This guidance from the WHO provides recommendations for countries to maintain essential health services during the COVID-19 outbreak. It suggests establishing simplified governance mechanisms to coordinate the response while continuing essential services. Countries should identify which services are most critical to prioritize, and may need to optimize service delivery locations and platforms. It also emphasizes the importance of effective patient screening, triage, and referral processes. Finally, the document recommends rapidly redistributing health workers through task sharing and reassignment to help address shortages caused by the increased demands of the outbreak.
eHealth Tools & Services: Needs of the Member States Report of the WHO Global...Dr Lendy Spires
The document summarizes the findings of the first global survey conducted by the WHO Global Observatory for eHealth (GOe) regarding the needs of WHO Member States for eHealth tools and services. Key findings include that Member States would welcome WHO's involvement in developing generic eHealth tools and guidance for creating and implementing eHealth services. Non-OECD countries expressed a need for guidance across a broad range of eHealth areas. The report recommends actions WHO could take to address Member States' needs, such as facilitating the development of commonly requested tools, providing access to existing tools and services, and supporting knowledge exchange and eHealth information resources.
Responding to Health System Failure on Tuberculosis in Southern AfricaHFG Project
This document discusses health system failures in combating tuberculosis (TB) in Southern Africa, focusing on miners. It applies the Flagship Framework's "control knobs" (financing, payment, organization, regulation, behavior) to analyze TB control programs. Miners in Southern Africa have the highest TB rates in the world due to occupational and socioeconomic risks. While treatment is effective, health systems struggle with social determinants like poverty, multi-sectoral issues, and long treatment times. The analysis recommends a patient-centered approach involving whole-of-government and multi-sectoral cooperation to better address the underlying drivers fueling the TB epidemic.
Health Trends in the Middle East and North AfricaHFG Project
In the past several decades, countries in the Middle East and North Africa have made significant improvements in developing their health systems and improving the health status of their populations. However, the region continues to face substantial and diverse political, economic, social, and health challenges: a rise in the burden of noncommunicable diseases, ongoing conflicts in several countries, and refugee crises. To inform future USAID health investments in the Middle East and North Africa, the Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project and the Health Financing and Governance (HFG) project conducted an analysis of the private health sector and the health financing landscape from January 2017 to April 2018. The countries included in this analysis are Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, Syria, Tunisia, the West Bank and Gaza, and Yemen.
This document contains a proposal from Perle and Co. to address the cholera epidemic in Haiti through multiple interventions over 10 years. The proposal includes strategies to control the cholera epidemic through water and sanitation improvements, strengthen the healthcare system through education and coordination, invest in the agricultural sector through reforestation and financing, use moringa to combat malnutrition, create a claims settlement for those affected by cholera, and enhance UN accountability. It provides implementation timelines, estimated budgets, and metrics to evaluate the success of reducing cholera incidence and increasing trained farmers by 2024. Limitations including natural disasters and political instability are also noted.
Tool to Assess Entomological Monitoring, Environmental Compliance, and Vector...HFG Project
The document provides a checklist to assess country capacity for entomological monitoring, environmental compliance, and vector control related to the prevention and control of Zika and other arboviruses. The checklist contains 9 thematic areas to evaluate current status, recommendations, and responsible administrative levels. It will be used to review strengths and gaps in capacity in 5 Latin American and Caribbean countries to propose recommendations for improving readiness to prevent and control Zika and other arboviruses.
Entomological Monitoring, Environmental Compliance, and Vector Control Capaci...HFG Project
The first case of local, vector-borne transmission of the Zika virus in the Americas was identified in May 2015 in Brazil. By July 2016, the virus had spread to nearly all Zika-suitable transmission zones in the Americas, including the majority of countries and territories in the Latin America and the Caribbean region. Governments in the region face a formidable challenge to minimize Zika transmission and limit the impact of Zika on their populations.
The United States Agency for International Development (USAID) supports efforts to strengthen the region’s Zika response through targeted technical assistance, stakeholder coordination, and implementation of key interventions. In El Salvador, the USAID-funded Health Finance and Governance project assessed country capacity to conduct vector control and entomological monitoring of Aedes mosquitoes, the primary vector of the virus. The assessment was conducted from July 11 to July 21, 2016, and sought to gauge current capacities, identify strengths and weaknesses in these capacities, and recommend countermeasures, i.e., specific strategies to minimize the impact of Zika virus transmission.
