Diabetes mellitus, also called diabetes, is a chronic metabolic condition in which the hormone insulin is not produced by the
pancreas in sufficient quantities or is not utilized effectively by the body to control blood glucose levels. As a result, blood
glucose levels are abnormally high (hypergl...ycaemia). Chronic uncontrolled hyperglycemia leads to long-term target organ damage, such as: retinopathy, nephropathy and neuropathy (microvascular complications); stroke, coronary heart disease
and peripheral arterial disease (macrovascular complications).
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The Community-based Health System Model Series briefs identify and discuss critical health system inputs and processes that have contributed to the implementation and expansion of community-based service delivery in different countries.
Countries were selected for their geographic diversity, type o...f service delivery model, and programmatic scale-up.
This brief reviews Malawi’s community health model to inform future policy, program design, and implementation in other countries.
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Since the Alma Ata Declaration in 1978, community health volunteers (CHVs) have been at the forefront, providing health services, especially to underserved communities, in low-income countries. However, consolidation of CHVs position within formal health systems has proved to be complex and continue...s to challenge countries, as they devise strategies to strengthen primary healthcare. Malawi’s community health strategy, launched in 2017, is a novel attempt to harmonise the multiple health
service structures at the community level and strengthen service delivery through a team-based approach. The core community health team (CHT) consists of health surveillance assistants (HSAs), clinicians, environmental health officers and CHVs. This paper reviews Malawi’s strategy, with particular focus on the interface between HSAs, volunteers in community-based programmes and
the community health team. Our analysis identified key challenges that may impede the strategy’s implementation:
(1) inadequate training, imbalance of skill sets within CHTs and unclear job descriptions for CHVs; (2) proposed community-level interventions require expansion of pre-existing roles for most CHT members; and (3) district authorities may face challenges meeting financial obligations and filling community-level positions. For effective implementation, attention and further deliberation is needed on the appropriate forms of CHV support, CHT composition with possibilities of co-opting trained CHVs
from existing volunteer programmes into CHTs, review of CHT competencies and workload, strengthening coordination and communication across all community actors, and financing mechanisms. Policy support through the development of an addendum to the strategy, outlining opportunities for task-shifting between CHT members, CHVs’ expected duties and interactions with paid CHT personnel is recommended.
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The Government of Malawi is committed to improving health and livelihoods in Malawi through community health – the
provision of basic health services in rural and urban communities with the participation of people who live there.
Historically, Community Health has significantly contributed to im...provements in Malawi’s health outcomes in particular
attainment of MDG4. However, the community health system faces resource constraints and inconsistencies around quality
of service – which negatively affect health outcomes.
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Background: Community Health Workers (CHWs) have a positive impact on the provision of community-based
primary health care through screening, treatment, referral, psychosocial support, and accompaniment. With a
broad scope of work, CHW programs must balance the breadth and depth of tasks to mainta...in CHW motivation for
high-quality care delivery. Few studies have described the CHW perspective on intrinsic and extrinsic motivation to
enhance their programmatic activities.
Methods: We utilized an exploratory qualitative study design with CHWs employed in the household model in Neno
District, Malawi, to explore their perspectives on intrinsic and extrinsic motivators and dissatisfiers in their work. Data
was collected in 8 focus group discussions with 90 CHWs in October 2018 and March–April 2019 in seven purposively
selected catchment areas. All interviews were audiotaped, transcribed verbatim, coded, and analyzed using Dedoose.
Results: Themes of complex intrinsic and extrinsic factors were generated from the perspectives of the CHWs in
the focus group discussions. Study results indicate that enabling factors are primarily intrinsic factors such as positive
patient outcomes, community respect, and recognition by the formal health care system but can lead to the chal-
lenge of increased scope and workload. Extrinsic factors can provide challenges, including an increased scope and
workload from original expectations, lack of resources to utilize in their work, and rugged geography. However, a posi-
tive work environment through supportive relationships between CHWs and supervisors enables the CHWs.
Conclusion: This study demonstrated enabling factors and challenges for CHW performance from their perspec-
tive within the dual-factor theory. We can mitigate challenges through focused efforts to limit geographical distance,
manage workload, and strengthen CHW support to reinforce their recognition and trust. Such programmatic empha-
sis can focus on enhancing motivational factors found in this study to improve the CHWs’ experience in their role. The
engagement of CHWs, the communities, and the formal health care system is critical to improving the care provided
to the patients and communities, along with building supportive systems to recognize the work done by CHWs for
the primary health care systems.
