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 primar...y 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.
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This short paper aims to identify key evidence gaps in our knowledge of livestock- and fisheries-linked antimicrobial resistance in the developing world, and to document on-going or planned research initiatives on this topic by key stakeholders.
The antimicrobial resistant (AMR) infections in anima...ls that are of most potential risk to human health are likely to be zoonotic pathogens transmitted through food, especially Salmonella and Campylobacter. In addition, livestock associated methicillin resistant Staphylococcus aureus (LA MRSA) and extended spectrum beta lactamase E. coli (ESBL E. coli) are emerging problems throughout the world.
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Research in Brief.
The international community’s predominant response to the Venezuelan migration crisis remains focused on humanitarian relief. This is important, for two populations: a) the over 50,000 ‘pendular’ migrants who go back and forth across the border every day in order to access ...food and basic services; b) those who seek residency in Colombia or another country, and require immediate support in terms of food, shelter, and medical access. However, Betts states, for the over 1.2 million migrants who have settled in Colombia, a longer-term vision is needed, which must be based on seeing Venezuelan migration as a development opportunity that can benefit both migrants and citizens
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This is an update of a seven-year TB and Leprosy national strategic plan (TBL-NSP), which extends from 2013 to 2020. The update focuses on the plan covering from 2017-20 and is based on the 2017 external mid-term programme review key findings and recommendations; the global and national End TB strat...e-gies and targets; stakeholders consultation and recent revision of the national TB guidelines.
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The chapter Fostering Health Systems’ Monitoring to Better Serve Older Populations is part of the publication series entitled Decade of Healthy Aging: Situation and Challenges. The publications are designed to favor the prioritization of effective actions at the local level as well as the monitori...ng of data and public health policies, and providing evidence-based information. Along with the objective of presenting the available updated knowledge about the situation of health and aging at the beginning of the Decade of Healthy Aging in the Americas, this publication gives information about health systems’ monitoring to better serve the needs of older adults and emphasizes the need for societies and health systems to better adapt to an aging population. It introduces the 360-tool as a guide to adapt health systems through monitoring tracers/indicators and highlighting the data and information that is readily available, disaggregated by age. This information can aid in decision-making and resource allocation to support older adults’ needs. Concerning the 360-tool development, a consensus has been reached on seven tracer indicators with high relevance to informing policy, and case studies in selected countries have assessed the feasibility of this approach. The list of indicators and the process related to the development of the tool are presented in this publication. The Decade of Healthy Aging 2021-2030 is a period to guide action towards the transformation of societies by fostering the inclusion of older people in every decision. This publication intends to contribute to this strategy and highlight the upcoming challenges and opportunities on healthy aging.
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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 (WASH) services in all health care facilities. Such services are needed to provide quality care, ensure ad...herence 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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A resource for pesticide registrars and regulators.
The WHO urged governments to restrict access to highly toxic pesticides used for self-poisoning . Other effective interventions include education, youth intervention programs and follow-up of people at risk—and better data. Only 80 out of 183 WH...O member states reported high-quality vital registration data in 2016
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PLoS ONE 11(1): e0144662. doi:10.1371/journal.pone.0144662
Children in every country are struggling with the impact of COVID-19. An entire generation has had its education disrupted, from nurseries and pre-primaries to universities and apprenticeships
Let’s make Disability visible in the fight against HIV
In-and Out-Patient Treatment
In 2017, 3.6 million of the estimated 10 million people with TB worldwide were “missed” by national TB programmes (NTPs). Two thirds of them are thought to access TB treatment of questionable quality from public and private providers who are not engaged by the NTP. The quality of care provided i...n these settings is often not known or substandard. Closing these gaps and ensuring patient-centred care imply that quality-assured and affordable TB services must be made available wherever people choose to seek care.
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Bull World Health Organ 2020;98:773–780
Universal health coverage (UHC) depends on a strong primary health-care
system. To be successful, primary health care must be expanded at community and household levels as much of the world’s population still lacks access to health facilities for basic... services. Abundant evidence shows that community-based interventions are effective for improving health-care utilization and outcomes when integrated with facility-based services. Community involvement is the cornerstone of local, equitable and integrated primary health care.
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Los cambios del contexto en 2018 nos traen varios desafíos y oportunidades para el 2019. Este año tuvimos la posesión del Presidente Duque y un redireccionamiento de las prioridades del Gobierno en la agenda nacional. Asimismo, observamos un incremento sustantivo en los flujos migratorios mixtos ...provenientes de Venezuela, mientras en algunas de las zonas históricamente más afectadas por el conflicto armado se ejercían esfuerzos para la implementación de los Acuerdos de Paz con las FARC-EP. En ese contexto, observamos en algunas regiones del país la continuidad de dinámicas de violencia con afectaciones a la población civil y el subsecuente deterioro de los indicadores humanitarios: el desplazamiento interno, restricciones a la movilidad, amenazas y asesinatos a líderes(as) y defensores(as) de derechos humanos, incidentes MAP/MUSE. Todos ellos alcanzaron niveles que no registrábamos desde hace algunos años. Además, la incertidumbre por los diálogos de paz con el Ejecito de Liberación Nacional aumenta el riesgo de estos desafíos.
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These guidelines were developed as part of Kenya's fast-track plan to end AIDS among adolescents and young people. Based on research into adolescent and young key populations in Kenya and elsewhere, they outline a package of HIV prevention services, and emphasize the need to combine biobehavioural i...nterventions with services in education, job skills training, mental health, and social care and protection.
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