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Pathways to progress: a multi-level approach to strengthening health systems
Samuels, F., Amaya, A.B., Rodríguez Pose, R. and Balabanova, D.
Overseas Development Institute
(2014)
C1
Findings on maternal and child health in Nepal, Mozambique and
Rwanda, and neglected tropical diseases in Cambodia and Sierra Leone | This report synthesises findings from five country case studies
...
from the health dimension of this project, which focus on maternal and child health (MCH) (Mozambique,Nepal, Rwanda) and neglected tropical diseases (NTDs)(Cambodia, Sierra Leone). MCH was selected given its centrality in two of the Millennium Development Goals (MDGs) and its ability to act as a proxy for strengthened health systems. NTDs, while until recently relatively neglected in global policy debates, are now attracting more interest, not least because they are viewed as diseases of the poor whose treatment could positively impact on most of the other MDGs.
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Background
Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinica
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l staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced asthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention.
Methods
We conducted six focus group discussions, including 15 children and 28 carers, and individual interviews with four lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified.
Results
Prior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approach.
Discussion
Asthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage.
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This FY 2017 Malaria Operational Plan presents a detailed implementation plan for Senegal, based on the strategies of PMI and the National Malaria Control Program (NMCP) strategy. It was developed in
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consultation with the NMCP and with the participation of national and international partners involved in malaria prevention and control in the country. The activities that PMI is proposing to support fit in well with the new National Malaria Control strategy and plan (2016-2020) and build on investments made by PMI and other partners to improve and expand malaria-related services, including the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) malaria grants. This document briefly reviews the current status of malaria control policies and interventions in Senegal, describes progress to date, identifies challenges and unmet needs to achieving the targets of the NMCP and PMI, and provides a description of activities that are planned with FY 2017 funding.
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This FY 2019 Malaria Operational Plan presents a detailed implementation plan for Burkina Faso, based on the strategies of PMI and the National Malaria Control Program (NMCP). It was developed in co
...
nsultation with the NMCP and with the participation of national and international partners involved in malaria prevention and control in the country. The activities that PMI is proposing to support fit in well with the national malaria control strategy and plan and build on investments made by PMI and other partners to improve and expand malaria-related services, including malaria grants from the Global Fund to Fight AIDS, Tuberculosis, and Malaria. This document briefly reviews the current status of malaria control policies and interventions in Burkina Faso, describes progress to date, identifies challenges and unmet needs to achieving the targets of the NMCP and PMI, and provides a description of activities that are planned with FY 2019 funding.
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Globally each year, millions of people suffer illness or lose their lives because the vaccines, medicines and diagnostic tests that they need are either unavailable or unaffordable – and this lack of
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access to medicine is acute in low- and middle-in-
come countries (LMICs). While the COVID-19 pandemic laid this inequity bare, it also saw the pharmaceutical industry develop and bring new vaccines and treat- ments to market at unprecedented speed. As the world emerges from the worst
of this crisis, pharmaceutical companies are now at an important juncture, where lessons learned from the pandemic can prove pivotal in finding solutions to bridge long-standing gaps in access to medicine in LMICs.
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Addressing comorbidities and risk factors for TB is a crucial component of Pillar one of the End TB Strategy, which focuses on integrated patient-centred care and prevention, including action on TB
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and comorbidities. The Framework for collaborative action on TB and comorbidities aims to support countries in the evidence-informed introduction and scale-up of holistic people-centred services for TB, comorbidities and health-related risk factors, with the goal of comprehensively addressing TB and other co-existing health conditions. It should be used in conjunction with relevant WHO guidelines. The Framework is intended for use by people working in ministries of health, other relevant line-ministries, policymakers, international technical and funding organizations, researchers, nongovernmental and civil society organizations, as well as primary care workers, specialist health practitioners, and community health workers who support the response to TB and comorbidities in both the public and private sectors.
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Recently, a renewed interest in large-scale community health worker (CHW) programs has been seen globally. This renewal provides an opportune moment to take stock of issues and challenges such progr
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ams face and what can be done to make them as effective as possible. With this in mind, this manual is intended to be used a practical guide for policymakers and program
managers wishing to develop or strengthen a CHW program, drawing lessons from other countries that have implemented CHW programs at-scale. Throughout, we discuss major policy and programmatic issues that decision-makers and planners need to consider when designing, implementing, scaling up or strengthening a national-level CHW program. We offer an overview
of specific challenges CHW programs face, country lessons, tools, and other resources that may be helpful, while incorporating relevant programmatic examples as much as possible.
