Monitoring is a crucial element in any successful programme. It is important to
know if health care facilities – and ultimately countries – are meeting the agreed
goals and objectives for preventing and managing cardiovascular diseases (CVD).
Monitoring is the on-going collection, management ...and use of information to
assess whether an activity or programme is proceeding according to plan and/
or achieving defined targets. Not all outcomes of interest can be monitored. Clear
outcomes must be identified that relate to the most important changes expected to result from the project and to what is realistic and measurable within the timescale of the project. Once these outcomes have been articulated, indicators can be chosen that best measure whether the desired outcomes are being met.
To allow progress to be monitored, this module provides a set of indicators on
CVD management. Agreeing on a set of indicators allows countries to compare
progress in CVD management and treatment across different districts or
subnational jurisdictions, as well as at a facility level, identify where performance
can be improved, and track trends in implementation over time. Monitoring
these indicators also helps identify problems that may be encountered so that
implementation efforts can be redirected.
This module starts from the collection of data at facility level, which is then
“transferred up” the system: facility-level data are aggregated at subnational level
to produce reports that allow tracking of facility and subnational performance over time and allow for comparison among facilities. National-level data are obtained through population-based surveys.
Implementing a monitoring system requires action at many levels. At national and
subnational levels, staff can determine how best to integrate data elements into
existing data collection systems – such as the routine service-delivery data that are collected through facility-level Health Management Information Systems (HMIS).
In the facility setting, personnel must be aware of what data are needed. Sample
data-collection tools are included, recognizing that countries use different datamanagement systems for HMIS, so the CVD monitoring tools will be adapted to work with the HMIS system being used by the country, such that the indicators can be collected with minimal disruption/work to existing systems and tools
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In many low- and middle-income countries, there is a wide gap between evidencebased recommendations and current practice. Treatment of major CVD risk factors remains suboptimal, and only a minority of patients who are treated reach their target levels for blood pressure, blood sugar and blood choles...terol.
In other areas, overtreatment can occur with the use of non-evidence-based
protocols. The aim of using standard treatment protocols is to improve the quality
of clinical care, reduce clinical variability and simplify the treatment options,
particularly in primary health care. Standard treatment protocols can be developed by preparing new national treatment guidelines or by adapting or adopting international guidelines.
The Evidence-based protocols module uses hypertension and diabetes screening
and treatment as an entry point to control cardiovascular risk factors, prevent target organ damage, and reduce premature morbidity and mortality. A comprehensive risk- based approach for integrated management of hypertension, diabetes, and high cholesterol is included in the Risk-based CVD management module.
This module includes clinical practice points and sample protocols for:
1. hypertension detection and treatment
2. type 2 diabetes detection and treatment
3. identifying basic emergencies – care and referral.
HEARTS emphasizes adaptation, dissemination, and use of a standardized set of
simple clinical-management protocols, which should be drug- and dose-specific,
and include a core set of medications. The simpler the protocols and management tools, the more likely they are to be used correctly, and the higher the likelihood that a programme will achieve its goals.
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Procurement and supply management activities are fundamental to consistent and reliable access to essential medicines and health products. To reduce the impact of CVD, action needs to be taken to improve prevention, diagnosis, care and management of CVD diseases. Affordable essential medicines and t...echnologies to manage CVD disease must be available where and when they are required. Medicines and technologies need to be managed appropriately to ensure that the correct medicines are selected, procured in the right quantities, distributed to facilities in a timely manner, and handled and stored in a way that maintains their quality. This needs to be backed up by policies that enable sufficient quantities to be procured in order to reduce cost inefficiencies, ensure the reliability and security of the distribution system, and encourage the appropriate use of these health products. In order to avoid stock-outs and the disruption of treatment, all related activities need to be conducted in a timely manner, with performance continually monitored, and prompt action taken in response to problems that may arise. Additionally, medication must be dispensed correctly and used rationally by the healthcare provider and patient alike. The purpose of this guide is to explain the necessary steps.
