Biology, Diagnosis and Treatment, Epidemiology and Prevention
Cette note stratégique porte spécifiquement sur le Grand Nord : soit les territoires de Beni et de Lubero au nord du Nord-Kivu constituant l’épicentre de la flambée épidémiquee. D’autres enquêtes participatives doivent être menées auprès des populations touchées, mais étant donné l...actuelle transmission du virus, la priorité a été accordée à la communication des considérations clées et des recommandations immédiates.
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As part of the Mental Health Gap Action Programme, WHO has developed training manuals (Training of trainers and supervisors training manual and Training of health-care providers training manual) to support implementation of the mhGAP Intervention Guide for mental, neurological and substance use (MNS...) disorders in non-specialized health settings, version 2.0. These manuals can be used to build capacity among non-specialist health-care providers in the assessment and management of people with priority MNS conditions in low resource settings.
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In recent years, Rwanda has been on the fast track to achieve major health improvements for its entire population. With the support of government agencies and various non-governmental partners, the Ministry of Health (MoH) has endeavored to decentralize Rwanda’s health system and bring health serv...ices closer to the people. Guided by multitude of national and international development frameworks, Rwanda’s healthcare successes include the establishment of a community health insurance scheme (mutuelle de santé), a system of cooperative-financed community health workers in every village, and interventions for researching, preventing, and treating diseases like HIV/AIDS, TB, and malaria.
As the MoH continues to design innovative means to reach and surpass its prescribed health outcome targets, it will hold as core principles the integration of service provision, the increase in healthcare capacity, and the attainment of sustainable funding sources. Rwanda is committed to achieving the Millennium Development Goals by 2015 and has declared Family Planning (FP) a national priority for poverty reduction and socioeconomic development of the country. Modern contraceptive use has more than quadrupled from 2005 to 2010, rising from 10% to 45%, but the government’s Economic Development and Poverty Reduction Strategy calls for an increase the modern contraceptive prevalence to 70% by 2016. While structural changes in health care and supply chains have led to noteworthy improvements in FP and other services, there are still many challenges that must be overcome. As such, a strategic plan is needed to coordinate FP efforts around a well-defined set of objectives and responsibilities.
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[Preface]. For more than forty years Primary Health Care (PHC) has been recognized as the cornerstone of an effective and responsive health system. The Alma-Ata Declaration of 1978 reaffirmed the right to the highest attainable level of health, with equity, solidarity and the right to health as its ...core values. It stressed the need for comprehensive health services, not only curative but services that addressed needs in terms of health promotion, prevention, rehabilitation and treatment of common conditions. A strong resolutive first level of care is the basis for health system development [...] The Pan American Health Organization/World Health Organization (PAHO/WHO) has supported the countries in the establishment of interprofessional PHC teams, in the transformation of health education and in building capacity in the strategic planning, and management of human resources for health. Nursing can play a critical role in advancing PHC. New profiles such as the advanced practice nurses, as discussed in this document, can be fundamental in this effort, and in particular, in health promotion, disease prevention and care, especially in rural and underserved areas.
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Cette publication présente le Programme sur la santé, l’environnement et les changements climatiques pour les Amériques 2021-2030. Le Programme est un appel à l’action au secteur de la santé pour qu’il prenne l’initiative d’agir sur les déterminants environnementaux de la santé dans... les Amériques. L’Organisation panaméricaine de la Santé (OPS) travaillera avec les États Membres pour atteindre son but et son objectif, qui consistent à permettre à tous de vivre en bonne santé et à promouvoir le bien-être de tous à tout âge, en employant une approche durable et équitable qui accorde la priorité à la réduction des iniquités en matière de santé. Le programme a été élaboré sous l’égide de la Stratégie mondiale de l’OMS sur la santé, l’environnement et les changements climatiques et s’appuie sur les engagements énoncés dans le Programme d’action sanitaire durable pour les Amériques 2018-2030 et le Plan stratégique de l’OPS 2020-2025. Le programme a été élaboré en consultation avec le groupe consultatif technique et par un processus décisionnel consensuel avec les États Membres au cours de la période 2019-2020. En vue de la réalisation de l’objectif de développement durable 3, le programme se concentre sur l’amélioration de la performance des programmes et des institutions de santé publique environnementale, la promotion de systèmes de santé résilients et durables sur le plan environnemental et la promotion de villes et de communautés saines et résilientes sur le plan environnemental. Sa mise en œuvre sera adaptée au contexte, en fonction des besoins et des réalités des pays. Il profitera aux pays et aux territoires en encourageant les pratiques de bonne gouvernance, en renforçant les rôles de leadership et de coordination du secteur de la santé, en favorisant l’action intersectorielle, en se concentrant sur la prévention primaire et en améliorant les données probantes et la communication. Il facilitera l’accès aux ressources humaines, techniques et financières nécessaires pour agir sur les déterminants environnementaux de la santé et fera en sorte que la Région soit pleinement engagée dans les processus et les accords mondiaux en matière de santé, d’environnement et de changements climatiques.
