Primary health care offers a cost–effective route to achieving universal health coverage (UHC). However, primary health-care systems are weak in many low- and middle-income countries and often fail to provide comprehensive, people-centred, integrated care. We analysed the primar...y health-care systems in 20 low- and middle-income countries using a semi-grounded approach. Options for strengthening primary health-care systems were identified by thematic content analysis. We found that: (i)despite the growing burden of noncommunicable disease, many low- and middle-income countries lacked funds for preventive services; (ii)community health workers were often under-resourced, poorly supported and lacked training; (iii)out-of-pocket expenditure exceeded 40% of total health expenditure in half the countries studied, which affected equity; and (iv)health insurance schemes were hampered by the fragmentation of public and private systems, underfunding, corruption and poor engagement of informal workers. In 14 countries, the private sector was largely unregulated. Moreover, community engagement in primary health care was weak in countries where services were largely privatized. In some countries, decentralization led to the fragmentation of primary health care. Performance improved when financial incentives were linked to regulation and quality improvement, and community involvement was strong. Policy-making should be supported by adequate resources for primary health-care implementation and government spending on primary health care should be increased by at least 1% of gross domestic product. Devising equity-enhancing financing schemes and improving the accountability of primary health-care management is also needed. Support from primary health-care systems is critical for progress towards UHC in the decade to 2030.
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Primary health care, as outlined in the 1978 Declaration of Alma-Ata and again 40 years later in the 2018 WHO/UNICEF document A vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development Goals, is a whole-of-government and whole-of-society a...pproach to health that combines the following three components: multisectoral policy and action; empowered people and communities; and primary care and essential public health functions as the core of integrated health services.(1) Primary health care-oriented health systems are health systems organized and operated so as to make the right to the highest attainable level of health the main goal, while maximizing equity and solidarity. They are composed of a core set of structural and functional elements that support achieving universal coverage and access to services that are acceptable to the population and that are equity enhancing. The term “primary care” refers to a key process in the health system that supports first-contact, accessible, continued, comprehensive and coordinated patient-focused care.
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13 July 2021
The module provides an overview of factors to consider when monitoring the safety of COVID-19 vaccines administered to pregnant and breastfeeding women. It describes how national routine AEFI surveillance should be adapted to cater for this specific group of population using both pass...ive and active surveillance methods. Specific considerations and limitations of each method are provided as well as tools for implementation.
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This programmatic brief explores how to expand HIV and STI prevention and contraceptive method options in contraceptive services and, thus, to reduce HIV and STI incidence among adolescent girls and women. It focuses on settings with extremely high HIV prevalence and incidence. This brief complement...s existing guidance on HIV prevention and sexual and reproductive health and rights (SRHR), amplifies calls for action and outlines more comprehensive approaches to integration of SRHR and HIV services. It also emphasizes the importance of SRHR for women living with HIV. It aligns with updated WHO recommendations for contraceptive eligibility for women at high risk of HIV and other HIV guidance for adolescent girls and young women.
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This report reviews the latest evidence on what works to reduce HIV-related stigma and discrimination through key programmes to reduce stigma and discrimination and increase access to justice in the six settings of focus for the Global Partnership. It includes guidance for national governments and k...ey stakeholders on how stigma and discrimination harm; how the stigmatization process operates and how we can stop it; key principles of stigma- and discrimination-reduction efforts; an overview of common intervention approaches; recommendations based on the latest evidence for reducing HIV-related stigma and discrimination in the six settings; and an overview of considerations for monitoring the success of the programmatic interventions recommended for each setting.
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This publication marks the 25th anniversary of the Beijing Declaration and Platform for Action. It is dedicated to the women leaders and allied community mobilizers who have devoted their lives to advancing the human rights and dignity of all people affected by the HIV epidemic, and to opposing soci...al injustice, gender inequality, stigma and discrimination, and violence. Unless otherwise indicated, the HIV-related statistics cited in this publication reflect the most recent UNAIDS data available.
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Enabling young children to achieve their full developmental potential is a human right and an essential requisite for sustainable development. Given the critical importance of enabling children to make the best start in life, the health sector, among other sectors, has an important role and responsi...bility to support nurturing care for early childhood development. This guideline provides direction for strengthening policies and programmes to better address early childhood development.
