Report of the 23rd WHO Expert Committee on the selection and use of essential medicines
This executive summary reports the recommendations made by the Expert Committee for the 2021 update of the WHO Model List of Essential Medicines (EML) and the Model List of Essential Medicine for Children (EMLc)....
The 23rd meeting of the WHO Expert Committee on Selection and Use of Essential Medicines was coordinated from Geneva, Switzerland, and held virtually from 21 June to 2 July 2021. The Committee considered 88 applications proposing additions, changes and deletions of medicines, medicine classes and formulation on the Model Lists of Essential Medicines. The Committee evaluated the scientific evidence for comparative effectiveness, safety and cost-effectiveness of the medicines in question. The Committee also considered a review of the therapeutic alternatives for medicines on the Model Lists, and update to the AWaRe classification of antibiotics, and reviews and reports relevant to the selection and use of essential medicines.
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This Practice Parameter reviews the evidence from research and clinical experience and highlights significant advances in the assessment and treatment of posttraumatic stress disorder since the previous Parameter was published in 1998. It highlights the importance of early identification of posttrau...matic stress disorder, the importance of gathering information from parents and children, and the assessment and treatment of comorbid disorders. It presents evidence to support trauma-focused psychotherapy, medications, and a combination of interventions in a multimodal approach.
Journal of the American Academy of Children & Adolescents Psychiatry, Vol. 49 No. 4 APRIL 2010 pp.414-430
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The pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of asthma treatment should be to achieve and maintain control of the... disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in terms of the pharmacological treatment, patient education, written action plan, training in correct inhaler use, and review of the inhaler technique at each office visit. A panel of 22 pulmonologists was invited to perform a critical review of recent evidence of pharmacological treatment of asthma and to prepare this set of recommendations, a treatment guide tailored to use in Brazil. The topics or questions related to the most significant changes in concepts, and consequently in the management of asthma in clinical practice, were chosen by a panel of experts. To formulate these recommendations, we asked each expert to perform a critical review of a topic or to respond to a question, on the basis of evidence in the literature. In a second phase, three experts discussed and structured all texts submitted by the others. That was followed by a third phase, in which all of the experts reviewed and discussed each recommendation. These recommendations, which are intended for physicians involved in the treatment of asthma, apply to asthma patients of all ages.
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Recovery partnership preparation package: Building capacity to reactivate safe essential health services and sustain health service resilience.
In the aftermath of an emergency, the recovery partnership preparation package supports the establishment and implementation of institutional health partne...rships, or ‘twinning partnerships’. These partnerships focus on shared learning and improvement in the services that are being delivered. The Twinning Partnerships for Improvement (TPI) approach supports capacity-building, the re-establishment of safe essential health services and encourages joint long term efforts on service delivery strengthening
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This technical report presents the results of a cross-sectional survey conducted in Sarajevo, the Federation of Bosnia and Herzegovina, Bosnia and Herzegovina, between June and August 2017, as part of the FEEDcities Project (Food Environment Description in cities – eastern Europe and central Asia).... The aim of the report is to describe the city’s local street food and takeaway food environment, exploring the characteristics of food vending sites, the industrially produced and homemade foods they typically offer, and the nutritional composition of these foods. Finally, the report provides guidance on how to address its findings through policy action.
The study was conducted through a bilateral partnership between the World Health Organization (WHO) and the Institute of Public Health of the University of Porto, in collaboration with the Faculty of Medicine, the Faculty of Nutrition and Food Sciences, the Faculty of Pharmacy of the University of Porto (WHO registration 2015/591370 and 2017/698514) and the Institute of Public Health of the Federation of Bosnia and Herzegovina. The study was funded through a voluntary contribution of the Ministry of Health of the Russian Federation, and through a contribution made by the Swiss Agency for Development and Cooperation (SDC)/Swiss Government to a joint WHO/SDC project, “Reducing Health Risk Factors in Bosnia and Herzegovina: Developing and Advancing Modern and Sustainable Public Health Strategies, Capacities and Services to Improve Population Health”, implemented in Bosnia and Herzegovina.
