Improvements in health cannot be achieved in isolation as they require an integrated, multisectorial development approach. The WHO's Regional Office for the Eastern Mediterranean has introduced the following community-based initiatives: basic development needs approach; healthy villages programme; healthy cities programme; women in health and development. These community-based initiatives have provided a stimulus for health and human development. This training manual provides material to help develop trainers; update the knowledge of field managers; and reinforce leadership and management skills.
Social inequality is widely recognized as an important cause of conflict and the social determinants of health in conflict settings reflect and reinforce these inequalities. This publication explores the impact of conflict and occupation on the health of people in six countries of the region, identifying loss of human rights, breaches of medical neutrality and psychosocial distress as key determinants that affect people's health in crisis settings. The publication also identifies some examples of activities and interventions that may help to mitigate the impact of these conflicts on the health and well-being of affected populations, as well as policy implications for all concerned parties.
The workforce established by the polio eradication programme have provided valuable support to COVID-19 vaccination efforts. Their work demonstrates that the skills, tools and expertise that have been built to eradicate polio can be repurposed effectively to build back stronger and more resilient public health systems. Lessons-learned from their role in COVID-19 vaccination efforts and essential immunization proves the case for a successful polio transition and the critical need to sustain this network to continue contributing to broader public health and immunization goals.
The World health statistics 2020 report is the annual compilation of health statistics for 194 Member States. It summarizes trends in life expectancy and causes of death and reports on progress towards the health and health-related Sustainable Development Goals (SDGs) and associated targets.
This report presents the recommendations of a WHO Expert Committee commissioned to coordinate activities leading to the adoption of international recommendations for the production and control of vaccines and other biological substances and the establishment of international biological reference materials. Following a brief introduction the report summarizes a number of general issues brought to the attention of the Committee. The next part of the report of particular relevance to manufacturers and national regulatory authorities outlines the discussions held on the development and adoption of new and revised WHO Recommendations Guidelines and guidance documents. Following these discussions a WHO guidance document on the Scientific principles for regulatory risk evaluation on finding an adventitious agent in a marketed vaccine was adopted along with WHO Guidelines on procedures and data requirements for changes to approved vaccines and revised WHO Recommendations to assure the quality safety and efficacy of poliomyelitis vaccines (inactivated). Subsequent sections of the report provide information on the current status and proposed development of international reference materials in the areas of antibiotics; biotherapeutics other than blood products; blood products and related substances; in vitro diagnostic device reagents; and vaccines and related substances. A series of annexes are then presented which include an updated list of all WHO Recommendations Guidelines and other documents on biological substances used in medicine (Annex 1). The above three WHO documents adopted on the advice of the Committee are then published as part of this report (Annexes 2–4). Finally all additions and discontinuations made during the 2014 meeting to the list of International Standards Reference Reagents and Reference Panels for biological substances maintained by WHO are summarized in Annex 5. The updated full catalogue of WHO International Reference Preparations is available at: http://www.who.int/bloodproducts/catalogue/en/.
Experience with public health emergencies such as the COVID-19 pandemic clearly demonstrates that weak public health capacities leave populations and health, economic, and social systems vulnerable. Health system challenges are increasing in number and complexity, while health system resourcing, often seen as a cost rather than an investment, remains inadequate. The limited resources available are skewed towards clinical services and emergency response, leaving persistent weaknesses in preventive, promotive and protective capacities. World Health Assembly resolution WHA69.1 of 2016 provided the World Health Organization (WHO) with a mandate to support Member States to strengthen the essential public health functions (EPHFs) while recognizing their critical role in achieving universal health coverage. This has been reaffirmed in the Declaration of Astana on Primary Health Care, 2018, and by global partners since, creating an impetus towards and need for guidance in strengthening public health stewardship and capacities informed by the EPHFs. This technical package provides a range of technical resources and flexible tools in relation to EPHFs, to support comprehensive operationalization of public health in countries. The unified list of essential public health functions (EPHFs) consists of 12 activities that can be used to operationalize public health in a country. This comprehensive approach to public health orients health systems to population need and health system risks, and governments and societies towards health and well-being. This maximizes health gains within available resources and builds resilience, while reducing population vulnerability and the overall burden on the health system. The EPHFs can be used to plan public health systems, strengthen stewardship and coordination for public health delivery at national and subnational levels, and integrate public health capacities within health and allied sectors. The EPHFs anchor protective, promotive and preventive capacities within health systems while leveraging multisectoral efforts for health. In this way, strengthening health systems with the EPHFs is central to the primary health care approach and supports the achievement of universal health coverage, health security and healthier populations in tandem.
