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1
This is the fifth report of the Global Evidence Review on Health and Migration (GEHM) series. The publication focuses on the mental health needs of refugees and migrants by providing an overview of
...
the available evidence on patterns of risk and protective factors and of facilitators and barriers to care at all levels (individual, family, community and national government). It identifies five high-level themes, each of which has implications for research and policy and is relevant across refugee and migrant groups, contexts and stages of the migration process: self-identity and community support; basic needs and security; cultural concepts of mental health as well as stigma; exposure to adversity and potentially traumatic events; navigating mental health and other systems and services.
more
Pharmaceutical system assessments are useful to diagnose problems, plan major projects and interventions, monitor progress, and compare the performance of one system with that of another. Recent years have seen a growth in demand for such assessment
...
s because of the global Fund to Fight AIDS, Tuberculosis and Malaria’s policy to conduct procurement and supply management (PSM) assessments as a grant condition. To produce useful results, all assessments should be structured.
more
Non-communicable diseases (NCDs) pose a substantial threat to many health systems, especially in low-income and middle-income countries (LMICs) where they are already overstretched. In the past few
...
decades, deaths from NCDs in LMICs have spiked, whereas numbers in high-income countries have stabilised. Worryingly, a large proportion of deaths from NCDs (29%) in LMICs occur among people younger than 60 years compared with the proportion in high-income countries (13%). This finding has been attributed to poor access to effective and equitable health-care services in most LMICs. The threat of NCDs in LMICs was recognised by the UN 2011 High-Level Meeting, and is now featured in Sustainable Development Goal 3 in the form of reducing premature mortality from NCDs by one-third before 2030. Cardiovascular diseases (CVDs) are the leading cause of deaths from NCDs (ie, 48% of all NCDs deaths). Therefore, substantial reductions in CVDs will have a major impact on reducing the overall burden of NCDs globally. The good news is that most CVDs can be prevented by addressing the key underlying behavioural risk factors, such as physical inactivity, unhealthy diet, tobacco use, and harmful use of alcohol, through population-wide approaches. Among individuals with or at high risk of CVD, early detection and effective management with appropriate counselling and medicines can reduce cardiovascular deaths substantially.
The importance of effective treatment for CVD has been recognised in the Global NCD Action Plan 2013–20, for which one of the nine global targets is that at least 50% of eligible individuals should receive drug therapy and counselling to prevent heart attacks and strokes by 2025.5 Although admirable, this is a hard target to achieve given that secondary prevention strategies in LMICs are often unaffordable or unavailable.
more
It is estimated that around 2 billion people worldwide do not have access to essential medicines. Access
...
to medicines in the Eastern Mediterranean Region varies among countries, depending on their income level and allocation of domestic resources to medicine and vaccine procurement. Access to safe and effective antibiotics remains a major challenge, especially for low- and middleincome countries. Barriers to access include high prices for new products, weak regulatory systems, substandard and falsified antibiotics, shortages of essential antimicrobials and inefficient procurement and supply management systems.
more
Background
Access to medicines is important for long‐term care of cardiovascular diseases and hypertension. This study provides a cross‐country assessment of availability, prices, and affordabi
...
lity of cardiovascular disease and hypertension medicines to identify areas for improvement in access to medication treatment.
Methods and Results
We used the World Health Organization online repository of national essential medicines lists (EMLs) for 53 countries to transcribe the information on the inclusion of 12 cardiovascular disease/hypertension medications within each country's essential medicines list. Data on availability, price, and affordability were obtained from 84 surveys in 59 countries that used the World Health Organization's Health Action International survey methodology. We summarized and compared the indicators across lowest‐price generic and originator brand medicines in the public and private sectors and by country income groups. The average availability of the select medications was 54% in low‐ and lower‐middle‐income countries and 60% in high‐ and upper‐middle‐income countries, and was higher for generic (61%) than brand medicines (41%). The average patient median price ratio was 80.3 for brand and 16.7 for generic medicines and was higher for patients in low‐ and lower‐middle‐income countries compared with high‐ and upper‐middle‐income countries across all medicine categories. The costs of 1 month's antihypertensive medications were, on average, 6.0 days’ wage for brand medicine and 1.8 days’ wage for generics. Affordability was lower in low‐ and lower‐middle‐income countries than high‐ and upper‐middle‐income countries for both brand and generic medications.
Conclusions
The availability and accessibility of pharmaceuticals is an ongoing challenge for health systems. Low availability and high costs are major barriers to the use of and adherence to essential cardiovascular disease and antihypertensive medications worldwide, particularly in low‐ and lower‐middle‐income countries.
