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Health inequities, within and across countries, stand as a critical global challenge of our time. Over 1 billion people face preventable diseases and premature deaths due to limited access to [...]

Sexual health is fundamental to overall health and well-being, to the dignity of the individual and to the social and economic development of communities and countries. (1) Three decades ago, [...]

Health system strengthening is key to achieving universal health coverage, a target of the sustainable development goals. For policy-makers to effectively focus health system strengthening efforts and translate them into [...]

The financial and economic choices societies make determine whether all individuals can enjoy the right to health. Crises quickly expose the values and interests that drive decisions towards health, as [...]

Rehabilitation is included in the universal health coverage (UHC) target of the sustainable development goals as an essential health service; access to rehabilitation is a human right. (1) Rehabilitation services [...]

As of 19 March 2021, 121 million cases and over 2.6 million deaths due to coronavirus disease 2019 (COVID-19) had been reported to the World Health Organization. While heads of [...]

The article calls for papers on advancing the science and practice of primary health care that will be published in the "Bulletin of the World Health Organization."

The aim of this paper is to contribute technical arguments to the debate about the importance of health examination surveys and their continued use during the post-pandemic health financing crisis, and in the context of a technological innovation boom that offers new ways of collecting and analysing individual health data (e.g. artificial intelligence). Technical considerations demonstrate that health examination surveys make an irreplaceable contribution to the local availability of primary health data that can be used in a range of further studies (e.g. normative, burden-of-disease, care cascade, cost and policy impact studies) essential for informing several phases of the health planning cycle (e.g. surveillance, prioritization, resource mobilization and policy development). Examples of the use of health examination survey data in the World Health Organization (WHO) European Region (i.e. Finland, Italy, Malta and the United Kingdom of Great Britain and Northern Ireland) and the WHO Region of the Americas (i.e. Chile, Mexico, Peru and the United States of America) are presented, and reasons why health provider-led data cannot replace health examination survey data are discussed (e.g. underestimation of morbidity and susceptibility to bias). In addition, the importance of having nationally representative random samples of the general population is highlighted and we argue that health examination surveys make a critical contribution to external quality control for a country's health system by increasing the transparency and accountability of health spending. Finally, we consider future technological advances that can improve survey fieldwork and suggest ways of ensuring health examination surveys are sustainable in low-resource settings., ((c) 2024 The authors; licensee World Health Organization.)

The article calls for papers addressing the health of vulnerable populations, constructs of social inclusion and exclusion, interventions for vulnerable populations in the context of sustainable development goals (SDG) at the micro- and macro-policy levels, and factors to vulnerabilities.

The article discusses principles underlying the position proposed by the World Health Organization Registry Platform Working Group on the Reporting of Findings of Clinical Trials which states that the findings of all clinical trials must be made publicly available. According to the authors, a significant proportion of health-care research remains unpublished and some researchers do not make all of their results available. They contend that the report is the start of a consultation process on how transparency can be achieved, with the intention that greater accessibility to the findings of clinical trials will lead to improvements in health care.

The World Health Organization (WHO) set up the messenger ribonucleic acid (mRNA) technology transfer programme in June 2021 with a development hub in South Africa and 15 partner vaccine producers in middle-income countries. The goal was to support the sustainable development of and access to life-saving vaccines for people in these countries as a means to enhance epidemic preparedness and global public health. This initiative aims to build resilience and strengthen local vaccine research, and development and manufacturing capacity in different regions of the world, especially those areas that could not access coronavirus disease 2019 (COVID-19) vaccines in a timely way. This paper outlines the current global vaccine market and summarizes the findings of a case study on the mRNA technology transfer programme conducted from November 2022 to May 2023. The study was guided by the vision of the WHO Council on the Economics of Health for All to build an economy for health using its four work streams of value, finance, innovation and capacity. Based on the findings of the study, we offer a mission-oriented policy framework to support the mRNA technology transfer programme as a pilot for transformative change towards an ecosystem for health innovation for the common good. Parts of this vision have already been incorporated into the governance of the mRNA technology transfer programme, while other aspects, especially the common good approach, still need to be applied to achieve the goals of the programme. [ABSTRACT FROM AUTHOR]

The authors convey their concerns on providing health care to people living in conflict-affected areas. Topics covered include accountability to affected populations as defined by the Inter-Agency Standing Committee, the need for operational guidance on the provision of trauma care in conflict settings, and the need for immediate evacuation from the location of injury to the care facility.

The World Health Organization (WHO) aims to reduce new leprosy cases by 70% by 2030, necessitating advancements in leprosy diagnostics. Here we discuss the development of two WHO's target product profiles for such diagnostics. These profiles define criteria for product use, design, performance, configuration and distribution, with a focus on accessibility and affordability. The first target product profile outlines requirements for tests to confirm diagnosis of leprosy in individuals with clinical signs and symptoms, to guide multidrug treatment initiation. The second target product profile outlines requirements for tests to detect Mycobacterium leprae or M. lepromatosis infection among asymptomatic contacts of leprosy patients, aiding prophylactic interventions and prevention. Statistical modelling was used to assess sensitivity and specificity requirements for these diagnostic tests. The paper highlights challenges in achieving high specificity, given the varying endemicity of M. leprae, and identifying target analytes with robust performance across leprosy phenotypes. We conclude that diagnostics with appropriate product design and performance characteristics are crucial for early detection and preventive intervention, advocating for the transition from leprosy management to prevention. [ABSTRACT FROM AUTHOR]

The author discusses how the Global Strategy For Women's and Children's Health for 2010-2015 has catalyzed over 300 stakeholders to make commitments raising over 45 billion U.S. dollars new financing and launched global initiatives for priority issues such as family planning, newborn and child survival. Topics discussed include calls for submissions to a them issue of the "Bulletin" on the health of women, children and adolescents.

The World Health Organization developed the Tricycle surveillance programme to obtain a global picture of antimicrobial resistance, especially in countries with limited surveillance capacity. The programme was developed within a One Health perspective. Tricycle provides a framework for applying a standardized technical protocol to determining the prevalence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in three sectors: the human, animal and environment sectors. Regular use of the protocol would enable information to be obtained on time trends and on inter- and intraregional variations, thereby generating dynamic data on antibacterial resistance for decision-makers. To date, 19 countries have begun implementing the Tricycle protocol, while other countries will start implementation in the coming years. The Network for Enhancing Tricycle ESBL Surveillance Efficiency (NETESE) was established to support countries implementing the Tricycle protocol. Currently, NETESE includes representatives from 15 institutions in eight low- or middle-income countries at different stages of Tricycle protocol implementation, and from four European countries involved in devising the protocol. This paper describes the Tricycle protocol, reports the initial experiences of NETESE participants with its implementation and discusses future challenges and opportunities. [ABSTRACT FROM AUTHOR]

