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Category
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1
Measures to strengthen primary health-care systems in low- and middle-income countries
Etienne V Langlois, Andrew Mc Kenzie, Helen Schneider & Jeffrey W Mecaskey
World Health Organization
(2020)
C_WHO
Primary health care offers a cost–effective route to achieving universal health coverage (UHC). However, primary health-care syst
...
ems are weak in many low- and middle-income countries and often fail to provide comprehensive, people-centred, integrated care. We analysed the primary health-care systems in 20 low- and middle-income countries using a semi-grounded approach. Options for strengthening primary health-care systems were identified by thematic content analysis. We found that: (i)despite the growing burden of noncommunicable disease, many low- and middle-income countries lacked funds for preventive services; (ii)community health workers were often under-resourced, poorly supported and lacked training; (iii)out-of-pocket expenditure exceeded 40% of total health expenditure in half the countries studied, which affected equity; and (iv)health insurance schemes were hampered by the fragmentation of public and private systems, underfunding, corruption and poor engagement of informal workers. In 14 countries, the private sector was largely unregulated. Moreover, community engagement in primary health care was weak in countries where services were largely privatized. In some countries, decentralization led to the fragmentation of primary health care. Performance improved when financial incentives were linked to regulation and quality improvement, and community involvement was strong. Policy-making should be supported by adequate resources for primary health-care implementation and government spending on primary health care should be increased by at least 1% of gross domestic product. Devising equity-enhancing financing schemes and improving the accountability of primary health-care management is also needed. Support from primary health-care systems is critical for progress towards UHC in the decade to 2030.
more
The Covid-19 pandemic has so far infected more than 30 million people in the world, having major impact on global health with collateral damage. In Mozambique, a public state of emergency was declared at the end of March 2020. This has limited peopl
...
e's movements and reduced public services, leading to a decrease in the number of people accessing health care facilities. An implementation research project, The Alert Community for a Prepared Hospital, has been promoting access to maternal and child health care, in Natikiri, Nampula, for the last four years. Nampula has the second highest incidence of Covid-19. The purpose of this study is to assess the impact of Covid-19 pandemic Government restrictions on access to maternal and child healthcare services. We compared health centres in Nampula city with healthcare centres in our research catchment area. We wanted to see if our previous research interventions have led to a more resilient response from the community.
METHODS: Mixed-methods research, descriptive, cross-sectional, retrospective, using a review of patient visit documentation. We compared maternal and child health care unit statistical indicators from March-May 2019 to the same time-period in 2020. We tested for significant changes in access to maternal and child health services, using KrushKall Wallis, One-way Anova and mean and standard deviation tests. We compared interviews with health professionals, traditional birth attendants and patients in the two areas. We gathered data from a comparable city health centre and the main city referral hospital. The Marrere health centre and Marrere General Hospital were the two Alert Community for a Prepared Hospital intervention sites.
RESULTS: Comparing 2019 quantitative maternal health services access indicators with those from 2020, showed decreases in most important indicators: family planning visits and elective C-sections dropped 28%; first antenatal visit occurring in the first trimester dropped 26%; hospital deliveries dropped a statistically significant 4% (p = 0.046), while home deliveries rose 74%; children vaccinated down 20%.
CONCLUSION: Our results demonstrated the negative collateral effects of Covid-19 pandemic Government restrictions, on access to maternal and child healthcare services, and highlighted the need to improve the health information system in Mozambique.
more
STANDARD OPERATING PROCEDURES
PARTICIPANT GUIDE
This Participant Guide has been designed to assist health facilities and community based non-clinicians to develop skills to provide linkage to care
...
, adherence and retention in care services for chronic conditions
more
Every day, schools engage in numerous activities that help promote the health and well-being of students, families, and communities. There is clear evidence of the benefits of the health-promoting s
...
chools (HPS) approach, not only for improving overall health outcomes (physical, mental, and social) in the educational community but also for achieving better learning outcomes. The closure of schools during the COVID-19 pandemic highlighted these benefits, as well as the close links between health, wellness, and education.
more
BMC Health Services Research 14(1):42 · January 2014
The objective of this international comparative study is to describe and compare the mental health policies in seven countries of Eastern Eu
...
rope that share their common communist history: Bulgaria, the Czech Republic, Hungary, Moldova, Poland, Romania, and Slovakia.
