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This working paper was conceived to offer practical tips and suggestions on how to establish and sustain the multisectoral coordination needed to develop and implement National Action Plans on AMR (NAPs). It is intended for anyone with responsibilit
...
y for addressing AMR at country level. Drawing on both the published literature and the operational experience of four ‘focal countries’ (Ethiopia, Kenya, Philippines and Thailand), it summarizes lessons learned and the latest thinking on multisectoral working to achieve effective AMR action. The experience in focal countries points to a number of tools and tactics that can be used to help establish and enhance sustainable multisectoral collaboration for AMR action. These can be grouped into four categories: political commitment, resources, governance mechanisms, and practical management.
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This handbook follows a comprehensive approach to health system strengthening at borders in order to support IHR national focal points and other national agencies in developing and implementing evid
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ence-based action plans for IHR capacity development at ground crossings. The approach includes the movement of travellers and baggage, cargo, containers, conveyances, goods and postal parcels across ground crossings, as well as the interaction with adjacent border communities. Other factors can be considered, if needed, throughout the risk assessment.
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In Kenya, the bacterial infections that contribute most to human disease are often those in which re-‐sistance is most evident. Examples are multidrug-‐resistant enteric bacterial pathogens such as typhoid,
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diarrhoeagenic Escherichia coli and invasive non-‐typhi salmonella, penicillin-‐resistant Streptococcus pneu-‐moniae, vancomycin-‐resistant enterococci, methicillin-‐resistant Staphylococcus aureus and multidrug-‐re-‐sistant Mycobacterium tuberculosis. Resistance to medicines commonly used to treat malaria is of particu-‐lar concern, as is the emerging resistance to anti-‐HIV drugs. Often, more expensive medicines are required to treat these infections, and this becomes a major challenge in resource-‐poor settings.
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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 attributa
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ble to health system failures exceeded deaths from 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 focus of the current quarterly edition of Eurohealth (from the European Observatory on Health Systems and Policies) is Antimicrobial Resistance (AMR) and contains the following articles:
• Strengthening implementation of AMR national ac
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tion plans
• Fostering clinical development and commercialisation of novel antibiotics
• Tackling AMR in the community
• Quantifying the benefits of vaccines in combating AMR
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The purpose of this document is to present and promote the minimum requirements for IPC programmes at the national and health care facility level, identified by expert consensus according to available evidence and in the context of the WHO core comp
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onents.
The minimum requirements are defined as: IPC standards that should be in place at the national and facility level to provide minimum protection and safety to patients, HCWs and visitors, based on the WHO core components for IPC programmes.
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The primary audience for this guidance is persons
working directly in vector-borne disease prevention
and control, including programme managers,
researchers and field workers. A brief technical
background is provided for the benefit of persons
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without expertise in vector-borne diseases; readers
working in the field may wish to skip the background
section and begin with the discussion of ethical
issues and values in Chapter 3. The guidance cannot
offer universally applicable answers to the complex
ethical issues raised, nor can it provide a checklist of
issues that are necessarily relevant in all situations.
Rather, its goal is to help readers recognize aspects
of their work that raise significant ethical challenges
and to respond to these challenges in accordance
with internationally accepted values and norms.
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Community-based strategies play a significant role in many health systems in low- and middle-income countries, especially in light of critical shortages in the health workforce. The term community health worker has been used to refer to volunteers and salaried, professional or lay health workers wit
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h a wide range of training, experience, scope of practice and integration in health systems. In the context of this study, we use the term community-based practitioner (CBPs) to reflect the diverse nature of these cadres of health workers.
CBPs provide preventive, promotive, curative and palliative services across a range of areas, including reproductive, maternal, newborn and child health, HIV, tuberculosis, malaria, control of other endemic diseases, and noncommunicable diseases. Significant evidence has emerged over the past two decades on their effectiveness, which has triggered interest in the potential to use their services to expand access to care, in particular in rural and underserved areas where deployment and retention of more qualified health workers is problematic. Calls have been made to integrate CBP programmes in human resources and health strategies, and to scale up rapidly the extent and coverage of CBP initiatives.
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This publication provides managers with guidance on how to create basic HIV prevention cascades as a starting point to enhance their ability to monitor and improve their programming and to facilitate comparisons of programme effectiveness across sit
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es.
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Health, safety and wellbeing of the Healthcare workers is a prerequisite for good quality of care and patient satisfaction in health services. Healthcare facilities that are not safe for workers and patients are not resilient to any shock arising from hostile events, outbreaks or any other emergenci
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es. Occupational Safety and Health Act (2005) and the National Occupational Safety and Health Policy of Zanzibar require the development of stringent systems for managing occupational safety and health in all workplaces and the health system in general.
