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In sum, the goal is to understand the need to increase fiscal space for health as a prerequisite, but within the framework of efforts to transform the health system. These changes should foster equi
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table and efficient expenditures and create or strengthen comprehensive integrated health systems with a first level of care capable of solving health problems and coordinating networks, based on a primary health care approach that offers not only curative care but also health promotion and disease prevention services.
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Introduction Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle-income countries (LMICs); however, little is known
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about the required training necessary for them to accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs.
Methods A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project’s Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers.
Results The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before–after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention.
Conclusion The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and cost-effectiveness of training programmes for CHWs.
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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. Howe
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ver, consolidation of CHVs position within formal health systems has proved to be complex and continues 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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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 Glob
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al report on health equity for persons with disabilities. 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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As part of the project ‘Equitable health financing for a strong health system in Mozambique’, N’weti and Wemos developed this policy brief with actionable policy recommendations for the Mozamb
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ican government and international organizations on how to increase resources for health in a sustainable and equitable manner. With global cooperation and adequate fiscal reforms, Mozambique can secure quality healthcare for its population and move toward a more self-reliant and healthy future.
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This comprehensive HPFM report thoroughly explores Kenya’s health financing landscape. It provides an in-depth analysis of the current state of affairs and sheds light on required strategic change
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s in health financing. The report points out the need to improve public financial management within the health sector, for more efficient financial systems. It focuses on better resourceraising and utilization mechanisms. The matrix highlights the need for consolidation of fragmented health financing arrangements, for a more efficient health system. It also emphasizes the need for enhancing strategic purchasing of health services, to improve the overall efficiency and quality of care. Additionally, the report stresses the critical
role of leveraging data and information systems for more evidence-based informed decision-making. These recommendations are crucial for advancing Kenya’s health financing system and moving closer to the UHC goal.
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PHSM are vital in reducing the risk and scale of infectious disease transmission and lowering hospitalization and deaths. Examples include contact tracing, quarantine and isolation, mask use, ventilation, school or workplace measures, mobility restrictions and travel requirements.
While these mea
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sures are essential, decision-making on PHSM becomes particularly complex during rapidly evolving health emergencies, with incomplete information and under significant public and political pressure, especially when the pathogen is novel or poorly understood. In such contexts, guidance needs to be agile and responsive, developed and adapted based on emerging evidence and shifting epidemiological patterns. Decision-makers are frequently confronted with difficult trade-offs, having to balance measures that are:
─ effective but socially disruptive;
─ cost-effective but logistically burdensome;
─ beneficial for public health but economically disruptive; or
─ practical but inequitable or unethical
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This is the third guidance note in a four-part series of notes related to impact evaluation developed by InterAction with financial support from the Rockefeller Foundation.This third guidance note, Introduction to Mixed Methods in
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Impact Evaluation, starts by explaining what a mixed methods (MM) impact evaluation design is and what distinguishes this approach from quantitative or qualitative impact evaluation designs. It notes that a mixed methods approach seeks to integrate social science disciplines with predominantly quantitative (QUANT) and predominantly qualitative (QUAL) approaches to theory, data collection, data analysis and interpretation. The guidance note is also available in French and Spanish on https://www.interaction.org/impact-evaluation-notes. ATTENTION: ANNEXES 1 TO 11 TO THIS DOCUMENT CAN BE FOUND IN ENGLISH VERSION ON: https://www.interaction.org/introduction-mixed-methods-impact-evaluation-annexes
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This is the fourth guidance note in a four-part series of notes related to impact evaluation developed by InterAction with financial support from the Rockefeller Foundation.This fourth guidance note, Use of
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Impact Evaluation Results, highlights three themes crucial for effective utilization of evaluation results. Theme one states that use does not happen by accident. Impact evaluations are more likely to be used when uses have been anticipated and planned from the earliest stages of the evaluation and, even better, from the planning stages of the work that is being evaluated. Theme two concerns the operations and systems required in an organization to use impact evaluations well. Theme three builds from the premise that the first two themes are necessary but insufficient conditions for the effective and widespread use of impact evaluations. The guidance note is also available in French, Arabic and Spanish on https://www.interaction.org/impact-evaluation-notes.
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Antimicrobial resistance (AMR) has emerged as a leading cause of death in the African region, surpassing fatalities from malaria, HIV, and TB. In response to this critical threat, the region has adopted the AMR Global Action Plan and the African Union Framework for Antimicrobial Resistance Control 2
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020 – 2025, which is tailored to meet the specific needs of African nations through a coordinated approach. While most countries in the region have developed and prioritized National Action Plans (NAPs) to tackle AMR, the overall response remains inadequate given the magnitude of the threat, which endangers human, animal, environmental, aquatic, and plant health.
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To understand the patterns of Rwanda’s achievements in health development, it is important to explore how Rwanda addresses the Social Determinants of Health (SDH) particularly those related to rou
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tine conditions in which people are born, live and work. It is in this particular context that a case study on Rwanda’s Performance in Addressing Social Determinants of Health was conducted by the Rwanda Ministry of Health, with technical and financial support from the World Health Organization (WHO). The overall goal of the exercise was to document Rwanda's recent initiatives that contribute to the advancements of the Rio Political Declaration on Social Determinants of Health.