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WHO needs US$2.54 billion to provide life-saving assistance to millions of people around the world facing health emergencies. WHO’s Health Emergency Appeal is a consolidation of WHO’s priorities
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and financial requirements for 2023 to carry out health interventions in emergency and humanitarian responses. The number of people in need of humanitarian relief has increased by almost a quarter compared to 2022, to a record 339 million. WHO is responding to an unprecedented number of intersecting health emergencies: climate change-related disasters such as flooding in Pakistan and food insecurity across the Sahel in the greater Horn of Africa; the war in Ukraine; and the health impact of conflict in Yemen, Afghanistan, Syria and north eastern Ethiopia – all of these emergencies overlapping with the health system disruptions caused by the COVID-19 pandemic and outbreaks of measles, cholera, and other killers. Contributions to the appeal can be fully flexible, flexible across a region, or flexible within a country appeal.
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The Urban Health Equity Assessment and Response Tool (Urban HEART) is a user-friendly guide for policy- and decision-makers at national and local levels to: identify and analyse inequities in health between people living
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in various parts of cities, or belonging to different socioeconomic groups within and across cities; facilitate decisions on viable and effective strategies, interventions and actions that should be used to reduce inter- and intra-city health inequities.
Also available in French and Spanish: https://apps.who.int/iris/handle/10665/79060
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Global Sexual and Reproductive Health Service Package for Men and Adolescent Boys
IPPF, UNFPA
(2017)
The Global Sexual and Reproductive Health Service Package for Men and Adolescent Boys has been developed to support providers of sexual and reproductive health (SRH) services to increase the range and quality
...
of services to meet the specific and diverse needs of men and adolescent boys. This package focuses specifically on the provision of such services integrated
within clinical and non-clinical contexts and follows a gender-transformative approach. It covers men and adolescent boys in all their diversity and takes a positive approach to SRH, seeing this not just as the absence of disease, but the positive expression of one’s gender, sex and sexuality. In doing so, this service package contributes to efforts to ensure universal access to sexual and reproductive health and rights (SRHR) as prioritized in the Sustainable Development Goals. This package is in no way intended to detract from the sexual and reproductive health and rights of women and adolescent girls, nor to divert resources, funding or attention from much-needed SRH services and programmes for women and adolescent girls.
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What are the FP and CAC competencies?
Through the clear articulation of the family planning and comprehensive abortion care (FP and CAC) competencies for the primary health care workforce, the aim is to advance improvements
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in FP and CAC service delivery by aligning health worker education approaches with population health needs and health system demands.
This document, which describes these competencies in detail, is intended to:
be a foundational tool to be adopted and adapted by educators and regulators for FP and CAC providers (students) with a pre-service training pathway of at least 12 months;
describe competencies that are relevant to current and future health practice;
enable widespread use of the competencies not only for curriculum development for pre-service education, but also for in-service education, regulation, qualifications, quality assurance, personal development, performance evaluation, recruitment, management and career progression;
focus on the core functions of FP and CAC providers within broader efforts towards achieving universal health coverage
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The key actions, activities, and approaches in this document are organized within each of the 5Cs (see Table 1 in the PDF) and those
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of the Strategic preparedness and response plan (SPRP) pillars as follows:
National action plan key activities, prioritized for the current context and the current understanding of the threat of SARS-CoV-2
A. Transition from emergency response to longer term COVID-19 disease management.
B. Integrate activities into routine systems.
C. Strengthen global health security.
Special considerations for fragile, conflict-affected and vulnerable (including humanitarian) settings
WHO global and regional support to Member States to implement their national action plans
Key guidance documents for reference
This is a living document that will be updated to incorporate new technical guidance in response to the evolving epidemiological situation. National plans should be implemented in accordance with the principles of inclusiveness, respect for human rights, and equity.
