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Neonatal mortality is a major challenge in reducing child mortality rates in Nepal. Despite efforts by the Government of Nepal, data from the last three demographic and health surveys show a rise in
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the contribution of neonatal deaths to infant and child mortality. The Government of Nepal has implemented community-based programs that were piloted and then scaled up based on lessons learned. These programs include, but are not limited to ensuring safe motherhood, birth preparedness package, community-based newborn care package, and integrated management of childhood illnesses. Despite the implementation of such programs on a larger scale, their effective coverage is yet to be achieved. Health system challenges included an inadequate policy environment, funding gaps, inadequate procurement, and insufficient supplies of commodities, while human resource management has been found to be impeding service delivery. Such bottlenecks at policy, institutional and service delivery level need to be addressed incorporating health information in decision-making as well as working in partnership with communities to facilitate the utilization of available services.
more
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 prev
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enting 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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The guidelines presented in this document are designed to provide a useful resource for healthcare professionals involved in clinical case management. They were developed taking into consideration services provided at different levels within the health
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system and resources available. These guidelines are intended to standardize care at both tertiary and secondary levels of service delivery across different socio economic stratifications of our society.
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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
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of date, inconsistent and informed by evidence from high-income countries 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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Designed for trainers of health workers, this manual offers skills-building sessions on developing more “male-friendly” health services. Utiliz
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ing participatory and experiential activities, the manual examines attitudinal and structural barriers that inhibit men from seeking HIV and AIDS services (both from the client and the provider perspectives), as well as strategies for overcoming such barriers. The manual is designed for all workers in a health care system—frontline staff, clinicians, and administrative, operational, and outreach workers.
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Hand hygiene is vital for safe health care delivery, yet practices at the point of
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care remain suboptimal worldwide. A comprehensive research agenda is therefore necessary to improve our understanding of factors influencing hand hygiene behaviour and to strengthen appropriate interventions. This agenda will provide insightful ideas for researchers to focus their projects and funding proposals and will direct donors towards the areas of hand hygiene evidence that require urgent support and innovation. It will also guide decision-makers and stakeholders at the national and international level and support country efforts in updating and strengthening hand hygiene promotion programmes. Global collaboration and investment in hand hygiene research remain essential to promote safe and effective care worldwide.
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There is a crucial need to initiate and sustain fistula programs that increase access and strengthen the capacity of the health care system to prov
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ide high quality services for repair and care of women living with female genital fistula. Therefore, it is important to pay particular attention to the quality of training, and to proactively determine how this training fits into the health care system. Furthermore, the quality of training is improved by committing adequate resources to ensure competent trainers, able to train and follow-up their trainees. Women with genital fistulae, their families and the community need to have confidence in the health care system. It is therefore necessary to have pro-active discussions about the quality of training with relevant stakeholders. These fistula training guidelines and standards go towards harmonizing the training approach and to improving the quality of training and hence, service delivery.
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This brief summarizes current evidence and guidance for maintaining safe and effective care across the spectrum of maternal, newborn and infant care
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while protecting mother and child and health care providers during COVID-19. Furthermore, implications of the principle of “do no harm” are reviewed for maternal, newborn and infant care delivery during COVID-19, so that this information is conveniently and readily available to clinical and health system policy leaders and stakeholders in countries and communities. Additionally, considerations for safe oxygen delivery as well as key Infection Prevention and Control (IPC) measures at home and in healthcare facilities for pregnant women, newborns and children are described in detail in the brief.
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This treatment guideline is intended to assist clinicians in the Behavioral Health department in treatment planning and service delivery for patients with Post Traumatic Stress Disorder (PTSD). It m
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ay also assist clinicians treating patients who have some of the signs and symptoms of PTSD but who do not meet the full criteria of PTSD. The treatment guideline is not intended to cover every aspect of clinical practice, but to focus specifically on the treatment models and modalities that clinicians in our outpatient treatment setting could provide. These guidelines were developed through a process of literature review and discussion amongst clinicians in the Behavioral Health department and represent a consensus recommendation for service provision for this disorder. The guideline is intended to inform both clinical and administrative practices with the explicit goals of outlining treatment that is: effective, efficient, culturally relevant and acceptable to clinicians, program managers, and patients.
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Supporting the continuity of health and nutrition services in the context of COVID-19 in refugee settings
recommended
The 2014–2015 Ebola outbreak was catastrophic in West Africa but the indirect impact of increasing the mortality rates of other conditions was also substantial. The increased number
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of deaths caused by malaria, HIV/AIDS, and tuberculosis attributable to health system failures exceeded deaths from Ebola.
With a relatively limited COVID-19 caseload, health systems may have the capacity to maintain routine service delivery in addition to managing COVID-19 cases. When caseloads are high, and/or health workers are directly affected, strategic adaptations are required to ensure that increasingly limited resources provide maximum benefit for the refugees and surrounding host population. The following are key considerations for UNHCR operations on prioritized health care services in the event of a COVID-19 outbreak. These are based on WHO Guidance for Maintaining Essential Health Services and UNHCR guidance for operations and where relevant operation or site level outbreak preparedness and response plans.
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Policy Note #3: Myanmar Health Systems in Transition Policy Notes Series
A network of basic health facilities has been established in each ... of the 330 townships, covering both rural and urban areas. For the vast majority of Myanmar’s people, particularly the 70% who reside in rural areas, the township health system (THS) is the only government-funded source of preventive, promotive and curative services.
