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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
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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.
more
he WHO South-East Region in 2019 accounted for nearly a million missing TB patients from the estimated incidence. Active case-finding (ACF) or systematic screening for tuberculosis is an important tool to reach out to missing TB patients. When appropriately implemented, the activity is cost effectiv
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e, helps to reduce diagnosis and treatment delays, and prevents the spread of the disease. This document presents an analysis of published ACF studies from the Region. It can be used by Member States for effective planning, implementation and monitoring of these activities.
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Since the launch of the 2012–2020 World Health Organization (WHO) road map for the control, elim-ination and eradication of neglected tropical diseases (NTDs) (1), considerable progress against NTDs has been made. Between 2010 and 2020, the number of people requiring interventions against NTDs glo
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bally fell by 600 million, and 42 countries, areas and territories eliminated at least one NTD (2). In January 2021, a new NTD road map for 2021–2030 (2) was launched, setting future targets and mile-stones for 20 diseases and disease groups. The road map also sets cross-cutting targets, including for strengthened capacity of national health systems to deliver interventions through existing infrastructure.
more
The internationally recognized criteria for diagnosis of neurocysticercosis include a requirement for neuroimaging techniques, such as computerized tomography (CT) and/or magnetic resonance imaging (MRI), ideally supported by serology. These facilities are not available in all settings, especially i
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n rural areas of low-income countries, making it difficult to identify and treat patients. Additionally, there is controversy about the role, type and duration of anthelmintic, antiinflammatory and antiepileptic drug (AED) treatments for different forms of neurocysticercosis.
These guidelines were developed to assist health-care providers in appropriate, evidence-based management of parenchymal neurocysticercosis. The guidelines do not address other forms of neurocysticercosis and do not include management of extraparenchymal disease (including cysticerci in the cerebral ventricles or subarachnoid space). The aim of the guidance is to improve decision-making to ensure appropriate patient care and to avoid misdiagnoses and inappropriate treatment of patients with neurocysticercosis.
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Infectious diseases cause over one billion human infections per year, with millions of deaths each year globally. Extensive health and financial burden is seen from both established and emerging infectious diseases. Infectious diseases also affect plants and animals, which may pose threats to agricu
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lture and water supplies with additional impacts on human health. This Question and Answers, prepared by the World Health Organization (WHO) and Convention on Biological Diversity (CBD) Secretariat under their joint work programme on biodiversity and health, and launched of the occasion of the International Day for Biodiversity 2020, summarizes some of the interlinkages between biodiversity and infectious diseases.
WHO is continuously monitoring and responding to the COVID 19 outbreak. This Q&A will be updated as more is known about COVID-19, how it is affecting people worldwide, and the effectiveness of interventions against the disease.
more
The World Health Organization and the Global Fund to Fight AIDS, Tuberculosis and Malaria are part of a group of agencies working together to accelerate progress towards the health-related SDGs through the Global Action Plan for Healthy Lives and Well-being for All. Understanding patterns of inequal
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ities in these diseases is essential for taking strategic, evidence-informed action to realize our shared vision of ending the epidemics of HIV, TB and malaria.
This report presents the first comprehensive analysis of the magnitude and patterns of socioeconomic, demographic and geographic inequalities in disease burden and access to services for prevention and treatment.
The results confirm there have been improvements in service coverage and decreased disease burden at the national level over the past decade. But they also reveal an uncomfortable reality: unfair inequalities between population subgroups within countries are widespread and have remained largely unchanged over the past decade. For some disease indicators, inequalities are even worsening.
Moreover, the report points to the persistent lack of available data to fully understand inequality patterns in HIV, TB and malaria. Collecting data to improve the monitoring of inequalities in these diseases is vital to develop targeted responses for impact.
There are, encouragingly, isolated successes in reducing inequities. Change is possible when deliberate action is taken to reach disadvantaged populations.
