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This page describes ten immediate water, sanitation and hygiene (WASH) actions that low-resource healthcare facilities can undertake with limited budget in the near-term (0-3 months) to prepare for and address COVID-19. On the second page, WHO and U
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NICEF have provided input on how to best adapt their Eight Practical Steps in the midst of COVID-19. Finally, we have compiled resources for action. While some activities may be temporary stopgaps, the goal is to provide incremental improvements that can be sustained and built upon after the outbreak subsides. In particular, the proper management of WASH will be critical to protect healthcare workers and prevent infections.
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Pakistan Crisis 2022
recommended
WHO is responding as Pakistan is affected by massive monsoon rainfall and unprecedented levels of flooding and landslides. Damage to health infrastructure, shortages of health workers, and limited health supplies are disrupting health services. Sign
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ificant public health threats include the spread of water- and vector-borne diseases, with outbreaks of diarrheal diseases, skin infections, respiratory tract infections, malaria, dengue, injuries, and more. With health services reduced, the management of non-communicable diseases are also affected. In addition, the loss of crops and livestock will have a significant impact on the nutrition and health of many communities who depend on these resources.
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Management of Type 2 Diabetes in Developing Countries: Balancing Optimal Glycaemic Control and Outcomes with Affordability and Accessibility to Treatment
Mohan, V.; Khunti, K.; Chan,S.P.; et al.
National Library of Medicine, National Center for Biotechnology Information
(2020)
CC3
With the growing prevalence of type 2 diabetes, particularly in emerging countries, its management in the context of available resources should be considered. International guidelines, while comprehensive and scientifically valid, may not be appropr
...
iate for regions such as Asia, Latin America or Africa, where epidemiology, patient phenotypes, cultural conditions and socioeconomic status are different from America and Europe. Although glycaemic control and reduction of micro- and macrovascular outcomes remain essential aspects of treatment, access and cost are major limiting factors; therefore, a pragmatic approach is required in restricted-resource settings. Newer agents, such as sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in particular, are relatively expensive, with limited availability despite potentially being valuable for patients with insulin resistance and cardiovascular complications. This review makes a case for the role of more accessible second-line treatments with long-established efficacy and affordability, such as sulfonylureas, in the management of type 2 diabetes, particularly in developing or restricted-resource countries.
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The pamphlet "Methamphetamine" provides information about methamphetamine, an illegal stimulant with high abuse potential, though it has limited medical uses for conditions like ADHD and narcolepsy. It explains short-term effects such as appetite su
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ppression, increased heart rate and blood pressure, and seizures, as well as long-term effects like paranoia, depression, insomnia, and "meth mouth." It also outlines the legal consequences of possession and encourages seeking help for addiction through treatment resources.
more
The Cholera Fact Sheet is available in English, Spanish, Arabic, French, and Haitian Kreyol. This heavily-illustrated, easy-to-read handout provides information for preventing, diagnosing and treating cholera with limited
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resources. It offers instructions for purifying drinking water and preparing a rehydration drink at home.
You can link to the English sheet, which includes links to all other languages: http://en.hesperian.org/hhg/Cholera_Factsheet#utm_source=MedBox&utm_medium=site&utm_campaign=cholera_hw
more
The purpose of the PAS III is to guide Pakistan’s overall national response for HIV and AIDS through 2020, through focused interventions with set targets, costs, roles and responsibilities. The successful implementation of PAS III involves multiple stakeholders to achieve priority outcomes outline
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d in the Strategy. The Strategy focuses on allocating limited resources to scale up high-impact, high-value interventions such as HTC and treatment to reduce AIDS related deaths and new HIV infections. Priorities in the PAS III have been identified to ensure maximum impact in reducing new infections, especially among key populations, improving treatment uptake and retention, and improving the quality of life of people living with HIV and AIDS in the context of limited financial and human resources.
more
This article describes a Community-Based Participatory Approach (CBPA) for children with intellectual disability in Endosulfan affected areas of Kasaragod district in Kerala state of India. The CBPA strategy evolved from Community Based Rehabilitation (CBR) and was led by Local Self-Government (LSG)
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members. It involves a four-pronged approach encompassing family, community, service centres and LSG, with a focus on income generation activities and creation of employment opportunities. The CBPA model considers the cultural
uniqueness and limited resources in areas where the unscientific and extensive use of pesticides has led to high prevalence of multiple deformities including intellectual disabilities.
