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Measures to strengthen primary health-care systems in low- and middle-income countries
Etienne V Langlois, Andrew Mc Kenzie, Helen Schneider & Jeffrey W Mecaskey
World Health Organization
(2020)
C_WHO
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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PHARMA’S RESPONSE TO THE COVID-19 VACCINES CRISIS. Update Feb., 14, 2022. In September 2021, Amnesty International published A Double Dose of Inequality, which assessed the extent to which the pharmaceutical industry was restricting access to Covi
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d-19 vaccines. This report updates that assessment of five leading vaccine manufacturers, AstraZeneca plc, BioNTech SE, Johnson & Johnson, Moderna Inc., and Pfizer Inc. It also includes for the first time an assessment of the two largest Chinese vaccine producers, China National Pharmaceutical Group Co., Ltd. (Sinopharm) and Sinovac Biotech Ltd. (Sinovac).
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No country can claim to be free from health-care associated infections, therefore, improvement of infection prevention and control (IPC) strategies is essential. WHO recommends the use of multimodal
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improvement strategies to implement IPC interventions. These include each item of standard and transmission-based precautions according to national guidelines or standard operating procedures and under the coordination of the national IPC focal point (or team, if existing). This publication consists of three focused improvement tools, called “aide-memoires”, which focus on 1) respiratory and hand hygiene, 2) personal protective equipment, and 3) environmental cleaning, waste and linen management, all elements of standard, droplet/contact and airborne precautions.
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Every year, an estimated 15 million babies are born preterm – before 37 weeks of pregnancy. That is more than 1 in 10 live births. Approximately 1 million children die each year worldwide due to complications from their early birth. Those that sur
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vive often face a lifetime of ill-health including disability, learning difficulties, and visual and hearing problems.
Half of the babies born at or below 32 weeks (2 months early) die in low-income settings, due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high-income countries, almost all these babies survive.
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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
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of maternal deaths.
Despite being preventable and treatable, PPH results in around 70 000 deaths 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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High prices, hard-to-access human insulin, few insulin producers, and weak health systems are just some of the barriers that people with diabetes face a century after insulin was discovered, WHO notes in a new report
There is a substantial and ever-increasing unmet need for rehabilitation worldwide, which is particularly profound in low- and middle
-income countries. The availability of accessible and affordable rehabilitation is necessary for many people with
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health conditions to remain as independent as possible, to participate in education, to be economically productive, and fulfil meaningful life roles.
more
Asthma is a serious global health problem affecting all age groups. Its prevalence is increasing in many countries, espacially among children. Although some countries have seen a decline in hospitalizations and deaths from asthma, asthma still imposes an unacceptable burden on health care systems, a
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nd on society through loss of productivity in the workplace and, espacially for pediatric asthma, disruption to the family.
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These guidelines – an update to the World Health Organization’s 2015 publication Consolidated strategic information guidelines – present a set of essential aggregate indicators and guidance on choosing, collecting and systematically analysing
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strategic information to manage and monitor the national health sector response to HIV.
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Guidance module.
The QualityRights training and orientation modules have been developed to enhance the knowledge, skills and understanding of key stakeholders on how to promote the rights of peopl
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e with psychosocial, intellectual or cognitive disabilities, improve the quality of services and support provided in the field of mental health and related areas, in line with international human rights standards, in particular the UN Convention on the Rights of Persons with Disabilities and the recovery approach.
mental health and related fields, in accordance with international human rights standards, in particular the UN Convention on the Rights of Persons with Disabilities and the recovery approach.
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The Wits Justice Project
HIV Nursing Matters / page 30-33 / June 2015
Source: Guidelines for the Prevention and Treatment of HIV in Arrested, Detained and Sentenced Persons, 2008.
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 peop
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le at risk—and better data. Only 80 out of 183 WHO member states reported high-quality vital registration data in 2016
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The UNAIDS 2020 global report is a call to action. It highlights the scale of the HIV epidemic and how it runs along the fault lines of inequalities.
The consolidated guidelines are complemented by an operational handbook which is designed to assist with implementation of the WHO recommendations by Member States, technical partners and others who are involved in the management
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of patients with DR-TB. The WHO Operational Handbook on Tuberculosis, Module 4: Treatment - Drug-Resistant Tuberculosis Treatment provides practical guidance on how to put in place the recommendations at the scale needed to achieve national and global impact.
The operational handbook provides practical information and tools that complement the recommendations in the guidelines. The strategies described in the operational handbook are based on the latest WHO recommendations which were formulated by Guideline Development Groups using the GRADE approach. In many cases however, the recommendations in their current form lacked sufficient clinical and programmatic detail, which is important for implementation. This operational handbook complements the guidelines with practical advice based on best practices and knowledge from the fields such as pharmacokinetics, pharmacodynamics, microbiology, pharmacovigilance and clinical and programmatic management.
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This timely report comes at a decisive moment in history where
we can reshape urban environments and health systems for the
majority of the world’s population that live in cities. Enabling
this transformation are the SDGs, which have reconfigur
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ed how
governments and the international community need to plan and
implement actions to eradicate poverty and inequality, create
inclusive economic growth, preserve the planet and improve
population health. Central to this quest is to create equitable,
healthier cities for sustainable development.
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This guideline provides health policy-makers and decision-makers in health professional training institutions with advice on the rationale for health-care providers’ use of counselling skills to address sexual health concerns in a primary health c
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are setting
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