These Policy Guidelines have been developed by the Ministry of Health in consultation with the Ministry responsible for Labour and other stakeholders, such as organizations of workers, employers and professional associations in the health sector. The purpose of these guidelines is to foster the implementation of the international commitments and the national legislation regarding decent work in the health system as well as to improve the quality of care and the resilience of health facilities.
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BACKGROUND: Growing political attention to antimicrobial resistance (AMR) offers a rare opportunity for achieving meaningful action. Many governments have developed national AMR action plans, but most have not yet implemented policy interventions to
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reduce antimicrobial overuse. A systematic evidence map can support governments in making evidence-informed decisions about implementing programs to reduce AMR, by identifying, describing, and assessing the full range of evaluated government policy options to reduce antimicrobial use in humans.
METHODS AND FINDINGS: Seven databases were searched from inception to January 28, 2019, (MEDLINE, CINAHL, EMBASE, PAIS Index, Cochrane Central Register of Controlled Trials, Web of Science, and PubMed). We identified studies that (1) clearly described a government policy intervention aimed at reducing human antimicrobial use, and (2) applied a quantitative design to measure the impact. We found 69 unique evaluations of government policy interventions carried out across 4 of the 6 WHO regions. These evaluations included randomized controlled trials (n = 4), non-randomized controlled trials (n = 3), controlled before-and-after designs (n = 7), interrupted time series designs (n = 25), uncontrolled before-and-after designs (n = 18), descriptive designs (n = 10), and cohort designs (n = 2). From these we identified 17 unique policy options for governments to reduce the human use of antimicrobials. Many studies evaluated public awareness campaigns (n = 17) and antimicrobial guidelines (n = 13); however, others offered different policy options such as professional regulation, restricted reimbursement, pay for performance, and prescription requirements. Identifying these policies can inform the development of future policies and evaluations in different contexts and health systems. Limitations of our study include the possible omission of unpublished initiatives, and that policies not evaluated with respect to antimicrobial use have not been captured in this review.
CONCLUSIONS: To our knowledge this is the first study to provide policy makers with synthesized evidence on specific government policy interventions addressing AMR. In the future, governments should ensure that AMR policy interventions are evaluated using rigorous study designs and that study results are published.
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In the last decade, Timor-Leste has made remarkable progress in strengthening its health system and improving the health status of its population. This has resulted in an increased life expectancy, and the achievement of Millennium Development Goals such as a reduction in infant and under-five morta
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lity, an improvement in maternal and child health outcomes, and an increase in immunization coverage. Further, the country has successfully eliminated infectious diseases such as polio, measles, and maternal and neonatal tetanus. There is full political commitment to reducing the incidence of tuberculosis (TB) by 80% and the number of deaths due to TB by 90% by 2030. The country has made great progress in the context of the pandemic, having established numerous quarantine facilities/isolation centres; trained health-care workers; streamlined the procurement and supply of medicines, consumables, personal protective equipment and other equipment; and strengthened the capacity in critical care across secondary and tertiary health care, to better respond to future pandemics and other disaster situations.
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Antimicrobial resistance (AMR) as a serious public health threat was globally acknowledged by WHO in 2015, through the launch of the Global Action Plan (GAP). With a limited number of new antibiotics in the developmental pipeline, many countries are in the process of establishing strategies for anti
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microbial stewardship (AMS). Within each country, different healthcare challenges have
contributed to AMR. This has also shaped individual AMS strategies and policies. In South Africa (SA), there is a high burden of infectious diseases, mainly of bacterial origin. In addition, SA also has the highest number of people living with
human immunodeficiency virus (HIV) globally. According to the 2019 statistics, there are approximately 7.97 million people living with HIV in SA. Together with this, SA has the fourth largest tuberculosis population globally.
Other important challenges include poverty, malnutrition, a high burden of non-communicable diseases, and a dire shortage of trained healthcare professionals (e.g. clinicians, pharmacists, and nurses).
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The revision of the SRHR Policy is based on the results of the analysis of the implementation process of the past policy, which has provided evidence to
ensure that the revised policy is relevant and effective. The revision has also been done with the participation of all
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national stakeholders who have
also international experience on SRHR issues. The Ministry urges all public and private institutions to use this policy as a guide in the implementation of
SRHR services in the country.
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This action plan is intended for senior-level decision-makers in ministries of health, malaria
programme managers, entomologists, and epidemiologists working on malaria and other vectorborne diseases programmes. It is also intended for decision-mak
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ers and technical and advocacy
staff at other organizations and stakeholders involved in public health, malaria control and
elimination, and urban and rural development.
