Regional Network for Equity in Health in east and southern Africa (EQUINET): Disussion Paper 111
The health services delivery system in Zambia is pyramid in structure, with primary healthcare (PHC) services at community level, at the base, followed by first and second level hospitals at distric...t and provincial levels, respectively, and third level (tertiary) services at national level. Notably, primary health services are free in Zambia and health service providers are either governmentowned or not-for-profit facilities.
Over the years, resource constraints have affected the quality and extent of healthcare services at all levels, requiring the mobilisation of additional resources for the sector. In doing so, prioritisation was high on the agenda of health sector reform. The EHB, therefore, prioritises interventions with the highest impact on the population, enabling policy makers to revisit priority diseases and conditions and to cost the services provided at each level of facility. Other key issues in developing the EHB in Zambia have included the need to have cost-effective services and cost per capita of services for more systematic budgeting, to rank interventions and to validate and cost the health benefit package as a whole.
more
Conflict, in its active or latent forms, is everywhere. The COVID-19 pandemic has demonstrated that public health emergencies can strike any country at any time. Given the universality of and interconnections between conflict, humanitarian crises, and public health emergencies, practitioners trained... in one sector or the other are being called upon to understand how to navigate all of these emergencies at once.
more
Background: A recent report by the Institute for Health Metrics and Evaluation (IHME) highlights that mental health receives little attention despite being a major cause of disease burden. This paper extends previous assessments of development assistance for mental health (DAMH) in two significant w...ays; first by contrasting DAMH against that for other disease categories, and second by benchmarking allocated development assistance against the core disease burden metric (disability-adjusted life year) as estimated by the Global Burden of Disease Studies. Methods: In order to track DAH, IHME collates information from audited financial records, project level data, and budget information from the primary global health channels. The diverse set of data were standardised and put into a single inflation adjusted currency (2015 US dollars) and each dollar disbursed was assigned up to one health focus areas from 1990 through 2015. We tied these health financing estimates to disease burden estimates (DALYs) produced by the Global Burden of Disease 2015 Study to calculated a standardised measure across health focus areas—development assistance for health (in US Dollars) per DALY.
more
The coronavirus disease (COVID-19) pandemic exacerbated pre-existing inequalities in the treatment and care of noncommunicable diseases (NCDs). This report examines the effect of the COVID-19 pandemic on access to NCD medicines, and the policies and strategies implemented by countries and health sys...tems to anticipate and mitigate stresses across NCD medicine supply chains. The full range of upstream and downstream impacts are investigated, including: manufacturing; procurement, importation and last mile delivery; patient-level effects through affordability and availability; and the effects on NCD medicine availability by category of disease. The report culminates in recommended actions and interventions for key stakeholders in the NCD pharmaceutical supply chain, including governments, regulatory authorities, manufacturers and the private sector; as well as directions for future research for improving access and supply chain access resilience.
more
The WHO Toolkit for the care and support of people affected by complications associated with Zika virus has been developed to serve as a model guide, with the goal of enhancing country preparedness for Zika virus outbreaks. The toolkit is intended to provide a systems approach involving public heal...th planners and managers so that the necessary infrastructure and resources can be identified and incorporated as needed, as well as technical and practical guidance for health care professionals and community workers.
The toolkit includes three manuals to provide countries with tools to effectively recognize people affected by Zika virus and deliver comprehensive care and support:
Manual for public health planners and managers
Manual for health care professionals
Manual for community workers
more
This is the ninth paper in our series, “Community Health Workers at the Dawn of a New Era”. Community health workers (CHWs) are in an intermediary position between the health system and the community. While this position provides CHWs with a good platform to improve community health, a major cha...llenge in large-scale CHW programmes is the need for CHWs to establish and maintain benefcial relationships with both sets of actors, who may have diferent expectations and needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system and with communities.
