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Global Health, Science and Practice. 2018 Mar 21; 6(1):8-16.Add to my documents.
Geneva, Switzerland, WHO, 2017. 12 p. (Summary Brief WHO/RHR/17.20)Contraception is an inexpensive and cost-effective intervention, but health workforce shortages and restrictive policies on the roles of mid- and lower-level cadres limit access to effective contraceptive methods in many settings. Expanding the provision of contraceptive methods to other health worker cadres can significantly improve access to contraception for all individuals and couples. Many countries have already enabled mid- and lower-level cadres of health workers to deliver a range of contraceptive methods, utilizing these cadres either alone or as part of teams within communities and/or health care facilities. The WHO recognizes task sharing as a promising strategy for addressing the critical lack of health care workers to provide reproductive, maternal and newborn care in low-income countries. Task sharing is envisioned to create a more rational distribution of tasks and responsibilities among cadres of health workers to improve access and cost-effectiveness.
Geneva, Switzerland, WHO, 2018. 100 p.The World Health Statistics series is WHO’s annual snapshot of the state of the world’s health. This 2018 edition contains the latest available data for 36 health-related Sustainable Development Goal (SDG) indicators. It also links to the three SDG-aligned strategic priorities of the WHO’s 13th General Programme of Work: achieving universal health coverage, addressing health emergencies and promoting healthier populations.
Geneva, Switzerland, WHO, 2017. 184 p. (Interactive Visualization of Health Data)In order to reduce health inequalities and identify priority areas for action to move towards universal health coverage, governments first need to understand the magnitude and scope of inequality in their countries. From April 2016 to October 2017, the Indonesian Ministry of Health, WHO, and a network of stakeholders assessed country-wide health inequalities in 11 areas, such as maternal and child health, immunization coverage and availability of health facilities. A key output of the monitoring work is a new report called State of health inequality: Indonesia, the first WHO report to provide a comprehensive assessment of health inequalities in a Member State. The report summarizes data from more than 50 health indicators and disaggregates it by dimensions of inequality, such as household economic status, education level, place of residence, age or sex. This report showcases the state of inequality in Indonesia, drawing from the latest available data across 11 health topics (53 health indicators), and eight dimensions of inequality. In addition to quantifying the magnitude of health inequality, the report provides background information for each health topic, and discusses priority areas for action and policy implications of the findings. Indicator profiles illustrate disaggregated data by all applicable dimensions of inequality, and electronic data visuals facilitate interactive exploration of the data. This report was prepared as part of a capacity-building process, which brought together a diverse network of stakeholders committed to strengthening health inequality monitoring in Indonesia. The report aims to raise awareness about health inequalities in Indonesia, and encourage action across sectors. The report finds that the state of health and access to health services varies throughout Indonesia and identifies a number of areas where action needs to be taken. These include, amongst others: improving exclusive breastfeeding and childhood nutrition; increasing equity in antenatal care coverage and births attended by skilled health personnel; reducing high rates of smoking among males; providing mental health treatment and services across income levels; and reducing inequalities in access to improved water and sanitation. In addition, the availability of health personnel, especially dentists and midwives, is insufficient in many of the country’s health centres. Now the country is using these findings to work across sectors to develop specific policy recommendations and programmes, such as the mobile health initiative in Senen, to tackle the inequalities that have been identified.
The continuum of HIV care in South Africa: implications for achieving the second and third UNAIDS 90-90-90 targets.