Objective To describe a systematic process of transforming paper registers into a digital system optimized to enhance service provision and fulfil reporting requirements. Methods We designed a formative study around primary health workers providing reproductive, maternal, newborn and child health services in three countries in Bangladesh, Indonesia and Pakistan. The study ran from November 2014 to June 2018. We developed a prototype digital application after conducting a needs assessment of health workers' responsibilities, workflows, routine data requirements and service delivery needs. Methods included desk reviews, focus group discussions, in-depth interviews; data mapping of paper registers; observations of health workers; co-design workshops with health workers; and usability testing. Finally, we conducted an observational feasibility assessment to monitor uptake of the application. Findings Researchers reviewed a total of 17 paper registers across the sites, which we transformed into seven modules within a digital application running on mobile devices. Modules corresponded to the services provided, including household enumeration, antenatal care, family planning, immunization, nutrition and child health. A total of 65 health workers used the modules during the feasibility assessment, and average weekly form submissions ranged from 8 to 234, depending on the health worker and their responsibilities. We also observed variability in the use of modules, requiring consistent monitoring support for health workers. Conclusion Lessons learnt from this study shaped key global initiatives and resulted in a software global good. The deployment of digital systems requires well-designed applications, change management and strengthening human resources to realize and sustain health system gains. Objectif Decrire un processus methodique de transformation des registres papier en systeme numerique optimise, en vue d'ameliorer la fourniture de services et de remplir les exigences relatives a l'etablissement de rapports. Methodes Nous avons concu une etude formative consacree aux professionnels des soins primaires proposant des services de sante reproductive et maternelle, de sante des nouveau-nes et de sante infantile dans trois pays: le Bangladesh, l'Indonesie et le Pakistan. Cette etude a ete menee entre novembre 2014 et juin 2018. Nous avons mis au point un prototype d'application numerique apres avoir evalue les besoins des soignants, leurs responsabilites, leur charge de travail, les donnees necessaires a leurs activites quotidiennes et les imperatifs lies a leurs prestations de service. Parmi les methodes employees figuraient des examens documentaires, des discussions de groupes, des entretiens approfondis; une cartographie des donnees fondee sur les registres papier; une observation des professionnels de la sante; des ateliers de cocreation avec les soignants; et enfin, des tests d'utilisabilite. Pour terminer, nous avons effectue une analyse de faisabilite observationnelle afin de mesurer le taux d'adhesion a l'application. Resultats Les chercheurs ont passe au crible un total de 17 registres papier sur l'ensemble des sites, que nous avons transformes en sept modules repris dans une application numerique compatible avec les appareils mobiles. Ces modules correspondaient aux services proposes, dont le recensement des menages, les soins prenatals, la planification familiale, la vaccination, la nutrition et la sante infantile. Au total, 65 soignants ont utilise les modules au cours de l'analyse de faisabilite et le nombre moyen de formulaires soumis chaque semaine etait compris entre 8 et 234, en fonction du soignant et de ses responsabilites. Nous avons egalement observe des variations dans l'utilisation des modules, ce qui montre la necessite d'assurer un suivi permanent aupres des professionnels de la sante. Conclusion Les lecons tirees de cette etude ont permis de faconner des initiatives internationales majeures et d'elaborer un logiciel d'interet mondial. Le deploiement de dispositifs numeriques requiert des applications bien pensees, une bonne gestion du changement et un renforcement des ressources humaines afin d'obtenir et de preserver les avantages pour le systeme de sante. Objetivo Describir un proceso sistematico que permita transformar los registros en papel en un sistema digital optimizado para mejorar la prestacion de servicios y cumplir con los requisitos de informacion. Metodos Se diseno un estudio formativo en torno a los profesionales de la salud primaria que prestan servicios de salud reproductiva, materna, neonatal e infantil en tres paises: de Bangladesh, Indonesia y Pakistan. El estudio se realizodesarrollo entre noviembre de 2014 y junio de 2018. Se desarrollo un prototipo de aplicacion digital despues de realizar una evaluacion sobre las necesidades de las responsabilidades de los profesionales sanitarios, los flujos de trabajo, los requisitos de datos rutinarios y las necesidades de prestacion de servicios. Los metodos incluyeron revisiones de documentos, grupos de discusion, entrevistas en profundidad; mapeo de datos de los registros en papel; observaciones de los profesionales sanitarios; talleres de codiseno con los profesionales sanitarios; y pruebas de usabilidad. Por ultimo, se llevo a cabo una evaluacion de viabilidad observacional para supervisar la aceptacion de la aplicacion. Resultados Los investigadores revisaron un total de 17 registros en papel en todos los sitios, que se adaptaron a siete modulos dentro de una aplicacion digital que funcionaba en dispositivos moviles. Los modulos correspondian a los servicios prestados, como la enumeracion de los hogares, la atencion prenatal, la planificacion familiar, la inmunizacion, la nutricion y la salud infantil. Un total de 65 profesionales sanitarios utilizaron los modulos durante la evaluacion de viabilidad, y la media de envios de formularios semanales oscilo entre 8 y 234, dependiendo del profesional sanitario y de sus responsabilidades. Tambien se observo una variabilidad en el uso de los modulos, lo que requirio un apoyo de seguimiento constante por parte de los profesionales sanitarios. Conclusion Las lecciones aprendidas de este estudio dieron forma a iniciativas globales clave y permitieron crear un programa informatico de interes mundial. El despliegue de los sistemas digitales requiere aplicaciones bien disenadas, la gestion del cambio y el fortalecimiento de los recursos humanos para realizar y mantener los beneficios del sistema sanitario., Introduction Global agencies advocate for the use of information and communication technologies to accelerate progress on priorities, such as the sustainable development goals, the Roadmap for Measurement and Accountability, and [...]

Law lies at the centre of successful national strategies for prevention and control of noncommunicable diseases. By law we mean international agreements, national and subnational legislation, regulations and other executive instruments, and decisions of courts and tribunals. However, the vital role of law in global health development is often poorly understood, and eclipsed by other disciplines such as medicine, public health and economics. This paper identifies key areas of intersection between law and noncommunicable diseases, beginning with the role of law as a tool for implementing policies for prevention and control of leading risk factors. We identify actions that the World Health Organization and its partners could take to mobilize the legal workforce, strengthen legal capacity and support effective use of law at the national level. Legal and regulatory actions must move to the centre of national noncommunicable disease action plans. This requires high-level leadership from global and national leaders, enacting evidence-based legislation and building legal capacities.

An introduction is presented to a series of papers focused on the scientific dialogue between sectors on health and economics, with topics including constitutional right to health, advancements in mental health as part of a well-being economy, and health taxonomy development to guide sustainable investment decisions.

The World Health Organization recommends economic measures such as taxes on tobacco, alcohol and unhealthy foods and beverages as part of a comprehensive strategy for prevention of noncommunicable diseases. However, progress in adopting these so-called health taxes has been hampered, in part, by different approaches and perceptions of key issues in different sectors of government. Health promotion is the responsibility of health policy-makers, while taxation is the mandate of finance ministries. Thus, strengthening cooperation between health and finance policy-makers is central to the successful adoption and implementation of effective health taxes. In this paper we identify the shared concerns of finance and health policy-makers about health taxes with the aim of enabling more effective cross-sector cooperation towards both additional financing for health systems and changes in unhealthy behaviours. For example, new approaches to supporting health taxation include the growing priority for health-system financing due to the growing burden of noncommunicable diseases, and the need to address the health and economic damage due to the coronavirus disease 2019 pandemic. As a result, high-level efforts to achieve progress on health taxes are gaining momentum and represent important progress towards using the combined expertise of health and finance policy-makers. [ABSTRACT FROM AUTHOR]