The first case of Zika in El Salvador was reported in November 2015. By mid-2016, nearly 7,000 cases were reported, 255 by pregnant women. Since the beginning of the epidemic, 318 pregnant women were clinically diagnosed with Zika, a few of which were also laboratory confirmed. While microcephaly has not appeared in significant numbers, Guillain-Barré Syndrome has, with 118 documented cases as per a report from February 2016.
Entry Point Mapping: A Tool to Promote Civil Society Engagement on Health Fin...HFG Project
ivil society organizations (CSOs), particularly those working in the health sector, frequently seek opportunities to influence public health policy or share feedback on the quality or accessibility of health services. While these organizations may have important contributions to make, they often are not aware of the most effective and accessible entry points to use. Entry Point Mapping provides a methodology for systemic review and identification of mechanisms, forums and public platforms by which civil society organizations can participate in health sector policy formulation, program implementation, and oversight.
This paper presents an Entry Point Mapping Tool designed for CSOs with advocacy experience and public health officials seeking to expand civil society participation and contains a step-by-step guide for researching and analyzing legal entry points for civil society participation in governance of public health care facilities. Because CSOs have varied interests, the tool includes a series of steps for individual CSOs to determine the level of government at which to pursue their specific advocacy interest and the process of collecting targeted information on legally required points of entry for their civic engagement.
In addition, the Entry Point Mapping Tool offers guidance on analyzing the effectiveness on these entry points and coaches CSOs through the negotiation process of activating or expanding existing entry points, creating new ones, and winning overall collaboration with health officials on improving health policy and service delivery. This tool also documents the experience of CSOs implementing the entry point mapping methodology in Bangladesh and Cote d’Ivoire to demonstrate how the tool can promote increased civil society engagement on issues of health finance and governance.
Integrating HIV/AIDS in Vietnam’s Social Health Insurance Scheme: Experience ...HFG Project
The document describes lessons learned from integrating HIV/AIDS services into Vietnam's social health insurance scheme from 2014-2017. It discusses challenges such as HIV services originally being provided through donor funding and separate from the insurance scheme. The Health Finance and Governance project worked with Vietnamese government agencies to address barriers through technical assistance. This included integrating HIV treatment facilities into the public system funded by insurance, expanding insurance coverage, and shifting to local drug procurement. The project aligned with government policies and created evidence to advocate for sustainable HIV financing as donors transitioned support. Major lessons were the importance of working within complex adaptive systems and existing policy frameworks.
eHealth Tools & Services: Needs of the Member States Report of the WHO Global...Dr Lendy Spires
The document summarizes the findings of the first global survey conducted by the WHO Global Observatory for eHealth (GOe) regarding the needs of WHO Member States for eHealth tools and services. Key findings include that Member States would welcome WHO's involvement in developing generic eHealth tools and guidance for creating and implementing eHealth services. Non-OECD countries expressed a need for guidance across a broad range of eHealth areas. The report recommends actions WHO could take to address Member States' needs, such as facilitating the development of commonly requested tools, providing access to existing tools and services, and supporting knowledge exchange and eHealth information resources.
Responding to Health System Failure on Tuberculosis in Southern AfricaHFG Project
This document discusses health system failures in combating tuberculosis (TB) in Southern Africa, focusing on miners. It applies the Flagship Framework's "control knobs" (financing, payment, organization, regulation, behavior) to analyze TB control programs. Miners in Southern Africa have the highest TB rates in the world due to occupational and socioeconomic risks. While treatment is effective, health systems struggle with social determinants like poverty, multi-sectoral issues, and long treatment times. The analysis recommends a patient-centered approach involving whole-of-government and multi-sectoral cooperation to better address the underlying drivers fueling the TB epidemic.
Health Trends in the Middle East and North AfricaHFG Project
In the past several decades, countries in the Middle East and North Africa have made significant improvements in developing their health systems and improving the health status of their populations. However, the region continues to face substantial and diverse political, economic, social, and health challenges: a rise in the burden of noncommunicable diseases, ongoing conflicts in several countries, and refugee crises. To inform future USAID health investments in the Middle East and North Africa, the Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project and the Health Financing and Governance (HFG) project conducted an analysis of the private health sector and the health financing landscape from January 2017 to April 2018. The countries included in this analysis are Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, Syria, Tunisia, the West Bank and Gaza, and Yemen.
