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Geneva, Switzerland, WHO, 2013.  p.The WHO Traditional Medicine Strategy 2014–2023 was developed and launched in response to the World Health Assembly resolution on traditional medicine (WHA62.13). The strategy aims to support Member States in developing proactive policies and implementing action plans that will strengthen the role traditional medicine plays in keeping populations healthy. Addressing the challenges, responding to the needs identified by Member States and building on the work done under the WHO traditional medicine strategy: 2002–2005, the updated strategy for the period 2014–2023 devotes more attention than its predecessor to prioritizing health services and systems, including traditional and complementary medicine products, practices and practitioners.
Monitoring national cervical cancer prevention and control programmes: quality control and quality assurance for visual inspection with acetic acid (VIA)-based programmes.
Geneva, Switzerland, WHO, 2013.  p.This guide outlines quality control (QC) and quality assurance (QA) considerations to support introduction or scale-up of visual inspection with acetic acid (VIA) as a screening test for cervical cancer, within the context of national comprehensive cervical cancer prevention and control programmes. The guide proposes a framework for QC and QA including a core set of indicators, and provides examples for how the indicators can be set, measured and used to strengthen programme implementation. The guide is intended primarily for programme managers, supervisors and other stakeholders working in public health programmes for cervical cancer prevention and control.
Geneva, Switzerland, WHO, 2010. 152 p.Consistent and correct use of condoms is vital to achieve the level of protection required to prevent unintended pregnancy and the transmission of HIV and other STIs. Another vital factor is the quality of the product. If condoms leak or break, they cannot offer adequate protection. In many programmes attention tends to be focused on the condom user and the promotion of condoms. Often, inadequate attention is paid to ensuring, as a key component of a comprehensive condom programming strategy, that a quality product is manufactured, purchased, stored, distributed and handled properly. The male latex condom is an important medical device, and its manufacture needs to be regulated and controlled as such.This document describes a technically sound, systematic process to support the manufacture, prequalification, procurement and distribution of a quality product that can meet the needs of different populations in a broad spectrum of challenging environmental conditions. It is intended primarily for any policy-maker, manager or procurement officer who has the responsibility for procuring, supplying and promoting natural latex male condoms.
[Geneva, Switzerland], WHO, 2009. 8 p.This report shows how countries with low prevalence of male circumcision but high prevalence of HIV have made progress to scale up male circumcision services.
The WHO/PEPFAR collaboration to prepare an operations manual for HIV prevention, care, and treatment at primary health centers in high-prevalence, resource-constrained settings: defining laboratory services.
American Journal of Clinical Pathology. 2009 Jun; 131(6):887-94.The expansion of HIV/AIDS care and treatment in resource-constrained countries, especially in sub-Saharan Africa, has generally developed in a top-down manner. Further expansion will involve primary health centers where human and other resources are limited. This article describes the World Health Organization/President's Emergency Plan for AIDS Relief collaboration formed to help scale up HIV services in primary health centers in high-prevalence, resource-constrained settings. It reviews the contents of the Operations Manual developed, with emphasis on the Laboratory Services chapter, which discusses essential laboratory services, both at the center and the district hospital level, laboratory safety, laboratory testing, specimen transport, how to set up a laboratory, human resources, equipment maintenance, training materials, and references. The chapter provides specific information on essential tests and generic job aids for them. It also includes annexes containing a list of laboratory supplies for the health center and sample forms.
Procuring Single-Use Injection Equipment and Safety Boxes: A Practical Guide for Pharmacists, Physicians, Procurement Staff and Programme Managers
Geneva, Switzerland, World Health Organization [WHO], 2003 May 5. (WHO/BCT/03.04)The objective of this guide is to accompany pharmacists, physicians, procurement staff and programme managers through the process of procuring single-use injection equipment and safety boxes of assured quality, on a national or international market, at reasonable prices. International organizations have established standardized procurement procedures for medicines and medical devices. This guide describes how these procedures can be used to ensure the procurement of injection equipment and safety boxes. Institutions procuring injection equipment need to develop a list of manufacturers that are prequalified on the basis of certain criteria which include international quality standards. This guide provides steps and tools for procurement, including a pre-qualification procedure of injection equipment for purchase. Developing a monitoring system for supplier performance will improve and safeguard the quality of injection equipment selected and prevent or eliminate unreliable suppliers.