The burden of totalitarian history still influences many areas of social and economic life, which also has to be taken into account in mental health policy. We may observe that after twenty years of health reforms and reforms of health reforms, the transition of the mental health systems still continues. In spite of many reform efforts in the past, a balance of community and hospital mental health services has not been achieved in this part of the world yet.
more
This updated Comprehensive Mental Health Action Plan 2013-2030 builds upon its predecessor and sets out clear actions for Member States, the WHO Secretariat and international, regional and national partners to promote mental
...
health and well-being for all, to prevent mental health conditions for those at-risk and to achieve universal coverage for mental health services. While the updated action plan includes new and updated indicators and implementation options, the original four major objectives remain unchanged: more effective leadership and governance for mental health; the provision of comprehensive, integrated mental health and social care services in community-based settings; implementation of strategies for promotion and prevention; and strengthened information systems, evidence and research.
In English, French, Spanish, Arabic and Russian available
more
Strengthening mental health responses to COVID-19 in the Americas: A health policy analysis and recommendations
A. Tausch; Oliveira e Souza, R.; Martinez Viciana, C.; et al.
Pan American Health Organization
(2021)
CC
The COVID-19 pandemic is having a major impact on the mental health of populations in the Americas. Studies
show high rates of depression and anxiety, among other psychological symptoms, particularly among women, young
people, those with pre-exist
...
ing mental health conditions, health workers, and persons living in vulnerable condi-
tions. Mental health systems and services have also been severely disrupted. A lack of financial and human resource
investments in mental health services, limited implementation of the decentralized community-based care approach
and policies to address the mental health gap prior to the pandemic, have all contributed to the current crisis. Coun-
tries must urgently strengthen their mental health responses to COVID-19 by taking actions to scale up mental
health and psychosocial support services for all, reach marginalized and at-risk populations, and build back better
mental health systems and services for the future.
more
This document adopts a health determinants framework for examining the evidence related to women’s poor mental health. From this perspective, public policy including economic policy, socio-cultura
...
l and environmental factors, community and social support, stressors and life events, personal behaviour and skills, and availability and access to health services, are all seen to exercise a role in determining women’s mental health status. Similarly, when considering the differences between women and men, a gender approach has been used. While this does not exclude biological or sex differences, it considers the critical roles that social and cultural factors and unequal power relations between men and women play in promoting or impeding mental health. Such inequalities create, maintain and exacerbate exposure to risk factors that endanger women’s mental health, and are most graphically illustrated in the significantly different rates of depression between men and women, poverty and its impact, and the phenomenal prevalence of violence against women.
more
Interim guidance. 12 May 2021. The Continuity of essential health services: Facility Assessment Tool can be used by countries to rapidly assess the capacity of health facilities to maintain the prov
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ision of essential health services during the COVID-19 pandemic. It can help to alert the authorities and other stakeholders about where service delivery and utilization may require modification and/or investment. This assessment tool covers the following aspects of essential health services:
health workforce (numbers, absences, COVID-19 infections, health workforce management, training and support);
financial management and barriers;
service delivery and utilization (facility closures, changes in service delivery, community communication campaigns, changes in service utilization and catch-up strategies);
IPC capacities (protocols, safety measures, guidelines and the availability of personal protective equipment (PPE) for staff);
availability of therapeutics, diagnostics and supplies, and vaccine readiness; and
provision of COVID-19 primary care services.
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The checklist is aligned with, and builds upon, existing COVID-19-related WHO guidelines and is structured around protective measures related to: 1) hand hygiene and respiratory etiquette; 2) physical distancing; 3) use of masks in schools; 4) environmental cleaning and ventilation; and 5) respectin
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g procedures for isolation of all people with symptoms. The checklist is designed to support policy-makers, staff and officials from the education and health sectors, local authorities, school principals/leaders and administrators, teachers’ unions, community leaders, school staff, teachers, parents and caregivers.
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8 January 2021
Sequencing enabled the world to rapidly identify SARS-CoV-2 and develop diagnostic tests and other tools for outbreak management. Continued genome sequencing supports the monitoring of the disease’s spread and evolution of the virus. Accelerated integration of genome sequencing int
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o the practices of the global health community is required if we want to be better prepared for the future threats. This document provides guidance for laboratories on maximizing the impact of SARS-CoV-2 sequencing now and other emerging pathogens in the future.