This document contains a proposal from Perle and Co. to address the cholera epidemic in Haiti through multiple interventions over 10 years. The proposal includes strategies to control the cholera epidemic through water and sanitation improvements, strengthen the healthcare system through education and coordination, invest in the agricultural sector through reforestation and financing, use moringa to combat malnutrition, create a claims settlement for those affected by cholera, and enhance UN accountability. It provides implementation timelines, estimated budgets, and metrics to evaluate the success of reducing cholera incidence and increasing trained farmers by 2024. Limitations including natural disasters and political instability are also noted.
Tool to Assess Entomological Monitoring, Environmental Compliance, and Vector...HFG Project
The document provides a checklist to assess country capacity for entomological monitoring, environmental compliance, and vector control related to the prevention and control of Zika and other arboviruses. The checklist contains 9 thematic areas to evaluate current status, recommendations, and responsible administrative levels. It will be used to review strengths and gaps in capacity in 5 Latin American and Caribbean countries to propose recommendations for improving readiness to prevent and control Zika and other arboviruses.
Entomological Monitoring, Environmental Compliance, and Vector Control Capaci...HFG Project
The first case of local, vector-borne transmission of the Zika virus in the Americas was identified in May 2015 in Brazil. By July 2016, the virus had spread to nearly all Zika-suitable transmission zones in the Americas, including the majority of countries and territories in the Latin America and the Caribbean region. Governments in the region face a formidable challenge to minimize Zika transmission and limit the impact of Zika on their populations.
The United States Agency for International Development (USAID) supports efforts to strengthen the region’s Zika response through targeted technical assistance, stakeholder coordination, and implementation of key interventions. In El Salvador, the USAID-funded Health Finance and Governance project assessed country capacity to conduct vector control and entomological monitoring of Aedes mosquitoes, the primary vector of the virus. The assessment was conducted from July 11 to July 21, 2016, and sought to gauge current capacities, identify strengths and weaknesses in these capacities, and recommend countermeasures, i.e., specific strategies to minimize the impact of Zika virus transmission.
The first case of Zika in El Salvador was reported in November 2015. By mid-2016, nearly 7,000 cases were reported, 255 by pregnant women. Since the beginning of the epidemic, 318 pregnant women were clinically diagnosed with Zika, a few of which were also laboratory confirmed. While microcephaly has not appeared in significant numbers, Guillain-Barré Syndrome has, with 118 documented cases as per a report from February 2016.
Entry Point Mapping: A Tool to Promote Civil Society Engagement on Health Fin...HFG Project
ivil society organizations (CSOs), particularly those working in the health sector, frequently seek opportunities to influence public health policy or share feedback on the quality or accessibility of health services. While these organizations may have important contributions to make, they often are not aware of the most effective and accessible entry points to use. Entry Point Mapping provides a methodology for systemic review and identification of mechanisms, forums and public platforms by which civil society organizations can participate in health sector policy formulation, program implementation, and oversight.
This paper presents an Entry Point Mapping Tool designed for CSOs with advocacy experience and public health officials seeking to expand civil society participation and contains a step-by-step guide for researching and analyzing legal entry points for civil society participation in governance of public health care facilities. Because CSOs have varied interests, the tool includes a series of steps for individual CSOs to determine the level of government at which to pursue their specific advocacy interest and the process of collecting targeted information on legally required points of entry for their civic engagement.
In addition, the Entry Point Mapping Tool offers guidance on analyzing the effectiveness on these entry points and coaches CSOs through the negotiation process of activating or expanding existing entry points, creating new ones, and winning overall collaboration with health officials on improving health policy and service delivery. This tool also documents the experience of CSOs implementing the entry point mapping methodology in Bangladesh and Cote d’Ivoire to demonstrate how the tool can promote increased civil society engagement on issues of health finance and governance.