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Inequality of access to palliative care and symptom relief is one of the greatest disparities in global health care (1). Currently, there is avoidable suffering on a massive scale due to lack of acc
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ess to palliative care and symptom relief in low- and middle-income countries (LMICs) (1). Yet basic palliative care that can prevent or relieve most suffering due to serious or life-threatening health conditions can be taught easily to generalist clinicians, can be provided in the community and requires only simple, inexpensive medicines and equipment. For these reasons, the World Health Assembly (WHA) resolved that palliative care is "an ethical responsibility of health systems"(2). Further, most patients who need palliative care are at home and prefer to remain there. Thus, it is imperative that palliative care be provided in the community as part of primary care. This document was written to assist ministries of health and health care planners, implementers and managers to integrate palliative care and symptom control into primary health care (PHC).
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The Quadripartite organizations have developed the One Health Priority Research Agenda for AMR report, this is a joint initiative to assist in directing and catalysing scientific interest and financial investments for the priority research agenda ac
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ross sectors for countries and funding bodies. The research agenda also serves as a guide to mitigate One Health AMR that will help policymakers, researchers, and a multidisciplinary scientific community work together on solutions to prevent and mitigate AMR within the One Health approach.
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Accessed: 02.05.2020
These interim IPC recommendations for health settings have been developed through the contributions of many individuals and institutions, such as the Centers for Disease Control-Kenya; ITECH; US Agency for International Develop
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ment (USAID) Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program; and WHO that are committed to ensuring that the transmission of COVID-19 to HCWs and the public within the health care setting is limited. The Ministry of Health (MOH) through the Directorate of Health Standards Quality Assurance and Regulations wishes to thank all the contributing authors led by the sub-committee on case management and IPC for the COVID-19 response for their expertise and time given to writing these guidelines.
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Men are less likely than women to seek help for mental health issues and are much more likely to commit suicide. This scoping review examined recent evidence published in English and Russian on the
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role of socially constructed masculinity norms in men’s help-seeking behaviour for mental health issues. The key sociocultural barriers to men’s help-seeking pertaining to masculinity norms were identified as self-reliance, difficulty in expressing emotions and self-control.
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The purpose of this document is to address specific needs and considerations for essential oral health services in the context of COVID-19 in accordance with WHO operational guidance on maintaining
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essential health services. This interim guidance is intended for public health authorities, chief dental officers at ministries of health and oral health care personnel working in private and public health sectors. The document may be subject to change as new information becomes available.
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The growing understanding of how sequence information can contribute to improved public health is driving global investments in sequencing facilities and programmes. The falling cost and complexity of generating GSD provides opportunities for expand
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ing sequencing capacity; however, challenges to widespread implementation remain. This document provides policy-makers and stakeholders with guidance on how to maximize the public health benefit of SARS-CoV-2 genomic sequencing activities in the short and long term as the pandemic continues to unfold. Practical considerations for the implementation of a virus genomic sequencing programme and an overview of the public health objectives of genomic sequencing are covered. This guidance focuses on SARS-CoV-2 but is applicable to other pathogens of public health concern.
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The chapter Closing the Gap: The Health Disparities of Older LGBTI People in the Americas, is part of the publication series titled ‘Decade of Healthy Aging: situation and challenges’. In order to outline the current knowledge available
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on the situation of health and well-being of older persons in the Americas at the beginning of the United Nations Decade of Healthy Aging (2021-2030), this document presents data and existing evidence different forms of discrimination and mistreatment older people face due to their sexual orientation and gender identities that ultimately increase health disparities. Previous studies on LGBTI older people offer valuable information on the lived experiences of these communities and demonstrate that they face unique challenges with aging, emphasizing the difficulties related to access to care. Very few studies on older people and aging include a focus on sexual orientation or gender identity; however, it is possible to point out that HIV/AIDS is one of the most significant health disparities confronting LGBTI older persons, followed by physical and mental health problems, substance use, social isolation, poverty, and the lack of access to quality healthcare, including long-term care facilities or other institutions. Closing the gap in access and quality of health and care services is an imperative to increase longevity, health status and quality of life of LGBTI older people.
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Recognizing the importance of the critical role of community health in disaster management, the Amref health Africa has
developed this operational guide to provide policy direction
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on COVID-19 response at community level. This guide has
been developed in collaboration with all the implementing countries in supporting prevention and control of COVID-19.
With a strong community COVID-19 response system at community level, we can all contribute to prevention and control
of COVID-19, and thereby improve health and livelihoods for all people
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Frontline health workers (FHWs) provide services directly to communities where they are most needed, especially in remote and rural areas. Many are community health workers and midwives, though they
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can also include local emergency responders/paramedics, pharmacists, nurses, and doctors who serve in community clinics.
The growing burden of non-communicable diseases (NCDs) on low- and middle-income countries threatens many health systems that are already weakened. In many countries, health systems—and health workers—are not prepared to address the complex nature of NCDs. Health systems are often fragmented, and designed to respond to single episodes of care or long-term prevention and control of infectious diseases.1 Many countries also continue to face shortages and distribution challenges of trained and supported health workers. As most NCDs are multifactorial in origin and are detected later in their evolution, health systems face significant challenges to provide early detection as well as affordable, effective, and timely treatment, particularly in underserved communities.
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