Regional Network for Equity in Health in east and southern Africa (EQUINET): Disussion Paper 111
The health services delivery system in Zambia is pyramid in structure, with primary healthcare (PHC) services at community level, at the base, followed by first and second level hospitals at distric...t and provincial levels, respectively, and third level (tertiary) services at national level. Notably, primary health services are free in Zambia and health service providers are either governmentowned or not-for-profit facilities.
Over the years, resource constraints have affected the quality and extent of healthcare services at all levels, requiring the mobilisation of additional resources for the sector. In doing so, prioritisation was high on the agenda of health sector reform. The EHB, therefore, prioritises interventions with the highest impact on the population, enabling policy makers to revisit priority diseases and conditions and to cost the services provided at each level of facility. Other key issues in developing the EHB in Zambia have included the need to have cost-effective services and cost per capita of services for more systematic budgeting, to rank interventions and to validate and cost the health benefit package as a whole.
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This regional advocacy strategy on HIV and AIDS, tuberculosis (TB) and sexually transmitted infetions (STIs) is intended for use by Southern African Development Community (SADC) Member States at a national level. This is an overall advocacy strategy highlighting the most important issues relating to... HIV and AIDS, TB and STIs in the Southern African region. It provides a broad advocacy framework for each of the issues identied, along with key targets, messages, and interventions
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This document adopts a health determinants framework for examining the evidence related to women’s poor mental health. From this perspective, public policy including economic policy, socio-cultural and environmental factors, community and social support, stressors and life events, personal behavio...ur and skills, and availability and access to health services, are all seen to exercise a role in determining women’s mental health status. Similarly, when considering the differences between women and men, a gender approach has been used. While this does not exclude biological or sex differences, it considers the critical roles that social and cultural factors and unequal power relations between men and women play in promoting or impeding mental health. Such inequalities create, maintain and exacerbate exposure to risk factors that endanger women’s mental health, and are most graphically illustrated in the significantly different rates of depression between men and women, poverty and its impact, and the phenomenal prevalence of violence against women.
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Global Development: Where Are We Now?
Today, we are facing a vital opportunity to change the profile of cardiovascular disease around the world.
The Millennium Development Goals (MDGs) are due to expire at the end of 2015, placing the cardiovascular health community in a unique position to shape t...he priorities for the next development agenda, and save millions of lives.
Despite its devastating impact on people of all ages, genders and ethnicities, cardiovascular disease was excluded from the Millennium Development Goals (MDGs), which were announced by the United Nations in 2000. That oversight was far-reaching;
for well over a decade, non-communicable diseases were omitted from the global funding agenda and deprioritized by other mechanisms. During that period of muted government action, the prevalence and burden of non-communicable diseases increased in every region of the world.
Fifteen years later, as the successors to the MDGs are being negotiated, we are in a position to call for the prioritization of cardiovascular disease on the forthcoming global development agenda. Once we have ensured that CVD is recognised at the global policy level, our efforts will turn to encouraging governments to honour their commitments on
the prevention and control of CVD.
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In many low- and middle-income countries, there is a wide gap between evidencebased recommendations and current practice. Treatment of major CVD risk factors remains suboptimal, and only a minority of patients who are treated reach their target levels for blood pressure, blood sugar and blood choles...terol.
In other areas, overtreatment can occur with the use of non-evidence-based
protocols. The aim of using standard treatment protocols is to improve the quality
of clinical care, reduce clinical variability and simplify the treatment options,
particularly in primary health care. Standard treatment protocols can be developed by preparing new national treatment guidelines or by adapting or adopting international guidelines.
The Evidence-based protocols module uses hypertension and diabetes screening
and treatment as an entry point to control cardiovascular risk factors, prevent target organ damage, and reduce premature morbidity and mortality. A comprehensive risk- based approach for integrated management of hypertension, diabetes, and high cholesterol is included in the Risk-based CVD management module.
This module includes clinical practice points and sample protocols for:
1. hypertension detection and treatment
2. type 2 diabetes detection and treatment
3. identifying basic emergencies – care and referral.
HEARTS emphasizes adaptation, dissemination, and use of a standardized set of
simple clinical-management protocols, which should be drug- and dose-specific,
and include a core set of medications. The simpler the protocols and management tools, the more likely they are to be used correctly, and the higher the likelihood that a programme will achieve its goals.