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Against the backdrop of the COVID-19 pandemic, health is receiving unprecedented public and political attention. Yet the fact that climate change also presents us with a health crisis deserves furth
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er recognition. From more deaths due to heat stress to increased transmission of infectious diseases, climate change affects the social and environmental determinants of health in ways that are profound and far-reaching. The fundamental interdependency of human health and the health of the environment is encapsulated in the concept of planetary health, a scientific field and social movement that has been gaining force since the 2015 publication of the Rockefeller Foundation-Lancet Commission report “Safeguarding human health in the Anthropocene epoch”.
We see an urgent need for strategic communication to raise awareness of climate-health synergies in order to overcome the misperception that climate and health are two independent agendas. The fragmented and sector-focused nature of thinking and action remains a significant barrier to integrating health considerations into climate planning and project development. Inevitably, collaboration across sectors requires a community of practice. Despite recent efforts focused on the climate-health nexus, much work remains to be done to translate scientific findings for policymakers, mobilise climate financing resources in support of health co-benefits, and promote genderjust solutions within climate change projects.
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Infectious disease outbreaks and epidemics are increasing in frequency, scale and impact. Health care facilities can amplify the transmission of emerging infectious diseases or multidrug-resistant organisms (MDRO) within their settings and communiti
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es. Therefore, evidence-based infection prevention and control (IPC) measures in health care facilities are critical for preventing and containing outbreaks, while still delivering safe, effective and quality health care. This toolkit is intended to support IPC improvements for outbreak management in all such facilities, both public and private throughout the health system. Specifically, this document systematically describes a framework of overarching principles to approach the preparedness, readiness and response outbreak management phases. The document also provides a toolkit of resource links to guide specific actions for each infectious disease and/or MDRO outbreak management phase at any health facility. This document is specifically tailored to an audience of stakeholders who establish and monitor health care facility-level IPC programs including: IPC focal points, epidemiologists, public health experts, outbreak response incident managers, facility-level IPC committee(s), safety and quality leads and managers, and other facility level IPC stakeholders.
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The Quadripartite organizations have developed the One Health Priority Research Agenda for AMR report, this is a joint initiative to assist in directing and catalysing scientific interest and financial investments for the priority research agenda ac
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ross sectors for countries and funding bodies. The research agenda also serves as a guide to mitigate One Health AMR that will help policymakers, researchers, and a multidisciplinary scientific community work together on solutions to prevent and mitigate AMR within the One Health approach.
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The increasing amounts of official development assistance (ODA) for health have been aimed primarily at fighting HIV/AIDS, malaria and tuberculosis. Neglected tropical diseases (NTD), one of the most serious public
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health burdens among the most deprived communities, have only recently drawn the attention of major donors. While frequently stated, the low share
of funding for NTD control projects has not been calculated empirically. Our analysis of ODA commitments for infectious disease control for the years 2003 to 2007 confirms that Development Assistance Committee (DAC)-countries and multilateral donors have largely ignored funding NTD control projects. On average, only 0.6% of total annual health ODA was dedicated
to the fight against NTDs while the average share of control projects for HIV/AIDS was 36.3%, for malaria 3.6%, and for tuberculosis 2.2%. This allocation of health ODA does not reflect the diseases’ respective health burdens.
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: Development assistance for health (DAH) is one of the most important means for Japan to promote
diplomacy with developing countries and contribute to the international community. This study, for
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the first time,
estimated the gross disbursement of Japan’s DAH from 2012 to 2016 and clarified its flows, including source, aid
type, channel, target region, and target health focus area
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Alcohol consumption is deeply embedded in the social landscape of many societies. Several major factors have an impact on levels and patterns of alcohol consumption in populations – such as historical trends in alcohol consumption, the availability of alcohol, culture, economic status and trends i
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n the marketing of alcoholic beverages, as well as implemented alcohol control measures. At the individual level, the patterns and levels of alcohol consumption are determined by many different factors, including gender, age and individual biological and socioeconomic vulnerability factors, as well as the policy environment. Prevailing social norms that support drinking behaviour and mixed messages about the harms and benefits of drinking encourage alcohol consumption delay appropriate health-seeking behaviour and weaken community action
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As a lower-middle-income country (LMIC), South Africa (SA) bears
the burden of maternal and neonatal mortality similar to other sub-
Saharan African countries. According to the Saving Mothers Report
2017/19, there has been a progressive and sustained reduction
in institutional maternal mortality
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(iMMR) in the past three triennia
(2010-2019), from 320 per 100,000 live births to 120 per 100,000 live
births.