AIDS. 2017 Feb 20; 31(4):545-552.BACKGROUND: We characterize engagement with HIV care in South Africa in 2012 to identify areas for improvement towards achieving global 90-90-90 targets. METHODS: Over 3.9 million CD4 cell count and 2.7 million viral load measurements reported in 2012 in the public sector were extracted from the national laboratory electronic database. The number of persons living with HIV (PLHIV), number and proportion in HIV care, on antiretroviral therapy (ART) and with viral suppression (viral load <400 copies/ml) were estimated and stratified by sex and age group. Modified Poisson regression approach was used to examine associations between sex, age group and viral suppression among persons on ART. RESULTS: We estimate that among 6511 000 PLHIV in South Africa in 2012, 3300 000 individuals (50.7%) accessed care and 32.9% received ART. Although viral suppression was 73.7% among the treated population in 2012, the overall percentage of persons with viral suppression among all PLHIV was 23.8%. Linkage to HIV care was lower among men (38.5%) than among women (57.2%). Overall, 47.1% of those aged 0-14 years and 47.0% of those aged 15-49 years were linked to care compared with 56.2% among those aged above 50 years. CONCLUSION: Around a quarter of all PLHIV have achieved viral suppression in South Africa. Men and younger persons have poorer linkage to HIV care. Expanding HIV testing, strengthening prompt linkage to care and further expansion of ART are needed for South Africa to reach the 90-90-90 target. Focus on these areas will reduce the transmission of new HIV infections and mortality in the general population.
Allocation of antiretroviral drugs to HIV-infected patients in Togo: Perspectives of people living with HIV and healthcare providers.
Journal of Medical Ethics. 2017 Dec; 43(12):845-851.Aim To explore the way people living with HIV and healthcare providers in Togo judge the priority of HIV-infected patients regarding the allocation of antiretroviral drugs. Method From June to September 2015, 200 adults living with HIV and 121 healthcare providers living in Togo were recruited for the study. They were presented with stories of a few lines depicting the situation of an HIV-infected patient and were instructed to judge the extent to which the patient should be given priority for antiretroviral drugs. The stories were composed by systematically varying the levels of four factors: (a) the severity of HIV infection, (b) the financial situation of the patient, (c) the patient's family responsibilities and (d) the time elapsed since the first consultation. Results Five clusters were identified: 65% of the participants expressed the view that patients who are poor and severely sick should be treated as a priority, 13% prioritised treatment of patients who are poor and parents of small children, 12% expressed the view that the poor should be treated as a priority, 4% preferred that the sickest be treated as a priority and 6% wanted all patients to get treatment. Conclusions WHO's guideline regarding antiretroviral therapy allocation (the sickest first as the sole criterion) currently in use in many African countries does not reflect the preferences of Togolese people living with HIV. For most HIV-infected patients in Togo, patients who cannot get treatment on their own should be treated as a priority.
American Mock World Health Organization: An Innovative Model for Student Engagement in Global Health Policy.
Global Health: Science and Practice. 2017 Mar 24; 5(1):164-174.The American Mock World Health Organization (AMWHO) is a model for experiential-based learning and student engagement in global health diplomacy. AMWHO was established in 2014 at the University of North Carolina at Chapel Hill with a mission to engage students in health policy by providing a simulation of the World Health Assembly (WHA), the policy-forming body of the World Health Organization that sets norms and transforms the global health agenda. AMWHO conferences are designed to allow students to take their knowledge of global health beyond the classroom and practice their skills in diplomacy by assuming the role of WHA delegates throughout a 3-day weekend. Through the process of developing resolutions like those formed in the WHA, students have the unique opportunity to understand the complexities behind the conflict and compromise that ensues through the lens of a stakeholder. This article describes the structure of the first 2 AMWHO international conferences, analyzes survey results from attendees, and discusses the expansion of the organization into a multi-campus national network. The AMWHO 2014 and 2015 post-conference survey results found that 98% and 90% of participants considered the conference "good" or "better," respectively, and survey responses showed that participants considered the conference "influential" in their careers and indicated that it "allowed a paradigm shift not possible in class."
Geneva, Switzerland, World Health Organization [WHO], 2017. 73 p.This tool for Monitoring human rights in contraceptive services and programmes contributes to the World Health Organization’s (WHO’s) ongoing work on rights-based contraceptive programmes. This work builds directly on WHO’s 2014 Ensuring human rights within contraceptive programmes: a human rights analysis of existing quantitative indicators and the 2015 publication Ensuring human rights within contraceptive service delivery implementation guide by the United Nations Population Fund (UNFPA) and WHO. This tool is intended for use by countries to assist them in strengthening their human rights efforts in contraceptive programming. The tool uses existing commonly-used indicators to highlight areas where human rights have been promoted, neglected or violated in contraceptive programming; gaps in programming and in data collection; and opportunities for action within the health sector and beyond, including opportunities for partnership initiatives.
