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Publication Years
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Toolboxes
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2
Health financing for the COVID-19 response: Process guide for national budgetary dialogue. ACT-A Health Systems Connector
World Health Organization (WHO), World Bank, Global Financing Facility (GFF) et al.
World Health Organization (WHO)
(2021)
CC
Annual and medium-term budget preparation processes are the platforms through which specific plans are transformed into actual resource allocation decisions. The aim of this Process Guide is to support
...
key stakeholders involved in these processes (such as the Cabinet, Ministries of Finance and Health, the Parliament, citizens, media, and civil society organizations) to reorient budgetary arrangements in order to facilitate the ability of national governments to respond to the COVID-19 pandemic by delivering, therapeutics, diagnostics, and vaccine services to their populations. Reorienting budgetary arrangements positions governments to sustain the capacity to mitigate and respond to COVID-19 while concurrently delivering other essential health services and working towards Universal Health Coverage (UHC). The reorientation process is an opportunity to better align budgetary arrangements to sustain systemic capacity to prevent emerging health threats over the short, medium, and long terms.
more
The manual is written for clinicians working at the district hospital (first-level referral care) who diagnose and manage sick adolescents and adults in resource constrained settings. It aims to support clinical reasoning, and to provide an effectiv
...
e clinical approach and protocols for the management of common and serious or potentially life-threatening conditions at district hospitals. The target audience thus includes doctors, clinical officers, health officers, and senior nurse practitioners. It has been designed to be applicable in both high and low HIV prevalence settings.
Volume 2 provides a symptom-based approach to clinical care for acute and subacute conditions (including mental health). It provides short summaries of the management of diseases that affect multiple systems of the body, focusing on communicable diseases. It also includes the chronic or long-term management of HIV, TB, alcohol, and substance use disorders.
more
This document provides a systematic approach in developing a coordinated, standardized, reliable, efficient, cost-effective, and sustainable specimen transport and referral system to support IVHD and VL testing networks. This document provides techn
...
ical and programmatic recommendations on the appropriate specimen storage and transportation of specimens for HIV VL and IVHD testing. Along with the national guidelines for specimen storage and transport, these standards should provide guidance on the creation or improvement of specimen referral networks and specimen transport systems. In addition, standard operating procedures (SOPs) targeting drivers and persons responsible for packing of specimens and results return are included in this document.
No publication year indicated in the document. more
No publication year indicated in the document. more
The United Nations Population Fund (UNFPA) is the lead UN agency working to further gender equality and women’s empowerment in Sri Lanka. We are pleased to be a part of the joint effort with the Ministry
...
of Health to develop the first ‘Standard Operating Procedures on sexual and gender-based violence for first-contact-point healthcare providers’.
These operating procedures were developed alongside the ‘National guidelines on sexual and gender-based violence’, which aims to strengthen Sri Lanka’s health systems response to survivors of violence. We are grateful to the British High Commission in Colombo for their support in developing these guidelines and procedures as they mark an important milestone in creating a safer Sri Lanka for all women and girls. UNFPA is proud to be a part of this journey, and we stand ready to provide continued assistance to the Government of Sri Lanka and all key stakeholders to ensure women and girls receive essential services that support their safety, well-being and access to justice and to create a violence-free Sri Lanka.
more
For the Fiscal Year 2014-2015, the Health Sector continued to implement interventions and strategies meant to improve the availability, accessibility and utilization of quality healthcare services across public and private health facilities; and to
...
ensure the reduction of the burden of communicable and non-communicable diseases in Rwanda. This annual report highlights key achievements registered by the health sector during the Fiscal Year 2014-2015. Achievements are highlighted under three big components: Health Programs, Health Systems Support and Budget Execution.
more
Evaluation of Community Management of Acute Malnutrition (CMAM)
Sheila Reed, Camille Eric Kouam, Krishna Belbase et al.
United Nations Children’s Fund (UNICEF) Evaluation Office
(2013)
This evaluation is the first systematic effort by UNICEF to generate evidence on how well its global as well as country level Community Management of Acute Malnutrition (CMAM) strategies have worked, including their acceptance and ownership in vario
...
us contexts and appropriateness of investments in capacity development and supply components. Overall, the evaluation recommends that UNICEF continue to promote and support CMAM as a viable approach to preventing and addressing severe acute malnutrition (SAM), with an emphasis on prevention through strengthening community outreach and integrating CMAM into national health systems and with other intervention
more
Cardiovascular diseases, principally ischemic heart disease (IHD), are the most important cause of death and disability in the majority of low- and lower-middle-income countries (LLMICs). In these c
...
ountries, IHD mortality rates are significantly greater in individuals of a low socioeconomic status (SES).