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INTRODUCTION: The COVID-19 pandemic has disrupted health systems around the world. The objectives of this study are to estimate the overall effect of the pandemic on essential health service use and outcomes in Mexico, describe observed and predicted trends in services over 24 months, and to estimat
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e the number of visits lost through December 2020.
METHODS: We used health information system data for January 2019 to December 2020 from the Mexican Institute of Social Security (IMSS), which provides health services for more than half of Mexico's population-65 million people. Our analysis includes nine indicators of service use and three outcome indicators for reproductive, maternal and child health and non-communicable disease services. We used an interrupted time series design and linear generalised estimating equation models to estimate the change in service use and outcomes from April to December 2020. Estimates were expressed using average marginal effects on the risk ratio scale.
RESULTS: The study found that across nine health services, an estimated 8.74 million patient visits were lost in Mexico. This included a decline of over two thirds for breast and cervical cancer screenings (79% and 68%, respectively), over half for sick child visits and female contraceptive services, approximately one-third for childhood vaccinations, diabetes, hypertension and antenatal care consultations, and a decline of 10% for deliveries performed at IMSS. In terms of patient outcomes, the proportion of patients with diabetes and hypertension with controlled conditions declined by 22% and 17%, respectively. Caesarean section rate did not change.
CONCLUSION: Significant disruptions in health services show that the pandemic has strained the resilience of the Mexican health system and calls for urgent efforts to resume essential services and plan for catching up on missed preventive care even as the COVID-19 crisis continues in Mexico.
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Community health worker teams are potential game-changers in ensuring access to care in vulnerable communities. Who are they? What do they actually do? Can they help South Africa realize universal health coverage? As the proactive arm of the health services, community health workers teams provide ho
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usehold and community education, early screening, tracing and referrals for a range of health and social services. There is little local or global evidence on the household services provided by such teams, beyond specific disease-oriented activities such as for HIV and TB. This paper seeks to address this gap.
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9 March 2022, Timely and accurate diagnostic testing for SARS-CoV-2 is an essential part of a comprehensive COVID-19 response strategy. Ag-RDTs can be performed by individuals in which they collect their own specimen, perform a simple rapid test and interpret their test result themselves at a time a
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nd place of their choosing, termed COVID-19 self-testing. This interim guidance provides a new recommendation that COVID-19 self-testing, using SARS-CoV-2 Ag-RDTs, should be offered as part of SARS-CoV-2 testing services. It also includes implementation considerations that can guide decisions on whether, and how, to adopt self-testing in different contexts, including the populations being prioritized; the disease prevalence in that population; and the impact on accessibility of testing, health care services and result reporting.
more
The One Health approach can help achieve progress and promotes synergies on national and global priorities by generating synergies at the human-animal-environmental interface. While evidence is still scare, it is likely that the approach is highly cost-effective and improves effectiveness of core pu
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blic health systems, through reducing morbidity, mortality, and economic costs of disease outbreaks. It also contributes to economic development through strengthening public health systems at the human-animal-environment interface protects health, agricultural production, and
ecosystem services
more
There is a broad consensus nowadays that the Earth is warming up as a result of greenhouse gas emissions caused by anthropogenic activities. It is also clear that current trends in the fields of energy, development and population growth will lead to continuous and ever more dramatic climate change.
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This is bound to affect the fundamental prerequisites for maintaining good health: clean air and water, sufficient food and adequate housing. The planet will warm up gradually, but the consequences of the extreme weather conditions such as frequent
storms, floods, droughts and heat-waves will have sudden onset and acute repercussions. It is widely accepted that climate change will have an impact on the spread of infectious diseases in Europe, which is likely to bring about new public health risks in the majority of cases. Transmission of infectious diseases depends on a number of factors, including climate and environmental elements. Foodborne and waterborne diseases, for instance, are associated with high temperatures. Disease-transmitting vectors (e.g. mosquitoes, sandflies and ticks) are highly sensitive to climate conditions, including temperature and humidity; their geographical distribution will widen as climate conditions change, potentially allowing them to spread into regions where they are not currently able to live.