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Scientific Brief, 30 June 2020
The Lancet Global Health Published:May 12, 2020DOI:https://doi.org/10.1016/S2214-109X(20)30229-1
This Interim Guidance outlines how key public health and social measures needed to reduce the risk of COVID-19 spread and the impact of the disease can be adapted for use in low capacity and humanitarian settings. The recommendations outlined here need to be adjusted to the scale of transmission, co...ntext and resources, in order to achieve the objective of managing COVID-19, namely to reduce transmission and facilitate the detection and management of infected and exposed individuals within the population. The Guidance is intended for humanitarian and development actors of all operational levels working with communities ocal authorities involved in COVID-19 preparedness and response operations in these settings, in support of national and local governments and plans. Additional considerations for support to residents of urban informal settlements and slums are available in Annex 1.
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Prevention, early diagnosis, and effective treatment are essential for the control and elimination of Neisseria gonorrhoeae as a public health problem. Currently, in Latin America and the Caribbean, treatment for gonorrhea infection is largely empiric and based on clinical diagnosis. In the Americas..., the high burden of new N. gonorrhoeae infections (estimated at 11 million new cases a year), the complexity of the disease epidemiology, and in many countries the limited resources, make it difficult to fully understand the burden of disease and the burden of antimicrobial resistance (AMR) in N. gonorrhoeae.
PAHO has developed this document to facilitate the navigation of available guidance and recommendations for N. gonorrhoeae AMR surveillance by public health and health care professionals, at the national and subnational levels, involved in designing, implementing, and/or strengthening AMR surveillance of N. gonorrhoeae and overall surveillance of sexually transmitted infections.
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The main objective of this guidance is to provide scientific advice on public health principles and considerations for infection and prevention control of COVID-19 in migrant and refugee reception and detention centres in the European Union and European Economic Area (EU/EEA) and the United Kingdom ...(UK).
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The report underscores that sexual and reproductive health and rights are often the first to be sacrificed during epidemics and that the gains of the past decade must be protected. The report also makes it clear that scarce resources must be focused on the most marginalized women and girls, includin...g sex workers, gender diverse people, women in prison and migrants and others without proof of employment or residence.
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he central Sahel region—Burkina Faso, Mali and Niger—is facing a severe humanitarian and protection crisis.
Massive displacement, most of it driven by intense and largely indiscriminate violence perpetrated by a range of armed actors against civilian populations, is taking place across the regi...on. While internal displacement is on the rise substantial numbers of refugees have fled to neighboring countries, and the situation risks spilling over into the coastal countries of Benin, Côte d'Ivoire, Ghana, and Togo.
This context is exacerbated by the COVID-19 pandemic, which is already affecting areas hosting refugees and IDPs
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This document summarizes preparedness and response activities to address the coronavirus disease (COVID-19) outbreak in South Sudan through the end of 2020. The addendum includes the activities and financial requirements of the updated National COVID-19 Response Plan. Originally issued in March prio...r to identification of the first person confirmed with COVID-19 in South Sudan and with a focus on preparedness, the updated plan encompasses a significantly scaled-up national response.
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a systematic review and meta-analysis Derek K Chu et al. on behalf of the COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors.
Published: The Lancet June 01, 2020 DOI: https://doi.org/10.1016S0140-6736(20)31142-9
'We did a systematic review of 172 observational studies in health-...care and non-health-care settings across 16 countries and six continents... Physical distancing of 1 m or more was associated with a much lower risk of infection, as was use of face masks (including N95 respirators or similar and surgical or similar masks [eg, 12–16-layer cotton or gauze masks]) and eye protection (eg, goggles or face shields)...'
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COVID‑19 strategic preparedness and response
Physical distancing measures are important to reduce COVID-19 transmission. However, when stringently applied, they can result in negative health and socio-economic impacts. This report draws on a rapid review of available literature, case studies from across Africa and expert knowledge to make reco...mmendations on adapting classic physical distancing measures to the contextual realities in Africa and on mitigating potential negative impacts.
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