This book reviews the current knowledge available on the prevalence of HIV/AIDS in the MENA/EM region with the goal of stimulating discussion among policy- and decisionmakers. In other regions, early investments in good surveillance and effective prevention programs have proved to be relative bargains, compared with the costs of a full-blown epidemic. As the authors argue, the time to act is now, while prevalence levels are still low. To that end, they make specific recommendations and offer best practices and case studies from around the world." "This volume is the product of the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organization (Eastern Mediterranean Regional Office), and the World Bank. It will be of particular interest to those in the fields of public health, social policy, and economic development, as well as to students and scholars of the region." --Résumé de l'éditeur.
This field manual is intended to help health professionals and public health coordinators working in emergency situations prevent, detect and control the major communicable diseases encountered by affected populations. The manual is the result of collaboration among a number of WHO departments and several external partner agencies in reviewing existing guidelines on communicable disease control and adapting them to emergency situations. The manual deals with the fundamental principles of communicable disease control in emergencies, which are: Rapid assessment to identify the communicable disease threats faced by the emergency-affected population, including those with epidemic potential, and define the health status of the population by conducting a rapid assessment; Prevention to prevent communicable disease by maintaining a healthy physical environment and good general living conditions; Surveillance to set up or strengthen disease surveillance system with an early warning mechanism to ensure the early reporting of cases to monitor disease trends, and to facilitate prompt detection and response to outbreaks; outbreak control to ensure outbreaks are rapidly detected and controlled through adequate preparedness (i.e. stockpiles, standard treatment protocols and staff training) and rapid response (i.e.confirmation, investigation and implementation of control measures); and disease management to diagnose and treat cases promptly with trained staff using effective treatment and standard protocols at all health facilities.
In June 2023, the World Health Organization (WHO) convened national public health stakeholders from 21 countries and WHO staff to establish a community of practice among public health stakeholders, with a specific focus on strengthening PHSM research and policies. This report provides an account of the discussions, outcomes and advice put forth during the meeting, highlighting the shared commitment to advancing PHSM research, decision-making and global monitoring of policies. At the meeting, national public health stakeholders shared case examples describing their experiences with PHSM implementation during health emergencies, including the COVID-19 pandemic. Through case studies presented by representatives from each country, as well as the discussions that followed, several key factors were identified that facilitated successful PHSM responses, namely, the existence of legal mechanisms for emergency responses, multisectoral collaboration, multisectoral governance, surveillance and contact tracing, national research initiatives, international recommendations and evidence in the absence of robust local data and research, community engagement, and social protection measures to mitigate the unintended negative consequences of PHSM. In addition, participants discussed challenges they had experienced relating to PHSM implementation and reflected on the additional resources and capacities that could have supported more effective PHSM. The report details these experiences, discussions as well as a call to action for PHSM participants put forth, encouraging all countries to commit to taking actions to strengthen PHSM as an essential countermeasure for epidemic and pandemic preparedness and response.
This toolkit for integrated vector management (IVM) is designed to help national and regional programme managers coordinate across sectors to design and run large IVM programmes. It is an extension of earlier guidance and teaching material published by the World Health Organization (WHO): Handbook for integrated vector management Monitoring and evaluation indicators for integrated vector management Guidance on policy-making for integrated vector management and Core structure for training curricula on integrated vector management. The toolkit provides the technical detail required to plan implement monitor and evaluate an IVM approach. IVM can be used when the aim is to control or eliminate vector-borne diseases and can also contribute to insecticide resistance management. This toolkit provides information on where vector-borne diseases are endemic and what interventions should be used presenting case studies on IVM as well as relevant guidance documents for reference. The diseases that are the focus of this toolkit are malaria lymphatic filariasis dengue leishmaniasis onchocerciasis human African trypanosomiasis and schistosomiasis. It also includes information on other viral diseases (Rift Valley fever West Nile fever Chikungunya yellow fever) and trachoma. If other vector-borne diseases appear in a country or area vector control with an IVM approach should be adopted as per national priorities. Malaria as one of the most important vector-borne diseases in sub-Saharan Africa is the main focus of this document. Programmes targeting other vector-borne diseases can learn from the experiences gained from malaria vector control and presented here.
This annual edition presents the most recent statistics since 1990 of over 80 health indicators for WHO's 193 Member States. This fourth edition includes an expanded set of over 76 key indicators and a section with 10 highlights in global health statistics in the past year. This book has been collated from publications and databases of WHO's technical programmes and regional offices. The core set of indicators was selected on the basis of relevance for global health, availability and quality of data, and accuracy and comparability of estimates. The statistics for the indicators are based on an interactive process of data collection, compilation, quality assessment, and estimation between WHO technical programmes and its Member States. In this process, WHO strives to maximize accessibility, accuracy, comparability, and transparency of country health statistics. In addition to national statistics, this publication presents statistics on the inequalities in health outcomes and interventions coverage within countries, disaggregated by urban/rural setting, wealth/assets, and educational level. Such statistics are primarily derived from the analysis of household surveys and are only available for a limited number of countries.
