The Future of PPPs in Low-Income Countries

2020 ◽  
pp. 239-266
Author(s):  
James Leigland
Keyword(s):  
Low Income ◽  
Risk Mitigation ◽  
Low Income Countries ◽  
Stakeholder Expectations ◽  
Capital Costs ◽  
The Future ◽  
Market Distortion ◽  
Preparation Work

While PPPs have not been as successful as expected, the various kinds of hybrid PPP project forms that have emerged may suggest ways in which PPPs can sustainably generate some value and meet some stakeholder expectations. These hybrids may indeed be successful, but in what ways do they represent significantly reduced expectations regarding the benefits of PPPs, as these projects were conceived in the 1990s? This chapter discusses what is perhaps the most dramatic compromise, the dominating role now played in most of these projects by subsidized or “blended” finance. Governments and their development partners pay for and manage most basic project preparation work, contribute to the capital costs of projects, and provide guarantees and other risk-mitigation mechanisms insisted on by private partners. How should blended finance like this be justified and managed to ensure against market distortion and wasted resources that could be used more productively elsewhere?

scholarly journals Three-dimensional structures in the design of therapeutics targeting parasitic protozoa: reflections on the past, present and future

2015 ◽  
Vol 71 (5) ◽  
pp. 485-499 ◽  
Author(s):  
Wim G. J. Hol
Keyword(s):  
Drug Development ◽  
Low Income ◽  
High Throughput Screening ◽  
Structural Information ◽  
Target Selection ◽  
Resistance Mechanisms ◽  
Low Income Countries ◽  
Human Beings ◽  
Parasitic Protozoa ◽  
The Future

Parasitic protozoa cause a range of diseases which threaten billions of human beings. They are responsible for tremendous mortality and morbidity in the least-developed areas of the world. Presented here is an overview of the evolution over the last three to four decades of structure-guided design of inhibitors, leads and drug candidates aiming at targets from parasitic protozoa. Target selection is a crucial and multi-faceted aspect of structure-guided drug design. The major impact of advances in molecular biology, genome sequencing and high-throughput screening is touched upon. The most advanced crystallographic techniques, including XFEL, have already been applied to structure determinations of drug targets from parasitic protozoa. Even cryo-electron microscopy is contributing to our understanding of the mode of binding of inhibitors to parasite ribosomes. A number of projects have been selected to illustrate how structural information has assisted in arriving at promising compounds that are currently being evaluated by pharmacological, pharmacodynamic and safety tests to assess their suitability as pharmaceutical agents. Structure-guided approaches are also applied to incorporate properties into compounds such that they are less likely to become the victim of resistance mechanisms. A great increase in the number of novel antiparasitic compounds will be needed in the future. These should then be combined into various multi-compound therapeutics to circumvent the diverse resistance mechanisms that render single-compound, or even multi-compound, drugs ineffective. The future should also see (i) an increase in the number of projects with a tight integration of structural biology, medicinal chemistry, parasitology and pharmaceutical sciences; (ii) the education of more `medicinal structural biologists' who are familiar with the properties that compounds need to have for a high probability of success in the later steps of the drug-development process; and (iii) the expansion of drug-development capabilities in middle- and low-income countries.

scholarly journals Climate Change and the Future Health of Children in Low-Income Countries

2020 ◽  
Vol 66 (2) ◽  
pp. 111-113
Author(s):  
Sara Ajanovic ◽  
Marta Valente ◽  
Rosauro Varo ◽  
Quique Bassat
Keyword(s):  
Climate Change ◽  
Low Income ◽  
Low Income Countries ◽  
Future Health ◽  
The Future

scholarly journals Visions in a Crystal Ball: The Future of Peritoneal Dialysis

2018 ◽  
Vol 45 (1-3) ◽  
pp. 218-223 ◽  
Author(s):  
Joanne M. Bargman ◽  
Michael Girsberger
Keyword(s):  
Peritoneal Dialysis ◽  
Low Income ◽  
Kidney Injury ◽  
Interdisciplinary Approach ◽  
Cardiorenal Syndrome ◽  
Low Income Countries ◽  
High Morbidity ◽  
Patients With Heart Failure ◽  
The Future ◽  
Osmotic Agent

Background: Peritoneal dialysis (PD) is one of the corner stones of renal replacement therapy and should be strongly considered if preemptive kidney transplantation is not available. Summary: There are several initiatives that may help the growth in the use of PD around the world. First, PD is an underused and valuable option in patients with heart failure and the chronic cardiorenal syndrome, especially in those with frequent hospitalizations despite optimal medical therapy. To identify these patients, an interdisciplinary approach of nephrologists and cardiologists is needed. These patients and other CKD patients with significant residual kidney function may do well with a regimen employing fewer than the usual number of bag exchanges, referred to as “incremental” dialysis. Second, acute kidney injury (AKI) is a worldwide burden with high morbidity and mortality, especially in low income countries. To reach the goal of zero preventable deaths caused by AKI by 2025 endorsed by the International Society of Nephrology, PD is the therapy of choice for treatment in this setting. Third, although dextrose has served well as the osmotic agent in PD solutions, there has been a continuous search for alternative agents. Hyperbranched polyglycerol might be such an osmole. Finally, to obviate the need for production and delivery of bags of PD solution, the development of home-generated dialysate is of interest. Key Message: The future of PD lies not only in accruing experience from the past decades, but also in staying open to other uses.

