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Operational guidance for managing programme quality.
These guidelines are about implementing the programme-quality standards of the Core Humanitarian Standard in limited access humanitarian respons
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e. They have been developed using approaches and tools tested by Oxfam, other INGOs and the UN in Afghanistan, DRC, Iraq, Somalia, Syria and Yemen. The guidelines are an operational resource to help programme designers and decision makers deliver ‘good enough’ programme quality in limited access humanitarian response.
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Non-communicable diseases (NCDs) pose a substantial threat to many health systems, especially in low-income and middle-income countries (LMICs) where they are already overstretched. In the past few decades, deaths from NCDs in LMICs have spiked, whereas numbers in high-income countries have stabilis
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ed. Worryingly, a large proportion of deaths from NCDs (29%) in LMICs occur among people younger than 60 years compared with the proportion in high-income countries (13%). This finding has been attributed to poor access to effective and equitable health-care services in most LMICs. The threat of NCDs in LMICs was recognised by the UN 2011 High-Level Meeting, and is now featured in Sustainable Development Goal 3 in the form of reducing premature mortality from NCDs by one-third before 2030. Cardiovascular diseases (CVDs) are the leading cause of deaths from NCDs (ie, 48% of all NCDs deaths). Therefore, substantial reductions in CVDs will have a major impact on reducing the overall burden of NCDs globally. The good news is that most CVDs can be prevented by addressing the key underlying behavioural risk factors, such as physical inactivity, unhealthy diet, tobacco use, and harmful use of alcohol, through population-wide approaches. Among individuals with or at high risk of CVD, early detection and effective management with appropriate counselling and medicines can reduce cardiovascular deaths substantially.
The importance of effective treatment for CVD has been recognised in the Global NCD Action Plan 2013–20, for which one of the nine global targets is that at least 50% of eligible individuals should receive drug therapy and counselling to prevent heart attacks and strokes by 2025.5 Although admirable, this is a hard target to achieve given that secondary prevention strategies in LMICs are often unaffordable or unavailable.
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Kangaroo mother care (KMC) is a critical strategy to care for preterm and low birth weight infants in resource-limited settings. Despite evidence of its effectiveness and low cost, coverage has remained low, largely due to sociocultural barriers. We
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aimed to better understand social norms and community perceptions of preterm infants and KMC (facility-initiated and community-continued) in Malawi, a country with a high preterm birth rate, to inform a pilot social and behavior change program.
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The availability of controlled medicines is crucial for patients requiring palliative care, pain relief and symptom management. Many individuals worldwide, especially in low- and middle-income countries, continue to experience limited
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access to these essential medicines. Enhancing access to controlled medicines is paramount in promoting universal health coverage. This report offers a detailed situational analysis of policies and programmes aimed at improving access to affordable, high-quality controlled medicines for pain management in the WHO South-East Asia Region. The report identifies the existing barriers, challenges and possible solutions to facilitate access to such medicines across all Member States.
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Chapter 16: Managing medicine selection - Key topics: the concept of essential medicines; selection of essential medicines and development of essential medicines lists, formularies, and treatment guidelines. - The rationale for selecting a limited
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number of essential medicines is that it may lead to better supply, more rational use, and lower costs.
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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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Rabies is a neglected zoonotic disease with a global burden of approximately 59,000 human deaths a year. Once clinical symptoms appear, rabies is almost invariably fatal; however, with timely and appropriate post-exposure prophylaxis (PEP) consisting of wound washing, vaccine, and in some cases rabi
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es immunoglobulin (RIG), the disease is almost entirely preventable. Access to PEP is limited in many countries, and when available, is often very expensive.
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Formularies are lists of antibiotics that are suggested for certain healthcare settings. In developing a recommended formulary, countries should consider the needs of patients and facilities where they receive care. For example, clinicians in rural or primary health centers may need wide
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access to first-line antibiotics (e.g., penicillin, ampicillin, TMP-SMX), but last resort antibiotics such as carbapenems or colistin might be limited to tertiary care hospitals. Efforts to create antibiotic formularies may be linked to efforts within countries to create or update essential medicine lists (EML).