Many countries have succeeded in eliminating malaria from their territories. However, they are still at risk of reintroduction from endemic countries and areas. The malaria programs in these countries face many challenges for prevention of malaria reintroduction, including weak malaria surveillance and vigilance systems, lack of malaria awareness among health professionals and travelers, uncontrolled population movement and lack of cooperation among countries. In the WHO Eastern Mediterranean Region 13 countries either eliminated malaria many years ago or are very close to malaria elimination. The main priority for these countries is to prevent re-establishment of local malaria transmission in receptive and vulnerable areas in their territories. These guidelines on prevention of reintroduction of malaria provide information on malaria surveillance and vigilance, malaria early warning system, prevention and control of re-introduced malaria, emergency preparedness for malaria outbreaks and monitoring, and evaluation of activities. The publication is targeted at policy and decision makers, health authorities responsible for malaria at national and sub-national levels and field staff. It can also be used in training courses on planning and management of malaria elimination.
WHO's concern is that, despite national and global efforts to control malaria, the disease burden remains high, especially in tropical Africa. The situation is further compounded in emergency situations. It is therefore necessary to review the current vector control strategies and their effectiveness in various operational and eco-epidemiological settings and to identify the challenges for implementation in different health systems. These would serve as a basis for the development of a strategic framework for strengthening malaria vector control implementation. The Roll Back Malaria (RBM) Initiative was launched by the WHO Director-General in 1998 as a Cabinet Project to coordinate global actions against malaria. The RBM goal is to reduce the global malaria burden by half by 2010 as compared to 2000"--Publisher's statement
There is a growing health workforce crisis in many countries. In the WHO Eastern Mediterranean Region, the disparity in supply and demand, geographic maldistribution in urban and rural setting, and imbalance in the number of different categories of professionals, represent further dimensions of the crisis facing health system development, and its health workforce. Human resources for health include trained health professionals, as well as non-health professionals, working in health systems and those who have gained some caring knowledge and skills and volunteer to support health in families and communities. The Health Workforce Development Series represents a major contribution on the part of the WHO Regional Office for the Eastern Mediterranean to the Human resources for Health Decade 2006-2015. It is aimed at supporting Member States of the Region in improving health system performance in general, and the health workforce in particular, through boosting institutional capacity building for human resources development. The series is generic, user-friendly, and has been specifically designed to meet the special needs of different countries in the Region for rapid yet sustainable health system improvement. Each country can select actions applicable to its own context for health system strengthening
The WHE Gender Mainstreaming Strategy (2022-2026) aims to provide guidance on how to systemically analyze and address relevant gender issues across WHE policies and programmes, to enable WHE work to contribute to gender equity and equality, which in turn will strengthen health emergency programming at all levels. It also provides strategic direction to facilitate how WHE can respond to the specific gender-based needs and risks that women, men, girls and boys and people with diverse gender identities experience as a consequence of health emergencies, in ways that improve the design and delivery of WHE policies and programmes, and contribute to reducing gender-inequalities including morbidity and mortality but also the medium and long term socio-economic effects of emergencies. This strategy is intended to guide WHE programming across the local, national, regional and global levels. It was developed by the WHE Gender Working Group, and responds to specific recommendations included in the WHA Resolution 74.7 on Strengthening WHO Preparedness for and response to health emergencies[1], among other key documents.
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 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, policymakers 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.