There is increasing use of machine learning for the health financing functions (revenue raising, pooling and purchasing), yet evidence lacks for its effects on the universal health coverage (UHC) objectives. This paper provides a synopsis of the use cases of machine learning and their potential benefits and risks. The assessment reveals that the various use cases of machine learning for health financing have the potential to affect all the UHC intermediate objectives--the equitable distribution of resources (both positively and negatively); efficiency (primarily positively); and transparency (both positively and negatively). There are also both positive and negative effects on all three UHC final goals, that is, utilization of health services in line with need, financial protection and quality care. When the use of machine learning facilitates or simplifies health financing tasks that are counterproductive to UHC objectives, there are various risks--for instance risk selection, cost reductions at the expense of quality care, reduced financial protection or over-surveillance. Whether the effects of using machine learning are positive or negative depends on how and for which purpose the technology is applied. Therefore, specific health financing guidance and regulations, particularly for (voluntary) health insurance, are needed. To inform the development of specific health financing guidance and regulation, we propose several key policy and research questions. To gain a better understanding of how machine learning affects health financing for UHC objectives, more systematic and rigorous research should accompany the application of machine learning. Alors que l'apprentissage machine connait un usage croissant pour les fonctions de financement de la sante (collecte de revenus, mise en commun et achat), les preuves manquent quant a ses effets sur les objectifs de la couverture sanitaire universelle (CSU). Ce document presente une synthese des cas d'utilisation de l'apprentissage machine et de leurs avantages et risques potentiels. [(evaluation revele que les differents cas d'utilisation de l'apprentissage machine pour le financement de la sante sont susceptibles d'affecter tous les objectifs intermediaires de la CSU: la distribution equitable des ressources (a la fois positivement et negativement), l'efficacite (principalement positivement) et la transparence (a la fois positivement et negativement). Il existe egalement des effets positifs et negatifs sur les trois objectifs finaux de la CSU, a savoir l'utilisation des services de sante en fonction des besoins, la protection financiere et la qualite des soins. Lorsque l'utilisation de l'apprentissage machine facilite ou simplifie des taches de financement de la sante qui vont a lencontre des objectifs de la CSU, differents risques se font jour, comme la selection des risques, la reduction des couts au detriment de la qualite des soins, la reduction de la protection financiere ou la surveillance excessive. Les effets positifs ou negatifs de l'utilisation de l'apprentissage machine dependent de la maniere dont la technologie est appliquee et de l'objectif poursuivi. C'est pourquoi s'imposent des orientations et des reglementations specifiques en matiere de financement de la sante, en particulier pour l'assurance maladie (volontaire). Afin d'eclairer l'elaboration de telles orientations et reglementations, nous proposons plusieurs questions cles en matiere de politique et de recherche. Pour mieux comprendre la facon dont l'apprentissage machine affecte le financement de la sante dans le cadre des objectifs de la CSU, une recherche plus systematique et plus rigoureuse devrait accompagner la mise en oeuvre de l'apprentissage machine. Aunque el uso del aprendizaje automatico para las funciones de financiacion sanitaria (recaudacion de ingresos, mancomunacion y compra) es cada vez mayor, no hay evidencias de sus efectos sobre los objetivos de la cobertura sanitaria universal (CSU). Este documento ofrece una sinopsis de los casos de uso del aprendizaje automatico y sus posibles beneficios y riesgos. La evaluacion revela que los diversos casos de uso del aprendizaje automatico para la financiacion sanitaria tienen el potencial de afectar a todos los objetivos intermedios de la CSU: la distribucion equitativa de los recursos (tanto positiva como negativamente), la eficiencia (principalmente positiva) y la transparencia (tanto positiva como negativamente). Tambien hay efectos positivos y negativos en los tres objetivos finales de la CSU, es decir, la utilizacion de los servicios sanitarios en funcion de las necesidades, la proteccion financiera y la atencion de calidad. El uso del aprendizaje automatico para facilitar o simplificar tareas de financiacion sanitaria contraproducentes para los objetivos de la CSU plantea diversos riesgos, como la seleccion de riesgos, la reduccion de costes a expensas de la calidad de la atencion, la disminucion de la proteccion financiera o el exceso de vigilancia. El caracter positivo o negativo de los efectos del aprendizaje automatico depende de como y con que fin se aplique la tecnologia. Por lo tanto, se necesitan directrices y reglamentos especificos para la financiacion sanitaria, en particular para los seguros de salud (voluntarios). Proponemos varias preguntas clave en materia de politica e investigacion para contribuir a la elaboracion de directrices y reglamentos especificos sobre financiacion sanitaria. A fin de comprender mejor como afecta el aprendizaje automatico al logro de los objetivos de la CSU en el ambito de la financiacion sanitaria, la aplicacion del aprendizaje automatico deberia ir acompanada de una investigacion mas sistematica y rigurosa., Introduction Over the past 10 years, the number of publications on artificial intelligence and machine learning related to health financing tasks has markedly increased, (1) in line with the trend [...]

A robust health infrastructure in every country is the most effective long-term preparedness strategy for global health emergencies. This includes not only health systems and their human resources, but also countries' legal infrastructure for health: the laws and policies that empower, obligate and sometimes limit government and private action. The law is also an important tool in health promotion and protection. Public health professionals play important roles in health law - from the development of policies, through their enforcement, to the scientific evaluation of the health impact of laws. Member States are already mandated to communicate their national health laws and regulations to the World Health Organization (WHO). In this paper we propose that WHO has the authority and credibility to support capacity-building in the area of health law within Member States, and to make national laws easier to access, understand, monitor and evaluate. We believe a strong case can be made to donors for the funding of a public health law centre or unit, that has adequate staffing, is robustly networked with its regional counterparts and is integrated into the main work of WHO. The mission of the unit or centre would be to define and integrate scientific and legal expertise in public health law, both technical and programmatic, across the work of WHO, and to conduct and facilitate global health policy surveillance.

Poor control of cardiovascular disease accounts for a substantial proportion of the disease burden in developing countries, but often essential anticoagulant medicines for preventing strokes and embolisms are not widely available. In 2019, direct oral anticoagulants were added to the World Health Organization's WHO Model list of essential medicines. The aims of this paper are to summarize the benefits of direct oral anticoagulants for patients with cardiovascular disease and to discuss ways of increasing their usage internationally. Although the cost of direct oral anticoagulants has provoked debate, the affordability of introducing these drugs into clinical practice could be increased by: price negotiation; pooled procurement; competitive tendering; the use of patent pools; and expanded use of generics. In 2017, only 14 of 137 countries that had adopted national essential medicines lists included a direct oral anticoagulant on their lists. This number could increase rapidly if problems with availability and affordability can be tackled. Once the types of patient likely to benefit from direct oral anticoagulants have been clearly defined in clinical practice guidelines, coverage can be more accurately determined and associated costs can be better managed. Government action is required to ensure that direct oral anticoagulants are covered by national budgets because the absence of reimbursement remains an impediment to achieving universal coverage. Tackling cardiovascular disease with the aid of direct oral anticoagulants is an essential component of efforts to achieve the World Health Organization's target of reducing premature deaths due to noncommunicable disease by 25% by 2025. [ABSTRACT FROM AUTHOR]

The World Health Organization has endorsed the use of outreach to promote: efficient redeployment of the health-care workforce; continuity of care at the local level; and professional support for local, rural, health-care workers. Australia is the only country that has had, since 2000, a sustained national policy on outreach for subsidizing medical specialist outreach to rural areas. This paper describes the adoption, implementation and prioritization of a national specialist outreach policy in Australia. Adoption of the national policy followed a long history of successful outreach, largely driven by the professional interest and personal commitment of the workforce. Initially the policy supported only new outreach services but concerns about the sustainability of existing services resulted in eligibility for funding being extended to all specialist services. The costs of travel, travel time, accommodation, professional support, staff relief at specialists' primary practices and equipment hire were subsidized. Over time, a national political commitment to the equitable treatment of indigenous people resulted in more targeted support for outreach in remote areas. Current priorities are: (i) establishing team-based outreach services; (ii) improving local staff's skills; (iii) achieving local coordination; and (iv) conducting a nationally consistent needs assessment. The absence of subsidies for specialists' clinical work can discourage private specialists from providing services in remote areas where clinical throughput is low. To be successful, outreach policy must harmonize with the interests of the workforce and support professional autonomy. Internationally, the development of outreach policy must take account of the local pay and practice conditions of health workers.