Public policy and franchising reproductive health: current evidence and future directions. Guidance from a technical consultation meeting.
Geneva, Switzerland, World Health Organization [WHO], Department of Reproductive Health and Research, 2007.  p.To assist policymakers and researchers to take advantage of lessons learned in the area of private-provider networks, particularly franchises, and to explore the types of policy options available to facilitate a greater role for the private sector, the World Health Organization's Department of Reproductive Health and Research, in collaboration with the United States Agency for International Development's (USAID) Private Sector Partnerships-One project, convened a technical consultation from 7 to 9 December, 2006 in Geneva, Switzerland. The meeting, entitled "Public Policy and Franchising Reproductive Health: current evidence and future directions", brought together experts in private-provider networks and franchises as well as in public policy. The consultation: reviewed the evidence to date on the performance and impact of health networks and franchises in low- and middle-income countries; explored public policy options that can facilitate and support the delivery of reproductive health through private-provider networks and health franchises in low- and middle-income countries. This Guidance Note is based on the proceedings of the meeting and offers policymakers and researchers the latest evidence on private-provider networks and franchises, lessons learned in the field, and policy recommendations on how to mobilize private-provider networks and health franchises to help address reproductive health care needs in developing countries. (excerpt)
Lancet. 2007 Nov 10; 370(9599):1653-1663.Vital statistics generated through civil registration systems are the major source of continuous monitoring of births and deaths over time. The usefulness of vital statistics depends on their quality. In the second paper in this Series we propose a comprehensive and practical framework for assessment of the quality of vital statistics. With use of routine reports to the UN and cause-of-death data reported to WHO, we review the present situation and past trends of vital statistics in the world and note little improvement in worldwide availability of general vital statistics or cause-of-death statistics. Only a few developing countries have been able to improve their civil registration and vital statistics systems in the past 50 years. International efforts to improve comparability of vital statistics seem to be effective, and there is reasonable progress in collection and publication of data. However, worldwide efforts to improve data have been limited to sporadic and short-term measures. We conclude that countries and developmental partners have not recognised that civil registration systems are a priority. (author's)
European Journal of Public Health. 2007 Oct; 17(5):409.In public health teaching, tuberculosis (TB) has been a traditional example of how disease occurrence is determined by the triad agent, environment, host. And it has since long been standard textbook knowledge that there are strong socioeconomic determinants behind all three components: The agent is more prevalent and is spread more easily in conditions of crowding and poor hygienic conditions, and under these conditions several host factors are also more prevalent, such as malnutrition and alcoholism. In recent years another dimension has been added to the socioeconomic patterning of TB: An already very solid mass of research has highlighted the social and economic aspects of care and follow-up of patients with TB. A recent example of this research is the paper by Wang et al. in this issue of the journal, on differences in both patient's delay and doctor's delay in the diagnosis of TB, when comparing residents and non-residents (rural immigrants) in Shanghai. (excerpt)
The Global Drug Facility: a unique, holistic and pioneering approach to drug procurement and management.