Initiative for Heavily Indebted Poor Countries (HIPC) and Multilateral Debt Relief Initiative (MDRI)-Status of Implementation and Proposals for the Future of the HIPC Initiative

Policy Papers ◽  
2011 ◽  
Vol 11 (59) ◽  
Author(s):  
Keyword(s):  
Low Income ◽  
Poor Country ◽  
Debt Relief ◽  
Low Income Countries ◽  
Poor Countries ◽  
The Future ◽  
The Status ◽  
Heavily Indebted Poor Countries ◽  
Hipc Initiative

This report aims to accomplish three objectives: (a) it provides an update on the status of implementation, impact, and costs of the Heavily Indebted Poor Country (HIPC) Initiative and the Multilateral Debt Relief Initiative (MDRI); (b) it proposes a modification of the reporting of progress under the initiatives, including the discontinuation of the annual status of implementation reports, and the preparation of periodic reports on debt vulnerabilities in low income countries (LICs), including HIPCs; and (c) it proposes a further ring-fencing of the list of countries eligible or potentially eligible for debt relief under the HIPC Initiative based on end-2010 income and indebtedness criteria.

Three Cases of Joubert Syndrome in a Consanguineous Syrian Family and a Interesting Case of Multinational Collaboration

2021 ◽  
Author(s):  
Davor Petrović ◽  
Vida Čulić ◽  
Zofia Swinderek-Alsayed
Keyword(s):  
Low Income ◽  
Autosomal Recessive ◽  
Autosomal Recessive Disorder ◽  
Joubert Syndrome ◽  
Interesting Case ◽  
Low Income Countries ◽  
Ocular Motor ◽  
Quality Health Care ◽  
Quality Health ◽  
Motor Apraxia

AbstractJoubert syndrome (JS) is a rare congenital, autosomal recessive disorder characterized by a distinctive brain malformation, developmental delay, ocular motor apraxia, breathing abnormalities, and high clinical and genetic heterogeneity. We are reporting three siblings with JS from consanguineous parents in Syria. Two of them had the same homozygous c.2172delA (p.Trp725Glyfs*) AHI1 mutation and the third was diagnosed prenatally with magnetic resonance imaging. This pathogenic variant is very rare and described in only a few cases in the literature. Multinational collaboration could be of benefit for the patients from undeveloped, low-income countries that have a low-quality health care system, especially for the diagnosis of rare diseases.

Reviewing the Development of Rural Finance in Vietnam

2013 ◽  
pp. 121-136
Author(s):  
Duong Pham Bao
Keyword(s):  
Low Income ◽  
Financial System ◽  
Low Income Countries ◽  
Supply Side ◽  
New Paradigm ◽  
Rural Finance ◽  
Market Mechanisms ◽  
Rural Credit ◽  
Rural Organizations ◽  
Doi Moi

The objective of this article is to review the development of the rural financial system in Vietnam in recent years, especially, after Doi moi. There are two opposite schools of thought in the literature on rural credit policies in developing countries. One is the conventional supply-side (government-led) approach while the other is called “a new paradigm” that emphasizes the importance of the viability of financial providers and the well functioning of rural credit markets. Conventional theories of rural finance contend that rural finance in low-income countries is generally accompanied by many failures. Contrary to these theories, rural finance in Vietnam does not encounter the above-mentioned failures so far. Up to the present time, it is progressing well. Using a supply-side approach, methodologically, this study reviews the development of the rural financial system in Vietnam. The significance of this study is to challenge the extreme view of dichotomizing between the old and the new credit paradigms. Analysis in this study contends that a rural financial market that, (1) is initiated and spurred by government; (2) operates principally under market mechanisms; and (3) is strongly supported by rural organizations (semi-formal/informal institutions) can progress stably and well. Therefore, the extremely dichotomizing approach must be avoided.

Abdominal Textiloma Mimicking as Left Colic Tumour: A Postoperative Complication Still Common in Low-Income Countries

EMJ Radiology ◽  
2020 ◽  
Keyword(s):  
Low Income ◽  
Early Stage ◽  
Low Income Countries ◽  
Fistula Formation ◽  
Emergency Laparotomy ◽  
Intermittent Fever ◽  
Gastrointestinal Complications ◽  
Surgical Safety ◽  
Surgical Teams ◽  
Safety Rules

Retained foreign bodies have become very rare in countries where the safety rules in the operating theatre are very rigorous and follow precise guidelines. There are low-income countries where hospital structures are precarious, in which the implementation of surgical safety rules has only been effective recently. Surgical teams in these countries are not yet well trained in the observance of the guidelines concerning swab count, meaning that textilomas are not uncommon. Abdominal textiloma may be asymptomatic, or present serious gastrointestinal complications such as bowel obstruction, perforation, or fistula formation because of misdiagnosis. It may mimic abscess formation in the early stage or soft tissue masses in the chronic stage. This case report presents a 27-year-old female who underwent an emergency laparotomy in a rural surgical centre for an ectopic pregnancy. Two months later, a swelling had appeared on the left side of her abdomen, gradually increasing in size, which was not very painful but caused digestive discomfort and asthenia. Intermittent fever was described and treated with antibiotics. The patient was referred to a better equipped centre to benefit from a CT scan. A textiloma was strongly suspected on the CT but a left colic mass was not excluded. Laparotomy confirmed the diagnosis of textiloma and the postoperative course was uneventful. Prevention rules must be strengthened in these countries where patients can hardly bear the costs of iterative surgeries for complications that are avoidable.

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