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Many low-resource settings have a shortage of physicians and health workers. (1) In order to provide patient-centred continuous care more effectively, primary care systems can include team-based care strategies in their clinic workflows and protocols. Team-based care uses multidisciplinary teams (wh...ich may involve new staff, or the shifting of tasks among existing staff). Teams can include patients themselves, primary care physicians, and other allied health professionals, such as nurses, pharmacists, counsellors, social workers, nutritionists, community health workers, or others. Teams reduce the burden on physicians by utilizing the skills of trained health workers. Strong evidence shows that team-based care is effective in improving hypertension control among patients in a cost-effective way. (2) Some amount of task shifting/team-based care is already taking place in many settings; this module provides further guidance on how to maximize this approach for greater impact.
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A module from the suite of health service capacity assessments in the context of the COVID-19 pandemic, Interim Guidance 20 October 2020.
This self-assessment tool is designed for acute health-care facilities (i.e. tertiary and secondary) but can be modified for the use in long-term care facilities..., to help identify, prioritize and address the gaps in infection prevention and control (IPC) capacity in managing their response to COVID-19. The tool should be used by IPC professionals and/or those responsible for disaster planning or outbreak management in the facility (such as the response to the COVID-19 outbreak) at the start of the improvement process. A sample workplan template is provided to address gaps identified and record required actions.
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The WHO Quality Health Services: a planning guide focuses on actions required at the national, district and facility levels to enhance quality of health services, providing guidance on implementing key activities at each of these three levels. It highlights the need for a health systems approach to ...enhance quality of care, with a common understanding on the activities needed by all stakeholders. The guide articulates the key actions required to improve the quality of health services for the entire population. It recognizes that the path varies for each country, district and facility – stimulating the reader to consider multiple factors and entry points for action. This planning guide is for staff working at all levels of the health system (i.e. national, district and facility) who have a role in enhancing the quality of health services. It is also relevant to all stakeholders initiating and supporting action at facility, district and/or national levels both in the public and private sectors.
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The checklist is aligned with, and builds upon, existing COVID-19-related WHO guidelines and is structured around protective measures related to: 1) hand hygiene and respiratory etiquette; 2) physical distancing; 3) use of masks in schools; 4) environmental cleaning and ventilation; and 5) respectin...g procedures for isolation of all people with symptoms. The checklist is designed to support policy-makers, staff and officials from the education and health sectors, local authorities, school principals/leaders and administrators, teachers’ unions, community leaders, school staff, teachers, parents and caregivers.
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The 2020 Report analyzes global health spending for 190 countries from 2000 to 2018 and provides insights as to the health spending trajectory from the MDG era to the SDG era prior to the crisis of 2020. The report shows that global spending on health continually rose between 2000 and 2018 and reach...ed US$ 8.3 trillion or 10% of global GDP. The data also show that out-of-pocket spending has remained high in low and lower-middle income countries, representing greater than 40% of total health spending in 2018. We also report and summarize the data on expenditures for PHC, as well as by disease and intervention, including for immunization. The report also analyzes the available data on budget allocation in response to the COVID-19 crisis. In addition, we combine World Bank/IMF projections of the macroeconomic and fiscal impact of the crisis with an analysis of the historical determinants of health spending patterns and UHC indicators, and based on this, we draw out the likely implications of 2020 for future health spending, highlighting key policy and monitoring concerns.
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WHO is launching a “Revised edition, 2021” for the Caring for women subjected to violence: A WHO training curriculum for health-care providers today. The revised edition includes 4 new modules three of which are for health managers to assess and strengthen health facility readiness and one modul...e, which is for managers and providers to support prevention of violence against women. The earlier content published in 2019 remains unchanged. The 2021 edition is aimed at creating an enabling health systems environment for health workers to provide quality care to women subjected to violence.
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Ensuring mental health and well-being has become a worldwide imperative and an important target of the Sustainable Development Goals. But in all countries around the world, our response has been woefully insufficient, and we have made
little progress to advance mental health as a fundamental human ...right.
One in ten people are affected by a mental health condition, up to 200 million people have an intellectual disability and an estimated 50 million people have dementia. Many persons with mental health conditions, or psychosocial, intellectual, or cognitive disabilities lack access to quality mental health services that respond to their needs and respect their rights and dignity.
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This sourcebook aims to detail why health needs to be part of urban and territorial planning and how to make this happen. It brings together two vital elements we need to build habitable cities on a habitable planet: 1) Processes to guide the development of human settlements – in this document ref...erred to as “urban and territorial planning (UTP)”; and 2) concern for human health, well-being and health equity at all levels – from local to global, and from human to planetary health.