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This Birth Defect Surveillance facilitator (train-the-trainer) guide 2nd edition covers foundational skills needed to begin the development, implementation and ongoing improvement of a congenital anomaly surveillance programme, whether population-based or hospital-based, in particular for countries ...with limited resources.
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Severe Acute Malnutrition (SAM) is one of the greatest child survival challenges in the world today and
reportedly affects more than 16.2 million children each year1. High impact, proven treatment interventions exist
yet sadly approximately only 3.2 million children with SAM have access to treatme...nt each year2. Thus, there
is a need to scale up interventions to improve coverage and access across high burden countries. While efforts
are currently underway to expand services in many countries, obstacles remain.
One critical barrier to expanding SAM treatment services is the acceptance, accessibility and utilisation of
ready-to-use therapeutic food (RUTF). In some countries and contexts, RUTF is still not fully accepted by
community members; while other countries face problems with procurement, storage and supply chain
management which impact on availability and use3. Reports from Ghana and Zambia highlighted that stock-
outs and logistical challenges are often noted as key contributors to high default rates in outpatient treatment
centres4.
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Evidence shows that oral pre-exposure prophylaxis (PrEP) reduces the risk of contracting HIV during sexual intercourse by more than 90% when taken daily. It is for this reason the National HIV Prevention Strategy 2015-2020 (2018 Revision) emphasises the role of preexposure prophylaxis (PrEP) in ...reducing new HIV infections in Malawi.
The Ministry of Health has prioritised PrEP use among the populations most at-risk of HIV infection in Malawi: young women ages 10 to 24 years, sero-discordant couples, female sex workers, men who have sex with men, and other priority populations (such as members of the uniformed services, prisoners, and mobile populations).
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Mpox continues to affect people around the world. A new framework released today by WHO will guide health authorities, communities and other stakeholders in preventing and controlling mpox outbreaks, eliminating human-to-human transmission of the disease, and reducing spillover of the virus from ani...mals to humans.
Mpox is a viral illness caused by the monkeypox virus (MPXV). It can cause a painful rash, enlarged lymph nodes and fever. Most people fully recover, but some get very sick. The virus transmits from person to person through close, including sexual, contact. It also has animal reservoirs in east, central and west Africa, where spillovers from animals to humans can occasionally occur, sparking further outbreaks.
There are two different clades of the virus: clade I and clade II. Clade I outbreaks are deadlier than clade II outbreaks.
A major emergence of mpox linked to clade II began in 2017, and since 2022, has spread to all regions of the world. Between July 2022 and May 2023, the outbreak was declared a Public Health Emergency of International Concern. While that outbreak has largely subsided, cases and deaths continue to be reported today, illustrating that low-level transmission continues around the world.
Currently, there is also a major outbreak of clade I virus in the Democratic Republic of the Congo (DRC), where cases have been on the rise for decades. Since the beginning of the year, over 6500 cases and 345 deaths have been reported in the DRC. Almost half of these are among children under the age of 15 years.
The Strategic framework for enhancing prevention and control of mpox (2024–2027) provides a roadmap for health authorities, communities, and stakeholders worldwide to control mpox outbreaks in every context, advance mpox research and access to countermeasures, and to minimize zoonotic transmission.
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For thousands of years, humans have been using wildlife for commercial and subsistence purposes. Wildlife trade takes place at local, national and international levels, with different forms of wildlife, such as live animals, partly processed products and finished products. Wildlife is a vital source... of safe and nutritious food, clothing, medicine, and other products, in addition to having religious and cultural value. Wildlife trade also contributes to livelihoods, income generation and overall economic development.
However, wildlife trade can have detrimental effects on species conservation, depleting natural resources, impoverishing biodiversity and degrading ecosystems (Morton et al., 2021). Wildlife trade, whether legal or illegal, regulated or unregulated, can pose threats to animal health and welfare. It also presents opportunities for zoonotic pathogens to spill over between wildlife and domestic animals, and for diseases to emerge with serious consequences for public or animal health and profound economic impacts (IPBES, 2020; Swift et al., 2007; Smith et al., 2009; Gortazar et al., 2014; Stephen, 2021; Stephen et al., 2022; FAO, 2020). The risk of pathogen spillover and disease emergence is amplified with increased interaction between humans, wildlife and domestic animals. The risk of pathogen spillover has also been exacerbated by climate change, intensified agriculture and livestock production, deforestation, and other land-use changes. Wildlife trade is also a risk to ecosystem biodiversity via the introduction of invasive species (Wikramanayake et al., 2021). Therefore, increased effort must be put into understanding the potential consequences of the wildlife trade, mapping and analysing the adjacent risks, and implementing strategies to manage those risks. Reducing wildlife-trade risks not only helps to limit disease but also minimises the negative effects of invasive species. Between 1960 and 2021, invasive alien species caused estimated cumulative damage of around 116 billion euros across 39 countries in the European Union alone, despite strict import regulations (Haubrock et al., 2021). The effect of invasive species is extremely apparent.