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Antibiotic stewardship refers to coordinated efforts and activities that seek to measure and improve use of antibiotics. Implementation of ASPs has demonstrated positive public health and clinical impacts including reducing costs, lengths of hospital stays, and the burden of antibiotic resistance wh
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ile maintaining or improving patient outcomes. The U.S. Centers for Disease Control and Prevention (CDC) released the Core Elements of Hospital Antibiotic Stewardship Programs in 2014, which outlines essential components for ASPs in hospitals and provides practical guidance for implementing a robust ASPin an acute care facility. Variations to the Core Elements have been developed to deal with the particular challenges in small, rural or critical access hospitals in the United States and in outpatient facilities and nursing homes.
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The Covid-19 pandemic has so far infected more than 30 million people in the world, having major impact on global health with collateral damage. In Mozambique, a public state of emergency was declared at the end of March 2020. This has limited peopl
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e's movements and reduced public services, leading to a decrease in the number of people accessing health care facilities. An implementation research project, The Alert Community for a Prepared Hospital, has been promoting access to maternal and child health care, in Natikiri, Nampula, for the last four years. Nampula has the second highest incidence of Covid-19. The purpose of this study is to assess the impact of Covid-19 pandemic Government restrictions on access to maternal and child healthcare services. We compared health centres in Nampula city with healthcare centres in our research catchment area. We wanted to see if our previous research interventions have led to a more resilient response from the community.
METHODS: Mixed-methods research, descriptive, cross-sectional, retrospective, using a review of patient visit documentation. We compared maternal and child health care unit statistical indicators from March-May 2019 to the same time-period in 2020. We tested for significant changes in access to maternal and child health services, using KrushKall Wallis, One-way Anova and mean and standard deviation tests. We compared interviews with health professionals, traditional birth attendants and patients in the two areas. We gathered data from a comparable city health centre and the main city referral hospital. The Marrere health centre and Marrere General Hospital were the two Alert Community for a Prepared Hospital intervention sites.
RESULTS: Comparing 2019 quantitative maternal health services access indicators with those from 2020, showed decreases in most important indicators: family planning visits and elective C-sections dropped 28%; first antenatal visit occurring in the first trimester dropped 26%; hospital deliveries dropped a statistically significant 4% (p = 0.046), while home deliveries rose 74%; children vaccinated down 20%.
CONCLUSION: Our results demonstrated the negative collateral effects of Covid-19 pandemic Government restrictions, on access to maternal and child healthcare services, and highlighted the need to improve the health information system in Mozambique.
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Senegal has adopted the World Health Organization–Joint United Nations Programme on HIV/AIDS recommended 90-90-90 targets.5 The adoption of this strategy means that the country is expected, by 2020, to have 90% of its population living with HIV diagnosed, 90% of all those diagnosed receiving susta
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ined HIV treatment, and 90% of those receiving antiretroviral therapy having suppressed viral load measures.5 To achieve these outcomes, having good clinical laboratory services for diagnosis and follow-up will be critical.6 More specifically, investments will be needed to improve laboratory infrastructure, and to facilitate the access and availability of routine viral load and early infant diagnosis (EID) measures through the implementation of point-of-care (POC) diagnostic platforms along with an efficient and sustainable quality assurance programme.
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Buruli ulcer caused by Mycobacterium ulcerans is a neglected tropical disease characterized by extensive ulceration involving predominantly the upper and lower limbs of patients. The disease is common in rural tropical communities in West and Central Africa, where
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access to proper health care is limited. Pathogenesis of the characteristic painless ulcers is linked to the elaboration by M. ulcerans of a lipid toxin called mycolactone that has potent cytopathic, immunosuppressive, and analgesic effects on a host of cells in cutaneous tissues. Mycolactone is known to profoundly inhibit secretion of a plethora of proteins that are essential for wound healing. Even though a combination antibacterial therapy of streptomycin and rifampicin for 8 weeks is effective for treatment, it relies on good and appropriate wound management to prevent secondary bacterial infections and improve healing. Evidence-based interventions for wound care in Buruli ulcer disease are often lacking and have relied on expert advice and recommendations. Surgical interventions are limited to debridement of necrotic tissue and grafting of extensive ulcers, usually after antibiotic therapy. Patients’ rehabilitation is an important component of care to reduce disabilities associated with the disease and proper integration into the community after treatment.
