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Aside from the CPM, more recent examples of strategies to improve malaria case management services include the introduction of malaria diagnostics into licensed private outlets, typically drug shops [12,13,14]. These pilot interventions have included the provision of subsidized RDTs and have been implemented with supportive interventions, including training and supervision of providers. Several studies have concluded that RDTs can be stocked and used safely to treat malaria outside formal health facilities in Uganda [15, 16] and that their use can lead to reduced prescription of anti-malarial drugs among RDT negative patients [12, 13, 17]. Given these positive findings, the policy on diagnostic testing in the private sector is under review by the government.
A total of 1266 outlets were identified during the national outlet survey that met the fever case management survey eligibility criteria. Of these eligible outlets, 1146 outlets were visited for the fever case management study. There were 1089 outlets that participated in patient screening and 259 outlets that did not have any eligible patients. Of a total of 830 outlets with complete patient observation and exit interviews, 423 were private for-profit health facilities, 147 were pharmacies and 260 were drug stores.
Table 3 provides a description of fever patients who were eligible for the fever case management study and had completed both observation and exit interviews. The results show that across the private sector, 74.2% of respondents were patients seeking treatment at outlets as compared to 25.8% of respondents that were seeking treatment on behalf of the patient. 23.1% of respondents had sought treatment elsewhere prior to being interviewed at the facility and this first source of treatment was most commonly from other private facilities (13.8%) rather than the public sector (9.7%). Among all respondents, 8.6% reported receiving a malaria test, 20.5% received a medicine, and 12.5% an anti-malarial at a previous treatment source.
The fever case management findings point to sub-optimal private sector case management, illustrating that even in situations where malaria diagnostic testing is available, patients are not routinely tested. The findings demonstrate that among all respondents interviewed, less than half (44%) received a confirmatory test and this was even lower among those visiting drug stores (29%), where most treatment is sought. These findings however are also consistent with other research that has shown irrational treatment decisions by health providers despite availability of diagnostic tests [38,39,40].
Fairfax County does not provide software or technical support for viewing imagery. Free GIS viewing software is available from private vendors (e.g., ESRI's Explorer products or Hexagon Geospatial's GeoMedia Viewer).
Fairfax County's imagery is collected during tree leaf-off conditions to see as much of the ground and paved surfaces as possible. The USDA National Agriculture Imagery Program (NAIP) site has leaf-on imagery for viewing and download for users interested in tree canopy coverage.
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With a view to the common good, it is necessary to pursue always and with untiring determination the goal of a proper equilibrium between private freedom and public action, understood both as direct intervention in economic matters and as activity supportive of economic development. In any case, public intervention must be carried out with equity, rationality and effectiveness, and without replacing the action of individuals, which would be contrary to their right to the free exercise of economic initiative. In such cases, the State becomes detrimental to society: a direct intervention that is too extensive ends up depriving citizens of responsibility and creates excessive growth in public agencies guided more by bureaucratic logic than by the goal of satisfying the needs of the person.[738] 2ff7e9595c
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