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Heart failure (HF) is a leading global public health problem with >64 million prevalent cases globally. Patients with HF with reduced ejection fraction (HFrEF) from low- and middle-income countries experience a 22%
...
to 58% higher 1-year mortality rate than those in high-income countries.1 Guideline-directed medical therapy (GDMT) consisting of ACE (angiotensin-converting enzyme) inhibitors or ARB (angiotensin receptor blockers) or ARNI (angiotensin receptor-neprilysin inhibitors), β-blockers, MRA (mineralocorticoid receptor antagonists), and SGLT2 (sodium-glucose cotransporter 2) inhibitors substantially reduces mortality among patients with HFrEF. These medicines are among the most cost-effective interventions and are thus included as the highest priority health system interventions recommended by the Disease Control Priorities Project.2 Despite this high-quality evidence, GDMT remains widely underutilized in low- and middle-income countries resulting in widespread undertreatment of patients with HFrEF due to health system-, provider-, and patient-level barriers.1 National essential medicines lists (EMLs) promoted by the World Health Organization (WHO) guide countries on which medications to purchase in the setting of limited resources and have resulted in higher procurement and availability of essential medicines in the public sector.3 We provide a cross-sectional analysis of national EMLs in 53 low- and middle-income countries, and availability, price, and affordability of GDMT in select countries to identify potential barriers to access to these essential medicines for patients with HFrEF.
more
Infectious disease epidemics pose a threat to reproductive, maternal, newborn and child health (RMNCH) both directly—by worsening women’s and children’s
...
health outcomes—and indirectly—by reducing their access to services.1–4 Greater investment is therefore needed to mitigate the negative effects of COVID-19 and avoid a reversal of recent gains in RMNCH coverage and outcomes.1 However, COVID-19 has reduced household and government budgets,5 and there are concerns about the extent to which resources have been diverted away from RMNCH.
more
Viral Load Scale-up and Decentralized Testing Experience in Botswana.
This AIDS 2016 presentation highlights how Botswana’s decentralized testing model provides an example of how “taking the services closer to the people, rather than people co
...
ming to the services” can increase access, when supported by strong partnerships.
more
G7 leaders commit US$ 4.3 billion to finance global equitable access to tests, treatments and vaccines in 2021
Chapter 16: Managing medicine selection - Key topics: the concept of essential medicines; selection of essential medicines and development of essential medicines lists, formularies, and treatment guidelines. - The rationale for selecting a limited number of essential medicines is that it may lead
...
to better supply, more rational use, and lower costs.
more
Health inequities are unjust and avoidable systematic differences in the health status and access to
...
health resources of
different population groups. Health inequity manifests itself at all levels as differences across countries, within countries, between communities, and within population groups. Health inequities arise from social determinants of health, or social and
environmental conditions in which people are born, grow, live, work and age; they do not occur randomly or by chance, and are largely beyond an individual’s control.
more
Over 90% of the morbidity and mortality related to chronic obstructive pulmonary disease (COPD) and asthma occurs in low-income and middle-income countries (LMICs) due to well documented factors inc
...
luding decreased access to screening, trained health professionals, and therapies for disease management. Inhaler therapy (eg, aerosolised medications by inhalation, nebulisation, or propellant) is the mainstay of treatment for COPD and asthma. Adherence to maintenance medications for COPD and asthma results in improved lung function and quality of life, as well as decreased hospitalisation and mortality. WHO have included short-acting beta-agonists, long-acting muscarinic antagonists, and inhaled corticosteroids on the essential medications list, with a target goal of achieving 80% availability of these medications in public and private facilities. However, despite these efforts, accessibility, and affordability of medications for COPD and asthma remains scarce.
more
The burden of mental health conditions in the Region is high and actions are being taken by WHO to address this issue. These include the PARO Declaration (1) by the
...
health ministers of Member States at the Seventy-fifth Session of the WHO Regional Committee for South-East Asia on universal access to people-centred mental health care and services.
more
Survival, Health and Dignity for Refugees
Accessed March 13, 2019
WEEKLY EPIDEMIOLOGICAL RECORD, NO 23, 7 JUNE 2024, pp.307-318
The most recent estimate of the global number of deaths from dog-mediatedrabies is 59 000 per year.1 Rabies is associated with a 99.9% fatality rate and severe trauma in families in which a rabies death
occurs, and remains a major publ
...
ic health concern in most of Africa and Asia and some parts of South America
more
Here access to all documents and articles http://thelancet.com/commissions/palliative-care