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.In January 2006, the Stop TB Partnership launched the Global Plan to Stop TB 2006-2015, which describes the actions and resources needed to reduce tuberculosis (TB) incidence, prevalence and deaths. A fundamental aim of the Global Plan is to expand equitable access to affordable high-quality anti-tuberculous drugs and diagnostics. A principal tool developed by the Stop TB Partnership to achieve this is the Global Drug Facility (GDF). This paper demonstrates the GDF's unique, holistic and pioneering approach to drug procurement and management by analysing its key achievements. One of these has been to provide 9 million patient-treatments to 78 countries in its first 6 years of operation. The GDF recognized that the incentives provided by free or affordable anti-tuberculosis drugs are not sufficient to induce governments to improve their programmes' standards and coverage, nor does the provision of free or affordable drugs guarantee that there is broad access to, and use of, drug treatment in cases where procurement systems are weak, regulatory hurdles exist or there are unreliable distribution and storage systems. Thus, the paper also illustrates how the GDF has contributed towards making sustained improvements in the capacity of countries worldwide to properly manage their anti-TB drugs. This paper also assesses some of the limitations, shortcomings and risks associated with the model. The paper concludes by examining the GDF's key plans and strategies for the future, and the challenges associated with implementation. (author's)
Geneva, Switzerland, World Health Organization [WHO], 2006 Apr. 20 p. (WHO/HTM/TB/2003.328 Rev.2)The IDA Foundation is a non-profit organization supporting health care in low- and middle-income countries by providing high-quality drugs and medical supplies at the lowest possible price. In addition, IDA provides procurement agency services and offers consultancy and training on topics related to the various aspects of pharmaceutical supply management. IDA is based in the Netherlands and is ISO 9002-2000 and GDP certified. The quality of IDA products is verified in IDA's GcLP-approved laboratories. GLC is a subgroup of the Stop TB Working Group on DOTS-Plus for MDR-TB. GLC has been established to review applications from potential DOTS-Plus pilot projects and determine whether they are in compliance with WHO's Guidelines for establishing DOTSPlus pilot projects for the management of MDR-TB. Projects that are approved will benefit from second-line anti-TB drugs at concessional prices and from technical assistance from the GLC. (excerpt)
Geneva, Switzerland, UNAIDS, 1996 Jan. 35 p. (UNAIDS/96.5)These guidelines are destined for policy makers and programme planners wishing to introduce national external quality assessment schemes (NEQAS) for serological testing for human immunodeficiency viruses (HIV). They describe some important basic principles and the main practical aspects of NEQAS. The objectives of external quality assessment schemes are briefly discussed below and elsewhere (References 1 and 2 in bibliography, Annex 2). It is now widely accepted that quality assurance, quality control and quality assessment constitute an essential part of HIV testing and of diagnostic testing in general. Quality assessment is one component of a total quality assurance programme. The availability of excellent HIV tests does not automatically guarantee reliable laboratory results. Many steps are involved between the moment when a specimen enters the laboratory and the moment when the result of the test is reported to the physician, and at each step something can go wrong. Therefore each government should ensure that sufficient support is made available for a National Reference Laboratory to provide a suitable programme to monitor and if necessary improve the quality of HIV testing in the country. A well-functioning national programme is an important step towards achieving high-quality laboratory performance nationwide. (excerpt)
Geneva, Switzerland, UNAIDS, 1997 Nov. 7 p. (UNAIDS Best Practice Collection; UNAIDS Technical Update)Since 1985, HIV testing has been essential in securing the safety of blood supplies, monitoring the progress of the epidemic and diagnosing individuals infected with the virus. Various assays are now available, allowing testing strategies to be tailored to the epidemiological conditions and budgets of national health systems. New techniques -- including simple tests giving instant results -- hold great promise, but also raise some serious issues for governments and for individuals. HIV infection is most frequently diagnosed by detecting antibodies which the body produces as it tries to resist the virus. These antibodies usually begin to be produced within 3 to 8 weeks after the time of infection. The period following infection but before the antibodies become detectable is known as the .window period.. Antibodies are much easier to detect than the virus itself. It is sometimes possible to detect HIV antigen during the window period if, by coincidence, an individual is tested during the short peak of high levels of circulating virus particles. After this peak, the level of p24 antigen steeply declines to the point where it is no longer detectable. It fluctuates or rises steeply again, usually years later, when the clinical situation of the patient starts to deteriorate with the onset of AIDS. (excerpt)
