For the primary health worker in a low/middle-income country (LMIC) setting, delivering quality primary care is challenging. This is often complicated by clinical guidance that is out of date, inconsistent and informed by evidence from high-income c...ountries that ignores LMIC resource constraints and burden of disease. The Knowledge Translation Unit (KTU) of the University of Cape Town Lung Institute has developed, implemented and evaluated a health systems intervention in South Africa, and localised it to Botswana, Nigeria, Ethiopia and Brazil, that simplifies and standardises the care delivered by primary health workers while strengthening the system in which they work. At the core of this intervention, called Practical Approach to Care Kit (PACK), is a clinical decision support tool, the PACK guide. This paper describes the development of the guide over an 18-year period and explains the design features that have addressed what the patient, the clinician and the health system need from clinical guidance, and have made it, in the words of a South African primary care nurse, ‘A tool for every day for every patient’. It describes the lessons learnt during the development process that the KTU now applies to further development, maintenance and in-country localisation of the guide: develop clinical decision support in context first, involve local stakeholders in all stages, leverage others’ evidence databases to remain up to date and ensure content development, updating and localisation articulate with implementation.
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Key questions
What is already known?
Critical illness is common throughout the world and COVID-19 has caused a global surge of critically ill patients.
There are large gaps in the quality of care for critically ill patients, especially in low-staffed and low-resourced settings, and mortal...ity rates are high.
Essential Emergency and Critical Care (EECC) is the effective lifesaving care of low-cost and low-complexity that all critically ill patients should receive in all wards in all hospitals in the world.
What are the new findings?
The clinical processes that comprise EECC and the essential care of critically ill patients with COVID-19 have been specified in a large consensus among clinical experts worldwide.
The resource requirements for hospitals to be ready to provide this care has been described.
What do the new findings imply?
The findings can be used across medical specialties in hospitals worldwide to prioritise and implement essential care for reducing preventable deaths.
Inclusion of the EEEC processes could increase the impact of pandemic preparedness and response programmes and policies for health systems strengthening.
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As countries aim to progress towards the Sustainable Development Goals (SDGs) and achieving universal health coverage, health inequities driven by racial discrimination and intersecting factors rema...in pervasive. Inequities experienced by indigenous peoples as well as people of African descent, Roma and other ethnic minorities are of concern globally; they are unjust, preventable and remediable.
Health systems themselves are important determinants of health and health equity. They can perpetuate health inequities by reflecting structural racism and discriminatory practices of wider society. For instance, systemic racism, implicit bias, misinformed clinical practice, or discrimination by health professionals contributes to health inequities. However, health systems can also be a leading force for tackling the inequities faced by populations experiencing racial discrimination.
Primary health care (PHC) is the essential strategy for reorientating health systems and societies to become healthier, equitable, effective and sustainable. In 2018, on the 40th anniversary of the Declaration of Alma-Ata, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) renewed the emphasis on PHC with their strategy,
WHO outlines 14 strategic and operational levers for policy-makers to strengthen PHC. Within each lever, there are multiple potential entry points for targeted actions to address racial discrimination, foster intercultural care, and reduce health inequities experienced by indigenous peoples as well as people of African descent, Roma and other ethnic minorities.
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Monitoring is a crucial element in any successful programme. It is important to
know if health care facilities – and ultimately countries – are meeting the agreed
goals and objectives for preventing and managing cardiovascular diseases (CVD).
...
Monitoring is the on-going collection, management and use of information to
assess whether an activity or programme is proceeding according to plan and/
or achieving defined targets. Not all outcomes of interest can be monitored. Clear
outcomes must be identified that relate to the most important changes expected to result from the project and to what is realistic and measurable within the timescale of the project. Once these outcomes have been articulated, indicators can be chosen that best measure whether the desired outcomes are being met.
To allow progress to be monitored, this module provides a set of indicators on
CVD management. Agreeing on a set of indicators allows countries to compare
progress in CVD management and treatment across different districts or
subnational jurisdictions, as well as at a facility level, identify where performance
can be improved, and track trends in implementation over time. Monitoring
these indicators also helps identify problems that may be encountered so that
implementation efforts can be redirected.
This module starts from the collection of data at facility level, which is then
“transferred up” the system: facility-level data are aggregated at subnational level
to produce reports that allow tracking of facility and subnational performance over time and allow for comparison among facilities. National-level data are obtained through population-based surveys.
Implementing a monitoring system requires action at many levels. At national and
subnational levels, staff can determine how best to integrate data elements into
existing data collection systems – such as the routine service-delivery data that are collected through facility-level Health Management Information Systems (HMIS).