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Evidence-based guidelines are one of the most useful tools for improving public health and clinical practice. Their purpose is to formulate interventions based on strong evidence of efficacy, avoid unnecessary risks, use resources efficiently, reduce clinical variability and, in essence, improve hea...lth and ensure quality care, which is the purpose of health systems and services. These guidelines were developed following the GRADE methodology, with the support of a panel of clinical experts from different countries, all convened by the Pan American Health Organization. By responding to twelve key questions about the clinical diagnosis and treatment of dengue, chikungunya, and Zika, evidence-based recommendations were formulated for pediatric, youth, adult, older adult, and pregnant patients who are exposed to these diseases or have a suspected or confirmed diagnosis of infection. The purpose of the guidelines is to prevent progression to severe forms of these diseases and the fatal events they may cause. The recommendations are intended for health professionals, including general, resident, and specialist physicians, nursing professionals, and medical and nursing students, who participate in caring for patients with suspected dengue, chikungunya, or Zika. They are also intended for health unit managers and the executive teams of national arboviral disease prevention and control programs, who are responsible for facilitating the process of implementing these guidelines.
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Since the last situation report on the multi-country outbreak of cholera was published on 1 June 2023 (covering data reported until 15 of May), no new country reported a cholera outbreak. In total, 24 countries have reported cases since the beginning of 2023. The WHO African Region remains the most ...affected region with 14 countries reporting cholera cases since the beginning of the year. The overall capacity to respond to the multiple and simultaneous outbreaks continues to be strained due to the global lack of resources, including shortages of the Oral Cholera Vaccine (OCV) and cholera supplies, as well as overstretched public health and medical personnel, who are dealing with multiple parallel disease outbreaks and other health emergencies. Based on the large number of outbreaks and their geographic expansion, as well as a lack of vaccines and other resources, WHO continues to assess the risk at global level as very high.
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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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In sum, the goal is to understand the need to increase fiscal space for health as a prerequisite, but within the framework of efforts to transform the health system. These changes should foster equitable and efficient expenditures and create or strengthen comprehensive integrated health systems with... a first level of care capable of solving health problems and coordinating networks, based on a primary health care approach that offers not only curative care but also health promotion and disease prevention services.
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The increasing amounts of official development assistance (ODA) for health have been aimed primarily at fighting HIV/AIDS, malaria and tuberculosis. Neglected tropical diseases (NTD), one of the most serious public health burdens among the most deprived communities, have only recently drawn the atte...ntion of major donors. While frequently stated, the low share
of funding for NTD control projects has not been calculated empirically. Our analysis of ODA commitments for infectious disease control for the years 2003 to 2007 confirms that Development Assistance Committee (DAC)-countries and multilateral donors have largely ignored funding NTD control projects. On average, only 0.6% of total annual health ODA was dedicated
to the fight against NTDs while the average share of control projects for HIV/AIDS was 36.3%, for malaria 3.6%, and for tuberculosis 2.2%. This allocation of health ODA does not reflect the diseases’ respective health burdens.