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Global growth is projected to slow significantly amid high inflation, tight monetary policy, and more restrictive credit conditions. The possibility of more widespread bank turmoil and tighter monetary policy could result in even weaker global growth and lead to financial dislocations in the most vu...lnerable emerging market and developing economies (EMDEs). Comprehensive policy action is needed to foster macroeconomic and financial stability. Among many EMDEs, and especially in low-income countries, bolstering fiscal sustainability will require generating higher revenues, making spending more efficient, and improving debt management practices. Continued international cooperation is also necessary to tackle climate change, support populations affected by crises and hunger, and provide debt relief where needed.
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Policy note: Cambodia Health Systems in Transition.
The health system includes a mix of public and private providers. The use of private providers is much greater among the wealthy, while the use of informal-sector health providers is greater among the poor. Due to these circumstances there is ...considerable scope to establish appropriate public-private cooperation and to reinforce the regulatory mandate of the Ministry of Health (MOH).
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In many low- and middle-income countries, there is a wide gap between evidencebased recommendations and current practice. Treatment of major CVD risk factors remains suboptimal, and only a minority of patients who are treated reach their target levels for blood pressure, blood sugar and blood choles...terol.
In other areas, overtreatment can occur with the use of non-evidence-based
protocols. The aim of using standard treatment protocols is to improve the quality
of clinical care, reduce clinical variability and simplify the treatment options,
particularly in primary health care. Standard treatment protocols can be developed by preparing new national treatment guidelines or by adapting or adopting international guidelines.
The Evidence-based protocols module uses hypertension and diabetes screening
and treatment as an entry point to control cardiovascular risk factors, prevent target organ damage, and reduce premature morbidity and mortality. A comprehensive risk- based approach for integrated management of hypertension, diabetes, and high cholesterol is included in the Risk-based CVD management module.
This module includes clinical practice points and sample protocols for:
1. hypertension detection and treatment
2. type 2 diabetes detection and treatment
3. identifying basic emergencies – care and referral.
HEARTS emphasizes adaptation, dissemination, and use of a standardized set of
simple clinical-management protocols, which should be drug- and dose-specific,
and include a core set of medications. The simpler the protocols and management tools, the more likely they are to be used correctly, and the higher the likelihood that a programme will achieve its goals.
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Myanmar is prone to various natural hazards that include earthquakes, floods, cyclones, droughts, fires, tsunamis, some of whichhave the potential to impact large numbers of people. In the event that large numbers of people are affected(such as was the case in 2008 following cyclone Nargis), the gov...ernment may decide to request international assistance to respond to the disaster.
The overall goal of the ERPP is to mitigate the impact of disasters and save as many lives as possible from preventable causes. It aims to ensure that effective and timely assistance is provided to people in need through effective coordination and communication on emergency preparedness and humanitarian response between members of the HCTin Myanmar. The approach has been developed in collaboration with the Government, to facilitate a coordinated and effective support to people affected by humanitarian crises.
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Obesity and diabetes are affecting the peoples of the Americas at high and increasing rates. National surveys demonstrate that obesity is increasing in prevalence among all age groups; 7% to 12% of children under 5 years old and
one-fi fth of adolescents are obese, while rates of overweight and obe...sity among adults approach 60%. Obesity is the major modifi able risk factor for diabetes.
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HEARTS provides a set of locally adaptable tools for strengthening the
management of CVD in primary health care.
HEARTS is designed to enhance implementation of WHO PEN by providing:
• operational guidance on further integrating CVD management
• technical guidance on evaluating the impact of... CVD care on patient outcomes.
For countries not using WHO PEN, CVD management can still be integrated into
primary health care. The process of implementing HEARTS will vary, depending
on country context, and may require a significant reorienting and strengthening
of the health system. At some sites, existing CVD management services may be
reoriented toward a risk-based approach, while other sites may adopt a public
health approach, strengthening management of particular risk factors such as
hypertension. Whether or not introducing CVD management into primary care is a
new intervention, successful implementation will require engagement with national and local health planners, managers, service providers, and other stakeholders.
