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Measures to strengthen primary health-care systems in low- and middle-income countries
Etienne V Langlois, Andrew Mc Kenzie, Helen Schneider & Jeffrey W Mecaskey
World Health Organization
(2020)
C_WHO
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
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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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This manual summarizes key issues related to the safety of NTD medicines and their administration, with a focus on essential medicines used in mass drug administration (MDA), also called preventive chemotherapy. It can be used as a standalone reference manual, but is intended to be used in conjuncti
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on with the accompanying training modules, which provide practical instruction, and the aide-mémoires. Versions of the aide-mémoires and training modules are available respectively for both (i) programme managers and district-level health officials and (ii) community drug distributors and community health workers
more
Addressing comorbidities and risk factors for TB is a crucial component of Pillar one of the End TB Strategy, which focuses on integrated patient-centred care and prevention, including action on TB and comorbidities. The Framework for collaborative action on TB and comorbidities aims to support coun
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tries in the evidence-informed introduction and scale-up of holistic people-centred services for TB, comorbidities and health-related risk factors, with the goal of comprehensively addressing TB and other co-existing health conditions. It should be used in conjunction with relevant WHO guidelines. The Framework is intended for use by people working in ministries of health, other relevant line-ministries, policymakers, international technical and funding organizations, researchers, nongovernmental and civil society organizations, as well as primary care workers, specialist health practitioners, and community health workers who support the response to TB and comorbidities in both the public and private sectors.
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The recommendations in this guideline are intended to inform development of national and subnational health policies, clinical protocols and programmatic guides. The target audience includes national and subnational public health policy-makers, implementers and managers of maternal, newborn and chil
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d health programmes, health-care facility managers, supervisors/instructors for in-service training, health workers (including midwives, auxiliary nurse-midwives, nurses, paediatricians, neonatologists, general medical practitioners and community health workers), nongovernmental organizations, professional societies involved in the planning and management of maternal, newborn and child health services, academic staff involved in research and in the pre-service education and training of health workers, and those involved in the education of parents.
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Cardiovascular diseases, principally ischemic heart disease (IHD), are the most important cause of death and disability in the majority of low- and lower-middle-income countries (LLMICs). In these countries, IHD mortality rates are significantly greater in individuals of a low socioeconomic status (
...
SES).
Three important focus areas for decreasing IHD mortality among those of low SES in LLMICs are (1) acute coronary care; (2) cardiac rehabilitation and secondary prevention; and (3) primary prevention. Greater mortality in low SES patients with acute coronary syndrome is due to lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, non-availability of thrombolysis and coronary revascularization, and the non-affordability of expensive medicines (statins, dual anti-platelets, renin-angiotensin system blockers). Facilities for rapid diagnosis and accessible and affordable long-term care at secondary and tertiary care hospitals for IHD care are needed. A strong focus on the social determinants of health (low education, poverty, working and living conditions), greater healthcare financing, and efficient primary care is required. The quality of primary prevention needs to be improved with initiatives to eliminate tobacco and trans-fats and to reduce the consumption of alcohol, refined carbohydrates, and salt along with the promotion of healthy foods and physical activity. Efficient primary care with a focus on management of blood pressure, lipids and diabetes is needed. Task sharing with community health workers, electronic decision support systems, and use of fixed-dose combinations of blood pressure-lowering drugs and statins can substantially reduce risk factors and potentially lead to large reductions in IHD. Finally, training of physicians, nurses, and health workers in IHD prevention should be strengthened.
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People living with disabilities (PLWDs) have poor access to health services compared to people without disabilities. As a result, PLWDs do not benefit from some of the services provided at health facilities; therefore, new methods need to be developed to deliver these services where PLWDs reside. Th
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is case study reports a household-based screening programme targeting PLWDs in a rural district in Malawi. Between March and November 2016, a household-based and integrated screening programme was conducted by community health workers, HIV testing counsellors and a clinic clerk. The programme provided integrated home-based screening for HIV, tuberculosis, hypertension and malnutrition for PLWDs. The programme was designed and implemented for a population of 37 000 people. A total of 449 PLWDs, with a median age of 26 years and about half of them women, were screened. Among the 404 PLWDs eligible for HIV testing, 399 (99%) agreed for HIV testing. Sixty-nine per cent of PLWDs tested for HIV had never previously been tested for HIV. Additionally, 14 patients self-reported to be HIV-positive and all but one were verified to be active in HIV care. A total of 192 of all eligible PLWDs above 18 years old were screened for hypertension, with 9% (n = 17) referred for further follow-up at the nearest facility. In addition, 274 and 371 PLWDs were screened for malnutrition and tuberculosis, respectively, with 6% (n = 18) of PLWDs referred for malnutrition, and 2% (n = 10) of PLWDs referred for tuberculosis testing. We successfully implemented an integrated home-based screening programme in rural Malawi.
