Since antiretroviral (ARV) medicines represent one of the most costly components of therapy for HIV in middle-income countries, ensuring their efficient procurement is highly relevant. In 2008, Mexico created a national commission for the negotiation of ARV prices to achieve price reductions for their public HIV treatment programmes. The objective of this study is to assess the immediate impact of the creation of the Mexican Commission for Price Negotiation on ARV prices and expenditures. A longitudinal retrospective analysis of procurement prices, volumes and type of the most commonly prescribed ARVs procured by the two largest providers of HIV/AIDS care in Mexico between 2004 and 2009 was carried out. These analyses were combined with 26 semi-structured key informant interviews to identify changes in the procurement process. Prices for ARVs dropped by an average of 38% after the first round of negotiations, indicating that the Commission was successful in price negotiations. However, when compared with other upper-middle-income countries, Mexico continues to pay an average of six times more for ARVs. The Commission's negotiations were successful in achieving lower ARV prices. However, price reduction in upper-middle-income countries suggests that the price decrease in Mexico cannot be entirely attributed to the Commission's first round of negotiations. In addition, key informants identified inefficiencies in the forecasting and procurement processes possibly affecting the efficiency of the negotiation process. A comprehensive approach to improving efficiency in the purchasing and delivery of ARVs is necessary, including a better clarification in the roles and responsibilities of the Commission, improving supply data collection and integration in forecasting and procurement, and the creation of a support system to monitor and provide feedback on patient ARV use.

Successful health-sector reform in developing countries is built on sustainable service delivery models that meet reform goals while addressing community needs. When government efforts fall short, innovative private-sector solutions can offer more-efficient alternatives that provide care to impoverished populations. We identify organizations that use elements of a focused care approach to overcome barriers to delivering care in low-resource settings. Using the experience of the Aravind Eye Care System, we describe the essential elements of the specialty care model, its replication across countries, and the challenges to extending this model beyond eye care.

PROLOGUE:The hospital competitive landscape has endured often convulsive transformation during the past decade. The industry has been buffeted by conflicting forces, hampering its health as a sector and influencing the strength of its competitive posture with respect to other components of the health care delivery system. Such factors have, at various times, included persistent overcapacity, misallocation of institutional assets and resources, low payment rates, aggressive competition from physician-owned entities and specialty hospitals, and the increasing burden of uncompensated care.Under the conventional competitive wisdom that size begets strength, such market forces have sparked a trend toward rapid and aggressive hospital mergers and the ascendancy of hospital systems operating as integrated delivery systems. And, as we learned from Health Affairs' 2003 thematic issue on hospitals, hospital consolidation, by way of hospital systems acquiring other hospitals, far outstripped the competitive transformation achieved through mergers. This paper analyzes the market and capital investment strategy at Catholic Healthcare West (CHW) between 1996 and 2005 to illuminate the strengths and weaknesses of chain organization. Abandoning its erstwhile focus on integrated delivery and growth for growth's sake in favor of selective divestments and investments, CHW achieved a remarkable turnaround in operating earnings and financial asset strength. As a nonprofit organization with religious sponsorship, however, CHW also developed a strategic approach to how to balance the financial investment and divestment priorities with those stemming from its charitable mission. The paper illustrates CHW's strategy to distribute capital investments across the system's forty hospitals in terms of each facility's profitability, the economic prospects of the market in which it is located, the extent to which it provides charitable services, and the social and health needs of its community.

Introduction The Mzumbe University MSc Health Monitoring and Evaluation (M&E) Program, launched in 2013, is aimed at building human resources capacity in Tanzania and East Africa by developing high-caliber M&E professionals to provide leadership in public health systems and the private sector. This case study aimed to describe the process of establishing the program and report results of an interim evaluation. Case The program’s innovative curriculum focuses on enabling graduates to implement M&E systems that respond to organizational challenges. Program content was driven by results of a training needs assessment, which sought input from stakeholder organizations. The curriculum is competency-based with content determined by learning objectives established for each course. It is delivered over three academic semesters followed by a fourth semester during which students implement field projects that serve as their master’s dissertations. The program draws on outside faculty and M&E practitioners to assure that student learning is balanced between theory and practice. Graduates are expected to assume influential positions in their workplaces, including public and private health organizations, hospitals, central and local government health authorities as well as international health organizations. Discussion The MSc Health M&E Program at Mzumbe University serves as a model for sustainable human resources for health M&E capacity and development in the East African region and beyond. The interim evaluation validated the success of the methods used in program development and implementation. Student feedback indicates that they have acquired the required skills to serve successfully in M&E leadership positions post-graduation.