Three important focus areas for decreasing IHD mortality among those of low SES in LLMICs are (1) acute coronary care; (2) cardiac rehabilitation and secondary prevention; and (3) primary prevention. Greater mortality in low SES patients with acute coronary syndrome is due to lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, non-availability of thrombolysis and coronary revascularization, and the non-affordability of expensive medicines (statins, dual anti-platelets, renin-angiotensin system blockers). Facilities for rapid diagnosis and accessible and affordable long-term care at secondary and tertiary care hospitals for IHD care are needed. A strong focus on the social determinants of health (low education, poverty, working and living conditions), greater healthcare financing, and efficient primary care is required. The quality of primary prevention needs to be improved with initiatives to eliminate tobacco and trans-fats and to reduce the consumption of alcohol, refined carbohydrates, and salt along with the promotion of healthy foods and physical activity. Efficient primary care with a focus on management of blood pressure, lipids and diabetes is needed. Task sharing with community health workers, electronic decision support systems, and use of fixed-dose combinations of blood pressure-lowering drugs and statins can substantially reduce risk factors and potentially lead to large reductions in IHD. Finally, training of physicians, nurses, and health workers in IHD prevention should be strengthened.
more
This is the fourth guidance note in a four-part series of notes related to impact evaluation developed by InterAction with financial support from the Rockefeller Foundation.This fourth guidance note
...
, Use of Impact Evaluation Results, highlights three themes crucial for effective utilization of evaluation results. Theme one states that use does not happen by accident. Impact evaluations are more likely to be used when uses have been anticipated and planned from the earliest stages of the evaluation and, even better, from the planning stages of the work that is being evaluated. Theme two concerns the operations and systems required in an organization to use impact evaluations well. Theme three builds from the premise that the first two themes are necessary but insufficient conditions for the effective and widespread use of impact evaluations. The guidance note is also available in French, Arabic and Spanish on https://www.interaction.org/impact-evaluation-notes.
more
Technical meeting to support Ebola affected countries on the recovery and resilience plans with a focus on GAVI, the Global Fund and other partners' funding - Report, 9-11 June 2015
World Health Organization
(2015)
The objectives of the meeting were to agree on coordinated and aligned support to the 3 countries’ national health recovery plans (Guinea, Liberia, Sierra Leone); to identify cross-cutting areas a
...
nd opportunities for integration; to identify ways to improve implementation modalities; and to identify actions including technical assistance needed to support the countries in the process of building resilient health systems.
The outcomes of the meeting consisted in proposed country action plans to move forward with the implementation of the recovery plans. The action plans includes:priorities and areas of work; activities needed to improve implementation modalities; technical assistance needs.
more
The coronavirus outbreak that began in 2019 (COVID-19) threatens to reverse years of hard-won gains in preventing and treating HIV. Fragile health systems are further stressed as health workers navi
...
gate an increased client load and demands at work while also being concerned for their own health and that of their families. Health facilities have been redesigned to care for patients with COVID-19, posing challenges to other services. Governments and civil society organizations have redirected scarce resources and shifted programming priorities to respond to the pandemic. Several countries have reported intermittent declines in HIV testing and diagnosis, antenatal care visits, collection of antiretroviral medicines (ARVs) by people living with HIV, and attendance at clinic appointments. Community-based education and support programmes have had to rapidly adapt to restrictions on movement and public gatherings. Children, adolescents, and women have experienced multiple deprivations due to the adverse impact of the pandemic.
more
The Kabeho Mwana project (2006–2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6
...
of Rwanda’s 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems. The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of iCCM should therefore include CHW management and social support mechanisms. Finally, re-analysis of national survey data improved evaluation findings by providing impact estimates.
more
To guide One Health capacity building efforts in the Republic of Guinea in the wake of the 2014–2016 Ebola virus disease (EVD) outbreak, we sought to identify and assess the existing
...