To achieve the national policy objective of progressing towards universal health coverage (UHC) through a primary health-care approach by 2030, the THS is critical to success. It is responsible for the bulk of health care delivery – particularly in rural areas – and is at the heart of national health development in Myanmar. However, if the THS is to be the backbone of health care provision, it currently suffers from a severe case of osteoporosis. more
A network of basic health facilities has been established in each ... of the 330 townships, covering both rural and urban areas. For the vast majority of Myanmar’s people, particularly the 70% who reside in rural areas, the township health system (THS) is the only government-funded source of preventive, promotive and curative services.
To achieve the national policy objective of progressing towards universal health coverage (UHC) through a primary health-care approach by 2030, the THS is critical to success. It is responsible for the bulk of health care delivery – particularly in rural areas – and is at the heart of national health development in Myanmar. However, if the THS is to be the backbone of health care provision, it currently suffers from a severe case of osteoporosis. more
Lessons from three African Countries.
Achieving Health for All, and in particular universal health coverage (UHC), will not happen without fully functioning basic water, sanitation and hygiene (WAS
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H) services in all health care facilities. Such services are needed to provide quality care, ensure adherence to infection prevention and control (IPC) norms and standards and guarantee that facilities are able to provide environments that respect the dignity and human rights of all care seekers, especially mothers, newborns and children. WHO undertook a series of national situational analyses in three countries (Ghana, Ethiopia and Rwanda) to understand current barriers to change, accountability structures and measures to strengthen WASH in health care facilities and more broadly, the quality of health service delivery.
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The interventions summarized in this guide are intended to lower the risk of delivery and post-partum complications for both the mother and the newborn, particularly the risk
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of postpartum haemorrhage and infections, and improve the immediate care of premature babies. The recommendations are also intended to minimize the exposure of health care providersto blood and bodily fluids that could transmit Ebola
more
Background: COVID-19 is a global public health crisis that affects all sectors; studying the impact of this pandemic on the delivery
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of cardiology services in Africa is crucial as COVID-19-related cardiovascular complications may worsen the CVD burden in this already highly affected and resource-limited continent
Methods: This was a cross-sectional e-survey study conducted amongst cardiologists in African countries. The primary outcome was the change in service delivery in African cardiology units during the on-going COVID-19 pandemic. The secondary outcomes were the satisfaction of cardiologists with regards to the workload and factors associated with this satisfaction.
Results: There was a significant reduction in working time and the number of patients consulted by week during this pandemic (p<0.001). In general, there was a decrease in the overall activities in cardiovascular care delivery. The majority of cardiology services (76.5%) and consulting programs (85%) were adjusted to the pandemic. Only half of the participants were satisfied with their workload. Reconfiguration of the consultation schedule was associated with a reduced satisfaction of participants (p=0.02).
Conclusions: COVID-19 is associated with an overall reduction in cardiology services rendered in Africa. Since the cardiovascular burdens continue to increase in this part of the World and the risk of cardiovascular complications linked to SARS COV2 remains unchanged cardiology, departments in Africa should anticipate a significant surge of cardiology services demanded by patients after the COVID-19 pandemic.
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The Department of Health is committed to providing the best quality care to patients and users of
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health services, in order to meet their expectations and needs, and to improve service delivery.
The main purpose of the National Core Standards is to:
• Develop a common definition of quality of care, which should be found in all health establishments in South Africa as a guide to the public and to managers and staff at all levels;
• Establish a benchmark against which health establishments can be assessed, gaps identified, strengths appraised; and
• Provide a national framework to certify health establishments as compliant with standards
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Nurses are critical to deliver on the promise of “leaving no one behind” and the global effort to achieve the Sustainable Development Goals (SDGs). They make a central contribution to national and global targets related to a range
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of health priorities, including universal health coverage, mental health and noncommunicable diseases, emergency preparedness and
response, patient safety, and the delivery of integrated, people-centred care.
No global health agenda can be realized without concerted and sustained efforts to maximize the contributions of the nursing workforce and their roles within interprofessional health teams. To do so requires policy interventions that enable them to have maximum impact and effectiveness by optimizing nurses’ scope and leadership, alongside accelerated investment
in their education, skills and jobs. Such investments will also contribute to the SDG targets related to education, gender, decent work and inclusive economic growth.
This State of the world’s nursing 2020 report, developed by the World Health Organization (WHO) in partnership with the International Council of Nurses and the global Nursing Now campaign, and with the support of governments and wider partners, provides a compelling case on the value of the nursing workforce globally.
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Primary care can play a significant role in the COVID-19 response by differentiating patients with respiratory symptoms from those with COVID-19, making an early diagnosis, helping vulnerable people cope with their anxiety about the virus, and reduc
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ing the demand for hospital services. This document provides national and subnational health managers, as well as staff at primary care facilities, with interim guidance on timely, effective and safe supportive management of patients with suspected and confirmed COVID-19 at the primary care level; and delivery of essential health services at the primary care level during the COVID-19 outbreak
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These guidelines provide new and updated recommendations on the use of point-of-care testing in children under 18 months
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of age and point-of-care tests to monitor treatment in people living with HIV; the treatment monitoring algorithm; and timing of antiretroviral therapy (ART) among people living with HIV who are being treated for tuberculosis.
New recommendations launched today outline key new actions that countries can take to improve the delivery of HIV testing, treatment and care services by providing greater options for differentiated approaches such as, supporting HIV treatment start in the community, ensuring that children are diagnosed and treated early, and that viral load treatment monitoring is more accessible, focused and triggers clinical action
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