Lancet Glob Health 2020Published OnlineNovember 27, 2020 https://doi.org/10.1016/S2214-109X(20)30449-6
Primary health care offers a cost–effective route to achieving universal health coverage (UHC). However, primary health-care systems are weak in many low- and middle-income countries and often fail to provide comprehensive, people-centred, integrated care. We analysed the primar...y 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.
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Objective: To review the effectiveness of antibiotic stewardship interventions in hospitals in low- and middle-income countries.
The toolkit provides guidance on where to get started, including the structures and resources that should be put in place at the national and health-care facility level, through a stepwise approach in low-resource settings. As the ultimate goal of an AMS programme is sustainable behaviour change in ...physicians’ antibiotic prescribing practices, the toolkit also provides detailed guidance on how to plan, perform and assess AMS interventions – including feedback on antibiotic use over time. Finally, the toolkit provides an overview of the competencies an AMS team needs to guide health-care professionals in changing their antibiotic prescribing behaviours.
Please note that this course is part of a training package, so please register for the complementary course WHO Policy Guidance on Integrated Antimicrobial Stewardship Activities so that you can complete your learning journey.
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Lancet Planet Health 2022;6: e760–68
The emergence of COVID-19 has drawn the attention of health researchers sharply back to the role that food systems can play in generating human disease burden. But emerging pandemic threats are just one dimension of the complex relationship between agriculture... and infectious disease, which is evolving rapidly, particularly in low-income and middle-income countries (LMICs) that are undergoing rapid food system transformation. This changing relationship is examined through four current disease issues.
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Those who clean are the first line of defense against health care-associated infections (HAIs), and support efforts to reduce antimicrobial resistance (AMR).
Strengthening the training of this important group can contribute to resolving many of today’s public health challenges. This is importan...t given that cleaning both surfaces and hands is vital to control the transmission of a number of HAIs.
This two-part training package targets those who clean heath care facilities.
The Trainer’s Guide takes the user through how to prepare, deliver and sustain an effective training for those who clean. The Modules and Resources provides instructions, definitions, photographs, posters and specific illustrations of recommended practices
The package can be used by those who deliver environmental cleaning training programmes and/or those with a background in IPC including ministries of health, nongovernmental organizations, academic institutions, experts working in Quality of care, IPC and environmental cleaning/ Water, sanitation and Hygiene (WASH) and Health facility IPC focal points and onsite cleaning supervisors
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Progress in tuberculosis control worldwide, including achievement of 2015 global targets, requires adequate financing sustained for many years. WHO began yearly monitoring of tuberculosis funding in 2002. We used data reported to WHO to analyse tuberculosis funding from governments and international... donors (in real terms, constant 2011 US$) and associated progress in tuberculosis control in low-income and middle-income countries between 2002 and 2011. We then assessed funding needed to 2015 and how this funding could be mobilised.
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Global HIV control funding falls short of need. To maximize health outcomes, it is critical that national governments sustain reasonable commitments, and that international donor assistance be distributed according to country needs and funding gaps. We develop a country classification framework in t...erms of actual versus expected national domestic funding, considering resource needs and donor financing. With UNAIDS and World Bank data, we examine domestic and donor HIV program funding in relation to need in 84 low- and middle-income countries. We estimate expected domestic contributions per person living with HIV (PLWH) as a function of per capita income, relative size of the health sector, and per capita foreign debt service.
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Background
How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. We investigated how alternative tax systems aff ect the breadth, depth, and height of health system coverage.
Methods
We used cross-national longitudin...al fi xed eff ects models to assess the relationships between total and diff erent types of tax revenue, health system coverage, and associated child and maternal health outcomes in 89 low-income and middle-income countries from 1995–2011.
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Between 2012 and 2016, development assistance for HIV/AIDS decreased by 20·0%; domestic financing is therefore critical to sustaining the response to HIV/AIDS. To understand whether domestic resources could fill the financing gaps created by declines in development assistance, we aimed to track spe...nding on HIV/AIDS and estimated the potential for governments to devote additional domestic funds to HIV/AIDS.
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This report provides an analysis of donor government funding to address the HIV response in low- and
middle-income countries in 2022, the latest year available, as well as trends over time. It includes both
bilateral funding from donors and their contributions to the Global Fund to Fight AIDS, Tub...erculosis and
Malaria (Global Fund), UNITAID, and UNAIDS. Overall, the analysis shows that while donor government
funding for HIV increased between 2021 and 2022, this was primarily due to the timing of payments from
the U.S. government and not actual increases in commitments.
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Donor government disbursements to combat HIV in low- and middle-income countries totaled US$8 billion in 2018, little changed from the US$8.1 billion total in 2017 and from the levels of a decade ago, finds a new report from the Kaiser Family Foundation (KFF) and the Joint United Nations Programme o...n HIV/AIDS (UNAIDS)
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The objective is to estimate the level and trend of develoment assistance for comunity health worker related projects in low and middle income countries between 2007 and 2017
One of the main limitations to accessing hearing aids is the lack of diagnostic and rehabilitative services, especially at primary and secondary levels of care. This is due to the small number of specialists in ear and hearing care, and to their poor territorial distribution which is more evident in... low- and middle-income countries
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Many vaccines and drugs hold the promise of reducing mortality and morbidity among pregnant women and infants living in low- and middle-income countries (LMICs). However, sufficient information on the safety of drugs and vaccines in pregnant women is rarely available at the time of product licensure... or approval. To account for this, active safety surveillance efforts are needed during the post-licensure and post-approval
phase to assess the safety of drugs and vaccines in pregnant women and their offspring. Pregnancy exposure registries (PER) are used to monitor the safety of vaccines and drugs. PERs are observational studies that systematically collect health information on exposure to medical products such as drugs and vaccines during pregnancy. This review demonstrates that a number of resources presently exist in LMICs that perform active safety surveillance in pregnant populations. These results indicate such systems employ a wide variety of approaches, each with their own set of strengths and challenges, as summarized in the final section of the report.
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