The primary purpose of this manual on climate change and infectious diseases is to raise the awareness and the level of knowledge of health workers at national, regional and local levels in the former Yugoslav Republic of Macedonia on the health risks associated with climate change and infectious diseases. This manual was devel-
oped as part of the WHO Regional Office for Europe project, Protecting health from climate change: a seven–country initiative, implemented with financial support from the German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety.
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Self-care interventions are among the most promising and exciting new approaches to improve health and well-being, both from a health systems perspective and for people who use these interventions.
The World Health Organization (WHO) uses the following working definition of self-care: Self-care i
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s the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health worker. The scope of self-care as described in this definition includes health promotion; disease prevention and control; self-medication; providing care to dependent persons; seeking hospital/specialist/primary care if necessary; and rehabilitation, including palliative care. It includes a range of self-care modes and approaches. While this is a broad definition that includes many activities, it is important for health policy to recognize the importance of self-care, especially where it intersects with health systems and health professionals.
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Ce guide donne un aperçu complet des informations essentielles relatives à la vaccination, notamment des informations techniques sur les vaccins, un examen des meilleures pratiques de gestion des programmes de vaccination, des conseils sur la prestation des services de vaccination, le suivi et l'
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valuation, la surveillance des maladies et le rôle du changement de comportement.
more
Parasites & Vectors volume 11, Article number: 264 (2018)
Dengue creates a staggering epidemiological and economic burden for endemic countries. Without a specific therapy and with a commercial vaccine that presents some problems relative to its full effectiveness, initiatives to improve vector
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control strategies, early disease diagnostics and the development of vaccines and antiviral drugs are priorities. In this study, we present the probable origins of dengue in America and the trajectories of its spread. Overall, dengue diagnostics are costly, making the monitoring of dengue epidemiology more difficult and affecting physicians’ therapeutic decisions regarding dengue patients, especially in developing countries. This review also highlights some recent and important findings regarding dengue in Brazil and the Americas. We also summarize the existing DENV polymerase chain reaction (PCR) diagnostic tests to provide an improved reference since these tests are useful and accurate at discriminating DENV from other flaviviruses that co-circulate in the Americas. Additionally, these DENV PCR assays ensure virus serotyping, enabling epidemiologic monitoring.
more
Antimicrobial resistance (AMR) is a threat to global health and development and it contributes to millions of deaths worldwide each year. Inappropriate use and overuse of antibiotics are driving an increase in AMR and have a detrimental impact on the effectiveness of these critical medicines. Throug
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h the Global Action Plan on AMR, WHO is working to improve the surveillance of antimicrobial resistance and reduce inappropriate antibiotic consumption.
There is a recognized need for high-quality resources to improve antibiotic prescribing globally. To address this need, a pragmatic approach was taken by WHO to develop actionable guidance for empiric antibiotic use.
The WHO AWaRe (Access, Watch, Reserve) antibiotic book provides concise, evidence-based guidance on the choice of antibiotic, dose, route of administration, and duration of treatment for more than 30 of the most common clinical infections in children and adults in both primary health care and hospital settings. The information included in the book supports the recommendations for antibiotics listed on the WHO Model Lists of Essential Medicines and Essential Medicines Children and the WHO AWaRe classification of antibiotics.
The WHO AWaRe antibiotic book is accompanied by summary infographics for each infection for both adults and children that provide a quick-reference guide for health care workers at the point of care.
more
The sixteenth meeting of the Strategic and Technical Advisory Group for Neglected Tropical Diseases (STAG-NTD) was held as a hybrid meeting, 27–28 September 2022.