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The Global Burden of Disease Study (GBD) began 30 years ago with the goal of providing timely, valid and relevant assessments of critical health outcomes. Over this period, the GBD has become progressively more granular. The latest iteration provides assessments of thousands of outcomes for diseases..., injuries and risk factors in more than 200 countries and territories and at the subnational level in more than 20 countries. The GBD is now produced by an active collaboration of over 8,000 scientists and analysts from more than 150 countries. With each GBD iteration, the data, data processing and methods used for data synthesis have evolved, with the goal of enhancing transparency and comparability of measurements and communicating various sources of uncertainty. The GBD has many limitations, but it remains a dynamic, iterative and rigorous attempt to provide meaningful health measurement to a wide range of stakeholders.
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The World Heart Federation (WHF) is a leading global advocate for stronger legislation and policies regarding cardiovascular disease (CVD) and its risk factors, including raised cholesterol. The present Cholesterol Advocacy Toolkit 2022 provides WHF member organizations with information as well as p...ractical tools to
support cholesterol advocacy at the local and regional levels.
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About one fourth of the world’s population is estimated to have been infected with the tuberculosis (TB) bacilli, and about 5–10% of those infected develop TB disease in their lifetime. The risk for TB disease after infection depends on several factors, the most important being the person’s im...munological status. TB preventive treatment (TPT) given to people at highest risk of progressing from TB infection to disease remains a critical element to achieve the global targets of the End TB Strategy, as reiterated by the second UN High Level Meeting on TB in 2023. Delivering TPT effectively and safely necessitates a programmatic approach to implement a comprehensive package of interventions along a cascade of care: identifying individuals at highest risk, screening for TB and ruling out TB disease, testing for TB infection, and choosing the preventive treatment option that is best suited to an individual, managing adverse events, supporting medication adherence and monitoring programmatic performance.
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Diabetes mellitus (DM) is a global epidemic with significant morbidity. Diabetic
retinopathy (DR) is the specific microvascular complication of DM and affects 1 in 3 persons with DM. DR remains a leading cause of vision loss in working adult populations. Patients with severe levels of DR are report...ed to have poorer quality of life and reduced levels of physical, emotional, and social well-being, and they utilize more health care resources.
Epidemiological studies and clinical trials have shown that optimal control of blood glucose, blood pressure, and blood lipids can reduce the risk of developing retinopathy and slow its progression. Timely treatment with laser photocoagulation, and increasingly, the appropriate use of intraocular administration of vascular endothelial growth factor (VEGF) inhibitors can prevent visual loss in vision- threatening retinopathy, particularly diabetic macular edema (DME). Since visual loss may not be present in the earlier stages of retinopathy, regular screening of persons with diabetes is essential to enable early intervention.
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Countries reported disruptions in all health-care settings. In more than half of countries surveyed, many people are still unable to access care at the primary care and community care levels. Significant disruptions have also been reported in emergency care, particularly concerning given the impact... on people with urgent health needs. Thirty-six per cent of countries reported disruptions to ambulance services; 32% to 24-hour emergency room services; and 23% to emergency surgeries.
Elective surgeries have also been disrupted in 59% of countries, which can have accumulating consequences on health and well-being as the pandemic continues. Disruptions to rehabilitative care and palliative care were also reported in around half of the countries surveyed.
Major barriers to health service recovery include pre-existing health systems issues which have been exacerbated by the pandemic as well as decreased demand for care.
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Lancet Public health 2022 January 6, 2022 https://doi.org/10.1016/ S2468-2667(21)00249-8
Growth in the number of individuals living with dementia underscores the need for public health planning efforts and policy to address the needs of this group. Country-level estimates can be used to inform nati...onal planning efforts and decisions. Multifaceted approaches, including scaling up interventions to address modifiable risk factors and investing in research on biological mechanisms, will be key in addressing the expected increases in the number of individuals affected by dementia.
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1 June 2020
Countries around the world are facing the challenge of increased demand for care of people with COVID-19, compounded by fear, misinformation and limitations on movement that disrupt the delivery of health care for all conditions. Maintaining essential health services: operational guidan...ce for the COVID-19 context recommends practical actions that countries can take at national, subregional and local levels to reorganize and safely maintain access to high-quality, essential health services in the pandemic context. It also outlines sample indicators for monitoring essential health services, and describes considerations on when to stop and restart services as COVID-19 transmission recedes and surges. This document expands on the content of pillar 9 of the COVID-19 strategic preparedness and response plan, supersedes the earlier Operational guidance for maintaining essential health services during an outbreak, and complements the recently-released Community-based health care, including outreach and campaigns, in the context of the COVID-19 pandemic. It is intended for decision-makers and managers at the national and subnational levels.
