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Policy Brief, Updated in March 2017
Key messages
• The criminalisation of male-to-male sex heightens HIV and other sexually transmissible infection (STI) risks and vulnerabilities, and hinders access to HIV and STI services including HCT ... .
• Men who have sex with men (MSM) and transgender persons (TG) are not a homogeneous group. As such, a variety of HCT service models are needed to reach the various segments of these populations.
• Stigma and discrimination remain ongoing issues at a number of service points. Targeted training of service providers is therefore needed so that MSM and TG are not discouraged from seeking HCT and high-quality prevention, treatment and care services.
• Specific guidelines on HIV prevention, treatment and care services for MSM or TG help improve the delivery of services. more
Key messages
• The criminalisation of male-to-male sex heightens HIV and other sexually transmissible infection (STI) risks and vulnerabilities, and hinders access to HIV and STI services including HCT ... .
• Men who have sex with men (MSM) and transgender persons (TG) are not a homogeneous group. As such, a variety of HCT service models are needed to reach the various segments of these populations.
• Stigma and discrimination remain ongoing issues at a number of service points. Targeted training of service providers is therefore needed so that MSM and TG are not discouraged from seeking HCT and high-quality prevention, treatment and care services.
• Specific guidelines on HIV prevention, treatment and care services for MSM or TG help improve the delivery of services. more
International Journal of Mental Health Systems December 2011, 5:3
Community mental health programs in low-income countries face a number of challenges. Using a case study methodology developed for
...
this purpose, it is possible to compare programs and begin to assess the effectiveness of diverse service delivery models
more
AHRO Reviews of Nursing
recommended
AHRO Reviews of Nursing is an international open-access journal that promotes the dissemination of quality knowledge in all aspects of nursing pra
...
ctice
The AHRO Review of Nursing (ARN) is an international, open-access, peer reviewed, scientific journal that seeks to promote the dissemination of quality knowledge related to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, ARN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice.
ARN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to ARN's scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice.
more
Background
Low- and middle-income countries now experience the highest prevalence and mortality rates of cardiovascular disease.
Main text
While improving the availability and delivery
...
of proven, effective therapies will no doubt mitigate this burden, we posit that studies evaluating cardiovascular disease risk factors, management strategies and service delivery, in diverse settings and diverse populations, are equally critical to improving outcomes in low- and middle-income countries. Focusing on examples drawn from four cardiovascular diseases — coronary artery disease, stroke, diabetes and kidney disease — we argue that ethnicity, culture and context matter in determining the risk factors for disease as well as the comparative effectiveness of medications and other interventions, particularly diet and lifestyle interventions.
Conclusion
We believe that a host of cohort studies and randomized control trials currently being conducted or planned in low- and middle-income countries, focusing on previously understudied race/ethnic groups, have the potential to increase knowledge about the cause(s) and management of cardiovascular diseases across the world.
more
Hum Resour Health 20, 37 (2022). https://doi.org/10.1186/s12960-022-00735-y.
For countries to achieve universal health coverage, they need to have well-functioning and resilient health systems. Achieving this requires a sufficient number of qualifi
...
ed health workers and this necessitates the importance of investments in producing and regulating health workers. It is projected that by 2030, Africa would need additional 6.1 million doctors, nurses, and midwives. However, based on the current trajectory, only 3.1 million would be trained and ready for service delivery. To reduce current shortages of the health workforce, Africa needs to educate and train 3.0 million additional health workers by 2030. This study was conducted to describe the distribution and ownership of the health training institutions, production of health workers, and the availability of accreditation mechanisms for training programmes in the WHO African Region.
more
USAID/Afghanistan’s $443 million investment in the Afghan Sustainable Water Supply and Sanitation (SWSS) activity is one of the Agency’s largest single investments in sustainable rural water supply del
...
ivery. The project installed about 2,123 wells with hand pumps across Afghanistan from 2009–2012. This report presents findings from a retrospective evaluation of a random selection of wells with hand pumps installed under the SWSS project.
This evaluation’s key purpose is to identify factors that support and hinder sustainable water service delivery in different contexts. more
This evaluation’s key purpose is to identify factors that support and hinder sustainable water service delivery in different contexts. more
This policy brief describes key HIV viral load thresholds and the available viral load testing approaches for monitoring how well antiretroviral therapy is working for people living with HIV. It provides clarification for and elaborates upon the current treatment monitoring algorithm from the Consol
...
idated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach.
This information can help people living with HIV to live healthy lives, ensure that HIV is not transmitted to other people and support policy-makers in determining the optimal allocation of resources for viral load testing and communicating the results.
more
All young people, including those with special needs and from the most vulnerable groups, have the right to quality health care services. Unfortunately, this right is not a reality, particularly in the case of sexual and reproductive health services
...