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I examine the effectiveness of donors in targeting the highest burden of malaria in the Democratic Republic of Congo when health information structure is fragmented. I exploit local variations in the burden of malaria induced by mining activities as well as financial and epidemiological data from he...alth facilities to estimate how local aid is matching local health needs. Using a regression discontinuity design, I find significant but quantitatively small variations in aid to health facilities located within mining areas. Comparing local aid with the additional cost of treatment and prevention associated with the increased risk of malaria transmission, I find suggestive evidence that local populations with the highest burden of the disease receive a proportionately lower share of aid compared to neighbouring areas with reduced exposure to malaria infection. The evidence of disparities in the allocation of aid for malaria supports the view that donors may have inaccurate information about local population needs.
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Since the last situation report on the multi-country outbreak of cholera was published on 6 July 2023 (covering data reported until 15 of June), and as of 15 July 2023, one new outbreak of cholera was reported from India on 15 May 2023. In total, 25 countries have reported cases since the beginning ...of 2023. The WHO African Region remains the most affected region with 14 countries reporting cholera cases since the beginning of the year. The overall capacity to respond to the multiple and simultaneous outbreaks continues to be strained due to the global lack of resources, including shortages of the Oral Cholera Vaccine (OCV) and cholera supplies, as well as overstretched public health and medical personnel, who are dealing with multiple parallel disease outbreaks and other health emergencies. Based on the large number of outbreaks and their geographic expansion, as well as a lack of vaccines and other resources, WHO continues to assess the risk at global level as very high.
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Developmental disabilities are common. Yet, children with developmental disabilities have been neglected in health systems planning and policy provisions for health and continue to experience stigmatization, institutionalization, barriers to access health care and inequalities in health and educatio...n outcomes.
Using findings from research and practice and guided by the tenets of international human rights conventions, this WHO-UNICEF Global Report on children with developmental disabilities provides principles and approaches to intentionally include the needs and aspirations of children and young people with developmental disabilities in policy, programming and public health monitoring. It makes the case for greater accountability and proposes 10 priority actions to accelerate changes towards inclusive environments and responsive multisectoral care systems for children with developmental disabilities.
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Advances in the treatment of pediatric cancer have made it possible to expand initiatives beyond cure and cover aspects such as early detection, continuity of treatment and reduction in toxicity. All this has paved the way for a more comprehensive vision of patient care, which means better chances o...f healing and a fuller life - objectives of the World Initiative against Childhood Cancer. Within this comprehensive care, psychosocial care includes the social, psychological, spiritual and functional dimensions of the disease process of patients. This series includes guidelines and standards based on evidence that guarantee the quality of said care. The standards are the result of discussion and review by different professionals from Latin America and the Caribbean. Module 1 focuses on psychosocial evaluation as a strategy to support the objectives of the World Initiative against Childhood Cancer, and as a tool for health professionals to gather the necessary information to offer these patients a comprehensive approach focused on well-being, adaptation to the disease process, and adherence to treatment.
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This brief update on tuberculosis (TB) in the African region covers the state of TB in the WHO African region, strategic priorities and targets and the impact of COVID-19 on essential services. This is followed by key figures for the region, the role of WHO in country support and, recognizing the im...portance of diagnosis and drug susceptibility testing, a focus onstrengthening laboratory networks and the regional laboratory and diagnostic objectives. A brief update of the state of the science and how this is funded across the African region is provided, before closing with challenges and opportunities,strategic directions and a brief discussion of funding concerns. Discussions around the drivers of the disease, and issues of the poverty, inequality and stigma that continue to plague those living with TB are fully recognized, but are outside the scope of this report.
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The Democratic Republic of Timor-Leste has the highest TB incidence rate in the South East Asian Region - 498 per 100,000, which is the seventh highest in the world. In Timor-Leste TB is the eighth most common cause of death.
The salient observations are as follows:
In 2018, 487 (12.5%) of the... 3906 notified TB patients were tested for RR-TB and only 12 lab confirmed RR-TB patients were initiated on standard MDR-TB treatment of 20-months duration, (a 3-fold increase in RR-TB detection compared with 2017). This amounts to treatment coverage of only 17% of 72 estimated MDR/RR-TB among notified TB patients (3906) and 5% of 240 estimated incident MDR-TB patients as compared to 62% treatment coverage of 6300 incident drug sensitive TB patients estimated in TLS. The treatment success in the 2016 annual cohort of 6 MDR-TB patients has been reported at 83%. 80% of TB patients know their HIV Status with around 1% TB-HIV co-infection, 37/ 77 (48%) TB-HIV Co-infection Detected. Of the 387 PLHIV currently alive on ART, exact status on TB screening and testing is unknown. % of PLHIV newly enrolled in HIV care who received IPT is not known.