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Diabetes mellitus, commonly known as diabetes, is a group of metabolic disorders characterized by the presence of hyperglycaemia in the absence of treatment. The heterogeneous aetiopathology includes defects in insulin secretion, insulin action, or both. The long-term specific complications of diabe
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tes include retinopathy, nephropathy, and neuropathy. People with diabetes are also at increased risk of other diseases, including cardiac, peripheral arterial and cerebrovascular disease, cataracts, erectile dysfunction, and nonalcoholic fatty liver disease. They are also at an increased risk of some infectious diseases such as tuberculosis, and are likely to experience poorer outcomes.
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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 situatio
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n in a country, including the state of the health sector, 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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Health system resilience is not an inevitable byproduct of any investment in health but must be intentionally programmed and developed with necessary input, investment and contextualization. This technical product aims to guide national, subnational
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, and global health actors to operationalize the concept of health system resilience for advancement of universal health coverage, health security and ultimately better health for all. It supports the translation of relevant conceptual guidance and high-level recommendations into practical actions.
The specific objectives are to:
present a concise overview of the concept of health system resilience;
provide a roadmap outlining practical and foundational steps for building health system resilience to be adapted to different contexts;
share examples of actions and tools, including stakeholder roles, to support country application of the roadmap.
The target audience for this work is the various stakeholders involved in strengthening health systems and public health including management of emergencies (from prevention and preparedness to response and recovery) and other public health challenges in countries. This ranges from the donors, policy-makers and decision-makers at global, national and subnational levels to the implementing institutions and line managers of health system functions and services across the health system building blocks.
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In Sierra Leone, Health care delivery is organized around a three-tier system i) primary level constituting peripheral health units (community health centers, community health posts, and maternal and child health posts secondary level constituting district hospitals tertiary level comprising region
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al and national referral hospitals [Figure 3].
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The protracted humanitarian situation in northeastern Nigeria, particularly in Borno, Adamawa, and Yobe (BAY) States, remains a concern due to ongoing insecurity, displacement, food insecurity, disease outbreaks, and climate-related shocks. To address these complex challenges, the health sector has
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developed a comprehensive humanitarian response strategy aligned with the three States Development plans, Durable Solutions for the Population Displacement Plan, and the Humanitarian Need Response Plan for 2025. This strategy aims to reduce morbidity and mortality among crisisaffected populations by ensuring timely, equitable, and effective delivery of lifesaving health services, while strengthen the resilience of health system and enhancing local and national capacities for sustainable health response in protracted emergency.
Supported by an in-depth analysis of the ongoing health humanitarian response using the Strengths, Weaknesses, Opportunities, and Threats (SWOT) methodology, the strategy is guided by three key objectives:
1. Provide access to lifesaving interventions and sustain an effective response to the prolonged health emergency.
2. Prevent, mitigate, and prepare for health risks from all hazards and respond to all health emergencies.
3. Advance the primary health care approach and essential health system capacities for universal health coverage.
To achieve these objectives, the strategy employs the “Five C” framework which refers to:
• Collaborative Surveillance: Enhancing collaborative efforts for effective monitoring.
• Community Protection: Implementing community-based protection measures.
• Safe and Scalable Care: Ensuring care that is both secure and scalable.
• Access to Countermeasures: Facilitating access to necessary countermeasures.
• Emergency Coordination: Coordinating emergency responses efficiently.
These proactive approaches are designed to be more anticipatory and preemptive rather than reactive, aiming to meet the needs of the crisis-affected population by providing lifesaving interventions, enhancing preventive and anticipatory actions, and ensuring the resilience of the health system. All actions are guided by International Humanitarian Standards and the Humanitarian Principles.
The implementation of the health humanitarian response strategy will involve collaboration with local authorities, non-governmental organizations (NGOs), and international organizations. The strategy emphasizes localization and resource mobilization, efficient logistics and supply chain management, mainstreaming protection, and the deployment and training of healthcare workers. Continuous monitoring and periodic evaluation will ensure the effectiveness of the response. Cross-sector collaboration with sectors such as WASH, Nutrition, Education, and Protection will be crucial to enhance the quality and reach of health interventions. Additionally, sustainability and transition approaches will ensure long-term health outcomes and benefits, bridging the gap from humanitarian to development efforts.
By adopting this comprehensive approach, the humanitarian response in northeastern Nigeria, particularly in BAY States, can be effectively guided, ultimately reducing the suffering of affected populations.
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