more
Glob Ment Health (Camb). 2015; 2: e12. Published online 2015 Jul 14. doi: 10.1017/gmh.2015.10
Low and middle income countries (LMICs) are facing an increase of the impact of mental health problems while confronted with limited
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resources and limited access to mental health care, known as the ‘mental health gap’. One strategy to reduce the mental health gap would be to utilize the internet to provide more widely-distributed and low cost mental health care. We undertook this systematic review to investigate the effectiveness and efficacy of online interventions in LMICs.
more
This manual is a resource for Health Counselors working in Family Physician Clinics (FPC) as part of the MANAS program. This program is for common mental disorders like depression and anxiety seen in primary health care facilitieslike the FPC; since depression is the common
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est disorder within this group of stress related mental health problems, in the manual we refer to these problems simply as ‘Depression’. The aim of the MANAS program is to integrate the recognition and treatment of Depression into routine primary health care.In the MANAS program, a range of effective treatments will be provided for patients with Depression. These treatments are matched to the individual requirements of patients to both improve the effectiveness of the treatments and to use the limited resources efficiently.
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Supporting the continuity of health and nutrition services in the context of COVID-19 in refugee settings
recommended
The 2014–2015 Ebola outbreak was catastrophic in West Africa but the indirect impact of increasing the mortality rates of other conditions was also substantial. The increased number of deaths caused by malaria, HIV/AIDS, and tuberculosis attributable to health system failures exceeded deaths from
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Ebola.
With a relatively limited COVID-19 caseload, health systems may have the capacity to maintain routine service delivery in addition to managing COVID-19 cases. When caseloads are high, and/or health workers are directly affected, strategic adaptations are required to ensure that increasingly limited resources provide maximum benefit for the refugees and surrounding host population. The following are key considerations for UNHCR operations on prioritized health care services in the event of a COVID-19 outbreak. These are based on WHO Guidance for Maintaining Essential Health Services and UNHCR guidance for operations and where relevant operation or site level outbreak preparedness and response plans.
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The current effort on fighting COVID-19 cannot conceal the fact that climatic and geological hazards affect Latin-America and the Caribbean every year. At a time when countries of the region are actively responding to the pandemic, they also need to prepare for and implement actions to mitigate the
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potential impacts of other recurrent hazards. For instance, countries like Guatemala and El Salvador have been recently hit by tropical storm Amanda and, as the Caribbean region faces its annual hurricane season, countries are enhancing climate-hazard preparedness. Many countries are bracing for a two-tier crisis as they grapple with complicated logistics, limited resources and scant supplies.
more
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
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, 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.
more
Bioethics - Medical, Ethical and Legal Perspectives
There’s evidence that implementing the four medical ethics principles may be challenging especially in low income country contexts with extreme resource scarcity and limited capacity to facilita
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te deliberations on the different ethical dilemmas. These challenges can partly be explained by the social, economic, and political contexts in which the decisions are made, as well as the limited time, training and guidance to facilitate ethical decision making. Based on current literature, and using the example of bedside rationing; this chapter synthesizes the challenges clinicians face when operationalizing the four principle; identifying the opportunities to address them. We suggest that clinicians’ ability to implement the four principles are constrained by meso‐ and macro‐level decision making as well as their lack of training, explicit guidelines, and peer support. To ameliorate this situation, current efforts to strengthen the clinicians’ capacity to make ethical decisions should be complimented with developing of context relevant guidelines for ethical clinical decision making. The renewed global commitment to the sustainable development goals and universal healthcare coverage should be recognized as an opportunity to leverage resources and champion the integration of equity and justice as a core value in resource allocation at the bedside, meso-, macro- and global levels.