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This page presents all our content related to COVID-19. It aims to: 1. Help people who want to understand or work on COVID-19 right now. 2. Help people who are considering biosecurity careers longer term.
This page will focus on leveraged opportunities in research, policy, technology and startups.
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Many people will find their best opportunities to help in their local community – supporting health workers, driving delivery vans, helping friends and family, looking after neighbours, and so on. If you already play a role in providing essential services it’s likely that working hard at your day job, while making efforts to avoid spreading the virus, is one of the most valuable things you can do.
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Outbreaks of mpox in newly affected countries have mostly been identified in communities of gay, bisexual and other men who have sex with men who have had recent sexual contact with a new partner or partners. Communities of trans and gender diverse people linked to the same sexual networks have also
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been affected.
This document (updated in March 2023) is intended for use by individuals, community leaders, influencers, health workers and others affected by or working on the mpox outbreak. It contains information to help people reduce their risk of mpox and to help slow the spread of the virus. This is the third version of this publication – it has been updated based on current public health advice.
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The Child Protection handbook provides a synthesis of good practice and learning and enables better advocacy and communication on child protection risks, needs and responses. Standards addressing child protection needs cover core work areas and critical issues. Those addressing strategy relate to ca
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se management, community-based child protection, child-friendly spaces and protection of excluded children. A fourth set of standards gives guidance on how workers in other sectors can ensure that their programmes are accessible and beneficial to children. DOCUMENT ALSO AVAILABLE IN: Arabic, Chinese, French, Indonesian, Korean, Spanish, Turkish, Urdu on http://cpwg.net/minimum_standards-topics/cpms-full-version/.
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The document provides guidance on managing acute diarrhoea outbreaks, specifically cholera and shigellosis. It outlines steps for identifying outbreaks, differentiating between cholera and shigellosis, and treating patients based on the severity of dehydration. Recommendations include the use of ora
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l rehydration solutions (ORS), antibiotics in severe cases, and strict hygiene practices to prevent transmission. The document also emphasizes community protection measures such as disinfection of water sources, isolation of cases, and proper food hygiene. It is a practical resource for health workers to quickly respond to diarrhoeal disease outbreaks.
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The document provides guidance on managing acute diarrhoea outbreaks, specifically cholera and shigellosis. It outlines steps for identifying outbreaks, differentiating between cholera and shigellosis, and treating patients based on the severity of dehydration. Recommendations include the use of ora
...
l rehydration solutions (ORS), antibiotics in severe cases, and strict hygiene practices to prevent transmission. The document also emphasizes community protection measures such as disinfection of water sources, isolation of cases, and proper food hygiene. It is a practical resource for health workers to quickly respond to diarrhoeal disease outbreaks.
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This WHO information document explains the compassionate use of the investigational Ebola vaccine (rVSV-ZEBOV) during the Ebola outbreak in North Kivu, Democratic Republic of the Congo. It answers common questions about the vaccine, including how it works, who is eligible to receive it, the ring vac
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cination strategy, possible side effects, and safety measures. The document emphasizes that vaccination is voluntary and forms only one part of a broader Ebola outbreak response that also includes case isolation, contact tracing, safe burials, and community engagement. Its purpose is to provide clear and accessible information to the public and healthcare workers about Ebola vaccination and outbreak control.
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The PDF "Vamos proteger-nos da Cólera" provides comprehensive guidance on cholera prevention and response strategies, particularly for use in community health settings. It emphasizes the importance of safe water use by treating water with bleach, b
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oiling it for at least 5 minutes, or using purification tablets like Aquatabs. Handwashing is highlighted as a key measure, especially after using the latrine, before preparing food, and before eating. Sanitation practices include using and maintaining clean latrines or, if unavailable, burying feces far from homes and water sources.
The document also addresses diarrhea treatment, recommending the preparation and use of Oral Rehydration Solution (ORS) with added zinc for effective recovery. It encourages breastfeeding for infants with diarrhea and stresses the importance of cooking food thoroughly, keeping it covered, and ensuring all utensils and surfaces are clean. Proper waste management, including the disposal of household waste, is highlighted to maintain a clean and safe environment.