According to the Rapid Mortality Survey, the country’s infant mortality
rate has declined from 29 deaths per 1000 live births in 2014 to 25
deaths per 1,000 live births in 2018. The institutional neonatal death
rate showed a slight decrease from 12,7 deaths per 1,000 live births in
2016 to the current level of 12 per 1,000 live births and has remained
static at this level for the past three years (saDHIS).
Working towards the Sustainable Development Goal (SDG) of reducing maternal mortality to below 70 per 100 000 live births and neonatal mortality to 12 deaths per 1000 live births, South Africa aims to reduce institutional maternal mortality, neonatal mortality and stillbirths by 50% by 2030.
This Maternal, Perinatal and Neonatal Health Policy provides a
framework for the delivery of quality, comprehensive, and integrated
MNH services and will guide the development and review of guidelines
and related MNH interventions, including strengthening of the service
delivery platform, governance, leadership and accountability for
the provision of quality MNH services, development of advocacy
messages, and guiding civil society priorities and community
initiatives. The policy will also guide the development and review of
academic curricula and the setting of research priorities.
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This operational guidance on MHPSS provides a practical orientation and tools for UNHCR country operations. It covers specific points of good practice to consider when developing MHPSS programming and offers advice on priority issues and practical difficulties, while also providing some background i
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nformation and definitions. Since MHPSS is a cross cutting concept this operational guidance is relevant for programming in various sectors, including health, community based protection, education, shelter, nutrition, food security and livelihoods.
The focus of this operational guidance is on refugees and asylum seekers, but it may apply to other persons of concern within UNHCR operations such as stateless persons, internally displaced persons and returnees. The guidance is meant for operations in both camp and non-camp settings, and in both rural and urban settings in low and middle-income countries with a UNHCR presence.
The guidance should be adapted according to different contexts. A standardized format for programme implementation cannot be offered because this depends to a large extent on existing national capacities and local opportunities.
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A case study of the role of an Essential Health Benefit in the delivery of integrated health services in Zambia
Luwabelwa, M.; Banda, P; Palale M.; Chama-Chiliba, C.
Regional Network for Equity in Health in east and southern Africa (EQUINET)
(2017)
C1
Regional Network for Equity in Health in east and southern Africa (EQUINET): Disussion Paper 111
The health services delivery system in Zambia is pyramid in structure, with primary healthcare ( ... PHC) services at community level, at the base, followed by first and second level hospitals at district and provincial levels, respectively, and third level (tertiary) services at national level. Notably, primary health services are free in Zambia and health service providers are either governmentowned or not-for-profit facilities.
Over the years, resource constraints have affected the quality and extent of healthcare services at all levels, requiring the mobilisation of additional resources for the sector. In doing so, prioritisation was high on the agenda of health sector reform. The EHB, therefore, prioritises interventions with the highest impact on the population, enabling policy makers to revisit priority diseases and conditions and to cost the services provided at each level of facility. Other key issues in developing the EHB in Zambia have included the need to have cost-effective services and cost per capita of services for more systematic budgeting, to rank interventions and to validate and cost the health benefit package as a whole. more
The health services delivery system in Zambia is pyramid in structure, with primary healthcare ( ... PHC) services at community level, at the base, followed by first and second level hospitals at district and provincial levels, respectively, and third level (tertiary) services at national level. Notably, primary health services are free in Zambia and health service providers are either governmentowned or not-for-profit facilities.
Over the years, resource constraints have affected the quality and extent of healthcare services at all levels, requiring the mobilisation of additional resources for the sector. In doing so, prioritisation was high on the agenda of health sector reform. The EHB, therefore, prioritises interventions with the highest impact on the population, enabling policy makers to revisit priority diseases and conditions and to cost the services provided at each level of facility. Other key issues in developing the EHB in Zambia have included the need to have cost-effective services and cost per capita of services for more systematic budgeting, to rank interventions and to validate and cost the health benefit package as a whole. more