. Many youth in need of sexual and reproductive health care may either decline or be denied access to health services for a variety of reasons: Providers are often biased and do not feel comfortable serving youth who are sexually active; youth do not feel comfortable accessing existing services because they are not "youth-friendly" and may not meet their needs; and, often, community members do not feel that youth should have access to sexual and reproductive health services.
To address provider and site bias toward serving youth, EngenderHealth created a training curriculum intended to sensitize all staff at a health care facility on the provision of youth-friendly services. The curriculum was created as a result of the participatory work that we have been doing with youth in Nepal to address the needs of all levels of providers at different service-delivery settings. The curriculum has been field-tested and used in Nepal, Russia, Mongolia, and the United States.
Youth-Friendly Services allows staff to reflect upon and assess their own beliefs about adolescent sexuality while ensuring that those values and attitudes do not compromise the basic sexual and reproductive health rights to which youth are entitled. The curriculum also helps providers understand cross-cultural principles of adolescent development and health needs specific to youth. Once participant knowledge, attitudes, and skills are improved, sites conduct a self-assessment on the youth-friendliness of their services and create an action plan for specific improvements.
more
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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- Module 1: Understanding modelling approaches for sexual, reproductive, maternal, newborn, child and adolescent health, and nutrition
Coronavirus disease 2019 (COVID-19) has a wide range of documented effects. It directly causes death and disabili
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ty for some people infected. However, disruption to essential health services, resources allocated to mitigation and therefore away from essential health service delivery, and the overall impact on the economy and society must also be considered within the response to COVID-19. Understanding the magnitude of all of these effects is an essential part of developing mitigation polices.
Several epidemiological models have been created to assess the potential impact of disruptions to essential health services caused by COVID-19 on morbidity and mortality from conditions other than COVID-19 illness. This guide presents models that have been used to assess these indirect impacts. The effects have been studied in various settings, using a variety of models.
The guide is intended for people who need to understand what the models say, their construction and their underlying assumptions, or need to use models and their outcomes for planning and programme development and to support policy decisions for a country or region.
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Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030 (“the road map”) sets explicit targets for the elimination of onchocerciasis by 2030, including eliminating the need for mass
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drug administration (MDA) of ivermectin in at least one focus in 34 countries, in more than 50% of the population in at least 16 countries, and in the entire endemic population in at least 12 countries. The road map also targets interruption of onchocercal transmission in 12 countries by 2030. Achieving these targets and milestones will require a number of critical actions. These include establishing a well-coordinated global partnership to connect stakeholders and existing partnerships at all levels in order to improve coordination and collaboration, accelerate technical progress, implement a harmonized research agenda and enhance service delivery.
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Int. J. Environ. Res. Public Health 2022, 19(4), 2359; https://doi.org/10.3390/ijerph19042359.
With improved access to antiretroviral treatment (ART), adults with HIV live longer to reach older age. The number of older adults living with HIV is inc
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reasing steadily, giving rise to a new population of interest in HIV research and for invigorated considerations in health service delivery and policy. We analysed the profile of comorbidities in older people (50 years and older) living with HIV in South Africa.
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Nurses are key players in health promotion and disease prevention and the backbone of health care systems worldwide. Nurses work on the front lines of disease prevention, health promotion, and healt
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h management and are often the unsung heroes in health care facilities and emergency response. Despite the critical role they play in health care, there is a nursing shortage across the world that will affect the delivery of competent nursing care. This fact sheet highlights key action points for targeted investment in the nursing workforce and calls on Member States to strengthen nursing within the context of their own country efforts. Suggestions for action and strategies for strengthening the nursing workforce in primary health care services are through investment in education, jobs, leadership, and service delivery are provided.
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Neglected tropical diseases (NTDs) are a category of chronic, disabling, and at times disfiguring diseases and conditions that occur most commonly in the setting of extreme poverty. Historically, NT
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Ds have received less attention and funding when compared to other diseases occurring in the same regions of the world. Several NTDs have internationally agreed upon targets for their control, elimination, and eradication. Nineteen countries in the WHO African Region have successfully eliminated at least one NTD, however recent gap analyses identified moderate to severe gaps across technical, strategy and service delivery, and enabling factors. This report summarizes the findings of a scoping review of published literature undertaken to highlight control, elimination, and eradication efforts towards NTDs across the WHO African Region over the last 30 years.
