Public-Private Partnerships: A Pathway to Health Equity in Developing Countries
Dahat A. Hussein
In the face of mounting healthcare challenges, developing countries grapple with resource constraints, underfunded health systems, and a growing burden of infectious and non-communicable diseases. The question is no longer whether healthcare systems can sustain themselves under these pressures—the evidence says they cannot—but how they can adapt and evolve to meet these needs. One promising approach lies in establishing and strengthening public-private partnerships (PPPs) [1].
PPPs are collaborations in which governments and private entities collaborate to achieve common health goals, leveraging the strengths of both sectors. The public sector offers reach, regulatory frameworks, and an understanding of population health needs, while the private sector contributes innovation, efficiency, and financial resources. Together, they can address healthcare access, quality, and affordability gaps [1].
In many developing countries, healthcare access remains unequal. Rural and underserved populations often lack essential services, while urban areas face overcrowded and overburdened public hospitals. By pooling resources and expertise, PPPs can deliver sustainable solutions, such as building health facilities in remote areas, funding community health programs, or providing cutting-edge technology and training to public hospitals. Initiatives like the African Access Initiative have brought affordable medicines and diagnostic tools to low-income countries by fostering collaborations between governments and pharmaceutical companies. These partnerships ensure the availability of life-saving medications for conditions like cancer and diabetes [2]. In countries like India, PPPs have been instrumental in building state-of-the-art hospitals in rural areas, combining public funding with private expertise. For example, the Karnataka state government’s partnership with private hospitals expanded tertiary healthcare access to previously underserved populations [3]. Partnerships with multinational corporations and NGOs have facilitated training for healthcare professionals, enabling them to provide higher-quality care. In Kenya, PPPs have focused on improving maternal and child health outcomes through community-based education programs [4], in 2010, the Kurdistan Regional Government (KRI) asked for assistance from the RAND Corporation, a U.S.-based nonprofit policy think tank specializing in research and development across various fields, to support the reform of the healthcare system in the Kurdistan Region of Iraq. The primary goal of the reform was to establish a health system that could efficiently provide high-quality services to all individuals, with the support of Public-Private Partnerships (PPPs) [5].
Despite their promise, PPPs are not without challenges. Critics argue that these arrangements can lead to the privatization of public health assets or create inequities in service delivery. For instance, poorly regulated PPPs may prioritize profitability over the needs of vulnerable populations, leaving rural or low-income communities underserved. Transparency, accountability, and robust legal frameworks are essential to mitigate these risks. Governments must ensure that PPP agreements prioritize public health outcomes with clear success metrics and oversight mechanisms.
As the global health landscape evolves, developing countries have an opportunity to harness PPPs as a tool for resilience and equity. By fostering inclusive partnerships that align public and private incentives, countries can mobilize resources, improve service delivery, and ensure sustainable healthcare financing.
The need for innovation and collaboration in healthcare has never been more urgent. Governments, private entities, and civil society must work together to create partnerships that prioritize the well-being of all citizens, particularly the most vulnerable. With the right frameworks, public-private partnerships can move beyond being a stopgap solution and become a cornerstone of sustainable health systems.
Let us embrace the potential of PPPs and work toward a future where healthcare is a right, not a privilege, for everyone, everywhere.
Ari M. Abdullah, Zuhair D. Hammood, Lana R.A. Pshtiwan, Rawa M. Ali, Abdulwahid M. Salih, Hadeel A. Yasseen, Abdullah A. Qadir, Masty K. Ahmed, Shko H. Hassan, Hawkar A. Nasralla, Sanaa O. Karim, Hawar A. Sofi, Fahmi H. Kakamad
Desmoid-Type Fibromatosis of The Breast: A Case Series
Ari M. Abdullah, Zuhair D. Hammood, Lana R.A. Pshtiwan, Rawa M. Ali, Abdulwahid M. Salih, Hadeel...
Introduction Desmoid-type fibromatosis (DTF), also called aggressive fibromatosis, is a rare, benign, locally aggressive condition. Mammary DTF originates from fibroblasts and myofibroblasts within the breast tissue, representing 0.2% of all breast tumors. This study aims to present and discuss the clinical presentation and management of seven cases of breast DTF.
Methods
This single-center case series was conducted at the breast clinic of Smart Health Tower in Sulaymaniyah, Iraq. It included all patients diagnosed as breast DTF by histopathological examination, with those lacking complete data excluded. The patients were treated and managed between January 2021 and August 2024.