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Because of the limited access to more powerful diagnostic tools, there is a paucity of data regarding the burden of fungal infections in Burkina Faso. The aim of this study was to estimate the incid
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ence and prevalence of serious fungal infections in this sub-Saharan country. We primarily used the national demographic data and performed a PubMed search to retrieve all published papers on fungal infections from Burkina Faso and its surrounding West African countries. Considering the prevalence of HIV infection (0.8% of the population) and a 3.4% incidence of cryptococcosis in hospitals, it is estimated that 459 patients per year develop cryptococcosis. For pneumocystosis, it is suggested that 1013 new cases occur every year. Taking into account the local TB frequency (population prevalence at 0.052%), we estimate the prevalence of chronic pulmonary aspergillosis at 1120 cases. Severe forms of asthma with fungal sensitization and allergic bronchopulmonary aspergillosis are estimated to affect 7429 and 5628 cases, respectively. Vulvovaginal candidiasis may affect 179,000 women, and almost 1,000,000 children may suffer from tinea capitis. Globally, we estimate that roughly 1.4 million people in Burkina Faso (7.51% of the population) suffer from a serious fungal infection. These data should be used to drive future epidemiological studies, diagnostic approaches, and therapeutic strategies.
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Many migrants find themselves with limited access, if any, to information about risks, prevention measures, health care and other essential services. Migrants in transit, those in need of internatio
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nal protection or without legal status are likely to be particularly vulnerable, as well as those who are homeless, held in detention, living in camps, formal or informal settlements or otherwise precarious conditions
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Infographic illustrating how to wash your hands correctly when there is limited access to soap and clean water.
Debt has become a substantial burden for developing countries due to limited access to financing, rising borrowing costs, currency devaluations and sluggish growth. These factors compromise the coun
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tries’ ability to react to emergencies, tackle climate change and invest in their people and the future. The latest report, A World of Debt, discusses the actions needed to unleash the resources needed to build a more prosperous, inclusive, and sustainable world.
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This is an open-access training course for frontline healthcare providers who manage acute illness and injury with limited resources. Produced in response to requests from multiple countries and int
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ernational partners, the BEC package includes a Participant Workbook and electronic slide decks for each module. Integrating the guidance from WHO Emergency Triage, Assessment and Treatment (ETAT) for children and the Integrated Management of Adult/Adolescent Illness (IMAI), BEC teaches a systematic approach to the initial assessment and management of time-sensitive conditions where early intervention saves lives
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More than 230,000 people displaced by Typhoon Mangkhut in Philippines
Access is still limited due to landslides in mountain areas. Some areas are still flooded, leaving people vulnerable to disease
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s including leptospirosis, dengue, acute gastroenteritis and AWD
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1-2-3- Servie COVID-19 Information
recommended
WHO is working with Viamo, a global social enterprise improving lives via mobile, to provide WHO’s COVID-19 information, including vaccines, to the hardest to reach populations, in their languages, through the mobile phones they own. This includes people with simple phones (feature phones) or with
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limited access to the internet. Since the onset of COVID-19, Viamo’s 3-2-1 Service has become a trusted, toll-free source of life-saving COVID-19 health information for people in 19 countries. Listeners dial in and access important messages that help them make better informed decisions to live healthier lives.
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The document focuses on household water treatment methods to ensure access to safe drinking water, particularly in areas with limited access to cle
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an water sources. It highlights the importance of safe water, noting that contaminated water is a major cause of waterborne diseases such as diarrhea and cholera. Treating water at the household level is emphasized as an effective way to reduce health risks.
The document outlines several treatment methods, including boiling, which kills most pathogens; chlorination, which disinfects water by adding chlorine; filtration, which removes dirt and certain microbes using simple or advanced filters; and solar disinfection (SODIS), which involves exposing water in clear plastic bottles to sunlight for several hours to kill microbes. Additionally, it stresses the importance of safe water storage, such as using clean and covered containers to prevent recontamination, and practicing good hygiene, including regular handwashing and maintaining cleanliness around water sources.
By promoting these methods, the document aims to raise awareness and provide practical solutions for improving water quality at the household level, thereby reducing the spread of diseases and enhancing public health.
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