This sourcebook identifies a comprehensive selection of existing resources and tools to support the incorporation of health into UTP, including advocacy frameworks, entry points and guidance, as well as tools and illustrative case studies. It does not provide prescriptions for specific scenarios – these should be determined by context, people and available resources.
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Obesity in all age groups, including children and adolescents, is a public health challenge across all settings. Obesity is now classified as a complex multifactorial chronic disease and not just a risk factor for other noncommunicable diseases and comorbidities. Recognizing the significance of prim...ary health care for an effective and efficient response to the obesity epidemic, the World Health Organization (WHO) has developed guidance on how to build capacity in the health system to deliver health services for prevention and management of obesity across the life course. This policy brief discusses the challenges and opportunities for preventing obesity in children and adolescents, and providing health services to treat and manage those already living with obesity. It outlines possible interventions through the primary health care approach.
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The 2030 health-related Sustainable Development Goals call on countries to end AIDS as a public health threat and also to achieve universal health coverage. The World Health Organization (WHO) promotes primary health care (PHC) as the key mechanism for achieving universal health coverage, and the PH...C approach is also essential for ending AIDS and reaching other Sustainable Development Goal targets.
The PHC approach is defined as a whole-of-society approach to health that aims to maximize the level and distribution of health and well-being through three components: (1) primary care and essential public health functions as the core of integrated health services; (2) multisectoral policy and action; and (3) empowered people and communities.
This publication helps decision-makers to consider and optimize the synergies between existing and future assets and investments intended for both PHC and disease-specific responses, including HIV. Specifically, it aims to:
• provide guidance to policy-makers, health system managers and programmatic leads from both PHC and HIV backgrounds regarding opportunities to jointly advance their respective efforts to strengthen PHC and end AIDS as a public health threat; and
• provide a resource for all stakeholders who seek to contribute to strengthening PHC and ending AIDS as a public health threat in a synergistic manner, including people living with HIV, members of key and vulnerable populations, community and civil society representatives, people working in all areas of health systems, researchers, funders and private-sector decision-makers.
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The environment in which young people live, learn and play significantly affects their decisions about whether to consume alcohol. Environmental factors are the main risk factors driving alcohol consumption and related harm among young people. Environments that normalize alcohol consumption – term...ed alcogenic environments – include contexts with unregulated advertising and marketing of alcoholic beverages, higher alcohol outlet density, products designed to facilitate affordability and low prices of alcoholic beverages. A recent body of research evidence has emerged related to the measurement, functional significance and consequences of living in alcogenic environments. This includes findings on the complex and bidirectional interactions among alcohol acceptability, availability and affordability and how they create and perpetuate alcogenic environments. Comprehensive and enforced alcohol control policies are effective at delaying the age of onset and lowering alcohol prevalence and frequency among young people. Evidence consistently confirms the effectiveness of designing and implementing alcohol control policies that regulate upstream the drivers of alcogenic environment, including alcohol availability, acceptability and affordability. These policies need to be multipronged and address the complex interactions between these drivers and the local alcohol culture
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The world is off track to make significant progress towards universal health coverage (UHC) (SDG target 3.8) by 2030 as improvements to health services coverage have stagnated since 2015, and the proportion of the population that faced catastrophic levels of out-of-pocket (OOP) health spending has i...ncreased.
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This Community Conversation Kit (CCK) is designed to help people who have a leadership role speak with people in their community about how to protect themselves and those they care about from becoming ill with an infectious disease. This kit will help lead conversations that get people talking with ...each other and thinking differently about their health so they can take action. Using some simple tips and suggestions, the information in this kit will allow communities to exchange practical information that will help them know how to confidently protect their health.
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This integrated operational framework provides an overview of the connections between mental health, neurological and substance use (MNS) conditions, and their links to health, well-being and the broader public health and sustainable development agenda. The need for integrated approaches is increasi...ngly recognized as critical to address the complex interactions between mental health, brain health, substance use, and physical health, particularly in light of global threats such as the COVID-19 pandemic. The framework also provides a series of actions for governments and health service planners and advisors to achieve integration across four domains: leadership and governance; care services; promotion and prevention; and health information systems, evidence generation and research.
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