Dr Ren Minghui, Assistant Director-General, Universal Health Coverage/Communicable and Noncommunicable Diseases, welcomed participan
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ts to the meeting. He said the World Health Organization’s Department of Control of Neglected Tropical Diseases (WHO/NTD) was in a state of transition. Following the death of the late esteemed Director Dr Mwelecele Ntuli Malecela earlier in the year, Dr Gautam Biswas had taken over as Acting Director but would soon retire; the appointment of a new Director was under way. Owing to rotation of STAG-NTD members, this would be the last meeting for some and the first meeting for several new participants. The work however would continue with the same commitment. Discussions over the next two days would focus on critical issues regarding recovery of NTD services following the disruptions caused by coronavirus disease (COVID-19), which had impacted many health services worldwide. He looked forward to receiving the advice and guidance of STAG-N
more
Le présent document rassemble une série de recommandations émises par l’Organisation mondiale de la Santé (OMS) et l’Organisation panaméricaine de la Santé (OPS) pour aider les professionnels chargés des programmes de lutte antivectorielle en Amérique latine et dans les Caraïbes aux niv
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eaux national, infranational et local à mettre à jour et prendre des decisions à base factuelle qui touchent les mesures de lutte antivectorielle les mieux adaptées à chaque situation particulière. La GIV peut être utilisée lorsque la cible est la surveillance et la lutte ou l’élimination (en function de chaque situation) des MTV et peut contribuer à réduire le développement de la résistance aux insecticides au moyen de l’utilisation rationnelle de ces produits. Le présent document contient les instructions nécessaires pour mener à bien le mandat établi par l’OPS en 2008 (résolution CD48.R8, document CD48/13), en particulier, il complémente une série de guides de l’OMS publiés en 2012
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Schistosomiasis is a helminthic infection and one of the neglected tropical diseases (NTDs). It is caused by blood flukes of the genus Schistosoma. It is an important public health problem, particularly in poverty-stricken areas, especially those within the tropics and subtropics. It is estimated th
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at at least 236 million people worldwide are infected, 90% of them in sub-Saharan Africa, and that this disease causes approximately 300,000 deaths annually. The clinical manifestations are varied and affect practically all organs. There are substantial differences in the clinical presentation, depending on the phase and clinical form of schistosomiasis in which it occurs. Schistosomiasis can remain undiagnosed for a long period of time, with secondary clinical lesion. Here, we review the clinical profile of schistosomiasis. This information may aid in the development of more efficacious treatments and improved disease prognosis.
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Snakebite envenoming affects millions of people worldwide annually and is a significant source of mortality. Preventing and treating the problem is complex and requires collaboration among the fields of public health, medicine, ecology, and laboratory science. After being removed from the category A
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neglected tropical disease (NTD) list in 2013, snakebite envenoming was reinstated in 2017 in response to antivenom shortages and advocacy from researchers and international NGOs. In 2019, the World Health Organization (WHO) set a target to halve the number of deaths and cases of snakebite envenoming by 2030.
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The objective of this concept note and the framework it outlines is the elimination of a group of CDs and the negative health effects they generate, which together create a tangible burden on affected individuals, their families and communities, and on health care systems throughout the Region. Thou
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gh there is no unified consensus on the best measures to use for the public’s health and a nation’s epidemiologic situation, it is common for the disease burden to be measured by disease rates (incidence, prevalence, etc.), disease-specific death rates, comparative morbidity and mortality rates, geographic distribution, and disability-adjusted life years (DALYs). The current epidemiological situation, including data on disease rates or geographic distribution for the diseases in Table 1, is discussed below in Section 4. Hotez et al. (2008) were the first to review and compare the burden of DALYs in Latin America and the Caribbean—for NTDs, HIV/AIDS, malaria, and TB—as it existed about 10 years ago. Though the regional burden of TB, malaria, and neglected infectious diseases (NIDs) is somewhat less than it was 10 years ago, work (and schooling) continue to be lost to illness and premature death or disability, and the need for stepping up disease elimination efforts is evident in all communities living in vulnerable conditions....
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