systems and structures for zoonotic disease detection and control. We partnered with the government ministries responsible for human, animal, and environmental health to identify a list of zoonotic diseases – rabies, anthrax, brucellosis, viral hemorrhagic fevers, trypanosomiasis and highly pathogenic avian influenza – as the country's top priorities. We used each priority disease as a case study to identify existing processes for prevention, surveillance, diagnosis, laboratory confirmation, reporting and response across the three ministries. Results were used to produce disease-specific systems “maps” emphasizing linkages across the systems, as well as opportunities for improvement. We identified brucellosis as a particularly neglected condition. Past efforts to build avian influenza capabilities, which had degraded substantially in less than a decade, highlighted the challenge of sustainability. We observed a keen interest across sectors to reinvigorate national rabies control, and given the regional and global support for One Health approaches to rabies elimination, rabies could serve as an ideal disease to test incipient One Health coordination mechanisms and procedures. Overall, we identified five major categories of gaps and challenges: (1) Coordination; (2) Training; (3) Infrastructure; (4) Public Awareness; and (5) Research. We developed and prioritized recommendations to address the gaps, estimated the level of resource investment needed, and estimated a timeline for implementation. These prioritized recommendations can be used by the Government of Guinea to plan strategically for future One Health efforts, ideally under the auspices of the national One Health Platform. This work demonstrates an effective methodology for mapping systems and structures for zoonotic diseases, and the benefit of conducting a baseline review of systemic capabilities prior to embarking on capacity building efforts.
more
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 systems 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
Background: Community Health Workers (CHWs) have a positive impact on the provision of community-based
primary health care through screening, treatment, referral, psychosocial support, and accompan
...
iment. With a
broad scope of work, CHW programs must balance the breadth and depth of tasks to maintain CHW motivation for
high-quality care delivery. Few studies have described the CHW perspective on intrinsic and extrinsic motivation to
enhance their programmatic activities.
Methods: We utilized an exploratory qualitative study design with CHWs employed in the household model in Neno
District, Malawi, to explore their perspectives on intrinsic and extrinsic motivators and dissatisfiers in their work. Data
was collected in 8 focus group discussions with 90 CHWs in October 2018 and March–April 2019 in seven purposively
selected catchment areas. All interviews were audiotaped, transcribed verbatim, coded, and analyzed using Dedoose.
Results: Themes of complex intrinsic and extrinsic factors were generated from the perspectives of the CHWs in
the focus group discussions. Study results indicate that enabling factors are primarily intrinsic factors such as positive
patient outcomes, community respect, and recognition by the formal health care system but can lead to the chal-
lenge of increased scope and workload. Extrinsic factors can provide challenges, including an increased scope and
workload from original expectations, lack of resources to utilize in their work, and rugged geography. However, a posi-
tive work environment through supportive relationships between CHWs and supervisors enables the CHWs.
Conclusion: This study demonstrated enabling factors and challenges for CHW performance from their perspec-
tive within the dual-factor theory. We can mitigate challenges through focused efforts to limit geographical distance,
manage workload, and strengthen CHW support to reinforce their recognition and trust. Such programmatic empha-
sis can focus on enhancing motivational factors found in this study to improve the CHWs’ experience in their role. The
engagement of CHWs, the communities, and the formal health care system is critical to improving the care provided
to the patients and communities, along with building supportive systems to recognize the work done by CHWs for
the primary health care systems.
more
Introduction Pharmacovigilance (PV) systems to monitor drug and vaccine safety are often inadequate in sub-Saharan
Africa. In Malawi, a PV enhancement initiative was introduced to address major barriers to PV.
Objective The objective
...
of this initiative was to improve reporting of adverse events (AEs) by strengthening passive safety
surveillance via PV training and mentoring of local PV stakeholders and healthcare providers (HCPs) at their own healthcare
facilities (HCFs).
Methods An 18-month PV training and mentoring programme was implemented in collaboration with national stakeholders,
and in partnership with the Ministry of Health, GSK and PATH. Two-day training was provided to Expanded Programme on
Immunisation coordinators, identified as responsible for AE reporting, and four National Regulatory Authority representa-
tives. Abridged PV training and mentoring were provided regularly to HCPs. Support was given in upgrading the national
PV system. Key performance indicators included the number of AEs reported, transmission of AE forms, completeness of
reports, serious AEs reported and timeliness of recording into VigiFlow.
