Kaur]]></dc:creator>
<dc:date>2026-02-27T07:58:26-08:00</dc:date>
<dc:identifier>info:doi/10.9745/GHSP-D-24-00248</dc:identifier>
<dc:identifier>hwp:master-id:ghsp;GHSP-D-24-00248</dc:identifier>
<dc:publisher>Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs</dc:publisher>
<dc:title><![CDATA[Stakeholder Perceptions on Innovative Private Pharmacy Distribution Channels and Implications for Medicine Quality in Zambia: A Qualitative Study]]></dc:title>
<prism:publicationDate>2026-02-27</prism:publicationDate>
<prism:section>ORIGINAL ARTICLE</prism:section>
</item>
<item rdf:about="http://ghspjournal.org/content/early/2026/03/04/GHSP-D-24-00351.short?rss=1">
<title><![CDATA[Exploring a Road Map to Achieving Tobacco Endgame in sub-Saharan Africa: A Qualitative Study Among Stakeholders From 12 Countries]]></title>
<link>http://ghspjournal.org/content/early/2026/03/04/GHSP-D-24-00351.short?rss=1</link>
<description><![CDATA[Introduction:Tobacco endgame seeks to bring an end to tobacco use or drastically reduce prevalence to less than 5%. Discussions about tobacco endgame and the possible strategies to achieve this goal in sub-Saharan African are sparse. This study aimed to explore sub-Saharan African tobacco control stakeholders’ perspectives about tobacco endgame and ascertain what strategies they perceive to be suitable for the region to achieve this goal.Methods:This qualitative study involved a purposive sample of 29 stakeholders interviewed via online platforms guided by a semi-structured interview schedule. Stakeholders were from academia, civil society, and government departments in 12 sub-Saharan African countries. Interviews were conducted in English or French, transcribed verbatim (those in French were then translated to English), and thematically analyzed with the aid of NVivo version 12 software.Results:There is support for the adoption of tobacco endgame in sub-Saharan Africa by tobacco control stakeholders in the region due to the negative impact of tobacco on health, the environment, and economy. Proposed endgame approaches for the region were recommended to be Afrocentric and sensitive to cultural and regional dynamics. Stakeholders believed that the success of endgame strategies depends on political will, multisectoral collaboration, availability of resources, buy-in from the public, and monitoring of the tobacco industry. Suggested endgame strategies were categorized into 5 themes: (1) product-focused (less addictive tobacco and regulation of novel products); (2) user-focused (smoke-free generation, cessation support, and promotion of sports); (3) market/supply-focused (licensing of sellers, increase in taxes, control of illicit trade, and alternative income for farmers); (4) institutional structure-focused (tobacco industry monitoring and regulation); and (5) legislation implementation-focused (effective implementation of international treaties aimed at lowering tobacco use prevalence).Conclusion:There is support for a tobacco endgame in sub-Saharan Africa. Collaboration from various departments/ministries and support from government and the public would be needed to make tobacco endgame a reality in the region.]]></description>
<dc:creator><![CDATA[Catherine O. Egbe, Senamile P. Ngobese, Arshima Khan, Siphesihle Gwambe, Zinhle P. Ngcobo, Stella A. Bialous]]></dc:creator>
<dc:date>2026-03-04T06:21:25-08:00</dc:date>
<dc:identifier>info:doi/10.9745/GHSP-D-24-00351</dc:identifier>
<dc:identifier>hwp:master-id:ghsp;GHSP-D-24-00351</dc:identifier>
<dc:publisher>Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs</dc:publisher>
<dc:title><![CDATA[Exploring a Road Map to Achieving Tobacco Endgame in sub-Saharan Africa: A Qualitative Study Among Stakeholders From 12 Countries]]></dc:title>
<prism:publicationDate>2026-03-04</prism:publicationDate>
<prism:section>ORIGINAL ARTICLE</prism:section>
</item>
<item rdf:about="http://ghspjournal.org/content/early/2026/03/13/GHSP-D-24-00171.short?rss=1">
<title><![CDATA[Enhancing Service Quality and Empowerment in Government Clinics Through Continuous Quality Improvement of Community Score Cards: A Case Study From the Dominican Republic]]></title>
<link>http://ghspjournal.org/content/early/2026/03/13/GHSP-D-24-00171.short?rss=1</link>
<description><![CDATA[Background:The Dominican Republic offers universal, government-run health care through primary, secondary, and tertiary levels. Reliability and confidence in care have lower user satisfaction than other dimensions. Thus, the government aims to enhance relationships between service users and providers as a key health systems strengthening priority to improve primary care services.Program Description:From 2018 to 2023, a global nonprofit organization implemented social accountability, using an adapted Community Score Card (CSC) process, in 10 government-run clinic sites in the Dominican Republic. Each site implemented multiple CSC cycles, which involved a facilitated dialogue process among service users, providers, and community leaders, prioritization, action planning, and implementation. We developed a comprehensive monitoring and evaluation toolkit to facilitate ongoing analysis and use of data for continuous quality improvement of the social accountability approach and sharing of the results with stakeholders. The toolkit includes components that span all steps in the CSC process, including tracking participation of key stakeholder groups, assessing CSC facilitation quality, scoring clinics on 4 defined global indicators (quality of care, availability of medical staff, availability of medicines, and community participation), tracking progress on action plans, tracking participants’ level of empowerment over time, and assessing how interventions impacted change through periodic