Results
This study involved seven female patients with a mean age of 35.29 ± 14.29 years. Clinically, six of them (85.71%) presented with a non-tender palpable breast mass, while one patient (14.28%) reported breast pain. Ultrasound revealed hypoechoic lesions in all cases. The average size of the masses was 29.43 ± 17.26 mm. All patients underwent wide local excision of the breast mass. Histopathological examination confirmed the diagnosis of DTF in all cases.
Conclusion
Diagnosing a desmoid tumor of the breast can be difficult, as it can mimic breast carcinoma. The Wide local excision is often the preferred treatment to prevent future recurrences.
Arteriovenous Fistula Creation for Hemodialysis in Patients with End-Stage Renal Disease with and Without Surgical Drain: A Randomized Control Trial
Lokish S. Jaswel, Narayan Oste, Satish Vaidy
Introduction
Failure of an arteriovenous fistula (AVF) disrupts hemodialysis access and reduces the available area for future access. Preventive interventions are necessary to avoid AVF failure. This study evaluates the impact of surgical drainage during AVF creation for hemodialysis in patients with end-stage renal disease (ESRD).
Methods
This single-center, phase II, randomized controlled trial was conducted from June 2020 to June 2023. Ninety-four patients were randomly assigned into two groups: Group A (with a surgical drain) and Group B (without a drain). Patients were followed for six months post-surgery. The primary outcome was AVF primary patency, and secondary outcomes included postoperative complications.
Results
The average age of participants was 63.7 years, with 50 male patients. The most common cause of renal failure was glomerular disease (29.8%), and most AVFs were located on the left side (57.4%). Brachiocephalic AVFs were the most frequent type (70.2%). Postoperative hematoma was more common in Group B (42.6%) than in Group A (17%) (P = 0.007). The primary patency rate at six months was higher in Group A (87.2%) compared to Group B (76.6%), though the difference was not statistically significant (P = 0.180).
Conclusion
The use of surgical drainage during AVF creation may reduce postoperative complications, such as hematomas, and potentially improve primary patency rates, contributing to better outcomes for patients undergoing hemodialysis.
Dana O. Kareem, Ahmed MS. Amin, Ayman M. Mustafa, Akam K. Qadir, Meer N. Ahmed, Soma N. Omer, Hevin B. Jabbar, Rawezh Q. Salih, Mohammed T. Taha, Rozhgar A. Ezzat, Berun A. Abdalla, Shvan H. Mohammed
Tracing Hematological Shifts in Pregnancy: How Anemia and Thrombocytopenia Evolve Across Trimesters
Dana O. Kareem, Ahmed MS. Amin, Ayman M. Mustafa, Akam K. Qadir, Meer N. Ahmed, Soma N. Omer,...
Introduction
Given pregnancy's significant impact on hematological parameters, monitoring these changes across trimesters is crucial. This study aims to evaluate hematological profiles in pregnant women, primarily focusing on the prevalence of anemia and thrombocytopenia throughout the different trimesters.
Methods
This retrospective cross-sectional study was conducted at Smart Health Tower from March to December 2024, with ethical approval from Kscien Organization. Pregnant women aged 18-45 years in any trimester were included, excluding those with pre-existing hematological disorders or significant complications. Blood samples were collected during routine antenatal visits for hematological analysis. Data were analyzed using IBM SPSS version 26.0, with statistical significance set at p<0.05.
Results
This study included 243 pregnant women, with a mean age of 29.91 ± 6.32 years. The average hematological parameters were as follows: white blood cell count 9.45 ± 2.10 × 10⁹/L, red blood cell count 4.21 ± 0.45 × 10¹²/L, hemoglobin 11.93 ± 1.03 g/dL, and platelet count 239.11 ± 59.47 × 10⁹/L. Anemia and thrombocytopenia were identified in 16.0% and 5.0% of participants, respectively, with significant trimester-related variations (p= 0.033, p= 0.006). The highest prevalence of anemia (30.8%) was observed in women aged 26–30 years.
Conclusion
Significant changes in hematological parameters across pregnancy trimesters highlight the need for regular monitoring to diagnose and manage anemia, thrombocytopenia, and other abnormalities, ensuring optimal maternal and fetal health.
Abdulwahid M. Salih, Aras J. Qaradakhy, Shaho F. Ahmed, Rebaz M. Ali, Hiwa O. Baba, Ari M. Abdullah, Imad J. Habibullah, Dana O. Kareem, Shko H. Hassan, Ayman M. Mustafa, Harun Amanj Ahmed, Abdullah A. Qadir, Rebaz O. Mohammed
Primary Thyroid Non-Hodgkin B-Cell Lymphoma: A Case Series
Abdulwahid M. Salih, Aras J. Qaradakhy, Shaho F. Ahmed, Rebaz M. Ali, Hiwa O. Baba, Ari M....