African Journal of AIDS Research. 2004 Nov; 3(2):145-155.Despite the underlying importance of surveillance systems for the management of HIV/AIDS prevention and control programmes, there has been limited analysis of the quality of HIV/AIDS case-detection and case-reporting systems, beginning with peripheral facilities through to those at national levels. In Mozambique, HIV cases are generally correctly detected despite some unreliable use of test kits beyond their expiry date, uneven distribution of test kits among facilities, frequent disregard for bio-safety measures and irregular external quality assessment. Furthermore, HIV/AIDS case-reporting is compromised by poor data quality, including under-reporting and discrepancies across different reporting channels and organisational levels, as well as a lack of standardised data forms, data items collected and report formats. Our analysis of HIV/AIDS surveillance systems in Mozambique leads to the following key recommendations: (1) a strengthening and standardisation of both the case-detection and case-reporting systems at all levels; (2) the regular training of staff at peripheral facilities, to allow for better testing and improved local data analysis, validation and interpretation; (3) the redesign of reporting systems for blood banks, including integration of the AIDS case-reporting subsystems into one; and (4) the use of baseline data as a foundation for more comprehensive analysis across the country, in response to UNAIDS advice regarding second-generation HIV surveillance. (author's)
New Courier. 2005 Nov; 2-3.It has been a landmark year for development. Antipoverty campaigns and the Live 8 concerts helped turn up the heat on the leaders of the G8 group of industrialized countries, who raised hopes by pledging an extra US$50 billion of aid to Africa. That was followed by an EU members' pledge to increase aid to 0.7% of gross national income by 2015. While this represents a welcome boost of resources, the US$1.16 billion per annum specifically targeted at basic education remains far short of the estimated US$5.6 billion funding gap required to reach universal primary education and gender parity alone. Peter Smith, UNESCO's Assistant Director-General for Education, is not satisfied: "I want to see more commitment from donors," he stresses. But developing countries must raise their spending too, or donor fatigue will set in, he says: "They will say 'Who wants to invest in something that the people who own it don't want to invest in'." (excerpt)
Tools to determine quality of antiretrovirals. [Herramientas para determinar la calidad de los medicamentos antirretrovirales]
Washington, D.C., PAHO, .  p.The quality of pharmaceutical products in the Americas is normally ensured through the application of a regulatory and normative framework at the country level that assesses medicines used by the population in terms of quality, safety and efficacy. The application of Good Manufacturing Practices by the producers of pharmaceutical products, combined with the regulatory systems put in place by public health authorities establishes an effective framework in which product quality can be guaranteed. HIV/AIDS Antiretroviral medicines exist within the Latin American and Caribbean markets however as multisource (originator and generic) pharmaceutical products for which there are limited publicly available quality assurance standards, analytical methods and reference standards. Before countries move to procure ARV, a process must be initiated at the country to determine the acceptable quality reference and criteria. (excerpt)
Vox Sanguinis. 2002; 83 Suppl 1:173-177.A safe blood supply is a critical component in improving health care and in preventing the spread of infectious diseases globally. Millions of lives are saved each year through blood transfusions. Safe blood transfusion is an extremely cost-effective measure in developed countries such as the USA, where 2% of the health care budget which is spent on Blood Transfusion Services benefits 50% of the health services. Yet the quality and safety of blood transfusion therapy is of continuing concern, particularly in developing countries where 80% of the world's population lives. This concern is related to the risk of transfusion-transmissible infections (TTIs) due to unsafe transfusions. This results from blood collected from unsafe donors, the lack of quality systems in blood transfusion services, poor laboratory procedures in blood group serology and inadequate testing of donated blood for TTIs, errors in the administration of blood, and a lack of access and appropriate clinical use of blood and blood products for patients requiring transfusion. (excerpt)
Reducing HIV prevalence among young people: a review of the UNGASS prevalence goal and how it should be monitored.