more
As a result of Russia’s invasion of Ukraine, the people of Ukraine, especially the most vulnerable, are paying an enormous price. Lives and livelihoods are being lost, with more than ten million people forced from their homes— and their country—in search of safety. The war has unleashed catast...rophic damage to the country’s economy and threatens lasting increases in poverty and societal upheaval. The scale of the war and the devastation it has caused have jeopardized Ukraine’s hard-fought development gains, through destruction of production and property, disruption of trade, diminished investment due to amplified uncertainty, and erosion of human capita
more
The National AIDS Control Council recognizes the growing, organized and progressive inter-faith religious voice in the spheres of governance and development in Kenya. Across the country, the Faith Sector has been involved in HIV prevention, treatment, care and support to programmes towards... the HIV response.On behalf of the board and the NACC family, I want to thank the Faith Sector Working Group (FSWG) and the Faith Religious Leaders for their contribution in HIV prevention by recognizing their comparative advantage in moulding behaviors among the various populations. We pride in your ability of being able to reach millions of Kenyans at any given time. This is the more reason why NACC wishes to sincerely thank you for working closely with us on the HIV response.We appreciate the Faith Sector support to the provision of HIV and health care services provision which has facilitated access to health services even in the remotest parts our country. The role played by the Religious Leaders in addressing stigma and discrimination as the greatest barrier to access of HIV and Health services by PLHIV and other vulnerable populations is well acknowledged.Finally, our gratitude goes to the theologians who participated in the development of the Faith Sector HIV messages booklet, which provides a tool to facilitate the Religious Leaders with knowledge to address the gaps in the HIV response among the congregants.
more
The meeting was held from 26 to 27 March 2018 to review and discuss the following topics:
Advances and challenges in the use of fTLC, and new approaches to detecting mycolactone using monoclonal antibodies (mAbs).
The status of development of rapid diagnostic tests (RDTs) targeting the MUL..._3720 protein.
The role of PCR as a reference test, and hurdles in providing a confirmatory diagnosis and in establishing a quality assurance programme.
New molecular tools with potential for implementation at a level lower than in the national or regional reference laboratory, such as loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA).
The need to harmonize and standardize methods for collection and preparation of specimens, so samples can be referred for diagnosis and stored for evaluation of new diagnostic tests in optimal conditions.
Barriers to accessing early diagnosis and treatment, including coordination at the programme level, and lack of adequate diagnostic tools.
Defining target product profiles (TPPs) to guide the development of new diagnostic tools that can be applied at different levels of the health system. Participants agreed that two TPPs would be developed to address the current gaps: (i) a rapid test for BU diagnosis at the primary health-care level; and (ii) a test for diagnosis of BU that can also assist in treatment monitoring and differential diagnosis at the district hospital or reference centre.
more
This manual provides a framework for morbidity management and disability prevention of patients affected by NIDs and gives specific guidance for the proper care of patients suffering from chronic conditions caused by lymphatic filariasis, leprosy, trachoma, and Chagas disease. It is intended to be u...sed mainly by health care workers at the primary health care level, but health workers at more complex and specialized levels may also find it useful.
more
This document provides interim recommendations for the surveillance of Zika virus infection, microcephaly and Guillain-Barré syndrome, in four different contexts and describes reporting requirements to WHO. Transmission refers to vector-borne transmission, unless specified differently. Autochthonou...s infection is considered to be an infection acquired in-country, i.e. among patients with no history of travel during the incubation period or who have travelled exclusively to non-affected areas during the incubation period. This document does not provide guidance on laboratory investigation or vector surveillance.
more
This publication seeks to describe the best treatments and practices based on the scientific evidence available at the time of writing as evaluated by the authors and may change as a result of new research. Readers need to apply this knowledge to patients in accordance with the guidelines and laws o...f their country of practice. Some medications may not be available in some countries and readers should consult the specific drug information since not all the unwanted effects of medications are mentioned.
more
This document presents a brief overview of how UNHCR adapts its activities for mental health and psychosocial support (MHPSS) to the changing context of the pandemic. Staff of UNHCR and partners, in country offices in all regions of the world, have developed innovative field practices to continue pr...oviding essential MHPSS services to refugees. The examples in this document are testimony to the commitment and creativity of our staff and can serve as inspiration and encouragement for others to continue integrating MHPSS in the humanitarian work during and after the COVID-19 pandemic.