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This handbook is intended primarily for front-line health care providers who are likely to see children (among other clients) in their day-to-day practice. These may include general practitioners, nurses, midwives, gynaecologists,
paediatricians, m
...
ental health professionals, first responders and staff in emergency care.
Other professionals who may find it useful include social workers, those working in social welfare institutions, providers of psychosocial support, and those working in child care facilities and the education system.
Further, the content will benefit the work of policy-makers and managers to enable and support provision of clinical care to children experiencing, or who have experienced, child maltreatment.
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The WHO country office for Ghana, began the year 2019 with a 4-day staff retreat at the Busua Beach Resort in the Western Region from 04 to 08 March 2019. The theme for the retreat was ‘Impacting the Health and Lives
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of the people of Ghana through the Triple Billion Goal”. The staff outlined priorities and strategies to strengthen WHO’s contribution to the national health agenda during the year. Working in collaboration with the Ministry of Health/Ghana Health Service and other allied health institutions and stakeholders, the WHO country office, provided support aimed at achieving its
mission which is attaining the highest level of health by the people in the country though its six operational areas which are (i) Communicable Diseases (ii) Non-Communicable Diseases, (iii) Promoting Health through the Life Course (iv), Health Systems, (v) Preparedness, Surveillance and Response (vi) Corporate services and enabling functions.
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This document aims to provide concrete, pragmatic guidance for how TB modelling and related technical assistance is undertaken to support country decision-making. The target audience for this document are the participants and stakeholders in country
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-level TB modelling efforts, including the individuals who build and apply models; policy-makers, technical experts and other members of the TB community; international funding and technical partners; and individuals and organizations engaged in supporting TB policy-making.
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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 patie
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nts 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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This working paper was conceived to offer practical tips and suggestions on how to establish and sustain the multisectoral coordination needed to develop and implement National Action Plans on AMR (NAPs). It is intended for anyone with responsibility for addressing AMR at country level. Drawing on b
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oth the published literature and the operational experience of four ‘focal countries’ (Ethiopia, Kenya, Philippines and Thailand), it summarizes lessons learned and the latest thinking on multisectoral working to achieve effective AMR action. The experience in focal countries points to a number of tools and tactics that can be used to help establish and enhance sustainable multisectoral collaboration for AMR action. These can be grouped into four categories: political commitment, resources, governance mechanisms, and practical management.
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To complement the Global Strategy progress reporting, this report provides a detailed look at country leadership and action toward the Every Newborn National Milestones by 2020. Countries have taken the initiative to show the way forward and have demonstrated significant progress. As part
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of monitoring this progress, countries have adopted the Every Newborn Tracking Tool. This report presents a compilation of the data collated by the Every Newborn Tracking Tool in 2016, when 51 countries adopted the tool; it also spotlights examples of specific country activity for each National Milestone. Finally, Global Milestones for 2020 were part of the Every Newborn Action Plan to guide global and regional work in support of country efforts and this report highlights relevant progress towards those Global Milestones.
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Each humanitarian setting provides distinct opportunities and challenges for actors to coordinate and collaborate at strategic and operational levels. The Health and Protection Joint Operational Framework has been developed to ensure that the health and protection response during humanitarian emerge
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ncies can adapt to each environment and is adequately coordinated to ensure high-quality services to meet the needs of affected individuals and at-risk groups based on their situation or vulnerabilities.
The Health and Protection JOF was conceived in 2019 as a collaboration between the Global Health Cluster (GHC), the Global Protection Cluster (GPC) and its Areas of Responsibility (AoRs), the Inter-Agency Standing Committee Reference Group on Mental Health and Psychosocial Support in Emergency Settings (IASC MHPSS RG), and the Inter-Agency Working Group for Reproductive Health in Crisis (IAWG), in addition to key technical experts.
A Steering Group (SG) comprised of representatives from each of these entities guided the framework through a joint global analysis of good practices, gaps, and barriers to integrated and inter-sectoral response coordination. This included a mixed methods review of policy and practice, a survey of humanitarian experts, multiple case studies, structured stakeholder interviews, and field visits. This exercise produced a zero-draft which was then reviewed by field practitioners in three operational contexts to clarify and fully coordinate its operationally focused lens. Finally, the JOF was reviewed by the SG including via a series of consultations in early 2023 to consolidate the current framework.
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