use of the Most Significant Change monitoring and evaluation technique.Process Improvements:The data generated from the toolkit supported process improvements in the CSC approach, including the importance of youth leadership in social accountability and of achieving concrete change early on to drive the capacity for more complex change requiring vertical support. These iterative improvements to the CSC process resulted in empowerment and engagement of community members to drive change in government-run primary health clinics and improved perceptions of service quality. Case study data from the Dominican Republic show ongoing stakeholder participation, improvement across the 4 global indicators, and community empowerment, which collectively contribute to strengthening local health care services. The comprehensive toolkit supports efforts for continuous quality improvement while producing evidence locally, nationally, and globally for health systems strengthening and demonstrating the effectiveness of the CSC approach.Conclusions:Three key lessons emerged from the development of a CSC monitoring toolkit. First, a comprehensive toolkit centralizes data in one place and pulls together evidence from multiple sources. Second, a standardized toolkit allows for analysis at multiple levels. Finally, ensuring data are actionable locally is central to gathering complete, accurate data for continuous quality improvement.]]></description>
<dc:creator><![CDATA[Erin Morse, Mary Mukomba, Jose Eduardo Rodriguez, Kristen Mallory, Christian Taco, Cesar Jacome Castro, Enmanuel Diaz Santiago, Anne K. Sebert Kuhlmann]]></dc:creator>
<dc:date>2026-03-17T07:03:03-07:00</dc:date>
<dc:identifier>info:doi/10.9745/GHSP-D-24-00171</dc:identifier>
<dc:identifier>hwp:master-id:ghsp;GHSP-D-24-00171</dc:identifier>
<dc:publisher>Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs</dc:publisher>
<dc:title><![CDATA[Enhancing Service Quality and Empowerment in Government Clinics Through Continuous Quality Improvement of Community Score Cards: A Case Study From the Dominican Republic]]></dc:title>
<prism:publicationDate>2026-03-17</prism:publicationDate>
<prism:section>PROGRAM CASE STUDY</prism:section>
</item>
<item rdf:about="http://ghspjournal.org/content/early/2026/04/16/GHSP-D-24-00240.short?rss=1">
<title><![CDATA[Patterns and Drivers of Packaged (Fortified) Maize Flour Purchase in Urban and Peri-Urban Kenya]]></title>
<link>http://ghspjournal.org/content/early/2026/04/16/GHSP-D-24-00240.short?rss=1</link>
<description><![CDATA[Background:Large-scale food fortification is a widely applied strategy to address micronutrient deficiencies, and in Kenya, all industrially processed and packaged maize flour is mandated to be fortified with micronutrients. However, policymakers lack information regarding the population’s readiness to procure fortified foods. This study aims to measure the purchase rate of packaged (and presumably fortified) maize flour among households in two Kenyan cities and assess how food environment, household characteristics, and individual shopper perceptions influence consumption of this product.Methods:We conducted a survey of 1,507 households in urban and peri-urban Kisumu and Nairobi from May to June 2022 to gather information on food purchases, food-shopping behavior, awareness of fortification, and household demographics and socioeconomic status. Between June and August 2022, we conducted a census of food outlets to characterize the households’ home food environment. To analyze the data, we first conducted a descriptive analysis with statistics disaggregated by study-region, household poverty status, and/or status as a consumer of packaged maize flour. We then used a probit regression to determine the differential influence of various factors on the households’ likelihood of purchasing packaged (presumably fortified) maize flour.Results:Across Kisumu and Nairobi, 67% of households purchased packaged maize flour, with higher rates seen in urban and peri-urban Nairobi (68% and 70%, respectively) and lower rates seen in urban and peri-urban Kisumu (50% and 34%, respectively). While almost 100% of households had some access to packaged maize flour in their home food environment, the density of outlets that sell this product varied from 12/km2 in peri-urban Kisumu to 54/km2 in urban Nairobi. Moreover, households that purchased packaged maize flour resided in neighborhoods with approximately 11 more outlets/km2, on average, than other households. The local price premium charged for packaged maize flour compared to unpackaged maize flour was a negative and statistically significant driver of the purchase decision.Conclusions:If the goal is to enhance the population’s uptake of fortified maize meal, the government should encourage the private sector to invest more in food outlets that sell packaged maize flour; reduce the retail cost of packaged maize flour; raise awareness of the benefits of fortification (particularly in peri-urban Kisumu); and make relevant technologies available at the scale of smaller mills.]]></description>
<dc:creator><![CDATA[Semeni Ngozi, Ayala Wineman, Mywish K. Maredia, David Tschirley, Ian Fisher, Nahian Bin Khaled]]></dc:creator>
<dc:date>2026-04-16T07:17:59-07:00</dc:date>
<dc:identifier>info:doi/10.9745/GHSP-D-24-00240</dc:identifier>
<dc:identifier>hwp:master-id:ghsp;GHSP-D-24-00240</dc:identifier>
<dc:publisher>Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs</dc:publisher>
<dc:title><![CDATA[Patterns and Drivers of Packaged (Fortified) Maize Flour Purchase in Urban and Peri-Urban Kenya]]></dc:title>
<prism:publicationDate>2026-04-16</prism:publicationDate>
<prism:section>ORIGINAL ARTICLE</prism:section>
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