Report 2017: Transformative accountability for adolescents: Accountability for health and human rights of women, children and adolescents in the 2030 agenda.
Geneva, Switzerland, World Health Organization, 2017. 64 p.Adolescents, who number 1.2 billion, or 1 in 6 of the global population, are the key for progress on the Sustainable Development Goals (SDGs). Every year, 1.2 million adolescents die, often from preventable causes—such as violence, suicide, pregnancy-related complications among girls, HIV/AIDS, road injuries and drowning, as well as diseases and respiratory infections. As the report states, however, high impact, cost effective solutions to improve adolescent health can yield huge benefits and billions in savings that can place them on better tracks for life, reaping demographic dividends. The Independent Accountability Panel (IAP), under its mandate by the UN Secretary-General to assess progress on the 2016-2030 Global Strategy on Women’s, Children’s and Adolescents’ Health in the context of the SDGs from the specific lens of who is accountable to whom, and for what, launched its 2017 report. The IAP’s six recommendations are to: 1) Leverage Accountability to Achieve the Global Strategy and the SDGs, 2) Make adolescents visible and measure what matters, 3) Foster whole-of-government accountability to adolescents, 4) Make universal health coverage work for adolescents, 5) Boost accountability for investments, including for adolescent health and well-being, and 6) Unleash the power of young people, by meaningfully engaging them in decision-making, and empowering them to seize the full potential of the digital age.
[New York, New York], UNICEF, 2017 May. 20 p.As part of a series highlighting the challenges faced by children in current crisis situations, this UNICEF Child Alert examines the impact of the reforms, economic growth and national reconciliation process in Myanmar. It also looks at the investments in children’s health, education and protection that Myanmar is making, and shows how children in remote, conflict-affected parts of the country have yet to benefit from them.
Geneva, Switzerland, World Health Organization [WHO], 2015. 44 p.Key populations at higher risk of HIV include people who sell sex, men who have sex with men (MSM), transgender people and people who inject drugs. Young people who belong to one or more of these key populations – or who engage in activities associated with these populations – are made especially vulnerable to HIV by factors including widespread discrimination, stigma and violence, combined with the particular vulnerabilities of youth, power imbalances in relationships and, sometimes, alienation from family and friends. These factors increase the risk that they may engage – willingly or not – in behaviours that put them at risk of HIV, such as frequent unprotected sex and the sharing of needles and syringes to inject drugs. This technical brief is one in a series addressing four young key populations. It is intended for policy-makers, donors, service-planners, service-providers and community- led organizations. This brief aims to inform discussions about how best to provide services, programmes and support for young people who sell sex. It offers a concise account of current knowledge concerning the HIV risk and vulnerability of young people who sell sex; the barriers and constraints they face to appropriate services; examples of programmes that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build the strengths, competencies and capacities of young people.
Geneva, Switzerland, World Health Organization [WHO], 2015. 40 p.Key populations at higher risk of HIV include people who sell sex, men who have sex with men (MSM), transgender people and people who inject drugs. Young people who belong to one or more of these key populations – or who engage in activities associated with these populations – are made especially vulnerable to HIV by factors including widespread discrimination, stigma and violence, combined with the particular vulnerabilities of youth, power imbalances in relationships and, sometimes, alienation from family and friends. These factors increase the risk that they may engage – willingly or not – in behaviours that put them at risk of HIV, such as frequent unprotected sex and the sharing of needles and syringes to inject drugs. This technical brief is one in a series addressing four young key populations. It is intended for policy-makers, donors, service-planners, service-providers and community-led organizations. This brief aims to inform discussions about how best to provide health services, programmes and support for young MSM. It offers a concise account of current knowledge concerning the HIV risk and vulnerability of young MSM; the barriers and constraints they face to appropriate services; examples of programmes that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build to the strengths, competencies and capacities of young MSM.