Integrating HIV/AIDS in Vietnam’s Social Health Insurance Scheme: Experience ...HFG Project
The document describes lessons learned from integrating HIV/AIDS services into Vietnam's social health insurance scheme from 2014-2017. It discusses challenges such as HIV services originally being provided through donor funding and separate from the insurance scheme. The Health Finance and Governance project worked with Vietnamese government agencies to address barriers through technical assistance. This included integrating HIV treatment facilities into the public system funded by insurance, expanding insurance coverage, and shifting to local drug procurement. The project aligned with government policies and created evidence to advocate for sustainable HIV financing as donors transitioned support. Major lessons were the importance of working within complex adaptive systems and existing policy frameworks.
Reaching the Missing Middle: Ensuring Health Coverage for India’s Urban PoorHFG Project
This document discusses health coverage challenges facing India's urban poor population and opportunities to expand coverage through the new National Health Protection Scheme (NHPS). It notes that India's urban poor, estimated at 27% of the urban population, have been excluded from existing public health insurance schemes that target those below the poverty line. The NHPS, announced in 2018, aims to provide health insurance of up to 500,000 rupees per family annually. The document argues that integrating primary health care benefits into insurance schemes could help manage population health and reduce costs by keeping people healthy and out of hospitals. There is no single solution, but the NHPS could play a major role in expanding safety nets for the urban poor through financial protection and investing in
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Fighting Health Security Threats Requires a Cross-Border ApproachHFG Project
This document discusses how health security threats like Ebola and Zika require a cross-border approach. It summarizes efforts taken in the Caribbean region to strengthen health security through regional cooperation. Key steps included conducting a regional self-assessment using Global Health Security Agenda tools, developing a Caribbean Region GHSA Roadmap with input from over 70 stakeholders, and reinvigorating the Regional Coordinating Mechanism for Health Security. The roadmap establishes targets and plans for 19 health security capacities across Caribbean countries and aims to improve regional communication, coordination, and cooperation to address health threats.
Health System Reforms to Accelerate Universal Health Coverage in Côte d'IvoireHFG Project
The document summarizes health system reforms in Côte d'Ivoire to accelerate progress toward universal health coverage. Key reforms include improving funding and financial management through increased domestic resource mobilization and transparency measures. Service delivery is being strengthened by expanding maternal and child health services and ensuring drug availability. Governance is also being strengthened through audits of management risks and training inspectors to apply standardized financial controls at local levels.
Trends in health financing and the private health sector in the middle east a...HFG Project
In the past several decades, countries in the Middle East and North Africa have made significant improvements in developing their health systems and improving the health status of their populations. However, the region continues to face substantial and diverse political, macroeconomic,social, and health challenges. In 2010–2011, the mass uprisings over high unemployment, poverty, and political repression known as the Arab Spring began in several countries. These events led to a wave of social and political upheaval that had enduring repercussions throughout the region. Iraq, Libya, Syria, and Yemen remain embroiled in prolonged violent conflicts. Other countries are more stable but undergoing significant changes and reforms.
To understand current health financing policies and mechanisms, as well as the current role of the private sector in the health systems of the Middle East, the USAID Middle East Regional Bureau commissioned the Sustaining Health Outcomes through the Private Sector (SHOPS) Plus and Health Finance and Governance (HFG) projects to conduct a review of health financing and the private health sector in the 11 low-and middle-income countries in the region, focusing on the years 2008 to 2017.1 The countries included in this analysis are Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, Syria, Tunisia, the West Bank and Gaza, and Yemen. This review aims to highlight regional trends and identify gaps in information.
Health care financing in Saudi Arabia is provided mainly through government revenues, accounting for approximately 80% of total health care spending. Government spending on health as a percentage of the national budget has risen from 2.8% in 1970 to 6.4% in 2004. The remaining sources of health care financing include private sources such as personal out-of-pocket payments and employer-sponsored health insurance programs.
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
This document summarizes a presentation on the Philippine healthcare system. It discusses the history of healthcare in the Philippines from pre-Hispanic times to the modern era. It also outlines the key reforms and initiatives to establish universal healthcare, including the National Health Insurance Act, increased healthcare budgets, and the Aquino health agenda. The presentation highlights improved access to facilities and health outcomes such as increased life expectancy and reductions in mortality.
