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Publication Years
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2214
179
4
2
Category
1210
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294
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202
44
30
3
Toolboxes
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281
218
195
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127
109
92
71
54
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35
27
24
22
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13
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4
1
The attainment of Zambia’s goal of being a prosperous and middle-income country by 2030 as stipulated in its Vision 2030 is dependent on among ot
...
hers, a healthy and productive population. Therefore, the Government of the Republic of Zambia (GRZ) has prioritized health as a key socio-economic investment in the Seventh National Development Plan 2017-2021. The government is also committed to achieving the targets under the health goal number three and other health related targets under other goals of the 2030 Sustainable Development agenda. Despite progress which has been made in improving the health of Zambians, the country still faces a high burden of communicable diseases and a growing burden of non-communicable diseases. Structural and social deprivation including poverty, inequalities and marginalisation also remain major threats to health. In order to effectively address all the social determinants of health, all sectors should take into account health and well-being as a key element of policy development.
more
For the primary health worker in a low/middle-income country (LMIC) setting, delivering quality primary care is challenging. This is often complica
...
ted by clinical guidance that is out of date, inconsistent and informed by evidence from high-income countries that ignores LMIC resource constraints and burden of disease.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.
more
Severe and difficult asthma in a low- and middle-income country (LMIC) can relate to lack of availability of basic medications; potentially reversi
...
ble factors such as poor adherence or comorbidities such as obesity inhibiting a good response to treatment; and (rarely) true severe, therapy-resistant asthma. However, definitions of severity should encompass not merely doses of prescribed medication, but also underlying risk. The nature of asthmatic airway disease shows geographical variation, and LMIC asthma should not be assumed to be phenotypically the same as that in high-income countries (HICs). The first assessment step is to ensure another diagnosis is not being missed. Largely, political action is needed if children with asthma are to get access to basic medications. If a child is apparently not responding to low dose, simple medications, the next step is not to increase the dose but perform a detailed assessment of what factors (for example co-morbidities such as obesity, or social factors like poor adherence) are inhibiting a treatment response; in most cases, an underlying reason can be found. An assessment of risk of future severe asthma attacks, side-effects of medication and impaired lung development is also important. True severe, therapy-resistant asthma is rare and there are multiple underlying molecular pathologies. In HICs, steroid-resistant eosinophilia would be treated with omalizumab or mepolizumab, but the cost of these is prohibitive in LMICs, the biomarkers of successful therapy are likely only relevant to HICs. In LMICs, a raised blood eosinophil count may be due to parasites, so treating asthma based on the blood eosinophil count may not be appropriate in these settings.
more
Where there is no psychiatrist
recommended
2nd edition.
The book is aimed at general health workers in low- and middle-income country settings and has some chapters on perinatal mental heal
...
th. That said, it has definite applicability in high-income country settings too! In the new edition, there has been a big expansion of the psychosocial interventions. Thanks to your advocacy for such a resource being open-access (as the first edition was not), the book is freely available for download: https://www.cambridge.org/core/books/where-there-is-no-psychiatrist/47578A845CAFC7E23A181749A4190B54
more
Q4: Can convulsive epilepsy be diagnosed at first level care by a non-specialist health care provider in low and middle income country settings?
This publication articulates the WHO Botswana Country Office’s focus and investment needs for the biennium 2022–2023, building on achievements, networks, and partnerships fostered in 2020-2021.
As the leading health authority within the Unit
...
ed Nations system in Botswana, the WHO Country Office has been at the forefront of supporting the government to improve health since 1996. The WHO Country Office supports the Ministry of Health in realizing the health goals the Government of Botswana defines. Acknowledging that as an upper middle-income country, Botswana provides the bulk of its resources for implementing health programmes, the WHO directly brings technical expertise to the table by collaborating with relevant partners. Where the country office has limitations in terms of human resources with the requisite expertise to answer the country’s needs, the regional level and headquarters of the WHO will be mobilized to provide the necessary support.
more
Background and aims: Current coverage of mental health care in low- and middle-income countries is limited, not only in terms of access to services but also in terms of financial protection of perso
...
ns in need of care and treatment. This is especially pertinent considering the established relationship between mental illness and poverty and the need to ensure the financial risk protection of persons with mental disorders and their families as part of country's efforts to attain universal health coverage. This study set out to review the health and socio-economic contexts of Nigeria as well as to generate strategies for sustainable mental health financing that will be feasible, within the specific context of the country.
more
This operational guidance on MHPSS provides a practical orientation and tools for UNHCR country operations. It covers specific points of good practice to consider when developing MHPSS programming and offers advice on priority issues and practical d
...
ifficulties, while also providing some background information and definitions. Since MHPSS is a cross cutting concept this operational guidance is relevant for programming in various sectors, including health, community based protection, education, shelter, nutrition, food security and livelihoods.