The cestode Taenia solium is responsible for a considerable cross-sectoral health and economic burden due to human neurocysticercosis and porcine cysticercosis. The 2012 World Health Organization (WHO) roadmap for neglected tropical diseases called for the development of a validated strategy for control of T. solium; however, such a strategy is not yet available. In 2019, WHO launched a global consultation aimed at refining the post-2020 targets for control of T. solium for a new roadmap for neglected tropical diseases. In response, two groups working on taeniasis and cysticercosis mathematical models (cystiSim and EPICYST models), together with a range of other stakeholders organized a workshop to provide technical input to the WHO consultation and develop a research plan to support efforts to achieve the post-2020 targets. The workshop led to the formation of a collaboration, CystiTeam, which aims to tackle the population biology, transmission dynamics, epidemiology and control of T. solium through mathematical modelling approaches. In this paper, we outline developments in T. solium control and in particular the use of modelling to help achieve post-2020 targets for control of T. solium. We discuss the steps involved in improving confidence in the predictive capacities of existing mathematical and computational models on T. solium transmission, including model comparison, refinement, calibration and validation. Expanding the CystiTeam partnership to other research groups and stakeholders, particularly those operating in different geographical and endemic areas, will enhance the prospects of improving the applicability of T. solium transmission models to inform taeniasis and cysticercosis control strategies. [ABSTRACT FROM AUTHOR]

The World Health Organization released revised principles and recommendations for HIV and infant feeding in November 2009. The recommendations are based on programmatic evidence and research studies that have accumulated over the past few years within African countries. This document urges national or subnational health authorities to decide whether health services should mainly counsel and support HIV-infected mothers to breastfeed and receive antiretroviral interventions, or to avoid all breastfeeding, based on estimations of which strategy is likely to give infants in those communities the greatest chance of HIV-free survival. South Africa has recently revised its clinical guidelines for prevention of mother-to-child HIV transmission, adopting many of the recommendations in the November 2009 World Health Organization's rapid advice on use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. However, one aspect of the new South African guidelines gives cause for concern: the continued provision of free formula milk to HIV-infected women through public health facilities. This paper presents the latest evidence regarding mortality and morbidity associated with feeding practices in the context of HIV and suggests a modification of current policy to prioritize child survival for all South African children.

The neglected tropical diseases (NTDs), which affect the very poor, pose a major public health problem in the South-East Asia Region of the World Health Organization (WHO). Although more than a dozen NTDs affect the region, over the past five years four of them in particular - leprosy, lymphatic filariasis, visceral leishmaniasis (kala-azar) and yaws - have been targeted for elimination. These four were selected for a number of reasons. First, they affect the WHO South-East Asia Region disproportionately. For example, every year around 67% of all new leprosy cases and 60% of all new cases of visceral leishmaniasis worldwide occur in countries of the region, where as many as 850 million inhabitants are at risk of contracting lymphatic filariasis. In addition, several epidemiological, technological and historical factors that are unique to the region make each of these four diseases amenable to elimination. Safe and effective tools and interventions to achieve these targets are available and concerted efforts to scale them up, singly or in an integrated manner, are likely to lead to success. The World Health Assembly and the WHO Regional Committee, through a series of resolutions, have already expressed regional and global commitments for the elimination of these diseases as public health problems. Such action is expected to have a quick and dramatic impact on poverty reduction and to contribute to the achievement of the Millennium Development Goals. This paper reviews the policy rationale for disease control in the WHO South-East Asia Region, the progress made so far, the lessons learnt along the way, and the remaining challenges and opportunities.

Mental health is a low priority in most countries around the world. Minimal research and resources have been invested in mental health at the national level. As a result, WHO has developed the Assessment Instrument for Mental Health Systems (WHO-AIMS) to encourage countries to gather data and to re-evaluate their national mental health policy. This paper demonstrates the utility and limitations of WHO-AIMS by applying the model to four countries with different cultures, political histories and public health policies: Iraq, Japan, the Philippines and The former Yugoslav Republic of Macedonia. WHO-AIMS provides a useful model for analysing six domains: policy and legislative framework; mental health services; mental health in primary care; human resources; education of the public at large; and monitoring and research. This is especially important since most countries do not have experts in mental health policy or resources to design their own evaluation tools for mental health systems. Furthermore, WHO-AIMS provides a standardized database for cross-country comparisons. However, limitations of the instrument include the neglect of the politics of mental health policy development, underestimation of the role of culture in mental health care utilization, and questionable measurement validity.

The release of the new WHO guidelines on HIV and infant feeding, in a global context of widespread impoverishment, requires countries to re-examine their infant-feeding policies in relation to broader socioeconomic issues. This widening scope is necessitated by compelling new reports on the scale of global underdevelopment in developing countries. This paper explores these issues by addressing feeding choices made by HIV-infected mothers and programmes supplying free formula milks within a global environment of persistent poverty. Accumulating evidence on the increase in malnutrition, morbidity and mortality associated with the avoidance or early cessation of breastfeeding by HIV-infected mothers, and the unanticipated hazards of formula feeding, demand a deeper assessment of the measures necessary for optimum policies on infant and child nutrition and for the amelioration of poverty. Piecemeal interventions that increase resources directed at only a fraction of a family's impoverishment, such as basic materials for preparation of hygienic formula feeds and making flawed decisions on choice of infant feeding, are bound to fail. These are not alternatives to taking fundamental steps to alleviate poverty. The economic opportunity costs of such programmes, the equity costs of providing resources to some and not others, and the leakages due to temptation to sell capital goods require careful evaluation. Providing formula to poor populations with high HIV prevalence cannot be justified by the evidence, by humanitarian considerations, by respect for local traditions or by economic outcomes. Exclusive breastfeeding, which is threatened by the HIV epidemic, remains an unfailing anchor of child survival.

Objective: To estimate the cost of scaling up childhood immunization services required to reach the WHO-UNICEF Global Immunization Vision and Strategy (GIVS) goal of reducing mortality due to vaccine-preventable diseases by two-thirds by 2015., Methods: A model was developed to estimate the total cost of reaching GIVS goals by 2015 in 117 low- and lower-middle- income countries. Current spending was estimated by analysing data from country planning documents, and scale-up costs were estimated using a bottom-up, ingredients-based approach. Financial costs were estimated by country and year for reaching 90% coverage with all existing vaccines; introducing a discrete set of new vaccines (rotavirus, conjugate pneumococcal, conjugate meningococcal A and Japanese encephalitis); and conducting immunization campaigns to protect at-risk populations against polio, tetanus, measles, yellow fever and meningococcal meningitis., Findings: The 72 poorest countries of the world spent US$ 2.5 (range: US$ 1.8-4.2) billion on immunization in 2005, an increase from US$ 1.1 (range: US$ 0.9-1.6) billion in 2000. By 2015 annual immunization costs will on average increase to about US$ 4.0 (range US$ 2.9-6.7) billion. Total immunization costs for 2006-2015 are estimated at US$ 35 (range US$ 13-40) billion; of this, US$ 16.2 billion are incremental costs, comprised of US$ 5.6 billion for system scale-up and US$ 8.7 billion for vaccines; US$ 19.3 billion is required to maintain immunization programmes at 2005 levels. In all 117 low- and lower-middle-income countries, total costs for 2006-2015 are estimated at US$ 76 (range: US$ 23-110) billion, with US$ 49 billion for maintaining current systems and $27 billion for scaling-up., Conclusion: In the 72 poorest countries, US$ 11-15 billion (30%-40%) of the overall resource needs are unmet if the GIVS goals are to be reached. The methods developed in this paper are approximate estimates with limitations, but provide a roadmap of financing gaps that need to be filled to scale up immunization by 2015.

Since 1977, the WHO Model List of Essential Medicines (EML), published by WHO, has provided advice for Member States that struggle to decide which pharmaceutical technologies should be provided to patients within their public health systems. Originating from outside WHO, an incentive system has been put in place by various governments for the development of medicines for rare diseases ("orphan drugs"). With progress in pharmaceutical research (e.g. drugs targeted for narrower indications), these medicines will feature more often on future public health agendas. However, when current definitions for selecting essential medicines are applied strictly, orphan drugs cannot be part of the WHO Essential Medicines Programme, creating the risk that WHO may lose touch with this field. In our opinion WHO should explicitly include orphan drugs in its policy sphere by composing a complementary Orphan Medicines Model List as an addition to the EML. This complementary list of "rare essentials" could aid policy-makers and patients in, for example, emerging countries to improve access to these drugs and stimulate relevant policies. Furthermore, inconsistencies in the current EML with regard to medicines for rare diseases can be resolved. In this paper we propose selection criteria for an Orphan Medicines Model List that could form a departure point for future work towards an extensive WHO Orphan Medicines Programme.