Ethiopia Health Sector Financing Reform/HFG: End-of-Project ReportHFG Project
The HSFR/HFG project worked with the Government of Ethiopia from 2013-2018 to improve Ethiopia's health care financing system and expand access to health services. Key achievements included increasing the proportion of health facilities managing funds and services through boards representing communities, expanding revenue retention at health centers and hospitals, and piloting community-based health insurance. The project aimed to increase utilization of primary health services, enroll more people in insurance, and reduce out-of-pocket costs through technical support across Ethiopia's decentralized health system. Challenges remained in expanding reforms and improving health indicators, but the project strengthened sustainability by building local capacity and engaging stakeholders.
The document discusses health expenditure and financing in India. It notes that over 80% of health expenditure is private, with nearly 97% coming from out-of-pocket payments. Public expenditure on health is below 1% of GDP. It highlights challenges around human resources, rural-urban disparities, and gaps between health policy and implementation. Economics can help address issues of scarce resources and alternative uses to improve allocative efficiency in the health sector.
Budget matters for health: key formulation and classification issuesHFG Project
This policy brief aims to raise awareness on the role of public budgeting – specifically aspects of budget formulation – for non-PFM specialists working in health. As part of an overall WHO programme of work on Budgeting in Health, it will help clarify the characteristics and implications of various budgeting approaches for the health sector.
This document summarizes key findings from National Health Accounts conducted in Egypt between 1994-2009. It finds that private out-of-pocket spending remains the largest source of health financing. While total health spending has increased over time, government spending as a percentage of total health spending and of the overall government budget is among the lowest in the region. There are also inequities in spending between rich and poor and urban and rural populations. The document calls for increased public investment in health and reforms to address these inequities and increase the role of comprehensive insurance.
Overview of Ghana’s National Health Insurance SchemeHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
- Medicare is a social insurance program that provides health coverage to individuals aged 65 and older as well as those who are permanently disabled, regardless of income or health status. It covers over 43 million Americans.
- Medicare spending is projected to increase substantially by 2030 as the number of people enrolled is expected to rise from 46 million to 78 million. However, the program is facing financial challenges as costs are expected to exceed funding levels by 2019.
- Medicaid provides health coverage to over 74 million low-income individuals, including children, pregnant women, elderly, and disabled. Each state administers its own Medicaid program within federal guidelines.
Capacity Building in Human Resources Management of the Ministry of Health in ...HFG Project
The Ministry of Health in Guinea recognized after the Ebola outbreak that it needed to rebuild and strengthen its health workforce. With support from HFG, the MOH established better governance structures including upgrading its Division of Human Resources to a Department of Human Resources with new services and establishing an inter-ministerial committee to coordinate health workforce issues. HFG also helped improve Guinea's human resources information system and develop a multi-year workforce training plan to improve health services through clinical coaching.
The document discusses health care financing in Myanmar. It outlines the goals of a health system to provide good health outcomes, responsiveness, and fairness in financing. It then describes the various methods of health care financing in Myanmar including tax-based public financing, user fees, social security benefits, out-of-pocket payments, donor funding, health insurance, and community-based health insurance. It notes that Myanmar aims to explore alternative financing systems to augment roles of other providers and strengthen universal coverage while protecting people from financial hardship due to illness.
Kenya health sector reforms and roadmap towards uhc by Dr Isaaq Odongo, MOH K...achapkenya
Kenya has undertaken several health sector reforms and programs to achieve universal health coverage (UHC) as outlined in its Constitution and health policy. Key reforms include making primary healthcare and maternity services free, expanding insurance coverage, and increasing health funding. However, challenges remain such as high out-of-pocket costs, inadequate funding, and fragmentation of financing. Moving forward, Kenya's roadmap is to further increase health funding, minimize financing pools, define and provide essential service packages using pooled funds, and strengthen its health insurance program to expand coverage.
A Sustainable Healthcare Emergency Management Framework: COVID-19 and BeyondHealth Catalyst
With an ever-changing understanding of COVID-19 and a continually fluctuating disease impact, health systems can’t rely on a single, rigid plan to guide their response and recovery efforts. An effective solution is likely a flexible framework that steers hospitals and other providers through four critical phases of a communitywide healthcare emergency:
Prepare for an outbreak.
Prevent transmission.
Recover from an outbreak.
Plan for the future.
The framework must include data-supported surveillance and containment strategies to enhance detection, reduce transmission, and manage capacity and supplies, providing a roadmap to respond to immediate demands and also support a sustainable long-term pandemic response.
