In many low- and middle-income countries, there is a wide gap between evidencebased recommendations and current practice. Treatment of major CVD risk factors remains suboptimal, and only a minority of patients who are treated reach their target levels for blood pressure, blood sugar and blood choles
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terol.
In other areas, overtreatment can occur with the use of non-evidence-based
protocols. The aim of using standard treatment protocols is to improve the quality
of clinical care, reduce clinical variability and simplify the treatment options,
particularly in primary health care. Standard treatment protocols can be developed by preparing new national treatment guidelines or by adapting or adopting international guidelines.
The Evidence-based protocols module uses hypertension and diabetes screening
and treatment as an entry point to control cardiovascular risk factors, prevent target organ damage, and reduce premature morbidity and mortality. A comprehensive risk- based approach for integrated management of hypertension, diabetes, and high cholesterol is included in the Risk-based CVD management module.
This module includes clinical practice points and sample protocols for:
1. hypertension detection and treatment
2. type 2 diabetes detection and treatment
3. identifying basic emergencies – care and referral.
HEARTS emphasizes adaptation, dissemination, and use of a standardized set of
simple clinical-management protocols, which should be drug- and dose-specific,
and include a core set of medications. The simpler the protocols and management tools, the more likely they are to be used correctly, and the higher the likelihood that a programme will achieve its goals.
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Procurement and supply management activities are fundamental to consistent and reliable access to essential medicines and health products. To reduce the impact of CVD, action needs to be taken to improve prevention, diagnosis, care and management of
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CVD diseases. Affordable essential medicines and technologies to manage CVD disease must be available where and when they are required. Medicines and technologies need to be managed appropriately to ensure that the correct medicines are selected, procured in the right quantities, distributed to facilities in a timely manner, and handled and stored in a way that maintains their quality. This needs to be backed up by policies that enable sufficient quantities to be procured in order to reduce cost inefficiencies, ensure the reliability and security of the distribution system, and encourage the appropriate use of these health products. In order to avoid stock-outs and the disruption of treatment, all related activities need to be conducted in a timely manner, with performance continually monitored, and prompt action taken in response to problems that may arise. Additionally, medication must be dispensed correctly and used rationally by the healthcare provider and patient alike. The purpose of this guide is to explain the necessary steps.
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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).
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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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HEARTS provides a set of locally adaptable tools for strengthening the
management of CVD in primary health care.
HEARTS is designed to enhance implementation of WHO PEN by providing:
• operational guidance on further integrating CVD management
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• technical guidance on evaluating the impact of CVD care on patient outcomes.
For countries not using WHO PEN, CVD management can still be integrated into
primary health care. The process of implementing HEARTS will vary, depending
on country context, and may require a significant reorienting and strengthening
of the health system. At some sites, existing CVD management services may be
reoriented toward a risk-based approach, while other sites may adopt a public
health approach, strengthening management of particular risk factors such as
hypertension. Whether or not introducing CVD management into primary care is a
new intervention, successful implementation will require engagement with national and local health planners, managers, service providers, and other stakeholders.
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Recommended actions at international and national levels
Ramped-up cancer services could save 7 million lives over the next decade—and addressing huge service gaps between rich and poor countries is key to success, according to this report.
In 2019, over 90% of high-income countries reported that comprehensive cancer treatment services were available
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through the public health system, compared to fewer than 15% of low-income countries, according to WHO.
But poorer countries can make substantial strides with a universal health coverage approach and use of the latest science to meet their particular needs.
The report lays out proven ways to prevent new cancer cases without breaking the bank, including tobacco-control measures and vaccines that protect against common cancers.
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Choko AT et al. Journal of the International AIDS Society 2017, 20:21610 http://www.jiasociety.org/index.php/jias/article/view/21610 | http://dx.doi.org/10.7448/IAS.20.1.21610
Best practice guidelines are systematically developed statements designed to assist nurses working in partnership with persons and their families to make decisions about health care and services (Field & Lohr, 1990). This nursing Best Practice Guide
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line (BPG) is intended to replace the RNAO BPGs Screening for Delirium, Dementia and Depression in Older Adults (2010b) and Caregiving Strategies for Older Adults with Delirium, Dementia and Depression (2010a).
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Case Manangement Training Modules
Responses to epidemics, emergencies and disasters raise many ethical issues for the people involved, including public health specialists and policy makers. This training manual provides material on ethical issues in research, surveillance and patient care
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in these difficult contexts.
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The objective of Critical Considerations and Actions for Achieving Universal Access to Sexual and Reproductive Health in the Context of Universal Health Coverage through a Primary Health Care Approach is to provide guidance to WHO Member States for
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ensuring progress towards universal access to comprehensive sexual and reproductive health (SRH) in the context of primary health care (PHC)- and universal health coverage (UHC)-related policy and strategy reforms.
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29 Dec 2021. Comprehensive slideset updated regularly to include the latest data and guidance on best practices for COVID-19 diagnosis and prevention of COVID-19 transmission.
This ACTIVE toolkit provides evidence-based guidance on the key approaches to promote and enable older people to be physically active, regardless of who they are, where they live, or their intrinsic capacities (for example their visual or cognitive abilities) or whether they live with chronic condit
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ions (for example, diabetes, hypertension, and arthritis). It is designed to support all countries at national and subnational levels (particularly low- and middle-income countries with limited resources) to ensure that environments and settings support older people to be active, and that they provide physical activity services and programmes tailored to the needs, preferences and goals of all older people.
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Fistula Care's implementing partner in Ethiopia, IntraHealth, has developed materials to train health workers on obstetric fistula prevention, identification, and pre-repair care. The course contain
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s a participant handbook (PDF, 604 KB), a facilitator manual (PDF, 1.3 MB), ten modules, a variety of visual aids, and supplementary handouts
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Being a caregiver can be an exhausting and difficult task. It’s important to recognize caregiver burnout and cope healthily. Understanding caregiver burnout symptoms and coping mechanisms can help make caregiving more enjoyable and fulfilling.About 1 in 3 adults serves as an informal caregiver to
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another adult, like an aging parent or disabled relative. Although many find the opportunity to care for a loved one to be a privilege, it can also be demanding. Here is how to cope effectively.
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Fistula Care's implementing partner in Ethiopia, IntraHealth, has developed materials to train health workers on obstetric fistula prevention, identification, and pre-repair care. The course contain
...
s a participant handbook (PDF, 604 KB), a facilitator manual (PDF, 1.3 MB), ten modules, a variety of visual aids, and supplementary handouts
more