Geneva, Switzerland, World Health Organization [WHO], 2015. 36 p.Key populations at higher risk of HIV include people who sell sex, men who have sex with men (MSM), transgender people and people who inject drugs. Young people who belong to one or more of these key populations – or who engage in activities associated with these populations – are made especially vulnerable to HIV by factors including widespread discrimination, stigma and violence, combined with the particular vulnerabilities of youth, power imbalances in relationships and, sometimes, alienation from family and friends. These factors increase the risk that they may engage – willingly or not – in behaviours that put them at risk of HIV, such as frequent unprotected sex and the sharing of needles and syringes to inject drugs. This brief aims to inform discussions about how best to provide health services, programmes and support for young transgender people. It offers a concise account of current knowledge concerning the HIV risk and vulnerability of young transgender people; the barriers and constraints they face to appropriate services; examples of programmes that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build the strengths, competencies and capacities of these young people.
Geneva, Switzerland, World Health Organization [WHO], 2015. 34 p.Key populations at higher risk of HIV include people who sell sex, men who have sex with men (MSM), transgender people and people who inject drugs. Young people who belong to one or more of these key populations – or who engage in activities associated with these populations – are made especially vulnerable to HIV by factors including widespread discrimination, stigma and violence, combined with the particular vulnerabilities of youth, power imbalances in relationships and, sometimes, alienation from family and friends. These factors increase the risk that they may engage – willingly or not – in behaviours that put them at risk of HIV, such as frequent unprotected sex and the sharing of needles and syringes to inject drugs. This brief aims to inform discussions about how best to provide health services, programmes and support for young people who inject drugs. It offers a concise account of current knowledge concerning the HIV risk and vulnerability of young people who inject drugs; the barriers and constraints they face to appropriate services; examples of programmes that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build the strengths, competencies and capacities of young people who inject drugs.
Adolescent girls in disaster and conflict. Interventions for improving access to sexual and reproductive health services.
New York, New York, UNFPA, 2016. 92 p.Safe spaces, mobile medical teams and youth engagement are effective ways to reach displaced, uprooted, crisis-affected girls at a critical time in their young lives. Adolescent Girls in Disaster & Conflict: Interventions for Improving Access to Sexual and Reproductive Health Services is a collection of UNFPA-supported humanitarian interventions for reaching adolescents when crisis heightens vulnerability to gender-based violence, unwanted pregnancy, HIV infection, early and forced marriage and other risks.
Geneva, Switzerland, UNAIDS, 2016. 12 p.Gender inequalities and harmful gender norms are important drivers of the HIV epidemic, and they are major hindrances to an effective HIV response. While access to HIV services for women and girls remain a concern, a growing body of evidence also shows that men and adolescent boys have limited access to HIV services. Current effort to advance both gender equality and sexual and reproductive health and rights as key elements of the HIV response do not adequately reflect the ways that harmful gender norms and practices negatively affect men, women and adolescent body and girls in all their diversity. This in turn increases HIV-related vulnerability and risk among all of these groups.
Pakistan: increasing access to SRH services in fragile contexts for rural women in hard-to-reach areas.
London, United Kingdom, IPPF, 2015 Sep. 2 p.In some areas of Pakistan, girls and women are vulnerable to harmful traditional practices, like swara (now illegal, a form of reconciliation where a girl or woman is given in marriage to settle a dispute) and early marriage, and many of them face tremendous obstacles to basic services, including sexual and reproductive health (SRH) services.
Making universal access to sexual and reproductive health a reality – building momentum for comprehensive family planning.
London, United Kingdom, IPPF, 2015 Apr. 4 p.In 2015, 225 million women will not have access to contraception globally, resulting in 74 million unplanned pregnancies, ill health and over 500,000 maternal deaths. Maternal health is currently far off track and universal access to sexual and reproductive health remains a distant reality for many of the world’s poor, marginalized and vulnerable women, men and young people. To enable 120 million more women and girls to use contraception by 2020, IPPF is doing its part by: increasing family planning services to save the lives of 54,000 women, averting 46.4 million unintended pregnancies and preventing unsafe abortion; tripling the number of comprehensive and integrated sexual and reproductive health services annually, including 553 million services to adolescents. For over 60 years, IPPF has been at the vanguard in delivering comprehensive voluntary family planning services and is the leading global service provider for sexual and reproductive health. This technical briefing showcases IPPF’s work globally. We are a grassroots organization, directed by and responding to the needs of the communities that we serve.