Monitoring Health for the SDGs - Global Health Statistics 2024 - WHOChristina Parmionova
The 2024 World Health Statistics edition reviews more than 50 health-related indicators from the Sustainable Development Goals and WHO’s Thirteenth General Programme of Work. It also highlights the findings from the Global health estimates 2021, notably the impact of the COVID-19 pandemic on life expectancy and healthy life expectancy.
Reaching the Missing Middle: Ensuring Health Coverage for India’s Urban PoorHFG Project
This document discusses health coverage challenges facing India's urban poor population and opportunities to expand coverage through the new National Health Protection Scheme (NHPS). It notes that India's urban poor, estimated at 27% of the urban population, have been excluded from existing public health insurance schemes that target those below the poverty line. The NHPS, announced in 2018, aims to provide health insurance of up to 500,000 rupees per family annually. The document argues that integrating primary health care benefits into insurance schemes could help manage population health and reduce costs by keeping people healthy and out of hospitals. There is no single solution, but the NHPS could play a major role in expanding safety nets for the urban poor through financial protection and investing in
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Fighting Health Security Threats Requires a Cross-Border ApproachHFG Project
This document discusses how health security threats like Ebola and Zika require a cross-border approach. It summarizes efforts taken in the Caribbean region to strengthen health security through regional cooperation. Key steps included conducting a regional self-assessment using Global Health Security Agenda tools, developing a Caribbean Region GHSA Roadmap with input from over 70 stakeholders, and reinvigorating the Regional Coordinating Mechanism for Health Security. The roadmap establishes targets and plans for 19 health security capacities across Caribbean countries and aims to improve regional communication, coordination, and cooperation to address health threats.
Health System Reforms to Accelerate Universal Health Coverage in Côte d'IvoireHFG Project
The document summarizes health system reforms in Côte d'Ivoire to accelerate progress toward universal health coverage. Key reforms include improving funding and financial management through increased domestic resource mobilization and transparency measures. Service delivery is being strengthened by expanding maternal and child health services and ensuring drug availability. Governance is also being strengthened through audits of management risks and training inspectors to apply standardized financial controls at local levels.
Trends in health financing and the private health sector in the middle east a...HFG Project
In the past several decades, countries in the Middle East and North Africa have made significant improvements in developing their health systems and improving the health status of their populations. However, the region continues to face substantial and diverse political, macroeconomic,social, and health challenges. In 2010–2011, the mass uprisings over high unemployment, poverty, and political repression known as the Arab Spring began in several countries. These events led to a wave of social and political upheaval that had enduring repercussions throughout the region. Iraq, Libya, Syria, and Yemen remain embroiled in prolonged violent conflicts. Other countries are more stable but undergoing significant changes and reforms.
To understand current health financing policies and mechanisms, as well as the current role of the private sector in the health systems of the Middle East, the USAID Middle East Regional Bureau commissioned the Sustaining Health Outcomes through the Private Sector (SHOPS) Plus and Health Finance and Governance (HFG) projects to conduct a review of health financing and the private health sector in the 11 low-and middle-income countries in the region, focusing on the years 2008 to 2017.1 The countries included in this analysis are Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, Syria, Tunisia, the West Bank and Gaza, and Yemen. This review aims to highlight regional trends and identify gaps in information.
Health care financing in Saudi Arabia is provided mainly through government revenues, accounting for approximately 80% of total health care spending. Government spending on health as a percentage of the national budget has risen from 2.8% in 1970 to 6.4% in 2004. The remaining sources of health care financing include private sources such as personal out-of-pocket payments and employer-sponsored health insurance programs.
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
This document summarizes a presentation on the Philippine healthcare system. It discusses the history of healthcare in the Philippines from pre-Hispanic times to the modern era. It also outlines the key reforms and initiatives to establish universal healthcare, including the National Health Insurance Act, increased healthcare budgets, and the Aquino health agenda. The presentation highlights improved access to facilities and health outcomes such as increased life expectancy and reductions in mortality.
Ethiopia Health Sector Financing Reform/HFG: End-of-Project ReportHFG Project
The HSFR/HFG project worked with the Government of Ethiopia from 2013-2018 to improve Ethiopia's health care financing system and expand access to health services. Key achievements included increasing the proportion of health facilities managing funds and services through boards representing communities, expanding revenue retention at health centers and hospitals, and piloting community-based health insurance. The project aimed to increase utilization of primary health services, enroll more people in insurance, and reduce out-of-pocket costs through technical support across Ethiopia's decentralized health system. Challenges remained in expanding reforms and improving health indicators, but the project strengthened sustainability by building local capacity and engaging stakeholders.