The focus of this operational guidance is on refugees and asylum seekers, but it may apply to other persons of concern within UNHCR operations such as stateless persons, internally displaced persons and returnees. The guidance is meant for operations in both camp and non-camp settings, and in both rural and urban settings in low and middle-income countries with a UNHCR presence.
The guidance should be adapted according to different contexts. A standardized format for programme implementation cannot be offered because this depends to a large extent on existing national capacities and local opportunities.
more
The Vision 2020 is a reflection of our aspiration and determination as Rwandans, to construct a united, democratic and inclusive Rwandan identity, after so many years of authoritarian and exclusivist dispensation. We aim, through this Vision, to transform our
...
country into middle - income nation in which Rwandans are healthier, educated and generally more prosperous. The Rwanda we seek is one that is united and competitive both regionally and globally. To achieve this, the Vision 2020 identifies six interwoven pillars, including good governance and an efficient State, skilled human capital, vibrant private sector, world class physical infrastructure and modern agriculture and livestock, all geared towards prospering in national, regional and global markets.
more
Q3: Can febrile seizures (simple or complex) be managed at first or second level care by non-specialist health care providers in low and middle income cou
...
ntry settings? What is the role of diagnostic tests in the management of febrile seizures by non-specialists in low and middle income settings? For prophylaxis to prevent recurrence of simple or complex febrile seizures, which of the pharmacological interventions when compared with placebo/comparator produce benefit/harm in specified outcomes?
- continuous anticonvulsant therapy - intermittent anticonvulsant therapy - intermittent antipyretic treatment
more
Namibia is no exception to the growingglobal concern on the increasing burden of NCDs. Namibia is an upper middle income country with fast economic
...
growth since independence in 1990. The country is bearing the double burden of communicable and noncommunicable diseases and rapid urbanization. There is also high income inequality among the population.
more
The Government of the Republic of Zambia has placed priority on ensuring that Zambians are healthy and productive as a catalyst to the attainment of socioeconomic development . The Vision 2030 aims to transform Zambia into a prosperous middle-
...
income country as articulated also in the 7th National Develop-ment Plan (7NDP) and National Health Strategic Plan 2017 – 2021 (NHSP 2017-2020). However, this aspiration is threatened by the double burden of Communicable and Non-Communicable Diseas¬es. Zambia has been recording an increase in morbidity and mortality due to Non-Communicable Diseases (NCDs) such as cancers, diabetes, chronic respiratory and cardiovascular diseases. According to the 2016 WHO NCD country profiles, 29% of all deaths in Zambia are attributed to NCDs. This is unacceptably high, considering that most of these diseases can be reduced by modifying four main behavioural risk factors for NCDs which are tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity.
more
Globally, approximately 56.8 million people are in need of palliative care
services; 78% of them living in low and middle-income country yet only
...
about 12% have their needs being met causing great suffering for many.
more
The Defeat-NCD Partnership prioritises poorer countries because they bear the brunt of the enormous impact of NCDs with some 48% of premature deaths occurring in low and lower-middle income countrie
...
s. The resident of a low-income country faces a lifetime chance of 20-30% of dying from an NCD under the age of 70; this is two-to-four-fold higher than the equivalent risk for a high-income country resident. Meanwhile, when poor countries start getting a little more prosperous, the prevalence of NCD risk factors tend to initially increase.
more
These organisations have joined forces to accelerate access to COVID-19 vaccines, therapeutics and diagnostics by leveraging multilateral finance and trade solutions, particularly for low- and middle-incom
...
e countries.