In 2018, the mortality rate for TB was 94 deaths per 100,000 people (1200 per annum) in TL with an increasing mortality trend (Figure 1), despite TB services being available for nearly two decades.
A survey of catastrophic costs due to TB (2016) highlights that 83% of TB patients are reported to be facing catastrophic costs due to the disease. This is the highest rate in the world.
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This document lays out economic arguments for investing in the Access to COVID-19 Tools Accelerator (ACT-Accelerator). Framed within an overall context that recognizes the broader human health and societal impacts of the COVID-19 crisis, ACT-Accelerator's Economic Investment Case argues that investm...ent in ACT-Accelerator is the world’s best bet and most viable solution for restarting the global economy. It is intended for governments, multilaterals, civil society, businesses and foundations and all those interested in the work required to change the course of the pandemic. The global deployment of ACT-Accelerator’s comprehensive package of tools will reduce the severity of COVID-19 disease, enabling countries to transition out of the crisis thereby restarting domestic and international economic engines driving our global economy.
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The 2019-2023 Strategy for UNU-IIGH, developed in
2018, built on UNU-IIGH’s strategic advantage and
position vis-à-vis the UN and global health ecosystem.
The Strategy set a goal to advance evidencebased policy on key issues related to sustainable
development and health and shifted the Instit...ute’s
body of work from investigator-driven global health
projects to three priority-driven, policy-relevant pillars
of work, each reflecting UNU-IIGH’s unique value
position.
When the COVID-19 pandemic hit in 2020, the
Institute adapted and reprioritised its areas of work
while continuing to deliver on the main strategic
objectives of translating evidence to policy, generating
policy-relevant analyses on gender and health, and
strengthening capacity for local decision making
especially in the Global South.
The new strategic plan encompasses four work packages:
1. Gender Equality and Intersectionality: through this work, we will aim to improve the quality of health care through a human-centred approach, by ensuring the health system is responsive to the needs of structurally excluded individuals and communities; and by advancing a positive and enabling environment for the frontline health workforce—e.g. addressing the experience of gender-based violence.
2. Power and Accountability: through this work, we will catalyse equitable shifts in power and address key accountability deficits that prevent the equitable and effective functioning of the global health system and prevent adequate responsiveness to the needs of states and populations in the Global South.
3. Digital Health Governance: through this work, we will address the colonial legacies and power asymmetries that negatively impact robust digital health governance, identify ways to strengthen health data governance with a particular focus on SRHR and promote diversity in technology design and development.
4. Climate Justice and Determinants of Health: through this work we will leverage UNU-IIGH's position within the UN and network of UNU institutes, network experts, practitioners, policy-makers, and academics to advance evidence-based policy on the different dimensions of the climate emergency and its impact on health.
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Ahead of World Malaria Day, the WHO Global Malaria Programme published a new operational strategy outlining its priorities and key activities up to 2030 to help change the trajectory of malaria trends, with a view to achieving the global malaria targets. The strategy outlines 4 strategic objectives ...where WHO will focus its efforts, including developing norms and standards, introducing new tools and innovation, promoting strategic information for impact, and providing technical leadership of the global malaria response.
In recent years, progress towards critical targets of the WHO Global technical strategy for malaria 2016-2030 has stalled, particularly in countries that carry a high burden of the disease. In 2022 there were an estimated 608 000 malaria-related deaths and 249 million new malaria cases globally, with young children in Africa bearing the brunt of the disease.
Millions of people continue to miss out on the services they need to prevent, detect, and treat malaria. Additionally, progress in global malaria control has been hampered by resource constraints, humanitarian crises, climate change and biological threats such as drug and insecticide resistance.
“A shift in the global malaria response is urgently needed across the entire malaria ecosystem to prevent avoidable deaths and achieve the targets of the WHO global malaria strategy,” notes Dr Daniel Ngamije, Director of the Global Malaria Programme. “This shift should seek to address the root causes of the disease and be centred around accessibility, efficiency, sustainability, equity and integration.”
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