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Since the Alma Ata Declaration in 1978, community health volunteers (CHVs) have been at the forefront, providing health services, especially to underserved communities, in low-income countries. However, consolidation of CHVs position within formal h
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ealth systems has proved to be complex and continues to challenge countries, as they devise strategies to strengthen primary healthcare. Malawi’s community health strategy, launched in 2017, is a novel attempt to harmonise the multiple health
service structures at the community level and strengthen service delivery through a team-based approach. The core community health team (CHT) consists of health surveillance assistants (HSAs), clinicians, environmental health officers and CHVs. This paper reviews Malawi’s strategy, with particular focus on the interface between HSAs, volunteers in community-based programmes and
the community health team. Our analysis identified key challenges that may impede the strategy’s implementation:
(1) inadequate training, imbalance of skill sets within CHTs and unclear job descriptions for CHVs; (2) proposed community-level interventions require expansion of pre-existing roles for most CHT members; and (3) district authorities may face challenges meeting financial obligations and filling community-level positions. For effective implementation, attention and further deliberation is needed on the appropriate forms of CHV support, CHT composition with possibilities of co-opting trained CHVs
from existing volunteer programmes into CHTs, review of CHT competencies and workload, strengthening coordination and communication across all community actors, and financing mechanisms. Policy support through the development of an addendum to the strategy, outlining opportunities for task-shifting between CHT members, CHVs’ expected duties and interactions with paid CHT personnel is recommended.
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Clinical Child Psychology and Psychiatry Volume 28, Issue Pages 3-14
The Russian invasion of Ukraine on 24th February 2022 has prompted this article to summarise some of the salient mental health i
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ssues experienced by young asylum seekers and refugees focussing on resettlement countries, drawing on the substantial literature, for Child and Adolescent Mental Health Practitioners. Firstly, the various UNHCR categories of persons affected by war and persecution and statistics are described. By July 2022, over 100 million people globally were of concern to UNHCR, a number increased by the many millions of refugees fleeing Ukraine to neighbouring countries. Selected findings on the psychiatric epidemiology of young refugees are summarised, and some principles of Child and Adolescent Mental Health Service delivery and treatments are outlined. The research on Ukrainian refugees’ mental health is limited and this is an area that requires further investigation alongside active attempts to meet their mental health needs.
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This case study uses the Astana Primary Health Care (PHC) framework to explore the impact of the 2020–21 pandemic on primary health care in Kenya. While the pandemic exposed systemic challenges, such as limited testing capacity, an inadequate supp
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ly of PPE, and weak social protection, Kenya's health system also demonstrated notable adaptability. The response was largely hospital-centred, with PHC playing a secondary role. Nevertheless, innovations emerged on both the provider and consumer sides to maintain service delivery and access. The study emphasises the importance of building on these experiences to enhance emergency preparedness and develop a more robust and integrated health system.
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The Transformation Agenda (TA) ushered in an ambitious reform process intended to transform the World Health Organization (WHO) into an organization that is proactive, results-driven, accountable and which meets stakeholder expectations, towards transforming and improving public health services in t
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he African Region. It aimed to achieve a WHO that is pro-results, which optimally and creatively targets technical work as well as make operations more responsive, with greater effectiveness in both communications and partnerships. The Africa Region has been the epicentre of the human immunodeficiency virus (HIV) epidemic and it’s one of the leading causes of disease and death on the continent. The WHO, with partners, has worked tirelessly for many years to control the threat and reduce the negative impact of the disease. Since the early 2000s, significant progress has been made in the global fight against the scourge of HIV. However, the WCA subregion was falling concerningly behind ESA on several key indicators of progress. In 2016, the WHO joined UNAIDS, UNICEF and other partners in a call for a strong and urgent response to support WCA countries to develop catch-up plans to triple and fast-track ART coverage, to enable the region to catch up with ESA by the end of 2020. Implementation of a widespread test-and-treat strategy, coupled with the scale-up of differentiated service delivery (DSD) and mobilization of requisite funding, accelerated WCA’s progress towards this goal. The HIV treatment catch-up and fast-track plan has achieved its target of seeing the West and Central African region (WCA) catch up with the Eastern and Southern African region’s (ESA) antiretroviral coverage rate of 78% in 2021, albeit later than the 2020 target time frame. A 33% improvement was achieved in WCA, against 21% in ESA, between 2015–2020. WCA achieved a significant 42% increase, compared to ESA’s 23%, between 2015 and 2021, to see WCA draw level with ESA at 78%. In the Democratic Republic of the Congo (DRC) alone, progress of up to 47% was observed between 2015 and 2020, for example. In addition, 1.6 million more People Living with HIV (PLHIV) were enrolled on antiretroviral treatment (ART) between 2015 and 2020.
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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).
Monitoring is the on-going collection, management
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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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Comprehensive Abortion Care Training
Ministry of Health & Family Welfare Government of India
Ministry of Health & Family Welfare Government of India
(2010)
C1
Training and Service Delivery Guidelines