This guidance document has been produced by the World Health Organization (WHO) to assist blood services in the development of national plans to respond to any disaster, major incident or emergency that threatens sufficiency or safety of the blood supply. Such situations can be caused by natural forces, by factors influenced by humans or directly caused by humans. This document is intended to guide the national blood service through the process of planning how to respond in a timely, controlled and appropriate way to emergencies. In the preparation of the document, WHO has tried to include the elements that blood services or providers might need to consider, providing some background on the reasons for their inclusion and guidance on different response options that may be available. The consequences of an emergency may include interruption of blood supply due to a shortage of blood donors, or to a disrupted supply of critical materials and equipment used in blood collection, component preparation and laboratory testing, resulting in reduced availability of blood and blood components. Although the demand for transfusion may decrease in some situations, transfusions continue to be necessary for clinical emergencies and for those patients reliant on long-term transfusion support. In contrast, some emergencies, for instance those resulting in multiple casualties, could lead to a rapid surge in demand for blood over a short time. The challenge is to maintain essential transfusion services as well as responding to the emergency. Preparedness, including business continuity planning, is essential for blood services to mitigate the impact of emergencies. Preparation should be underpinned by locally sensitive risk assessment using relevant data at the local or country level. However, it is not possible to predict the nature of every situation that could impact on the blood supply, and it is therefore expected that blood services will review the elements in this document as well as assessing their own situation, needs, capabilities and resources, along with any additional relevant country-specific factors, in the development of their own response plans. Planning should consider the concurrence and combinations of events and the response should be proportionate and coordinated with others. The aim is to maintain critical services and prepare for recovery. Staff training and support is key to resilience. It is acknowledged that as well as affecting the sufficiency and safety of blood supply, major incidents in countries undertaking transplantation may threaten the safety and sufficiency of the supply of other products of human origin, such as cells, tissues and organs. Increasingly, blood services are taking overall national responsibility for transplantation in their capacity as the organization responsible for the collection, processing, storage and supply of cells, tissues and organs. This approach is both sensible and appropriate, as the overall donor selection and screening processes are the same or very similar. This guidance document can therefore also be used to assist those bodies responsible for the provision of cells, tissues and organs to prepare for emergencies. Resilience to disasters and emergencies requires a commitment to the blood supply and transfusion system as an integral part of the health care system.
In this guideline, the World Health Organization (WHO) provides the most current and relevant evidence-based global public health guidance on the initiation of treatment with pharmacological agents for hypertension in adults. The recommendations target adult, non-pregnant patients who were appropriately diagnosed with hypertension and counselled about life-style modifications. The guideline provides new recommendations on the threshold for the initiation of pharmacological treatment for hypertension, as well as recommendations on intervals for follow up, target blood pressure to be achieved for control, and the cadre of health care workers who may initiate treatment. The guideline provides the basis for deciding whether to initiate treatment with monotherapy, dual therapy or single-pill combinations, as well as guidance for countries selecting medicines and algorithms for hypertension control for their national guidelines for hypertension management.
The package of health system resilience indicators serves as a dedicated resource to measure and monitor health system resilience in routine operations as well as in the context of disruptive shocks and stressors. This work addresses an identified gap in measurement and monitoring of health system resilience. It complements the Health Systems Resilience Toolkit and supports implementation of the recommendations in WHO’s position paper on building health system resilience for UHC and health security. The package aims to support countries to progressively build their capacities to measure, monitor and build health system resilience from national to subnational levels covering health facilities and other service delivery platforms. It emphasizes an integrated approach to health system strengthening underpinned by essential public health functions, encompassing health emergency preparedness. It includes: - guidance on how to utilize and adapt the health system resilience indicators, including a step-by-step guide - a suite of recommended health system resilience indicators with technical specifications - supplementary indicators of relevance to health system resilience The primary target audience for this package is national and subnational health authorities (including planners and managers) and service providers, as well as local, regional, and global technical organizations and partners working on health system strengthening, including WHO, United Nations country teams, donors, nongovernment organizations, development and humanitarian agencies, and other health-related technical agencies.
The 14th FAO/WHO Joint Meeting on Pesticide Management (JMPM), hosted by the World Health Organization (WHO), was held online on the afternoons of 14 and 15 October 2021. As for the 13th JMPM in October 2020, the meeting time was significantly reduced from the usual three-and-a-half days to two half days, because of the obligation to meet electronically due to COVID-19. The meeting included: an update on activities of FAO, WHO and United Nations Environment Programme (UNEP); a review of progress in the production of new FAO/WHO guidance and revision of existing guidelines; proposals for developing new guidance and revising existing guidelines; a discussion of how to promote use of the guidance and agreement on next steps; a presentation on progress in the action plan for highly hazardous pesticides and the UNEP/FAO/WHO report on the impacts of pesticides and fertilizers; a presentation by the UN Special Rapporteur on Toxics and Human Rights, followed by discussion of how a human rights-based approach could be reflected in FAO/WHO guidance and in the Code of Conduct on Pesticide Management (the Code of Conduct); and a presentation of the process for revising the Code of Conduct, followed by discussion of whether an update is necessary and the issues to be considered if one is undertaken. The recommendations made by the JMPM are summarized in section 12. The list of meeting participants is attached as Annex 1.