London, England, London School of Hygiene and Tropical Medicine, 2002 Oct. iii, 67 p.The present review discusses the limitations of HIV prevalence estimates when used to track changes in the HIV epidemic in young people. In particular, it highlights important factors that need to be considered in interpreting prevalence data obtained from antenatal care (ANC) surveillance. The document suggests that, despite substantial efforts made in recent years to improve the quality and representativeness of sentinel surveillance systems and to develop adjustment methods that can be used to obtain more accurate estimates of HIV prevalence in the population, current estimates may not accurately reflect trends of infection in young people. Behavioural changes, such as delay in sexual debut and changes in patterns of contraceptive use, are shown to be important factors that need to be accounted for. In particular, increases in condom use among young people may affect observed trends of HIV infection from ANC surveillance in either direction, depending on the sector of the population that is more likely to use them (e.g. high or low risk groups). Furthermore, the combined effect of the discussed factors is difficult to predict and will be determined by the characteristics of the site and the stage of the HIV epidemic. (excerpt)
Washington, D.C., World Bank, 2004 Feb. 103 p.This Guide sets out principles and advice for the procurement of HIV/AIDS medicines and related supplies for programs scaling up antiretroviral therapy (ART) and associated health services, such as basic and palliative care, disease prevention, treatment of opportunistic infections, and laboratory tests. ART includes the treatment of infected adults and children and the prevention of mother-to-child transmission. A wide range of other commodities— particularly condoms and support for basic living and care—are also essential to support the treatment and prevention of HIV. The primary audience for this guide is World Bank staff and those responsible for procuring HIV/AIDS medicines and related supplies in Bank-funded programs and projects. That could include either procurement agency staff or technical agency staff. Policymakers and Bank partners will also benefit from the information and advice in the guide. (excerpt)
BMJ. British Medical Journal. 2004; 329:1036-1039.Imagine a new drug that reduces the absolute risk of treatment failure by three quarters—a rare situation in the West but a reality in countries where malaria is endemic, and where adding artesunate to existing drugs has this effect on cure. In middle and low income countries, life threatening infectious diseases are everywhere: new drugs can therefore have large effects on outcomes, and even modest benefits from new interventions can have a dramatic impact on health overall. In addition, wasting resources on ineffective interventions results in technical inefficiencies and substantial opportunity costs in countries least able to afford them; the Global Fund’s purchase of ineffective drugs is a recent example. Since 1990 there has been a massive collective effort, largely fuelled by the Cochrane Collaboration, for people from middle and low income countries to “get it together”—to work collectively to bring research evidence into systematic reviews and to consider ways to ensure the findings are used in clinical practice. We all want to put research into practice, but in the past the emphasis was implementing results from single studies. Now it is widely accepted that we need to “globalise the evidence, and localise the decision”—that is, set the results from a single study in the context of other relevant research. However, these syntheses of the evidence must then be actively managed to ensure change: they require dissemination, policies and systems that enable change, and influential people motivated to stimulate change. This article highlights some of our experiences and personal observations of preparing reviews and implementing change. (excerpt)
Development in Practice. 2004 Jun; 14(4):569-573.Monitoring and evaluation (M&E) are needed by all development interventions in order to document their output and outcomes. Once a set of goals has been established in response to a development ‘problem’, a corresponding set of indicators (i.e. variables or information) will also be identified in order to review progress towards those goals. In Africa, the so-called ‘expert’ evaluators—those who see M&E as their professional calling—have dominated the process of selecting social indicators. Unfortunately, this domination has given rise to sporadic and unreliable social data for M&E purposes facing every agency involved in development work in Africa. Zimbabwe is no exception. This Practical Note tells the story of UNICEF Zimbabwe’s search for relevant and reliable indicators based on solid data. The guiding philosophy in this effort is the belief that local communities themselves are among the many agencies involved in implementing development programmes—in the sense that they always seek ways of tackling whatever problems they face. These communities must therefore be active participants in the process of selecting indicators. The paper will first discuss the difficulty in establishing relevant data and