London, United Kingdom, IPPF, 2015 Oct. 50 p.As the largest civil society provider of family planning, IPPF plays a leadership role – holding governments to account for the pledges they made at the London Summit on Family Planning 2012, pushing for family planning and SRHR within the new Sustainable Development Goals national plans whilst strengthening our own delivery. Our new pledge is to reach an additional 45 million between 2015 and 2020 – meaning a total FP2020 contribution from IPPF of 60 million new users to family planning. This report showcases IPPF’s innovation and impact as the global leader in family planning services and advocacy.
Under-served and over-looked: prioritizing contraceptive equity for the poorest and most marginalized women and girls.
London, United Kingdom, IPPF, 2017 Jul. 40 p.This report is a synthesis of evidence revealed from a literature review, including 68 reports from 34 countries. The results are dire: the poorest women and girls, in the poorest communities of the poorest countries are still not benefitting from the global investment in family planning and the joined up actions of the global family planning movement. Women in the poorest countries who want to avoid pregnancy are one-third as likely to be using a modern method as those living in higher-income developing countries.
Scaling up proven innovative cervical cancer screening strategies: Challenges and opportunities in implementation at the population level in low- and lower-middle-income countries.
International Journal of Gynaecology and Obstetrics. 2017 Jul; 138 Suppl 1:63-68.The problem of cervical cancer in low- and lower-middle-income countries (LLMICs) is both urgent and important, and calls for governments to move beyond pilot testing to population-based screening approaches as quickly as possible. Experiences from Zambia, Bangladesh, Guatemala, Honduras, and Nicaragua, where scale-up of evidence-based screening strategies is taking place, may help other countries plan for large-scale implementation. These countries selected screening modalities recommended by the WHO that are within budgetary constraints, improve access for women, and reduce health system bottlenecks. In addition, some common elements such as political will and government investment have facilitated action in these diverse settings. There are several challenges for continued scale-up in these countries, including maintaining trained personnel, overcoming limited follow-up and treatment capacity, and implementing quality assurance measures. Countries considering scale-up should assess their readiness and conduct careful planning, taking into consideration potential obstacles. International organizations can catalyze action by helping governments overcome initial barriers to scale-up. (c) 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Policy brief on the case for investing in research to increase access to and use of contraception among adolescents.
Seattle, Washington, PATH, 2015 Mar. 4 p.This document outlines why governments and donors should invest now in research to help determine and implement the most effective and efficient ways to enable adolescents to access and use contraception. It summarizes the findings of a longer technical report.
Projected Uptake of New Antiretroviral (ARV) Medicines in Adults in Low- and Middle-Income Countries: A Forecast Analysis 2015-2025.
PloS One. 2016; 11(10):e0164619.With anti-retroviral treatment (ART) scale-up set to continue over the next few years it is of key importance that manufacturers and planners in low- and middle-income countries (LMICs) hardest hit by the HIV/AIDS pandemic are able to anticipate and respond to future changes to treatment regimens, generics pipeline and demand, in order to secure continued access to all ARV medicines required. We did a forecast analysis, using secondary WHO and UNAIDS data sources, to estimate the number of people living with HIV (PLHIV) and the market share and demand for a range of new and existing ARV drugs in LMICs up to 2025. UNAIDS estimates 24.7 million person-years of ART in 2020 and 28.5 million person-years of ART in 2025 (24.3 million on first-line treatment, 3.5 million on second-line treatment, and 0.6 million on third-line treatment). Our analysis showed that TAF and DTG will be major players in the ART regimen by 2025, with 8 million and 15 million patients using these ARVs respectively. However, as safety and efficacy of dolutegravir (DTG) and tenofovir alafenamide (TAF) during pregnancy and among TB/HIV co-infected patients using rifampicin is still under debate, and ART scale-up is predicted to increase considerably, there also remains a clear need for continuous supplies of existing ARVs including TDF and EFV, which 16 million and 10 million patients-respectively-are predicted to be using in 2025. It will be important to ensure that the existing capacities of generics manufacturers, which are geared towards ARVs of higher doses (such as TDF 300mg and EFV 600mg), will not be adversely impacted due to the introduction of lower dose ARVs such as TAF 25mg and DTG 50mg. With increased access to viral load testing, more patients would be using protease inhibitors containing regimens in second-line, with 1 million patients on LPV/r and 2.3 million on ATV/r by 2025. However, it will remain important to continue monitoring the evolution of ARV market in LMICs to guarantee the availability of these medicines.