more
This report examines the support to private healthcare provision in India by the World Bank’s private sector arm, the International Finance Corporation (IFC). Despite supporting private healthcare in the country since 1997, no healthcare results for lending and investments have been disclosed sinc...e the start of these operations over twenty-five years ago. The IFC has overwhelmingly invested in high-end urban hospitals which are out of reach for the majority of Indians. Several have consistently failed to provide free healthcare to poor patients despite this being a condition under which free or subsidized public land was allotted to these hospitals. Supporting private healthcare in a context where 37% of Indians experience catastrophic health expenditures in private hospitals appears to run counter to the World Bank Group’s focus on poverty reduction. These investments do not contribute to the building of stronger healthcare infrastructure or respond to unmet healthcare needs. Only 14% of IFC-financed hospitals are located in the 10 states ranked lowest in terms of the overall performance of the health system. Furthermore, we found many instances where regulators upheld complaints pertaining to violations of patients’ rights by these hospitals including overcharging, denial of healthcare, price rigging, financial conflict of interest and medical negligence.
more
The global emergence of antimicrobial resistance (AMR) is posing a threat to human health. Putting resources into the containment of AMR – including surveillance – is one of the highest-yield investments a country can make to mitigate its impact. In 2015, WHO launched the Global Antimicrobial Re...sistance Surveillance System (GLASS), the first global collaborative effort to foster AMR surveillance in bacteria causing acute infections. As of December 2018, 71 countries are enrolled in GLASS. The aim of this report is to document participation efforts and outcomes across these countries, and highlight differences and constraints identified to date. This report follows on from the first GLASS Report – Early implementation 2016-17, published in January 2018, and drawing on data from GLASS first data call in 2017.
more
Starting on 24 February 2022, a large-scale armed conflict in Ukraine triggered an unprecedented humanitarian crisis across the country, characterised, among other elements, by the displacement of a significant proportion of the Ukrainian population.
As early as April 2022, the International Organi...zation for Migration (IOM) began observing significant return movements. Conditions of return vary widely, as returnees arrive back to areas not directly affected by the war, but which have experienced a significant influx of internally displaced persons (IDPs), as well as to conflict-affected and recently de-occupied areas which have sustained severe damage.
more
Objective: To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and
middle-income countries.
Methods: We systematically searched medical databases and websites of medical societies and contacted international organizations.
Co...untry-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed
each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation).
We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of
guidelines and plans for dissemination to target audiences.
Findings: We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries.
Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending
surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development;
breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and
middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines
encompassed detailed implementation plans and socioeconomic considerations.
Conclusion: Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of
health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.
more
The new review paper, The Impacts of Climate Change on Health, identifies the extent to which increasing emissions, extreme weather and temperatures elevate health risks, from infectious disease to malnutrition, and assesses the associated health burden. It concludes that the health burden will exce...ed the level of demand that health systems are prepared for.
more
This report aims to outline the current available knowledge on the health and wellbeing of older persons in the Region of the Americas during the United Nations Decade of Healthy Ageing (2021-2030). It also seeks to guide political actions towards ensuring the human rights of older persons, and desc...ribes the negotiation and drafting process behind the Inter-American Convention on Protecting the Human Rights of Older Persons. It reports on the doctrinal and legal developments that led the Region of the Americas to draft the Convention and describes its action areas and guaranteed rights, as well as the obligations assumed by the States Parties. The Convention is an essential tool to advance the strategies of the Decade of Healthy Ageing. This publication reflects on the importance of having a major legal instrument for this purpose at the international level. The demographic transition in Latin America and the Caribbean will continue to shape the ability of countries and health systems to respond to the needs of the population. Given this reality, international instruments will be needed to guarantee the full enjoyment of the human rights of older persons. In order to design inclusive and sustainable systems, accurate, updated, and effective information is required. The Decade of Healthy Ageing––the initiative that constitutes the framework for this document––is a strategic period in which to focus on data generation and monitoring.
more
This summary highlights the experiences, results and actions from
the implementation of the Rapid Assessment Tool for Sexual and
The tool – developed by IPPF, UNFPA, WHO, UNAIDS, GNP+, ICW and Young Positives in
2009 – supports national assessments of the bi-directional linkages
between sexu...al and reproductive health (SRH) and HIV at the policy,
systems and services levels. Each country that has rolled out the
tool has gathered and generated information that will help to
determine priorities and shape national plans and frameworks for
scaling up and intensifying linkages. Country experiences and best
practices will also inform regional and global agendas.
more