In emergency situations, the guide advises seeking immediate medical attention for severe diarrhea and emphasizes the prompt burial of bodies during outbreaks to prevent contamination. Additionally, it provides visuals and strategies for community engagement, empowering health workers and communities to promote awareness and adopt effective cholera prevention measures.
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Coronavirus (COVID-19) - Cochrane Library
recommended
Cochrane provides high-quality, relevant, and up-to-date synthesized research evidence to inform health decisions. This page highlights content relating to the coronavirus (COVID-19) pandemic and the various related activities that Cochrane is undertaking in response.
They will be continually add
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ing updates and additions to this page. Sections include information and resources for:
Public, patients, and carers
Healthcare workers
Researchers
Policy and guideline developers
The Cochrane Community
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Workplaces have played an important role in both the spread and mitigation of the COVID-19 pandemic throughout the world. Being provided a healthy and safe workplace throughout the pandemic and beyond is a human right. Maintaining open, safe and healthy workplaces is of vital importance to protectin
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g livelihoods, wellbeing and public health. Critical public health measures can help protect workers, their clients, and the community at large. Through an introduction and 5 modules, this course aims to guide workers and their representatives, business leaders, employers, managers and occupational health and safety professionals on how to protect themselves and their workplace during the COVID-19 pandemic.
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The Infant and young child feeding counselling: an integrated course includes this Director’s guide, a Trainer’s guide and Participant’s manual. Additional tools include: Course handouts; Guidelines for follow-up after training; Supportive supervision/mentoring and monitoring and an accompanyi
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ng toolkit; a slide set for the trainer; a set of 24 Counselling cards and Guidance on the use of counselling cards. The course includes 79 sessions arranged within 8 modules, covering a range of topics, including breastfeeding, complementary feeding, growth assessment and monitoring, HIV and infant feeding, and infant and young child feeding counselling. Course facilitators can decide which sessions to cover, depending on the specific learning needs of the health workers in your community.
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The Participant’s manual contains summaries of information presented by the trainers, copies of worksheets and checklists for the clinical practice and practical sessions, and exercises that participants will do during the course. One manual should be provided for each participant, using the modul
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es selected, for use during the course and can be used as a reference after the course. child feeding counselling. Course facilitators can decide which sessions to cover, depending on the specific learning needs of the health workers in your community.
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WHO recommendations on maternal and newborn care for a positive postnatal experience. Presentation
recommended
This guideline aims to improve the quality of essential, routine postnatal care for women and newborns with the ultimate goal of improving maternal and newborn health and well-being. It recognizes a “positive postnatal experience” as a significant end point for all women giving birth and their n
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ewborns, laying the platform for improved short- and long-term health and well-being. A positive postnatal experience is defined as one in which women, newborns, partners, parents, caregivers and families receive information, reassurance and support in a consistent manner from motivated health workers; where a resourced and flexible health system recognizes the needs of women and babies, and respects their cultural context.
This is a consolidated guideline of new and existing recommendations on routine postnatal care for women and newborns receiving facility- or community-based postnatal care in any resource setting.
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This guideline aims to improve the quality of essential, routine postnatal care for women and newborns with the ultimate goal of improving maternal and newborn health and well-being. It recognizes a “positive postnatal experience” as a significant end point for all women giving birth and their n
...
ewborns, laying the platform for improved short- and long-term health and well-being. A positive postnatal experience is defined as one in which women, newborns, partners, parents, caregivers and families receive information, reassurance and support in a consistent manner from motivated health workers; where a resourced and flexible health system recognizes the needs of women and babies, and respects their cultural context.
This is a consolidated guideline of new and existing recommendations on routine postnatal care for women and newborns receiving facility- or community-based postnatal care in any resource setting.
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Strengthening mental health responses to COVID-19 in the Americas: A health policy analysis and recommendations
A. Tausch; Oliveira e Souza, R.; Martinez Viciana, C.; et al.
Pan American Health Organization
(2021)
CC
The COVID-19 pandemic is having a major impact on the mental health of populations in the Americas. Studies
show high rates of depression and anxiety, among other psychological symptoms, particularly among women, young
people, those with pre-existing mental health conditions, health
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workers, and persons living in vulnerable condi-
tions. Mental health systems and services have also been severely disrupted. A lack of financial and human resource
investments in mental health services, limited implementation of the decentralized community-based care approach
and policies to address the mental health gap prior to the pandemic, have all contributed to the current crisis. Coun-
tries must urgently strengthen their mental health responses to COVID-19 by taking actions to scale up mental
health and psychosocial support services for all, reach marginalized and at-risk populations, and build back better
mental health systems and services for the future.
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