Results In 18 months, 443 HCPs at 61 HCFs were trained. The number of reported AEs increased from 22 (January 2000 to
October 2016) to 228 (November 2016 to May 2018), enabling Malawi to become a member of the World Health Organization
Programme for International Drug Monitoring. Most (98%) AE report forms contained mandatory information on reporter,
event, patient and product, but under 1% were transmitted to the national PV office within 48 h.
Conclusion Regular PV training and mentoring of HCPs were effective in enhancing passive safety surveillance in Malawi,
but the transmission of reports to the national PV centre requires further improvement.
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Since the Alma Ata Declaration in 1978, community health volunteers (CHVs) have been at the forefront, providing health services, especially to underserved communities, in low-income countries. However, consolidation of CHVs position within formal h
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ealth systems has proved to be complex and continues to challenge countries, as they devise strategies to strengthen primary healthcare. Malawi’s community health strategy, launched in 2017, is a novel attempt to harmonise the multiple health
service structures at the community level and strengthen service delivery through a team-based approach. The core community health team (CHT) consists of health surveillance assistants (HSAs), clinicians, environmental health officers and CHVs. This paper reviews Malawi’s strategy, with particular focus on the interface between HSAs, volunteers in community-based programmes and
the community health team. Our analysis identified key challenges that may impede the strategy’s implementation:
(1) inadequate training, imbalance of skill sets within CHTs and unclear job descriptions for CHVs; (2) proposed community-level interventions require expansion of pre-existing roles for most CHT members; and (3) district authorities may face challenges meeting financial obligations and filling community-level positions. For effective implementation, attention and further deliberation is needed on the appropriate forms of CHV support, CHT composition with possibilities of co-opting trained CHVs
from existing volunteer programmes into CHTs, review of CHT competencies and workload, strengthening coordination and communication across all community actors, and financing mechanisms. Policy support through the development of an addendum to the strategy, outlining opportunities for task-shifting between CHT members, CHVs’ expected duties and interactions with paid CHT personnel is recommended.
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PQM conducted an assessment of the medicine quality assurance and quality control systems in Rwanda during November 9-13, 2009. Medicine quality assurance remains to be developed in Rwanda: the coun
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try has neither a medicine regulatory authority (MRA) nor a national medicine quality control laboratory – the two key institutions to ensure the quality, safety, and efficacy of medicines. The MOH Pharmacy Taskforce (PTF) is to be commended however for successfully controlling the pharmaceutical market to the extent that there is no informal medicines market in Rwanda. Based on its findings, the assessment team expects Rwanda to be able to make great strides in evidence-based medicines quality assurance in the short to medium term, provided it receives adequate technical assistance and financial support.
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The Practical Approach to Care Kit (PACK) is a health systems improvement programme designed to support the work of primary care health workers in
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underserved communities (like doctors, nurses, midwives, health officers, community health practitioners), strengthen the health services in which they work and thereby achieve the best possible patient outcomes
You can register for free and get the PACK Global Adult Guide for free
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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
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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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In the face of rapid increases in the number of hospitalizations due to COVID-19 in Latin America and the Caribbean, coupled with shortages of huma
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n and material resources, including medical equipment and gases, there is a need to redesign models of care in the Region to optimize available resources and ensure that more patients receive the quantity and quality of oxygen they need. Oxygen is included in the World Health Organization’s list of essential medicines and is used to care for patients at all levels of integrated health services networks. The efficacy of oxygen use in the treatment of patients with respiratory conditions caused by COVID-19 has been demonstrated, but there is great opportunity to improve the effectiveness of its use if it is used in a rational, sustainable, and safe way. Bearing in mind that the efficacy of a health technology is measured by its benefit under actual conditions of use, practical actions can be taken to improve the use of medical oxygen and avoid oxygen shortages. A drug is considered to be used rationally when patients receive it according to their clinical needs, in doses appropriate to their individual needs, for an appropriate period, and at a low cost to them and their community. By providing instruction on the rational use of oxygen and promoting it, negative repercussions can be avoided, such as loss of efficacy as a result of activities related to oxygen storage, distribution, and administration. Rational use of oxygen also involves controlling waste due to leaks in storage and distribution systems, use of gas at incorrect pressures, use of incorrectly adjusted flowmeters, and disconnections, among other problems. Another aspect to consider is the provision of adequate technical support for all oxygen production systems, in terms of maintenance and calibration, availability of electrical energy, and specific knowledge about these systems. For these reasons, a set of guidelines has been put together for the development of an efficient management system to deal with situations of oxygen scarcity, both now and in the future.
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