Iodine is a naturally occurring element and inorganic iodines found in the ocean accumulate in fish, shellfish and seaweed. Industrially iodine is used in many applications including the manufacture of inks, dyes, photographic agents and in water-purification. In the health-care industry, iodine is widely used as a disinfectant/biocide and in the production of soaps, bandages, and medicines. Iodine is also included as a salt in some countries to provide dietary supplementation. This Concise International Chemical Assessment Document (CICAD) evaluates the scientific literature on the health aspects of iodine and inorganic iodides. Its focus is on the health effects from environmental exposures beyond those associated with the diet and nutritional supplementation. Radioactive iodine isotopes are regarded as outside the scope of the document.
The 2006 World Health Report focuses on the chronic shortages of doctors, midwives, nurses and other health care support workers in the poorest countries of the world where they are most needed. This is particularly true in sub-Saharan Africa, which has only four in every hundred global health workers but has a quarter of the global burden of disease, and less than one per cent of the world's financial resources. Poor working conditions, high rates of attrition due to illness and migration, and education systems that are unable to pick up the slack reflect the depth of the challenges in these crisis countries. This report considers the challenges involved and sets out a 10-year action plan designed to tackle the crisis over the next ten years, by which countries can strengthen their health system by building their health workforces and institutional capacity with the support of global partners.
The complex challenges highlighted by the COVID-19 pandemic and other major health emergencies emphasize the need to rethink our approach to surveillance, while building upon the momentum of substantive investments in public health capacity in recent years. At the 75th World Health Assembly in May 2022, WHO set out a harmonizing framework to strengthen the global architecture for health emergency preparedness, response, and resilience (HEPR). Under the proposed global architecture, the ability to effectively prevent, prepare for, detect, respond to, and recover from health emergencies at subnational, national, regional and global levels depend on the operational readiness and capacities in five interconnected systems: collaborative surveillance, community protection, safe and scalable clinical care, access to countermeasures, and emergency coordination. This document defines the collaborative surveillance concept—proposing a conceptual model, dimensions across which collaboration should occur to enable multi-source and multisectoral surveillance, key objectives and concrete capabilities for how countries, with the support of WHO and partners, can further advance surveillance capabilities, and address fragmented and insufficient capacity. The collaborative surveillance concept was developed to support all stakeholders working on surveillance.
This publication describes the history of malaria in Uzbekistan. It evaluates the policies and strategies applied after the re-establishment of local transmission to contain malaria outbreaks in the 1990s and early 2000s, and highlights the interventions subsequently used to eliminate malaria in the country. Uzbekistan was officially certified by WHO as a malaria-free country in 2018. Lessons for countries embarking upon elimination are distilled. The publication is intended for health managers and personnel, researchers, teachers, students and post-graduates at medical schools.
This integrated operational framework provides an overview of the connections between mental health, neurological and substance use (MNS) conditions, and their links to health, well-being and the broader public health and sustainable development agenda. The need for integrated approaches is increasingly recognized as critical to address the complex interactions between mental health, brain health, substance use, and physical health, particularly in light of global threats such as the COVID-19 pandemic. The framework also provides a series of actions for governments and health service planners and advisors to achieve integration across four domains: leadership and governance; care services; promotion and prevention; and health information systems, evidence generation and research.
1. Introduction and methods of work.-- 2. Alcohol: equity and social determinants.-- 3. Cardiovascular disease: equity and social determinants.-- 4. Health and nutrition of children: equity and social determinants.-- 5. Diabetes: equity and social determinants.-- 6. Food safety: equity and social determinants.-- 7. Mental disorders: equity and social determinants.-- 8. Neglected tropical diseases: equity and social determinants.-- 9. Oral health: equity and social determinants.-- 10. Unintended pregnancy and pregnancy outcome: equity and social determinants.-- 11. Tobacco use: equity and social determinants.-- 12. Tuberculosis: the role of risk factors and social determinants.-- 13. Violence and unintentional injury: equity and social determinants.-- 14. Synergy for equity.
Health system recovery from disruptive events presents a window of opportunity for substantial improvements, applying lessons from ongoing or past experiences with shocks to build back better. Therefore, in addition to facilitating restoration to the pre-shock state, health systems recovery processes including planning can also address pre-existing and ongoing gaps, weaknesses and inequities by facilitating continuous and systematic improvement leading to better performance and resilience. This WHO technical product aims to support countries to prioritize and mainstream health system recovery through effective planning as part of efforts to build health system resilience in support of universal health coverage, health security and socioeconomic development. While this document is developed for application in recovery context, it is adaptable to other health system strengthening and reform processes initiated in recognition of gaps in health system functions, not necessarily in the context of a shock event. The target audience is health authorities at national and subnational levels in countries, WHO, other United Nations agencies, technical partners, and donors with a role to support health systems in any context.
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