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The health sector In Ukraine is beginning to change in recent years. The sector, based on a system of health care (Semashko) originating from the Soviet Union, had been stagnant for many years. Remarkably little had changed since Independence and the health care system is as of today still character
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ized by a very hierarchical and territorial system with large numbers of beds in institutional care settings. At the same time the Government of Ukraine has only limited resources available that are spread thin over the existing infrastructure
more
Uganda hosts approximately 1.1 million refugees making it Africa’s largest refugee hosting country and one of the five largest refugee hosting countries in the world. Most recently, throughout 2016- 2018, Uganda was impacted by three parallel emergencies from South Sudan, the Democratic Republic o
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f the Congo (DRC), and Burundi. In view of the on-going conflicts and famine
vulnerabilities in the Great Lakes Region, more refugee influxes and protracted refugee situations are anticipated in the foreseeable future. The unprecedented mass influx of refugees into Uganda in 2016-2018 has put enormous pressure on
the country’s basic service provision, in particular health and education services. Refugees share all social services with the local host communities. The refugee hosting districts are among the least developed districts in the country, and thus the additional refugee population is putting a high strain on already limited resources.
more
Leishmaniasis is a parasitic disease caused by the Leishmania parasite. This parasite typically lives in infected sand flies. You can contract leishmaniasis from a bite of an infected sand fly.
The sand flies that carry the parasite typically reside in tropical and subtropical environments. Fatal
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epidemics have occurred in areas of Asia, East Africa, and South America.
Affected regions are often remote and unstable, with limited resources for treating this disease. Doctors Without Borders calls leishmaniasis one of the most dangerous neglected tropical diseases. The organization also states this disease is second only to malaria in parasitic causes of death.
more
Leishmaniasis is a complex vector-borne disease involving in its transmission several species of protozoan parasites called Leishmania, a wide variety of animal reservoirs and phlebotomine sandflies vectors. Cutaneous Leishmaniasis (CL) is the most common form of the disease, and its clinical manife
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stations vary from few papules to multiple ulcers affecting the skin but also the mucous membranes, leaving permanent scars and serious disability. It is a disfiguring and stigmatizing disease that often has a devastating psychosocial and economic impact on the affected resources limited communities.
more
This ACTIVE toolkit provides evidence-based guidance on the key approaches to promote and enable older people to be physically active, regardless of who they are, where they live, or their intrinsic capacities (for example their visual or cognitive abilities) or whether they live with chronic condit
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ions (for example, diabetes, hypertension, and arthritis). It is designed to support all countries at national and subnational levels (particularly low- and middle-income countries with limited resources) to ensure that environments and settings support older people to be active, and that they provide physical activity services and programmes tailored to the needs, preferences and goals of all older people.
more
Heart failure (HF) is a leading global public health problem with >64 million prevalent cases globally. Patients with HF with reduced ejection fraction (HFrEF) from low- and middle-income countries experience a 22% to 58% higher 1-year mortality rate than those in high-income countries.1 Guideline-d
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irected medical therapy (GDMT) consisting of ACE (angiotensin-converting enzyme) inhibitors or ARB (angiotensin receptor blockers) or ARNI (angiotensin receptor-neprilysin inhibitors), β-blockers, MRA (mineralocorticoid receptor antagonists), and SGLT2 (sodium-glucose cotransporter 2) inhibitors substantially reduces mortality among patients with HFrEF. These medicines are among the most cost-effective interventions and are thus included as the highest priority health system interventions recommended by the Disease Control Priorities Project.2 Despite this high-quality evidence, GDMT remains widely underutilized in low- and middle-income countries resulting in widespread undertreatment of patients with HFrEF due to health system-, provider-, and patient-level barriers.1 National essential medicines lists (EMLs) promoted by the World Health Organization (WHO) guide countries on which medications to purchase in the setting of limited resources and have resulted in higher procurement and availability of essential medicines in the public sector.3 We provide a cross-sectional analysis of national EMLs in 53 low- and middle-income countries, and availability, price, and affordability of GDMT in select countries to identify potential barriers to access to these essential medicines for patients with HFrEF.
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Worldwide, studies on asthma prevalence have shown major rises over the last 30 years. The impact on the burden of asthma is being increasingly recognised. In some countries in Latin America, the prevalence of asthma is among the highest in the world. Asthma admissions are very common in children, l
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eading to high costs for the health systems of those countries. Unfortunately, Latin America has limited resources to pay for appropriate treatment. The main goals of the international guidelines for asthma treatment are not being met. However, asthma programmes operating in some countries are showing promising results in reducing asthma admissions and consequently decreasing the burden of asthma. Local adaptation of international guidelines must be implemented in order to decrease costs and optimise outcomes.
more