Can leprosy be eliminated? This paper considers the question against the background of the WHO programme to eliminate leprosy. In 1991 the World Health Assembly set a target of eliminating leprosy as a public health problem by 2000. Elimination was defined as reaching a prevalence of < 1 case per 10 000 people. The elimination programme has been successful in delivering highly effective antibiotic therapy worldwide. However, despite this advance, new-case detection rates remain stable in countries with the highest rates of endemic leprosy, such as Brazil and India. This suggests that infection has not been adequately controlled by antibiotics alone. Leprosy is perhaps more appropriately classed as a chronic stable disease than as an acute infectious disease responsive to elimination strategies. In many countries activities to control and treat leprosy are being integrated into the general health-care system. This reduces the stigma associated with leprosy. However, leprosy causes long-term immunological complications, disability and deformity. The health-care activities of treating and preventing disabilities need to be provided in an integrated setting. Detecting new cases and monitoring disability caused by leprosy will be a challenge. One solution is to implement long-term surveillance in selected countries with the highest rates of endemic disease so that an accurate estimate of the burden of leprosy can be determined. It is also critical that broad-based research into this challenging disease continues until the problems are truly solved.

Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources - out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance - classified according to their completeness and reliability. Total health spending rises from around 2-3% of gross domestic product (GDP) at low incomes (< 1000 US dollars per capita) to typically 8-9% at high incomes (> 7000 US dollars). Surprisingly, there is as much relative variation in the share for poor countries as for rich ones, and even more relative variation in amounts in US dollars. Poor countries and poor people that most need protection from financial catastrophe are the least protected by any form of prepayment or risk-sharing. At low incomes, out-of-pocket spending is high on average and varies from 20-80% of the total; at high incomes that share drops sharply and the variation narrows. Absolute out-of-pocket expenditure nonetheless increases with income. Public financing increases faster, and as a share of GDP, and converges at high incomes. Health takes an increasing share of total public expenditure as income rises, from 5-6% to around 10%. This is arguably the opposite of the relation between total health needs and need for public spending, for any given combination of services. Within public spending, there is no convergence in the type of finance - general revenue versus social insurance. Private insurance is usually insignificant except in some rich countries.

Objective To synthesize findings from recent studies of strategies to deliver insecticide-treated nets (ITNs) at scale in malaria-endemic areas. Methods Databases were searched for studies published between January 2000 and December 2010 in which: subjects resided in areas with endemicity for Plasmodium falciparum and Plasmodium vivax malaria; ITN delivery at scale was evaluated; ITN ownership among households, receipt by pregnant women and/or use among children aged < 5 years was evaluated; and the study design was an individual or cluster-randomized controlled design, nonrandomized, quasi-experimental, before-and-after, interrupted time series or cross-sectional without temporal or geographical controls. Papers describing qualitative studies, case studies, process evaluations and cost-effectiveness studies linked to an eligible paper were also included. Study quality was assessed using the Cochrane risk of bias checklist and GRADE criteria. Important influences on scaling up were identified and assessed across delivery strategies. Findings A total of 32 papers describing 20 African studies were reviewed. Many delivery strategies involved health sectors and retail outlets (partial subsidy), antenatal care clinics (full subsidy) and campaigns (full subsidy). Strategies achieving high ownership among households and use among children < 5 delivered ITNs free through campaigns. Costs were largely comparable across strategies; ITNs were the main cost. Cost-effectiveness estimates were most sensitive to the assumed net lifespan and leakage. Common barriers to delivery included cost, stock-outs and poor logistics. Common facilitators were staff training and supervision, cooperation across departments or ministries and stakeholder involvement. Conclusion There is a broad taxonomy of strategies for delivering ITNs at scale. [ABSTRACT FROM AUTHOR]

Following early success with a number of high-profile partnerships, WHO is increasingly working with the private for-profit sector. In so doing, the organization finds itself in the maelstrom of a vibrant debate on the roles of public, civic, and commercial entities in society and on the appropriate modes of interaction among them. This paper examines WHO's involvement with the commercial sector, particularly in partnerships. WHO's approach to this sector is outlined and the criticisms levelled at public-private partnerships are reviewed. An indication is given of the steps recently taken by WHO to confront the concerns that have been expressed. The paper argues that partnership between WHO and the commercial sector is inevitable and that it presents considerable opportunities, but also significant risks, for the organization and for public health. A strategy is proposed for directing the debate on issues critical to WHO and its role in the promotion and protection of public health.

Low back pain is the leading cause of years lived with disability globally. In 2018, an international working group called on the World Health Organization to increase attention on the burden of low back pain and the need to avoid excessively medical solutions. Indeed, major international clinical guidelines now recognize that many people with low back pain require little or no formal treatment. Where treatment is required the recommended approach is to discourage use of pain medication, steroid injections and spinal surgery, and instead promote physical and psychological therapies. Many health systems are not designed to support this approach. In this paper we discuss why care for low back pain that is concordant with guidelines requires system-wide changes. We detail the key challenges of low back pain care within health systems. These include the financial interests of pharmaceutical and other companies; outdated payment systems that favour medical care over patients' self-management; and deep-rooted medical traditions and beliefs about care for back pain among physicians and the public. We give international examples of promising solutions and policies and practices for health systems facing an increasing burden of ineffective care for low back pain. We suggest policies that, by shifting resources from unnecessary care to guideline-concordant care for low back pain, could be cost-neutral and have widespread impact. Small adjustments to health policy will not work in isolation, however. Workplace systems, legal frameworks, personal beliefs, politics and the overall societal context in which we experience health, will also need to change. [ABSTRACT FROM AUTHOR]