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The purpose of the WHO Manual for the Public Health Management of Chemical Incidents is to provide a comprehensive overview of the principles and roles of public health in the management of chemical incidents and emergencies. While this information is provided for each phase of the emergency cycle, ...including prevention, planning and preparedness, detection and alert, response and recovery, it is recognized that the management of chemical incidents and emergencies requires a multi-disciplinary and multi-sectoral approach and that the health sector may play an influencing, complementary or a leadership role at various stages of the management process. The target audience includes public health and environmental professionals, as well as any other person involved in the management of chemical incidents.
WHO and all those involved in the development of the publication hope that the publication will have wide application, especially in developing countries and countries with economies in transition, and that in the future the health sector will be better prepared to acknowledge and fulfill its roles and responsibilities in the management of chemical incidents and emergencies, thereby contributing to the prevention and mitigation of their health consequences.
The publication is also available in French: http://apps.who.int/iris/bitstream/handle/10665/246117/9789242598148-fre.pdf?sequence=1 and in Spanish: http://apps.who.int/iris/bitstream/handle/10665/246118/9789243598147-spa.pdf?sequence=1
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L’Agenda pour l’action contre l’exploitation sexuelle des enfants à des fins commerciales fournit un cadre détaillé et établit des catégories d’actions devant être prises par les gouvernements en partenariat
avec les organisations de la société civile et les autres acteurs-clés pou...r combattre les crimes sexuels
de nature commerciale commis contre les enfants. De manière générale, ces actions se concentrent
sur 1) la Coordination et la Coopération, 2) la Prévention, 3) la Protection, 4) le Rétablissement et la
Réinsertion et 5) la Participation des enfants.
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Le monde fait face aux conséquences graves du manque de services et de traitements de santé mentale disponibles. Les troubles mentaux touchent tous les pays, toutes les cultures et toutes les collectivités. Selon l’Organisation mondiale de la Santé (OMS), 10% de la charge mondiale de morbidit... est liée aux troubles mentaux, neurologiques et à l’usage de substances psychoactives.
Dans les pays à revenu faible ou intermédiaire, plus de 75% des personnes atteintes de troubles mentaux ne reçoivent aucun traitement. En 2020, en raison de la pandémie mondiale, 93% des pays ont déclaré que leurs services de santé mentale ont été suspendus ou interrompus (OMS, 2020e). L’OMS a signalé une hausse de 25% des cas de dépression et d’anxiété durant la pandémie. L’Organisation de coopération et de développement économiques (OCDE) estime que la dépression et l’anxiété coûtent à l’économie mondiale 1 000 milliards d’USD par an.
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Cette pandémie est un défi commun pour l’ensemble de l’humanité dans l’ère de la mondialisation. À ce jour, le partage des ressources, des expériences et des leçons, qui que vous soyez, est notre seule chance de gagner. Le vrai remède à cette pandémie n’est pas l’isolement, mais... la coopération.
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L’impact des interventions de lutte contre le paludisme, ces dernières années, a fortement modifié la répartition géographique du fardeau de la maladie. Cette nouvelle configuration impose une stratification plus opérationnelle permettant d’adapter les interventions aux caractéristiques ...pidémiologiques locales. L’approche focalisée des interventions spécifiques par zone devient alors un impératif.
Le présent PSN pour la période 2016 - 2020 clarifie ces nouvelles orientations strategiques.
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The Government of Malawi’s Health Sector Strategic Plan II highlights the importance of service integration; however, in practice, this has not been fully realized. We conducted a mixed methods evaluation of efforts to systematically implement integrated family planning and immunization services i...n all health facilities and associated community sites in Ntchisi and Dowa districts during June 2016–September 2017. Methods included secondary analysis of service statistics (pre- and postintervention), focus group discussions with mothers and fathers of children under age one, and in-depth interviews with service providers, supervisors, and managers. Results indicate statistically significant increases in family planning users and shifts in use of family planning services from health facilities to community sites. The intervention had no effect on immunization doses administered or dropout rates. According to mothers and fathers, benefits of service integration included time savings, convenience, and improved understanding of services. Provision and use of integrated services were affected by availability of human resources and commodities, community linkages, data collection procedures and availability, sociocultural barriers, organization of services, and supervision and commitment of health surveillance assistants. The integration approach was perceived to be feasible and beneficial by clients and providers.