In the facility setting, personnel must be aware of what data are needed. Sample
data-collection tools are included, recognizing that countries use different datamanagement systems for HMIS, so the CVD monitoring tools will be adapted to work with the HMIS system being used by the country, such that the indicators can be collected with minimal disruption/work to existing systems and tools
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This document provides countries with recommendations for structuring a public health entomology laboratory network. The document will help countries to identify their areas of need and determine how the entomology network can be strengthened, espec...ially in the context of a decentralized health system. The recommendations also consider the different degrees of development and different entomological research needed to support disease prevention and control activities.
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Public Health is the science field dedicated to promoting health and well-being, and preventing disease within the human population to ultimately increase the quality of our livelihood and life span.... Public Health does not focus on individual patients or diseases, but rather a given population and health system. The discipline is community-centered in its interventions and seeks to improve the health status of whole populations...
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The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches document is part of the WHO Guidance and technical packages on community mental health serv...ices set of publications. It provides a detailed description of person-centred and human rights-based approaches in mental health, and summary examples of good practice services around the world. It describes the linkages needed with housing, education, employment and social protection sectors, and presents examples of integrated regional and national networks of community-based mental health services. Specific recommendations and action steps are presented for developing community mental health services that respect human rights and focus on recovery. This comprehensive document is accompanied by a set of seven technical packages focused on specific categories of mental health services and guidance for setting up new services.
The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches is a set of publications that provides information and support to all stakeholders who wish to develop or transform their mental health system and services to align with international human rights standards including the UN Convention on the Rights of Persons with Disabilities.
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The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches document is part of the WHO Guidance and technical packages on community mental health serv...ices set of publications. It provides a detailed description of person-centred and human rights-based approaches in mental health, and summary examples of good practice services around the world. It describes the linkages needed with housing, education, employment and social protection sectors, and presents examples of integrated regional and national networks of community-based mental health services. Specific recommendations and action steps are presented for developing community mental health services that respect human rights and focus on recovery. This comprehensive document is accompanied by a set of seven technical packages focused on specific categories of mental health services and guidance for setting up new services.
The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches is a set of publications that provides information and support to all stakeholders who wish to develop or transform their mental health system and services to align with international human rights standards including the UN Convention on the Rights of Persons with Disabilities.
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The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches document is part of the WHO Guidance and technical packages on community mental health serv...ices set of publications. It provides a detailed description of person-centred and human rights-based approaches in mental health, and summary examples of good practice services around the world. It describes the linkages needed with housing, education, employment and social protection sectors, and presents examples of integrated regional and national networks of community-based mental health services. Specific recommendations and action steps are presented for developing community mental health services that respect human rights and focus on recovery. This comprehensive document is accompanied by a set of seven technical packages focused on specific categories of mental health services and guidance for setting up new services.
The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches is a set of publications that provides information and support to all stakeholders who wish to develop or transform their mental health system and services to align with international human rights standards including the UN Convention on the Rights of Persons with Disabilities.
more
The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches document is part of the WHO Guidance and technical packages on community mental health serv...ices set of publications. It provides a detailed description of person-centred and human rights-based approaches in mental health, and summary examples of good practice services around the world. It describes the linkages needed with housing, education, employment and social protection sectors, and presents examples of integrated regional and national networks of community-based mental health services. Specific recommendations and action steps are presented for developing community mental health services that respect human rights and focus on recovery. This comprehensive document is accompanied by a set of seven technical packages focused on specific categories of mental health services and guidance for setting up new services.
The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches is a set of publications that provides information and support to all stakeholders who wish to develop or transform their mental health system and services to align with international human rights standards including the UN Convention on the Rights of Persons with Disabilities.
more
The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches document is part of the WHO Guidance and technical packages on community mental health serv...ices set of publications. It provides a detailed description of person-centred and human rights-based approaches in mental health, and summary examples of good practice services around the world. It describes the linkages needed with housing, education, employment and social protection sectors, and presents examples of integrated regional and national networks of community-based mental health services. Specific recommendations and action steps are presented for developing community mental health services that respect human rights and focus on recovery. This comprehensive document is accompanied by a set of seven technical packages focused on specific categories of mental health services and guidance for setting up new services.