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WHO’s Country Cooperation Strategy (CCS) defines the Organization’s medium-term vision for working in and with a particular country. The CCS, developed in the context of global and national health priorities, examines the overall health situation in a country, including the state of the health s...ector, socioeconomic status and the major health determinants.
This CCS sets out WHO’s strategic framework for collaboration with the Syrian Arab Republic, from June 2022 until June 2025, in light of the 12 years of crisis that have had a devastating impact on the health sector and infrastructure of basic services. It carefully considers the current and projected issues during its transition from continued humanitarian assistance to recovery, resilience and development. The consolidation of health policies and strategies and health system strengthening, based on the strengthening of primary health care (PHC), aims to contribute to the achievement of national and global development and health goals and the targets of the SDGs.
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Adolescence is a critical stage in life for physical, cognitive and emotional development, shaping future health and well-being. Comprehensive measurement of adolescent health is essential to prioritize health issues, guide interventions and track progress. However, global, regional and national ado...lescent health measurement has historically been inconsistent and incomplete.
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As our world changes, so too does the burden of disease. Globalisation, evolving trade and consumption patterns, and increased access to life-saving medical care are just some of the factors that have transformed the global health landscape.
Malawi is a small and beautiful country in south-central Africa. It is divided into three administrative regions: south, central and north. The regions are further subdivided into 28 districts. The Southern Region is the most densely populated, while the Northern Region is the least populated.
The workshop aimed to support countries in the prioritization and acceleration of NCD prevention and management with a specific focus on accelerating the prevention and control of hypertension and diabetes, identifying the most impactful NCD interventions within their context, closing the gaps in ca...ncer care services through regional collaboration and integrating NCD services in when responding to emergencies.
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This report includes analysis from informal regional consultations in the African Region, the Caribbean and North America, Latin America, South-East Asia Region, European Region, Eastern Mediterranean Region, alongside three forums in the Western Pacific Region. It analyses the overarching similarit...ies, regional nuances and priorities raised across the six WHO regions for the meaningful engagement of individuals with lived experience.
It is the second publication in the WHO Intention to action series, which aims to enhance the limited evidence base on the impact of meaningful engagement and address the lack of standardized approaches on how to operationalise meaningful engagement. The Intention to action series aims to do this by providing a platform from which individuals with lived experience, and organizational and institutional champions, can share solutions, challenges and promising practices related to this cross-cutting agenda. The Intention to action series also aims to provide powerful narratives, inspiration and evidence towards the Fourth United Nations High Level Meeting on NCDs in 2025 and achieving the 2030 United Nations Sustainable Development Goals (SDGs).
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The Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020 by the World Health Organization (WHO) outlines a comprehensive strategy to address the global rise in noncommunicable diseases (NCDs), including cardiovascular diseases, cancer, chronic respiratory diseases,... and diabetes.
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This report is one of the first major products of the newly established Precision Public Health Metrics unit of the UCN cluster of the WHO Regional Office for Africa. The report presents national trends in communicable and non-communicable disease burden and control in the WHO African region. It tra...cks progress made with respect to disease burden reduction, elimination and eradication. It also highlights major emerging threats, opportunities and priorities in the fight against commu- nicable and non-communicable diseases in the region. It covers the period 2000-2022, but for some indicators, information is available only up to 2021.
The report shows the number of reported cases for malaria and vaccine preventable diseases (meningitis, measles, yellow fever, pertussis, diphtheria, tetanus, and polio); disease incidence due to HIV, tuberculosis and four major noncommunicable diseases (cardiovas- cular diseases, cancers, diabetes and chronic respira- tory diseases).
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An estimated 1.3 billion people globally experience significant disability. This figure has grown over the last decade and will continue to rise due to demographic and epidemiological changes. In 2022, the World Health Organization launched the Global report on health equity for persons with disabil...ities. This report demonstrated that many persons with disabilities are still being left behind. Experiencing persistent health inequities, persons with disabilities die earlier, they have poorer health and functioning, and they are more affected by health emergencies than the general population. These differences are largely associated with unjust factors both inside and beyond the health sector and are avoidable. The Global Report called upon Member States to take actions to make health sector more inclusive for persons with disabilities through the primary health care approach. This will be essential for countries to make health coverage truly universal and to progress towards other health-related targets in the sustainable development goals.
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