indicators in the context of Zimbabwe, a task which is now an urgent priority given the dual problems of HIV/ AIDS and a declining economy. It is generally believed that these two problems have been responsible for the reversal of social gains made immediately after independence—hence the need to know exactly what is going on. The paper will then highlight recent attempts by UNICEF Zimbabwe—together with its partners—to establish good and reliable information sources so that not only can it monitor and evaluate the various impacts of its programmes but also the social environment of children. In part, the pressure for community-generated indicators has also been driven by the shift in UNICEF’s approach to its work—an approach underpinned by human rights principles. The final part of the paper discusses the challenges that UNICEF and its partners have faced and continue to struggle with. It draws some lessons learned and points to what more could be done to improve the qualities of social indicators. (excerpt)
New York, New York, UNICEF, 2002 Apr. 15 p.Basic education is the right of every girl and boy. UNICEF is especially concerned about including children who are excluded from learning: those who are out of school, and those who are excluded while in school. Providing all children with access to schooling was the primary focus of the early drive towards Education For All (EFA) following the World Conference on Education For All in Jomtien, Thailand, in 1990. Progress has been made towards this goal. Primary-school enrolments have increased in all regions. However, of an estimated 700 million primary-school-aged children, roughly 120 million are still out of school today and the majority of these are girls. Ensuring access alone is not enough. The quality of education is also a significant issue, closely linked to the state of girls’ education. At the 2000 World Education Forum in Dakar, Senegal, 164 countries agreed to work for elimination of the gender gap in enrolment (gender parity) by the year 2005, and gender equality by 2015. We are nowhere near these goals. (author's)
The safety and feasibility of female condom reuse: report of a WHO consultation, 28-29 January 2002, Geneva.
Geneva, Switzerland, WHO, 2002. , 15 p.According to the recommendations of the first consultation, this second meeting (January 2002) was planned to review the resulting data and to develop further guidance on the safety of reuse of the female condom. The specific objectives and anticipated outcomes of this second consultation were to: Review the results and evaluate the implications of the recently completed microbiology and structural integrity experiments and the human use study; Develop a protocol or set of instructions for disinfecting and cleaning used female condoms safely; Outline future research areas and related issues for programme managers to consider when determining the balance of risks and benefits of female condom reuse in various contexts and settings. (excerpt)
Lancet. 2003 Jul 12; 362(9378):169.Artesunate is the key antimalarial drug in the treatment of multidrugresistant Plasmodium falciparum malaria in mainland southeast Asia. In China, Burma (Myanmar), Laos, Cambodia, and Vietnam it is widely available through the private sector. Widespread criminal production and distribution of counterfeit artesunate tablets in this region has resulted in the deaths of many people who would otherwise have survived their malaria infection. The spurious artesunate tablets contain no active drug. They are labelled to resemble a product, manufactured by Guilin Pharmaceutical Company, Guilin, People’s Republic of China, that is the most commonly available brand of artesunate. (excerpt)
Vaccines and biologicals. Ensuring the quality of vaccines at country level. Guidelines for health staff.
Geneva, Switzerland, WHO, Department of Vaccines and Biologicals, 2002. viii, 40 p. (WHO/V&B/02.16)The present guidelines have been prepared specifically for countries procuring their vaccines through UNICEF, and are aimed at all programme and regulatory authority personnel at country level, UNICEF and WHO country staff as well as staff of partner and support agencies, and all who handle, store and use vaccines. They describe the procedures necessary for ensuring vaccine quality from the moment when production starts until the time of administration. Some of the procedures described can be applied to any country, wherever they obtain their vaccines, while others are specific to UNICEF vaccine supply procedures. Part 1 describes the procedures for ensuring that vaccine production is maintained at a high standard. This is mainly the role of WHO, working closely with manufacturers and regulatory authorities. Part 2 describes the procedures for ensuring safe and efficient shipping to the country of destination. This is mainly the role of UNICEF, working with airline agencies and forwarding agents. Part 3 describes both the control mechanisms needed by receiving countries so that only high-quality shipments are accepted, and the systems of storage, handling, reconstitution and administration needed to ensure that the quality of vaccines is maintained until the moment of use. This is mainly the role of health ministries and immunization service staff. (excerpt)