The demographic transition towards an ageing population and the epidemiological transition from communicable to noncommunicable diseases have increased the demand for rehabilitation services globally. The aims of this paper were to describe the integration of rehabilitation into the Japanese health system and to illustrate how health information systems containing real-world data can be used to improve rehabilitation services, especially for the ageing population of Japan. In addition, there is an overview of how evidence-informed rehabilitation policy is guided by the analysis of large Japanese health databases, such as: (i) the National Database of Health Insurance Claims and Specific Health Checkups; (ii) the long-term care insurance comprehensive database; and (iii) the Long-Term Care Information System for Evidence database. Especially since the 1990s, the integration of rehabilitation into the Japanese health system has been driven by the country's ageing population and rehabilitation is today provided widely to an increasing number of older adults. General medical insurance in Japan covers acute and post-acute (or recovery) intensive rehabilitation. Long-term care insurance covers rehabilitation at long-term care institutions and community facilities for older adults with the goal of helping to maintain independence in an ageing population. The analysis of large health databases can be used to improve the management of rehabilitation care services and increase scientific knowledge as well as guide rehabilitation policy and practice. In particular, such analyses could help solve the current challenges of overtreatment and undertreatment by identifying strict criteria for determining who should receive long-term rehabilitation services. Tant la transition demographique vers un vieillissement de la population que la transition epidemiologique des maladies transmissibles vers les maladies non transmissibles ont entraine une augmentation de la demande en services de readaptation dans le monde. Le present document poursuit plusieurs objectifs: decrire l'integration de la readaptation dans le systeme de sante au Japon, et illustrer comment les systemes de sante contenant des donnees reelles peuvent etre utilises en vue d'ameliorer de tels services, en particulier pour une population nipponne vieillissante. En outre, il offre un apercu de la maniere dont la politique de readaptation etayee par des faits s'inspire de l'analyse de vastes bases de donnees sanitaires japonaises, parmi lesquelles: (i) la base de donnees nationale des demandes de remboursement au titre de l'assurance-maladie et des bilans de sante specifiques; (ii) la base de donnees complete de l'assurance pour les soins longue duree; et enfin, (iii) la base de donnees du systeme d'information relatif aux attestations de soins longue duree. Le vieillissement de la population a pousse le Japon a inclure la readaptation dans son systeme de sante, surtout depuis les annees 1990; aujourd'hui, un nombre croissant de personnes agees ont aisement acces a des services de readaptation. Au Japon, l'assurance-maladie globale prend en charge la readaptation intensive aigue et post-aigue (ou de retablissement). De son cote, l'assurance pour les soins longue duree couvre la readaptation dans les etablissements dedies et les infrastructures collectives accueillant des personnes agees, avec pour but de contribuer a preserver l'autonomie au sein d'une population vieillissante. Lanalyse de vastes bases de donnees sanitaires peut favoriser une meilleure gestion des services de readaptation et accroitre les connaissances scientifiques, mais aussi orienter les politiques et pratiques en la matiere. Ce type d'analyse peut surtout aider a s'attaquer aux enjeux actuels que representent les traitements excessifs ou insuffisants, en identifiant des criteres stricts permettant de determiner qui doit faire l'objet d'une readaptation sur le long terme. La transicion demografica hacia el envejecimiento de la poblacion y la transicion epidemiologica de las enfermedades transmisibles a las no transmisibles han aumentado la demanda de servicios de rehabilitacion en todo el mundo. Los objetivos de este articulo son describir la integracion de la rehabilitacion en el sistema sanitario japones e ilustrar como los sistemas de informacion sanitaria que contienen datos del mundo real se pueden utilizar para mejorar los servicios de rehabilitacion, en especial para la poblacion que envejece en Japon. Ademas, se ofrece una vision general de como la politica de rehabilitacion fundamentada en la evidencia se guia por el analisis de las grandes bases de datos sanitarias japonesas, como: (i) la Base de Datos Nacional de Reclamaciones al Seguro de Enfermedad y Chequeos Medicos Especificos; (ii) la base de datos integral del seguro de cuidados de larga duracion; y (iii) la base de datos del Sistema de Informacion de Cuidados de Larga Duracion para la Evidencia. En particular, desde la decada de 1990, la integracion de la rehabilitacion en el sistema sanitario japones se ha visto impulsada por el envejecimiento de la poblacion del pais y, en la actualidad, la rehabilitacion se ofrece de forma generalizada a una cantidad cada vez mayor de adultos mayores. El seguro medico general de Japon cubre la rehabilitacion intensiva aguda y posaguda (o de recuperacion). El seguro de cuidados de larga duracion cubre la rehabilitacion en instituciones de larga estancia y centros comunitarios para adultos mayores con el objetivo de ayudar a mantener la independencia en una poblacion que envejece. El analisis de las grandes bases de datos sanitarias puede servir para mejorar la gestion de los servicios de atencion a la rehabilitacion y aumentar los conocimientos cientificos, asi como para orientar la politica y la practica de la rehabilitacion. En concreto, estos analisis podrian ayudar a resolver los problemas actuales de sobretratamiento y subtratamiento, al identificar criterios estrictos para determinar quien debe recibir servicios de rehabilitacion de larga duracion., Introduction Member States of the United Nations are committed to the sustainable development goals, (1) which include universal health coverage as a key driver of health and well-being. In addition, [...]

Many HIV/AIDS (acquired immunodeficiency syndrome) models have been developed to help our understanding of the dynamics and interrelationships of the determinants of HIV (human immunodeficiency virus) spread and/or to develop reliable estimates of the eventual extent of such spread. These models range from very simple to very complex. WHO has developed a simple model for short-term projections of AIDS, details of which are presented here along with results obtained using the model to estimate and project AIDS cases for the USA, sub-Saharan Africa, and south/south-east Asia. WHO has also developed, based on the model described in this paper, a computer program (Epi Model), which will enable the user to easily change the values of any of the variables required by the WHO model.

Transforming our world: the 2030 agenda for sustainable development promotes the improvement of health equity, which entails ongoing monitoring of health inequalities. The World Health Organization has developed a multistep approach to health inequality monitoring consisting of: (i) determining the scope of monitoring; (ii) obtaining data; (iii) analysing data; (iv) reporting results; and (v) implementing changes. Technical considerations at each step have implications for the results and conclusions of monitoring and subsequent remedial actions. This paper presents some technical considerations for developing or strengthening health inequality monitoring, with the aim of encouraging more robust, systematic and transparent practices. We discuss key aspects of measuring health inequalities that are relevant to steps (i) and (iii). We highlight considerations related to the selection, measurement and categorization of dimensions of health inequality, as well as disaggregation of health data and calculation of summary measures of inequality. Inequality monitoring is linked to health and non-health aspects of the 2030 agenda for sustainable development, and strong health inequality monitoring practices can help to inform equity-oriented policy directives. [ABSTRACT FROM AUTHOR]

Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC. The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ) of HRH. The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates. The findings inform key principles for evidence-based decision-making on HRH in support of UHC. First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors. Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda. It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] Parvenir a la couverture sanitaire universelle (CSU) implique la repartition des ressources, et en particulier des ressources humaines pour la sante (RHS), afin de repondre aux besoins de la population. Cet article etudie les lecons politiques sur les RHS de quatre pays ayant accompli des progres durables en matiere de CSU: le Bresil, le Ghana, le Mexique et la Thallande. Son but est d'informer sur les politiques globales et les engagements flnanciers dans les RHS visant a promouvoir la CSU. L'article decrit les experiences des pays a l'aide d'un cadre analytique examinant la couverture efficace par rapport a la disponibilite, l'accessibilite, l'accepta bilite et la qualite (DAAQ) des RHS. Les dimensions DAAQ permettent de realiser une analyse de tracage des actions politiques en RHS depuis 1990 dans les quatre pays etudies, par rapport aux tendances nationales des statistiques de main-d'oeuvre et des taux de mortalite de la population. Les resultats indiquent quels sont les principes cles pour la prise de decisions basees sur les faits sur les RHS visant a promouvoir la CSU. Premierement, les RHS sont essentielles a l'expansion de la couverture des services de sante et de l'ensemble des avantages; deuxiemement, des strategies RHS pour chacune des dimensions DAAQ favorisent collectivement les progres vers une couverture efficace; et troisiemement, le succes est atteint a travers des partenariats impliquant des acteurs tant medicaux que non medicaux. Repondre aux defis sans precedent dans les domaines de la sante et d u developpement, qui concernent tous les pays, et transformer les faits RHS en politiques et en pratiques doivent etre a la base du programme de CSU et de l'agenda de developpement post-2015. C'est un imperatif politique qui exige un engagement et un leadership nationaux pour optimiser l'impact des ressources financieres et humaines disponibles et accroitre l'esperance de vie en bonne sante, avec la reconnaissance que les progres dans le domaine des soins de sante ne sont possibles qu'avec une main-d'oeuvre de sante adequate. [TEXT NOT REPRODUCIBLE IN ASCII] Lograr una cobertura sanitaria universal implica una distribucion de los recursos, en particular, de los recursos humanos para la salud (RHS), a fin de satisfacer las necesidades de la poblacion. Este documento examina las lecciones sobre politicas relacionadas con los RHS de cuatro paises que han conseguido avances ininterrumpidas en materia de cobertura sanitaria universal: Brasil, Ghana, Mexico y Tailandia. Su objetivo consiste en exponer la politica mundial y los compromisos financieros sobre RHS como ayuda para una cobertura sanitaria universal. El documento explica las experiencias de los paises mencionados por medio de un marco de trabajo analitica que examina la eficacia de una cobertura en funcion de la disponibilidad, accesibilidad, aceptabilidad y calidad (DAAC) de los RHS. Los aspectos DAAC permiten llevar a cabo analisis de seguimiento sobre las acciones politicas relativas a los RHS desde 1990 en los cuatro paises de interes en relacion con las tendencias nacionales en el numero de trabajadores y las tasas de mortalidad de la poblacion. Los resultados muestran los principios fundamentales para la toma de decisiones basadas en pruebas cientificas sobre los RHS como apoyo a una cobertura sanitaria universal. En primer lugar, los RHS son esenciales para expandir la cobertura de los servicios sanitarios y el conjunto de prestaciones. En segundo lugar, las estrategias RHS en cada uno de los aspectos DAAC respaldan de forma colectiva los logros en la eficacia de la cobertura y, en tercer lugar, los buenos resultados solo pueden conseguirse a traves de la asociacion de actores sanitarios y no sanitarios. Hacer frente a los desafios sanitarios y de desarrollo sin precedentes que afecta n a todos los paises y traducir las pruebas cientificas sobre RHS en politicas y practicas deben convertirse en los puntos centrales de la cobertura sanitaria universal y de la agenda de desarrollo a partir del ano 2015. Se trata de un imperativo politico que requiere un compromiso y liderazgo nacionales para potenciar el impacto de los recursos financieros y humanos disponibles, y asi mejorar la esperanza de vida saludable, sin olvidar que las mejoras en materia de asistencia sanitaria son posibles gracias a un personal sanitario apto para tal proposito., Introduction In December 2012, the United Nations General Assembly called upon all governments to 'urgently and significantly scale up efforts to accelerate the transition towards universal access to affordable and [...]

