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More than half of artemisinin combination therapies (ACTs) consumed globally are dispensed in the retail sector, where diagnostic testing is uncommon, leading to overconsumption and poor targeting. In many malaria-endemic countries, ACTs sold over the counter are available at heavily subsidized prices, further contributing to their misuse. Inappropriate use of ACTs can have serious implications for the spread of drug resistance and leads to poor outcomes for nonmalaria patients treated with incorrect drugs. We evaluated the public health impact of an innovative strategy that targets ACT subsidies to confirmed malaria cases by coupling free diagnostic testing with a diagnosis-dependent ACT subsidy. We conducted a cluster-randomized controlled trial in 32 community clusters in western Kenya (population approximately 160,000). Eligible clusters had retail outlets selling ACTs and existing community health worker (CHW) programs and were randomly assigned 1:1 to control and intervention arms. In intervention areas, CHWs were available in their villages to perform malaria rapid diagnostic tests (RDTs) on demand for any individual >1 year of age experiencing a malaria-like illness. Malaria RDT-positive individuals received a voucher for a discount on a quality-assured ACT, redeemable at a participating retail medicine outlet. In control areas, CHWs offered a standard package of health education, prevention, and referral services. We conducted 4 population-based surveys-at baseline, 6 months, 12 months, and 18 months-of a random sample of households with fever in the last 4 weeks to evaluate predefined, individual-level outcomes. The primary outcome was uptake of malaria diagnostic testing at 12 months. The main secondary outcome was rational ACT use, defined as the proportion of ACTs used by test-positive individuals. Analyses followed the intention-to-treat principle using generalized estimating equations (GEEs) to account for clustering with prespecified adjustment for gender, age, education, and wealth. All descriptive statistics and regressions were weighted to account for sampling design. Between July 2015 and May 2017, 32,404 participants were tested for malaria, and 10,870 vouchers were issued. A total of 7,416 randomly selected participants with recent fever from all 32 clusters were surveyed. The majority of recent fevers were in children under 18 years (62.9%, n = 4,653). The gender of enrolled participants was balanced in children (49.8%, n = 2,318 boys versus 50.2%, n = 2,335 girls), but more adult women were enrolled than men (78.0%, n = 2,139 versus 22.0%, n = 604). At baseline, 67.6% (n = 1,362) of participants took an ACT for their illness, and 40.3% (n = 810) of all participants took an ACT purchased from a retail outlet. At 12 months, 50.5% (n = 454) in the intervention arm and 43.4% (n = 389) in the control arm had a malaria diagnostic test for their recent fever (adjusted risk difference [RD] = 9 percentage points [pp]; 95% CI 2-15 pp; p = 0.015; adjusted risk ratio [RR] = 1.20; 95% CI 1.05-1.38; p = 0.015). By 18 months, the ARR had increased to 1.25 (95% CI 1.09-1.44; p = 0.005). Rational use of ACTs in the intervention area increased from 41.7% (n = 279) at baseline to 59.6% (n = 403) and was 40% higher in the intervention arm at 18 months (ARR 1.40; 95% CI 1.19-1.64; p < 0.001). While intervention effects increased between 12 and 18 months, we were not able to estimate longer-term impact of the intervention and could not independently evaluate the effects of the free testing and the voucher on uptake of testing. Diagnosis-dependent ACT subsidies and community-based interventions that include the private sector can have an important impact on diagnostic testing and population-wide rational use of ACTs. Targeting of the ACT subsidy itself to those with a positive malaria diagnostic test may also improve sustainability and reduce the cost of retail-sector ACT subsidies. ClinicalTrials.gov NCT02461628.

\"A comprehensive guide to public sector collaboration with private and nonprofit organizations for better service deliveryGoverning Cross-Sector Collaboration tackles the issues inherent in partnerships with nongovernmental actors for public service delivery, highlighting the choices available and the accompanying challenges and opportunities that arise. Based on research, interviews with public, private and nonprofit sector leaders, and considerable analysis of organizations involved in public-private-nonprofit collaborations, the book provides insight into cross-sector collaboration at the global, federal, state, and local levels. Through an examination of the primary modes of cross-sector collaboration, including collaborative contracting, partnerships, networks, and independent public services providers, the book presents a clear case for how public managers can assess the trade-offs and use these options to improve public service delivery. Nonprofit organizations, businesses, and third-party contractors are increasingly partnering with government to deliver public services. Recognizing the types of collaborative approaches, and their potential to solve public policy problems is quickly becoming a major task for public managers, with new methods and techniques constantly emerging. Governing Cross-Sector Collaboration provides specific examples and a framework for public managers to make strategic choices about how to engage private and nonprofit actors in delivering public goods and services while ensuring the public interest. The book provides effective methods for choosing, designing, governing, and evaluating networks, partnerships, and independent public-services providers, with in-depth discussion encompassing: Analysis and engagement of cross-sector organizations Fostering democratic accountability in the public interest Collaborative approaches (including contracts, networks and partnerships) and the issues associated with each type of arrangement Leadership and organizational learning in cross-sector collaboration Included case studies illustrate effective application of the concepts and methods described, providing both practicing public and nonprofit managers and public policy/administration students with insight into these emerging strategic alliances. The first comprehensive guide to public governance collaborations, Governing Cross-Sector Collaboration is an important and timely contribution to the field of public management\"-- Provided by publisher.

The Paris climate agreement to keep global average temperature rise below 2 °C requires the world to switch rapidly to low-carbon energy. Global carbon emissions must peak by 2020, fall to zero between 2060 and 2080 and become negative by 21001. The effort and investment needed would be immense, but it could happen: in 1800, the British government spent one-quarter of its per capita expenditure on becoming the worlds major naval power2; the US Interstate Highway System cost US$560 billion (in 2007 dollars) over 37 years of construction3.

This work provides a structured process for determining the commercial viability of large construction projects - from gas pipelines and bridges to hospitals and schools - procured with project finance (PF). With this guide, readers can develop their own assessment structures as required using the assessment mechanism described.

Great progress has been made in recent years in securing better access and financial protection against the cost of illness through collective financing of health care.Managing scarce resources effectively and efficiently is an important part of this story.

Fears rise that US government and private funders are working at cross purposes.

Private health care in low-income and middle-income countries is very extensive and very heterogeneous, ranging from itinerant medicine sellers, through millions of independent practitioners—both unlicensed and licensed—to corporate hospital chains and large private insurers. Policies for universal health coverage (UHC) must address this complex private sector. However, no agreed measures exist to assess the scale and scope of the private health sector in these countries, and policy makers tasked with managing and regulating mixed health systems struggle to identify the key features of their private sectors. In this report, we propose a set of metrics, drawn from existing data that can form a starting point for policy makers to identify the structure and dynamics of private provision in their particular mixed health systems; that is, to identify the consequences of specific structures, the drivers of change, and levers available to improve efficiency and outcomes. The central message is that private sectors cannot be understood except within their context of mixed health systems since private and public sectors interact. We develop an illustrative and partial country typology, using the metrics and other country information, to illustrate how the scale and operation of the public sector can shape the private sector's structure and behaviour, and vice versa.