Introduction
Non-Hodgkin lymphoma (NHL) of the thyroid, a rare malignancy linked to autoimmune disorders, is poorly understood in terms of its pathogenesis and treatment outcomes. This study aims to review a single-center experience in managing primary thyroid non-Hodgkin B-cell lymphoma cases.
Methods
This retrospective case series was conducted at a single center from January 2020 to November 2024, including patients diagnosed with B-cell NHL of the thyroid who underwent surgical intervention. Data, including clinical, demographic, laboratory, and imaging information, were extracted from medical records. Diagnostic procedures involved core needle or surgical biopsy with immunohistochemistry analysis. Treatment included excisional biopsy, thyroidectomy, lobectomy, and chemotherapy. Quantitative data is presented as means and standard deviations, and qualitative data as frequencies and percentages.
Results
Among nine NHL cases, seven (77.8%) were female, with a mean age of 60.78 ± 12.53 years. Anterior neck swelling was the most common presentation in 6(66.7%) cases. Seven patients (77.8%) received R-CHOP chemotherapy; histopathology confirmed B-cell lymphoma in eight cases (88.9%). Thyroid function was euthyroid in four cases (44.4%), hypothyroid in three (33.3%), and hyperthyroid in one (11.1%). TI-RADS (Thyroid Imaging Reporting and Data Systems) classification showed five cases (55.6%) as TI-RADS 5. Follow-up revealed no recurrence in four cases (44.4%), and two deaths (22.2%).
Conclusion
Primary thyroid NHL is a rare condition requiring early diagnosis and personalized treatment. The variability in treatment responses highlights the need for individualized approaches to optimize patient outcomes.
Berun A. Abdalla, Meer M. Abdulkarim, Shvan H. Mohammed, Rewas Ali Azeez, Talar Sabir Hameed, Nigar Hassan Mohammed, Rawezh Q. Salih, Dahat A. Hussein, Shvan L. Ezzat, Rebaz E. Ali, Karokh K. Mohammed, Barham H. Bapir, Shabaz J. Ibrahim, Dyari Q. Hamad
The Hidden Problem of Cross-Reactivity: Challenges in HIV Testing During the COVID-19 Era: A Systematic Review
Berun A. Abdalla, Meer M. Abdulkarim, Shvan H. Mohammed, Rewas Ali Azeez, Talar Sabir Hameed,...
Introduction
Human immunodeficiency virus (HIV) and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) surface glycoproteins, including shared epitope motifs, show similarities. This may lead to false-positive HIV results due to cross-reactivity between the two viruses. This study presents a systematic review of the published studies on their cross-reactivity.
Methods
A systematic review of the published studies of HIV and SARS-CoV2 cross-reactivity was conducted, the studies that met the following criteria were included: 1) Studies in the English language. 2) Studies in which the title included the required keywords. 3) Studies in which false positive results were achieved and confirmed. 4) Studies investigating the possibility of cross-reactivity between HIV and SARS-CoV2.
Results
A total of 11 studies and 466,140 patients were analyzed. Of the specified sexes, 363,786 (82.1%) of the participants were males. A total of 707 false-positive HIV results were recorded, of which 122 (17.3%) had detectable Coronavirus disease 2019 (COVID-19) antibodies. The remaining 585 (82.7%) false positives were either healthy patients or patients recovered from COVID-19 with no detectable COVID-19 antibodies. Twenty-five distinct tests were used as initial and confirmatory tests for both COVID-19 and HIV. Six (24%) unique fourth-generation HIV antigen/antibody combination tests, six (24%) HIV-specific molecular tests, and four (16%) HIV immunoassays were used.
Conclusion
COVID-19 should be considered a potential cause of false-positive results in HIV tests, due to the cross-reactivity between the antibodies or antigens from both viruses.
Fahmi H. Kakamad, Saywan K. Asaad, Abdullah K. Ghafour, Nsren S. Sabr, Hiwa S. Namiq, Lawen J. Mustafa, Azad S. Hattam, Soran H. Tahir, Ahmed H. Ahmed, Omed M. Hussein, Sakar O. Arif, Hawkar A. Nasralla, Marwan N. Hassan, Sarhang S. Abdalla, Bander A. Abdalla, Berun A. Abdalla
Differential Diagnosis of Neurogenic Thoracic Outlet Syndrome: A Review
Fahmi H. Kakamad, Saywan K. Asaad, Abdullah K. Ghafour, Nsren S. Sabr, Hiwa S. Namiq, Lawen J....