Objective To describe the temporal and geographical distribution of Zika virus infection and associated neurological disorders, from 1947 to 1 February 2016, when Zika became a Public Health Emergency of International Concern (PHEIC). Methods We did a literature search using the terms "Zika" and "ZIKV" in PubMed, cross-checked the findings for completeness against other published reviews and added formal notifications to WHO submitted under the International Health Regulations. Findings From the discovery of Zika virus in Uganda in 1947 to the declaration of a PHEIC by the World Health Organization (WHO) on 1 February 2016, a total of 74 countries and territories had reported human Zika virus infections. The timeline in this paper charts the discovery of the virus (1947), its isolation from mosquitos (1948), the first human infection (1952), the initial spread of infection from Asia to a Pacific island (2007), the first known instance of sexual transmission (2008), reports of Guillain-Barré syndrome (2014) and microcephaly (2015) linked to Zika infections and the first appearance of Zika in the Americas (from 2015). Conclusion Zika virus infection in humans appears to have changed in character as its geographical range has expanded from equatorial Africa and Asia. The change is from an endemic, mosquito-borne infection causing mild illness to one that can cause large outbreaks linked with neurological sequelae and congenital abnormalities. [ABSTRACT FROM AUTHOR]

Rising incomes, the spread of personal insurance, lifestyle factors adding to the burden of illness, ageing populations, globalization and skills transfer within the medical community have increased worldwide demand for organ transplantation. The Global Observatory on Donation and Transplantation, which was built in response to World Health Assembly resolution WHA57.18, has conducted ongoing documentation of global transplantation activities since 2007. In this paper, we use the Global Observatory’s data to describe the current distribution of – and trends in – transplantation activities and to evaluate the role of health systems factors and macroeconomics in the diffusion of transplantation technology. We then consider the implications of our results for health policies relating to organ donation and transplantation. Of the World Health Organization’s Member States, most now engage in organ transplantation and more than a third performed deceased donor transplantation in 2011. In general, the Member States that engage in organ transplantation have greater access to physician services and greater total health spending per capita than the Member States where organ transplantation is not performed. The provision of deceased donor transplantation was closely associated with high levels of gross national income per capita. There are several ways in which governments can support the ethical development of organ donation and transplantation programmes. Specifically, they can ensure that appropriate legislation, regulation and oversight are in place, and monitor donation and transplantation activities, practices and outcomes. Moreover, they can allocate resources towards the training of specialist physicians, surgeons and transplant coordinators, and implement a professional donor-procurement network. [ABSTRACT FROM AUTHOR]

Objective To assess the individual and community health effects of task shifting for emergency care in low-resource settings and underserved populations worldwide. Methods We systematically searched 13 databases and additional grey literature for studies published between 1984 and 2019. Eligible studies involved emergency care training for laypeople in underserved or low- resource populations, and any quantitative assessment of effects on the health of individuals or communities. We conducted duplicate assessments of study eligibility, data abstraction and quality. We synthesized findings in narrative and tabular format. Findings Of 19 308 papers retrieved, 34 studies met the inclusion criteria from low- and middle-income countries (21 studies) and underserved populations in high-income countries (13 studies). Targeted emergency conditions included trauma, burns, cardiac arrest, opioid poisoning, malaria, paediatric communicable diseases and malnutrition. Trainees included the general public, non-health-care professionals, volunteers and close contacts of at-risk populations, all trained through in-class, peer and multimodal education and public awareness campaigns. Important clinical and policy outcomes included improvements in community capacity to manage emergencies (14 studies), patient outcomes (13 studies) and community health (seven studies). While substantial effects were observed for programmes to address paediatric malaria, trauma and opioid poisoning, most studies reported modest effect sizes and two reported null results. Most studies were of weak (24 studies) or moderate quality (nine studies). Conclusion First aid education and task shifting to laypeople for emergency care may reduce patient morbidity and mortality and build community capacity to manage health emergencies for a variety of emergency conditions in underserved and low-resource settings. Objectif Evaluer l'impact, sur la sante individuelle et collective, du transfert des interventions de premiers secours dans les endroits disposant de ressources limitees et au sein des populations defavorisees a travers le monde. Methodes Nous avons analyse systematiquement 13 bases de donnees ainsi que toute litterature grise complementaire pour y trouver des etudes publiees entre 1984 et 2019. Les etudes retenues devaient faire mention d'une formation aux premiers secours pour les nonprofessionnels au sein des populations defavorisees ou dotees de peu de ressources, mais aussi d'une evaluation quantitative de l'impact sur la sante individuelle et collective. Nous avons duplique les appreciations d'admissibilite de l'etude, de qualite et d'abstraction des donnees. Enfin, nous avons synthetise les resultats sous forme de textes et de tableaux. Resultats Sur 19 308 articles recuperes, 34 etudes correspondaient aux criteres d'inclusion propres aux pays a faibles et moyens revenus (21 etudes) et aux populations defavorisees dans les pays a hauts revenus (13 etudes). Plusieurs situations d'urgence etaient ciblees: traumatismes, brulures, arrets cardiaques, intoxications aux opiaces, malaria, maladies infantiles contagieuses et malnutrition. Les stagiaires etaient des individus issus du grand public, des non-professionnels de la sante, des benevoles et des contacts proches de populations a risque, tous formes dans le cadre de cours multimodaux organises par des pairs et de campagnes de sensibilisation de l'opinion publique. Diverses retombees politiques et cliniques d'envergure ont ete constatees: amelioration de la capacite de gestion des urgences dans les communautes (14 etudes), consequences positives pour les patients (13 etudes) et sante collective (7 etudes). Bien que des effets non negligeables aient ete observes pour les programmes de lutte contre la malaria infantile, les traumatismes et l'intoxication aux opiaces, la plupart des etudes n'ont remarque que des effets d'ampleur modeste et deux ont rapporte un benefice nul. En outre, la majorite d'entre elles se sont revelees de pietre qualite (24 etudes) ou de qualite moyenne (9 etudes). Conclusion La formation aux premiers secours et le transfert des interventions aux non-professionnels peut contribuer a diminuer la morbidite et la mortalite des patients, mais aussi a developper les capacites communautaires de gestion des urgences sanitaires pour une serie de situations dans les milieux defavorises ou manquant de ressources. Objetivo Evaluar los efectos en la salud individual y comunitaria del cambio de tareas para la atencion de emergencia en entornos con bajos recursos y poblaciones desatendidas a nivel mundial. Metodos Se realizaron busquedas sistematicas en 13 bases de datos y en la literatura gris adicional de estudios publicados entre 1984 y 2019. Los estudios elegibles involucraron la formacion en atencion de emergencia para personas no profesionales en poblaciones subatendidas o de bajos recursos, y cualquier evaluacion cuantitativa de los efectos en la salud de los individuos o las comunidades. Se realizaron evaluaciones duplicadas de la elegibilidad de los estudios, la abstraccion de datos y la calidad. Se sintetizaron los resultados en formato narrativo y tabular. Resultados De los 19.308 documentos recuperados, 34 estudios cumplian los criterios de inclusion de paises con ingresos bajos y medios (21 estudios) y de poblaciones desatendidas de paises con ingresos altos (13 estudios). Las condiciones de emergencia a las que se dirigian incluian traumatismos, quemaduras, paros cardiacos, intoxicacion por opioides, malaria, enfermedades pediatricas transmisibles y desnutricion. Entre los alumnos se encontraban el publico en general, los profesionales no sanitarios, los voluntarios y los contactos cercanos de las poblaciones de riesgo, todos ellos formados a traves de campanas de educacion y concienciacion publica presenciales, entre companeros y multimodales. Los resultados clinicos y politicos mas importantes fueron la mejora de la capacidad de la comunidad para gestionar emergencias (14 estudios), los resultados de los pacientes (13 estudios) y la salud de la comunidad (7 estudios). Aunque se observaron efectos sustanciales en los programas para abordar la malaria pediatrica, los traumatismos y la intoxicacion por opioides, la mayoria de los estudios informaron de tamanos de efecto modestos y dos informaron de resultados nulos. La mayoria de los estudios fueron de calidad debil (24 estudios) o moderada (9 estudios). Conclusion La formacion de personas en primeros auxilios y la transferencia de tareas a los legos para la atencion de emergencias pueden reducir la morbilidad y la mortalidad de los pacientes y fomentar la capacidad de la comunidad para gestionar las emergencias sanitarias en una variedad de condiciones de emergencia en entornos desatendidos y de bajos recursos., Introduction Conditions that could be treated with prehospital and emergency care account for an estimated 24 million lives lost each year in low- and middle-income countries. (1) Training lay providers [...]