The aim is to vaccinate at least 40 percent of people in every country by the end of 2021, and at least 60 percent by mid-2022. The effort will track, coordinate, and advance delivery of COVID-19 vaccines, therapeutics and diagnostics, working with governments and partners at the global and local levels to address finance and trade barriers to ensure that vulnerable populations have access to these life-saving tools. It supports the goals of the ACT-Accelerator and complementary initiatives.
more
A variety of international organizations are involved in mobilizing resources from both public and private
sources and using them to extend development assistance to low-and middle-income countries
...
around the world. They provide country-focused financial and technical assistance to developing countries, and contribute to the generation of global public goods,
such as disease surveillance, norms and standards,
data and knowledge, and aid coordination
more
A general consensus exists that as a country develops economically, health spending per capita rises and the share of that spending that is prepaid through government or private mechanisms also rises. However, the speed and magnitude of these change
...
s vary substantially across countries, even at similar levels of development. In this study, we use past trends and relationships to estimate future health spending, disaggregated by the source of those funds, to identify the financing trajectories that are likely to occur if current policies and trajectories evolve as expected.
Methods
We extracted data from WHO's Health Spending Observatory and the Institute for Health Metrics and Evaluation's Financing Global Health 2015 report. We converted these data to a common purchasing power-adjusted and inflation-adjusted currency. We used a series of ensemble models and observed empirical norms to estimate future government out-of-pocket private prepaid health spending and development assistance for health. We aggregated each country's estimates to generate total health spending from 2013 to 2040 for 184 countries. We compared these estimates with each other and internationally recognised benchmarks.
Findings
Global spending on health is expected to increase from US$7·83 trillion in 2013 to $18·28 (uncertainty interval 14·42–22·24) trillion in 2040 (in 2010 purchasing power parity-adjusted dollars). We expect per-capita health spending to increase annually by 2·7% (1·9–3·4) in high-income countries, 3·4% (2·4–4·2) in upper-middle-income countries, 3·0% (2·3–3·6) in lower-middle-income countries, and 2·4% (1·6–3·1) in low-income countries. Given the gaps in current health spending, these rates provide no evidence of increasing parity in health spending. In 1995 and 2015, low-income countries spent $0·03 for every dollar spent in high-income countries, even after adjusting for purchasing power, and the same is projected for 2040. Most importantly, health spending in many low-income countries is expected to remain low. Estimates suggest that, by 2040, only one (3%) of 34 low-income countries and 36 (37%) of 98 middle-income countries will reach the Chatham House goal of 5% of gross domestic product consisting of government health spending.
Interpretation
Despite remarkable health gains, past health financing trends and relationships suggest that many low-income and lower-middle-income countries will not meet internationally set health spending targets and that spending gaps between low-income and high-income countries are unlikely to narrow unless substantive policy interventions occur. Although gains in health system efficiency can be used to make progress, current trends suggest that meaningful increases in health system resources will require concerted action.
Funding
Bill & Melinda Gates Foundation.
more
The Demographic Dividend study on Rwanda assessed the socio economic and human development potential of our country in the short, medium and long-term period using a comprehensive approach. It generated relevant policy and programme information to g
...
uide a well informed polciy required to propel Rwanda towards achieving its aspirations of being high middle income country by 2035 and high income country by 2050.
The primary objectives of this study were to assess Rwanda’s prospects for harnessing the demographic dividend and demonstrate priority policy and programme options that the country should adopt in order to optimise its chances of earning a maximum demographic dividend in the context of its youthful population and medium, long-term socio economic development aspirations.
more
The Demographic Dividend study on Rwanda assessed the socio-economic and human development potential of our country in the short, medium and long-term period using a comprehensive approach. It generated relevant policy and programme information to g
...
uide a well-informed polciy required to propel Rwanda towards achieving its aspirations of being high middle income country by 2035 and high income country by 2050.
The primary objectives of this study were to assess Rwanda’s prospects for harnessing the demographic dividend and demonstrate priority policy and programme options that the country should adopt in order to optimise its chances of earning a maximum demographic dividend in the context of its youthful population and medium, long-term socio-economic development aspirations.
more
The Demographic Dividend study on Rwanda assessed the socio-economic and human development potential of our country in the short, medium and long-term period using a comprehensive approach. It generated relevant policy and programme information to g
...
uide a well-informed polciy required to propel Rwanda towards achieving its aspirations of being high middle income country by 2035 and high income country by 2050.
The primary objectives of this study were to assess Rwanda’s prospects for harnessing the demographic dividend and demonstrate priority policy and programme options that the country should adopt in order to optimise its chances of earning a maximum demographic dividend in the context of its youthful population and medium, long-term socio-economic development aspirations.
more