Thoracic outlet syndrome (TOS) is a complex and often overlooked condition caused by the compression of neurovascular structures as they pass through the thoracic outlet. This compression can result in pain, numbness, tingling, muscle weakness, and vascular complications, with severe cases leading to thrombosis or embolism.
TOS is classified into three types based on the affected structure: neurogenic, venous, and arterial. Neurogenic TOS is the most prevalent, accounting for over 90% of cases, and is more commonly seen in females. Venous TOS represents 3–5% of cases, while arterial TOS is the rarest, comprising only 1%. Diagnosing TOS is challenging due to its symptom overlap with various musculoskeletal and neurological disorders, often leading to misdiagnosis. The absence of universally accepted diagnostic criteria further complicates identification, relying primarily on clinical evaluations and inconsistent diagnostic methods.
Neurogenic TOS, in particular, is difficult to distinguish from other conditions with similar presentations. This study provides a comprehensive review of the differential diagnosis of neurogenic TOS, comparing it with musculoskeletal and neurological disorders that share overlapping clinical features.
Eli Pradhan, Saif Hassan Alrasheed, Oksana I. Melnyk, Habibullah Azimi, Sina Raeisi, Amirhossein Aghajani, Baye Ashenef, Meer M. Abdulkarim, Roza E. Mirdan, Hawkar A. Nasralla, Yousif M. Mahmood
Hydatid Cyst of The Orbit: A Systematic Review with Meta-Data
Eli Pradhan, Saif Hassan Alrasheed, Oksana I. Melnyk, Habibullah Azimi, Sina Raeisi, Amirhossein...
Hydatidosis or hydatid cyst (HC) is a commonly recognized zoonotic disease caused by the larval form of the tapeworm Echinococcus granulosus. Humans act as intermediate hosts for this parasite, acquiring infection through direct contact with definitive hosts (e.g., sheep, goats, cattle, dogs) or consuming contaminated food or water. [1].
The global incidence of hydatidosis varies, with higher rates observed in regions where livestock farming is widespread. Key risk factors for contracting hydatidosis include close contact with dogs, livestock-related activities, and residence in areas where the disease is endemic. These cysts typically occur in the liver (50-70%) and lungs (20-30%). The global burden of HC is significant, with an estimated 2 to 3 million cases reported worldwide [2]. However, orbital HC is uncommon, representing less than 1% of all cases, accounting for 19.8% in endemic countries [3].
The World Health Organization (WHO) has classified Echinococcosis as one of the 20 neglected tropical diseases that pose significant public health concerns. To ensure consistent global monitoring, the WHO Informal Working Group on echinococcosis has categorized cysts of echinococcosis into five distinct types, grouped into three main categories. Specifically, CE1 and CE2 are indicative of active infection, CE3 represents an intermediate stage, while CE4 and CE5 are associated with inactive cysts [4].
In endemic regions, environmental and climatic conditions play a crucial role in the survival of parasite eggs and the living conditions of livestock and stray dogs. For example, Echinococcus granulosus eggs remain viable in water and damp sand for up to three weeks at 30°C, 4.5 weeks at 10–21°C, and 32 weeks at 6°C. They can also survive for several months in green pastures and gardens [4]. Although the WHO classifies hydatidosis as a neglected disease, it continues to be a significant public health concern due to its status as the second most impactful foodborne parasitic disease, its endemic presence in certain regions, and its potential to cause substantial morbidity. The WHO prioritizes the control and prevention of hydatidosis, particularly given its impact on human health, animals, and the food supply chain.
Orbital HC, although rare, is often linked to severe visual complications. As of the date of the current review, the available literature on orbital HC primarily consists of case reports and case series, with no reviews currently available. This study aims to provide and analyze a collection of data through a systematic review and a meta-data presentation.
Abdullah K. Ghafour, Soran S. Raoof, Soran H. Tahir, Rezheen J. Rashid, Dyari Q. Hamad, Pshdar H. Ramadhan, Hawkar A. Nasralla, Karukh K. Mohammed, Bootan J. Raheem
Asymptomatic Osteonecrosis of the Trochlea in an Adolescent: A Case Report
Abdullah K. Ghafour, Soran S. Raoof, Soran H. Tahir, Rezheen J. Rashid, Dyari Q. Hamad, Pshdar H....