Assessing the availability of LLINs for continuous distribution through routine antenatal care and the Expanded Programme on Immunizations in sub-Saharan Africa.
Malaria Journal. 2016 May 04; 15(1):255.BACKGROUND: In addition to mass distribution campaigns, the World Health Organization (WHO) recommends the continuous distribution of long-lasting insecticidal nets (LLINs) to all pregnant women attending antenatal care (ANC) and all infants attending the Expanded Programme on Immunization (EPI) services in countries implementing mosquito nets for malaria control. Countries report LLIN distribution data to the WHO annually. For this analysis, these data were used to assess policy and practice in implementing these recommendations and to compare the numbers of LLINs available through ANC and EPI services with the numbers of women and children attending these services. METHODS: For each reporting country in sub-Saharan Africa, the presence of a reported policy for LLIN distribution through ANC and EPI was reviewed. Prior to inclusion in the analysis the completeness of data was assessed in terms of the numbers of LLINs distributed through all channels (campaigns, EPI, ANC, other). For each country with adequate data, the numbers of LLINs reportedly distributed by national programmes to ANC was compared to the number of women reportedly attending ANC at least once; the ratio between these two numbers was used as an indicator of LLIN availability at ANC services. The same calculations were repeated for LLINs distributed through EPI to produce the corresponding LLIN availability through this distribution channel. RESULTS: Among 48 malaria-endemic countries in Africa, 33 malaria programmes reported adopting policies of ANC-based continuous distribution of LLINs, and 25 reported adopting policies of EPI-based distribution. Over a 3-year period through 2012, distribution through ANC accounted for 9 % of LLINs distributed, and LLINs distributed through EPI accounted for 4 %. The LLIN availability ratios achieved were 55 % through ANC and 34 % through EPI. For 38 country programmes reporting on LLIN distribution, data to calculate LLIN availability through ANC and EPI was available for 17 and 16, respectively. CONCLUSIONS: These continuous LLIN distribution channels appear to be under-utilized, especially EPI-based distribution. However, quality data from more countries are needed for consistent and reliable programme performance monitoring. A greater focus on routine data collection, monitoring and reporting on LLINs distributed through both ANC and EPI can provide insight into both strengths and weaknesses of continuous distribution, and improve the effectiveness of these delivery channels.
Bulletin of the World Health Organization. 2017 Jun; 95(6):445-452I.Objective To assess the feasibility of applying the World Health Organization’s proposed 15 indicators of quality of care for maternal and newborn health at health-facility level in low- and middle-income settings. Methods Six of the indicators are about maternal health, five are for newborn health and four are general cross-cutting indicators. We used data collected routinely in facility registers and obtained as part of facility assessments from 963 health-care facilities specializing in maternity services in 10 countries in Africa and Asia. We made a feasibility assessment of the availability of data and the clarity of indicator definitions and identified additional information and data collection processes needed to apply the proposed indicators in real-life settings. Findings Of the indicators evaluated, 10 were clearly defined, of which four could be applied directly in the field and six would require revisions to operationalize them. The other five indicators require further development, with one of them being ready for implementation by using information readily available in registers and four requiring further information before deployment. For indicators that measure coverage of care or availability of services or products, there is a need to further strengthen measurement. Information on emergency obstetric complications was not recorded in a standard manner, thus limiting the reliability of the information. Conclusion While some of the proposed indicators can already be applied, other indicators need to be refined or will need additional sources and methods of data collection to be applied in real-world settings.