This is an update to COVID-19: Operational guidance for maintaining essential health services during an outbreak: Interim guidance, 25 March 2020
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This publication provides guidance to governments, civil society organizations (nongovernmental organizations and community-based organizations) and other partners implementing HIV prevention, care and treatment programs with key populations. This guide is designed to assist these programs in the de...velopment of monitoring systems for frontline workers (such as peer outreach workers, staff outreach supervisors and program managers) to understand performance. It includes comprehensive tools and forms that various levels of staff can use to collect and analyze data to manage and improve a program.
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This report reviews the current situation in relation to national capacity to address NCDs and the progress made at country level over the past decade. It highlights that, while progress is being made, there is still much work to be done to create the infrastructure, policies, surveillance and healt...h systems response that will allow NCDs and their contributing risk factors to be successfully contained and reversed.
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Technical guidance.
This technical guidance aims to inform policy and practice development specifically related to improving the health of older refugees and migrants within the European Union and the larger WHO European Region. Both ageing and migration are in themselves complex multidimensional p...rocesses shaped by a range of factors at the micro, meso and macro levels over the life-course of the individual, but also with intertwined trajectories. Relevant areas for policy-making include healthy ageing over the life-course, supportive environments, people-centred health and long-term care services, and strengthening the evidence base and research
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The WHO Quality Health Services: a planning guide focuses on actions required at the national, district and facility levels to enhance quality of health services, providing guidance on implementing key activities at each of these three levels. It highlights the need for a health systems approach to ...enhance quality of care, with a common understanding on the activities needed by all stakeholders. The guide articulates the key actions required to improve the quality of health services for the entire population. It recognizes that the path varies for each country, district and facility – stimulating the reader to consider multiple factors and entry points for action. This planning guide is for staff working at all levels of the health system (i.e. national, district and facility) who have a role in enhancing the quality of health services. It is also relevant to all stakeholders initiating and supporting action at facility, district and/or national levels both in the public and private sectors.
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The report offers 20 top recommendations for getting ahead of future outbreaks in Yemen and similarly complex humanitarian settings.
In 2015, Yemen was declared a Level 3 emergency by the UN, kicking into gear the highest level of humanitarian support. A massive cholera outbreak followed, leading t...o 1 million suspected cases in 2 waves from September 2016-July 2018.
“We largely know ‘what to do’ to control cholera, but context-specific practices on ‘how to do it’ in order to surmount challenges to coordination, logistics, insecurity, access and politics remain needed,” the report states.
While the response improved between the 2 waves, there were gaps. For one, Yemen’s history of cholera should have triggered a heavy focus on pre-planning for an epidemic, such as stockpiling supplies and doubling down on community-based surveillance, the report fou
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The importance of robust mortality surveillance systems cannot be overstated in an era marked by increasing global health challenges where health threats loom large and population dynamics continue to evolve. Accurate and timely mortality data is essential for identifying trends and detecting emergi...ng health threats, evaluating the impact of interventions, and guiding evidence-based policy decisions.
This framework outlines a holistic approach to strengthening routine mortality surveillance systems, considering the unique contextual factors and challenges faced by African countries. It emphasizes the importance of establishing efficient data collection mechanisms, enhancing data quality and completeness, and promoting data sharing and collaboration among stakeholders.
Moreover, the framework recognizes the pivotal role of technology in the integration of data from fragmented mortality data sources. It highlights the potential of innovative data capture methods, advanced analytics, and real-time reporting systems to enhance mortality data’s accuracy, efficiency, and timeliness.
The continental framework for mortality surveillance aligns with Africa CDC’s mission and strategic goal by serving as a fundamental component in strengthening public health systems, enhancing disease surveillance capacities and capabilities, informing evidence-based policies and interventions, and promoting collaboration and coordination among African countries to address health challenges and improve health outcomes on the continent.
The successful implementation of this framework requires collective commitment and concerted efforts from governments, health institutions, and the international community. We hope this document will serve as a catalyst for transformative change, enabling countries to build resilient mortality surveillance systems that protect public health, save lives, and contribute to evidence-based decision-making.
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The KMC implementation strategy targets a broad audience. These include policy-makers and programme managers at national, regional and local levels, government and nongovernmental organizations working in the area of maternal and newborn care, global and national professional associations, public an...d private hospital management at all levels of care, and facility- and community-based maternal and infant care providers.
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This guidance document is meant to support practitioners working in disaster prone contexts to develop and implement more effective integrated resilience programming. It promotes programming that cuts across different fields of work like rights awareness, food security, emergency preparedness, livel...ihoods, education, health etc. whilst at the same time encouraging us to work simultaneously at the individual, household, community and national level. It includes specific recommendations for developing resilience programming for communities prone to floods, cyclone, drought and earthquakes. It also includes recommendations to develop safe school programming to help reduce the impact of disasters on school infrastructure, ensure education continuity and build the resilience of students, teachers and their families.
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