Introduction
Osteonecrosis, also known as avascular necrosis, aseptic necrosis, or ischemic necrosis, results from a temporary or permanent halt in blood flow to a portion of bone. This lack of blood supply can eventually cause the affected bone to collapse. Osteonecrosis around the elbow is not frequently observed. However, its occurrence in the trochlea known as Hegemann's disease is even rarer. Incidence rates of trochlear osteonecrosis have been reported to vary from 0.27% to less than 0.001% across different studies.
Case presentation
A 14-year-old male presented with severe right shoulder pain and swelling, along with mild right lateral-sided elbow pain due to a fall to the ground. The radiograph of the right shoulder revealed a proximal humeral metaphyseal greenstick fracture. Additionally, the radiograph of the right elbow incidentally revealed osteonecrosis of the distal humeral trochlea. The affected shoulder was immobilized and Conservative management was selected for treating the trochlear osteonecrosis.
Conclusion
Trochlear avascular necrosis is a rare condition that might cause mild discomfort or even be asymptomatic, potentially being diagnosed incidentally through radiographs. Typically, it can be managed with conservative treatment methods.
Ari M. Abdullah, Aras J. Qaradakhy, Yadgar A. Saeed, Aso S. Muhialdeen, Rebaz O. Mohammed, Hiwa O. Baba, Abdulwahid M. Salih, Abdullah A. Qadir, Rezheen J. Rashid, Fahmi H. Kakamand
Kikuchi-Fujimoto Disease Coexistent with Papillary Thyroid Carcinoma: A Report of Two Cases
Ari M. Abdullah, Aras J. Qaradakhy, Yadgar A. Saeed, Aso S. Muhialdeen, Rebaz O. Mohammed, Hiwa...
Introduction
Kikuchi-Fujimoto Disease (KFD), characterized by histiocytic necrotizing lymphadenitis, is a rare condition of unknown etiology. Diagnosis is dependent on lymph node biopsy. Despite its self-limiting nature, accurate identification is essential to exclude more serious conditions. This paper reports on two cases of KFD coexisting with papillary thyroid carcinoma (PTC).
Case presentation
Two cases of KFD related to papillary thyroid carcinoma (PTC) are described. In Case 1, a 25-year-old woman experienced submental swelling, fever, and exhaustion. Subsequent tests revealed a thyroid lesion and cervical lymphadenopathy, which were confirmed as PTC and KFD. In Case 2, a 39-year-old female patient had right neck swelling, prompting a complete thyroidectomy that revealed papillary thyroid cancer with KFD in cervical lymph nodes.
Conclusion
The conclusion emphasizes the importance of considering KFD while highlighting its masquerading nature and the unique scenario of its coexistence with PTC.
Rebaz M. Ali, Shkar O. Arif, Rezhen J. Rashid, Rawa M. Ali, Abubakar Ibrahim, Dana T. Gharib, Marwan A. Ghafoor, Afolabi Hafeez Abiola, Bamiro Akeem Moradehun, Shano M. Ali, Dear A. Ismaeil, Hoshman R. Asaad
Gastric Pyloric Schwannoma: A Case Report and Review of the Literature
Rebaz M. Ali, Shkar O. Arif, Rezhen J. Rashid, Rawa M. Ali, Abubakar Ibrahim, Dana T. Gharib,...
Introduction
Schwannomas are slow-growing, subclinical neoplasms rarely found in the gastrointestinal tract. This study reports a schwannoma in the pyloric region of the stomach.
Case presentation
A 50-year-old female presented with a one-week history of epigastric pain, dark tarry stools, and nausea. Endoscopic examination and biopsy confirmed the diagnosis of gastric schwannoma. The patient underwent surgical resection of the tumor. Histopathological examination showed benign spindle cells with strong S100 positivity, confirming schwannoma. Post-operative follow-up included treatment for H. pylori infection and monitoring for recurrence or complications. No recurrence was reported after six months.
Literature Review
Gastric schwannoma is challenging to distinguish from other submucosal tumors preoperatively. Reviews of recent case reports indicate the importance of detailed imaging in diagnosis, and surgical resection remains the treatment of choice, with an excellent prognosis and low recurrence rates.
Conclusion
Schwannoma is rare in the stomach, especially in the pyloric region. Definitive diagnosis may require immunohistochemical analysis. Appropriate follow-up after treatment can be essential to identify emerging complications and ensure timely intervention.