The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches is a set of publications that provides information and support to all stakeholders who wish to develop or transform their mental health system and services to align with international human rights standards including the UN Convention on the Rights of Persons with Disabilities.
more
The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches document is part of the WHO Guidance and technical packages on community mental health serv...ices set of publications. It provides a detailed description of person-centred and human rights-based approaches in mental health, and summary examples of good practice services around the world. It describes the linkages needed with housing, education, employment and social protection sectors, and presents examples of integrated regional and national networks of community-based mental health services. Specific recommendations and action steps are presented for developing community mental health services that respect human rights and focus on recovery. This comprehensive document is accompanied by a set of seven technical packages focused on specific categories of mental health services and guidance for setting up new services.
The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches is a set of publications that provides information and support to all stakeholders who wish to develop or transform their mental health system and services to align with international human rights standards including the UN Convention on the Rights of Persons with Disabilities.
more
The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches document is part of the WHO Guidance and technical packages on community mental health serv...ices set of publications. It provides a detailed description of person-centred and human rights-based approaches in mental health, and summary examples of good practice services around the world. It describes the linkages needed with housing, education, employment and social protection sectors, and presents examples of integrated regional and national networks of community-based mental health services. Specific recommendations and action steps are presented for developing community mental health services that respect human rights and focus on recovery. This comprehensive document is accompanied by a set of seven technical packages focused on specific categories of mental health services and guidance for setting up new services.
The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches is a set of publications that provides information and support to all stakeholders who wish to develop or transform their mental health system and services to align with international human rights standards including the UN Convention on the Rights of Persons with Disabilities.
more
The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches document is part of the WHO Guidance and technical packages on community mental health serv...ices set of publications. It provides a detailed description of person-centred and human rights-based approaches in mental health, and summary examples of good practice services around the world. It describes the linkages needed with housing, education, employment and social protection sectors, and presents examples of integrated regional and national networks of community-based mental health services. Specific recommendations and action steps are presented for developing community mental health services that respect human rights and focus on recovery. This comprehensive document is accompanied by a set of seven technical packages focused on specific categories of mental health services and guidance for setting up new services.
The WHO Guidance on community mental health services: Promoting person-centred and rights-based approaches is a set of publications that provides information and support to all stakeholders who wish to develop or transform their mental health system and services to align with international human rights standards including the UN Convention on the Rights of Persons with Disabilities.
more
As the world population is growing and health care resources are in high demand the pressure on medical services is becoming higher. Developing countries are already at a crisis point in health care... provision, and time demands a new approach in structuring medical resources. Primary care is the vital pillar for fundamental health care at community level and has been deemed as a cost-effective modality. In the West the primary care physician manages chronic medical conditions in communities and therefore reduces unnecessary hospital admissions. In the West, the primary care system is extremely well organised. Low-income countries must improve teaching, training and funding in primary care. In this article the urgent need for primary care is discussed in developing countries, and ways to minimise costs and improve clinical outcomes at community level.
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The WHO and UNICEF-led Hand Hygiene for All Initiative aims at ensuring implementation for WHO's global recommendations on hand hygiene to prevent and control COVID-19 pandemic, and hand hygiene improvement sustainability in countries as a mainstay of wider infection prevention and control (IPC) and... water, sanitation and hygiene (WASH) efforts.
But how can hand hygiene implementation be successful? By implementing strategies and approaches proven through the successes of the WHO Save Lives: Clean Your Hands campaign and fostering integration between hand hygiene and WASH improvements. This brief draws on learning from legacy work and the current evidence based and summarizes how joint action and collaboration are essential for successful strategies, in the context of the COVID-19 response and beyond
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This Eye health strategic plan presents the Ministry of Health’s five
year proposed strategies for eye care in Kenya. It sets the strategic
direction for the National Eye ...to-highlight medbox">Health Care System and presents
information on the priorities, objectives and indicators that the
Ministry has adopted especially with regard to the main eye diseases
and conditions in the country and health system strengthening.
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The purpose of this publication is to to provide a practical, stepwise approach to the implementation of the national action plans on AMR within the human health sector; and to provide a process and collation of existing WHO tools to prioritize, cos...t, implement, monitor and evaluate national action plan activities. The target audience of the publication are national/subnational stakeholders working on AMR within the human health sector. This includes national health authorities, national multi-sectoral coordination groups, senior technical experts and policymakers involved in implementing AMR activities at all levels of the health system, and implementation partners to accelerate sustainable implementation and monitoring and evaluation of national action plans on AMR.
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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...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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Implementation guide for national, district and facility levels.
This implementation guide contains practical guidance for policy-makers,
programme managers, health practitioners and other actors working to
establish and implement quality of care... (QoC) programmes for maternal,
newborn and child health (MNCH) at national, district and facility levels.
It is intended to help anyone, throughout the health system, who wants
to take action to improve the QoC for MNCH.
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