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Antimicrobial resistance (AMR) is a global human, animal, plant and environment health threat that needs to be addressed by every country. The impacts of AMR are wide-ranging in terms of human health, animal health, food security and safety, environmental effects on ecosystems and biodiversity, and ...socioeconomic development. Just like the climate crisis, AMR poses a significant threat to the delivery of the 2030 Agenda for Sustainable Development. The response to the AMR crisis has been spearheaded through the global action plan on antimicrobial resistance (GAP-AMR), developed by the World Health Organization (WHO) in 2015, in close collaboration with the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (WOAH), and formally endorsed by the three organizations’ governing bodies and by the Political Declaration of the high-level meeting of the United Nations General Assembly on AMR in 2016. In 2022, the three organizations officially became the Quadripartite by welcoming the United Nations Environment Programme (UNEP) into the alliance “to accelerate coordination strategy on human, animal and ecosystem health”.
The aim of the GAP-AMR is to ensure the continuity of successful treatment with effective and safe medicines.
Its strategic objectives include:
• improving the awareness and understanding of AMR;
• strengthening the knowledge and evidence base through surveillance and research;
• reducing the incidence of infection through effective sanitation, hygiene and infection prevention measures; optimizing the use of antimicrobial medicines in human and animal health; and
• developing the economic case for sustainable investment that takes account of the needs of all countries and increasing investment in new medicines, diagnostic tools, vaccines and other interventions.
With the adoption of the GAP-AMR, countries agreed to develop national action plans (NAPs) aligned with the GAP-AMR to mainstream AMR interventions nationally. Individually, the Quadripartite took action to advance AMR interventions in their respective sectors. FAO adopted a resolution on AMR recognizing that it poses an increasingly serious threat to public health and sustainable food production, and developed an AMR action plan to support the resolution’s implementation. For its part, WOAH developed a strategy on AMR aligned with the GAP-AMR, acknowledging the importance of a One Health approach to AMR. Similarly, more recently, UNEP’s governing body, the United Nations Environment Assembly, recognized that AMR is a current and increasing threat and a challenge to global health, food security and the sustainable development of all countries, and welcomed the GAP-AMR and the NAPs developed in accordance with its five overarching strategic objectives
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WHO today released its first roadmap to tackle postpartum haemorrhage (PPH) – defined as excessive bleeding after childbirth - which affects millions of women annually and is the world’s leading cause of maternal deaths.
Despite being preventable and treatable, PPH results in around 70 000 de...aths every year. For those who survive, it can cause disabilities and psychological trauma that last for years.
“Severe bleeding in childbirth is one of the most common causes of maternal mortality, yet it is highly preventable and treatable,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This new roadmap charts a path forward to a world in which more women have a safe birth and a healthy future with their families.”
The Roadmap aims to help countries address stark differences in survival outcomes from PPH, which reflect major inequities in access to essential health services. Over 85% of deaths from PPH happen in sub-Saharan Africa and South Asia. Risk factors include anaemia, placental abnormalities, and other complications in pregnancy such as infections and pre-eclampsia.
Many risk factors can be managed if there is quality antenatal care, including access to ultrasound, alongside effective monitoring in the hours after birth. If bleeding starts, it also needs to be detected and treated extremely quickly. Too often, however, health facilities lack necessary healthcare workers or resources, including lifesaving commodities such as oxytocin, tranexamic acid or blood for transfusions.
“Addressing postpartum haemorrhage needs a multipronged approach focusing on both prevention and response - preventing risk factors and providing immediate access to treatments when needed - alongside broader efforts to strengthen women’s rights,” said Dr Pascale Allotey, WHO Director for Sexual and Reproductive Health and HRP, the UN’s special programme on research development and training in human reproduction. “Every woman, no matter where she lives, should have access to timely, high quality maternity care, with trained health workers, essential equipment and shelves stocked with appropriate and effective commodities – this is crucial for treating postpartum bleeding and reducing maternal deaths.”
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Case Study on Improving HIV Testing and Services for Children Orphaned or made Vulnerable by HIV (OVC)