The maldistribution of health workers between urban and rural areas is a policy concern in virtually all countries. It prevents equitable access to health services, can contribute to increased health-care costs and underutilization of health professional skills in urban areas, and is a barrier to universal health coverage. To address this long-standing concern, the World Health Organization (WHO) has issued global recommendations to improve the rural recruitment and retention of the health workforce. This paper presents experiences with local and regional adaptation and adoption of WHO recommendations. It highlights challenges and lessons learnt in implementation in two countries -- the Lao People's Democratic Republic and South Africa - and provides a broader perspective in two regions -- Asia and Europe. At country level, the use of the recommendations facilitated a more structured and focused policy dialogue, which resulted in the development and adoption of more relevant and evidence-based policies. At regional level, the recommendations sparked a more sustained effort for cross-country policy assessment and joint learning. There is a need for impact assessment and evaluation that focus on the links between the rural availability of health workers and universal health coverage. The effects of any health-financing reforms on incentive structures for health workers will also have to be assessed if the central role of more equitably distributed health workers in achieving universal health coverage is to be supported. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) revised its global recommendations on treating pregnant women infected with the human immunodeficiency virus (HIV) with antiretrovirals and preventing mother-to-child transmission (PMTCT) of HIV. Initial draft recommendations issued in November 2009 were followed by a full revised guideline in July 2010. The 2010 recommendations on PMTCT have important implications in terms of planning, human capacity and resources. Ministries of health therefore had to adapt their national guidelines to reflect the 2010 PMTCT recommendations, and the Elizabeth Glaser Pediatric AIDS Foundation tracked the adaptation process in the 14 countries where it provides technical support. In doing so it sought to understand common issues, challenges, and the decisions reached and to properly target its technical assistance. In 2010, countries revised their national guidelines in accordance with WHO's most recent PMTCT recommendations faster than in 2006; all 14 countries included in this analysis formally conducted the revision within 15 months of the 2010 PMTCT recommendations' release. Governments used various processes and fora to make decisions throughout the adaptation process; they considered factors such as feasibility, health delivery infrastructure, compatibility with 2006 WHO guidelines, equity and cost. Challenges arose; in some cases the new recommendations were implemented before being formally adapted into national guidelines and no direct guidance was available in various technical areas. As future PMTCT guidelines are developed, WHO, implementing partners and other stakeholders can use the information in this paper to plan their support to ministries of health. INSET: Box 1. Summary of key changes in the 2010 PMTCT.... [ABSTRACT FROM AUTHOR]

Quality assurance is essential in laboratory medicine; an important component is external quality assessment in order to ensure that reliable performance is achieved by all laboratories and that between-laboratory comparability is maintained. In a number of countries there are national external quality assessment schemes. WHO has established a programme aimed at encouraging the organization of similar schemes in all countries. Towards this goal an international external quality assessment scheme has been established for each of the specialities of haematology, clinical chemistry, microbiology and parasitology.This paper describes the organization of the international scheme for haematology. There are now 62 laboratories taking part in 49 countries. The functioning of the scheme, the participants' response, and the extent to which the scheme has improved the standard of practice in their laboratories are described.

This paper describes the development of a tool that uses human rights concepts and methods to improve relevant laws, regulations and policies related to sexual and reproductive health. This tool aims to improve awareness and understanding of States' human rights obligations. It includes a method for systematically examining the status of vulnerable groups, involving non-health sectors, fostering a genuine process of civil society participation and developing recommendations to address regulatory and policy barriers to sexual and reproductive health with a clear assignment of responsibility. Strong leadership from the ministry of health, with support from the World Health Organization or other international partners, and the serious engagement of all involved in this process can strengthen the links between human rights and sexual and reproductive health, and contribute to national achievement of the highest attainable standard of health. [ABSTRACT FROM AUTHOR]

Controlled field trials of two dried inactivated typhoid vaccines have been carried out in British Guiana and Yugoslavia under the sponsorship of the World Health Organization. This paper gives details of the methods of preparation of these vaccines in such a manner as to permit of replication by others.Both vaccines were derived from the Ty 2 strain of Salmonella typhosa. For production of the acetone-inactivated vaccine, a portion of the surface agar growth of the Ty 2 strain was treated with acetone by the Landy method modified so that inactivation and handling were done in liquid suspensions rather than on a filter, and the vaccine was dried in the final containers. For the heat-phenol product, another portion of the same growth was processed by heating, the addition of 0.5% phenol and holding at room temperature for 72 hours followed by freeze-drying in the final containers. These vaccines are designed for use within a few hours of the addition of the reconstituting fluid.

In its seventh report, published in 1960, the WHO Expert Committee on Tuberculosis "noted the need for international standards for the definition and determination of drug resistance which will permit comparisons to be made from one area to another, and recommended that the World Health Organization take appropriate steps to establish such standards".(10) Acting on this recommendation, WHO took the first step towards standardization by convening in Geneva, in December 1961, an informal international meeting of specialists in the bacteriology of tuberculosis. At this meeting an attempt was made to formulate prerequisites for reliable sensitivity tests and to specify the technical procedures for them.The first part of the present paper is a joint contribution by the participants in the meeting, summarizing the general conclusions reached and recommendations made with regard to tests of sensitivity to the three main antituberculosis drugs-isoniazid, streptomycin and p-aminosalicylic acid. The other three parts describe, in turn, three different tests for determining drug sensitivity-the absolute-concentration method, the resistance-ratio method and the proportion method-that are generally considered to give reasonably accurate results.