The document discusses health expenditure and financing in India. It notes that over 80% of health expenditure is private, with nearly 97% coming from out-of-pocket payments. Public expenditure on health is below 1% of GDP. It highlights challenges around human resources, rural-urban disparities, and gaps between health policy and implementation. Economics can help address issues of scarce resources and alternative uses to improve allocative efficiency in the health sector.
Budget matters for health: key formulation and classification issuesHFG Project
This policy brief aims to raise awareness on the role of public budgeting – specifically aspects of budget formulation – for non-PFM specialists working in health. As part of an overall WHO programme of work on Budgeting in Health, it will help clarify the characteristics and implications of various budgeting approaches for the health sector.
This document summarizes key findings from National Health Accounts conducted in Egypt between 1994-2009. It finds that private out-of-pocket spending remains the largest source of health financing. While total health spending has increased over time, government spending as a percentage of total health spending and of the overall government budget is among the lowest in the region. There are also inequities in spending between rich and poor and urban and rural populations. The document calls for increased public investment in health and reforms to address these inequities and increase the role of comprehensive insurance.
Overview of Ghana’s National Health Insurance SchemeHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
- Medicare is a social insurance program that provides health coverage to individuals aged 65 and older as well as those who are permanently disabled, regardless of income or health status. It covers over 43 million Americans.
- Medicare spending is projected to increase substantially by 2030 as the number of people enrolled is expected to rise from 46 million to 78 million. However, the program is facing financial challenges as costs are expected to exceed funding levels by 2019.
- Medicaid provides health coverage to over 74 million low-income individuals, including children, pregnant women, elderly, and disabled. Each state administers its own Medicaid program within federal guidelines.
Capacity Building in Human Resources Management of the Ministry of Health in ...HFG Project
The Ministry of Health in Guinea recognized after the Ebola outbreak that it needed to rebuild and strengthen its health workforce. With support from HFG, the MOH established better governance structures including upgrading its Division of Human Resources to a Department of Human Resources with new services and establishing an inter-ministerial committee to coordinate health workforce issues. HFG also helped improve Guinea's human resources information system and develop a multi-year workforce training plan to improve health services through clinical coaching.
The document discusses health care financing in Myanmar. It outlines the goals of a health system to provide good health outcomes, responsiveness, and fairness in financing. It then describes the various methods of health care financing in Myanmar including tax-based public financing, user fees, social security benefits, out-of-pocket payments, donor funding, health insurance, and community-based health insurance. It notes that Myanmar aims to explore alternative financing systems to augment roles of other providers and strengthen universal coverage while protecting people from financial hardship due to illness.
Kenya health sector reforms and roadmap towards uhc by Dr Isaaq Odongo, MOH K...achapkenya
Kenya has undertaken several health sector reforms and programs to achieve universal health coverage (UHC) as outlined in its Constitution and health policy. Key reforms include making primary healthcare and maternity services free, expanding insurance coverage, and increasing health funding. However, challenges remain such as high out-of-pocket costs, inadequate funding, and fragmentation of financing. Moving forward, Kenya's roadmap is to further increase health funding, minimize financing pools, define and provide essential service packages using pooled funds, and strengthen its health insurance program to expand coverage.
A Sustainable Healthcare Emergency Management Framework: COVID-19 and BeyondHealth Catalyst
With an ever-changing understanding of COVID-19 and a continually fluctuating disease impact, health systems can’t rely on a single, rigid plan to guide their response and recovery efforts. An effective solution is likely a flexible framework that steers hospitals and other providers through four critical phases of a communitywide healthcare emergency:
Prepare for an outbreak.
Prevent transmission.
Recover from an outbreak.
Plan for the future.
The framework must include data-supported surveillance and containment strategies to enhance detection, reduce transmission, and manage capacity and supplies, providing a roadmap to respond to immediate demands and also support a sustainable long-term pandemic response.
Monitoring Health for the SDGs - Global Health Statistics 2024 - WHOChristina Parmionova
The 2024 World Health Statistics edition reviews more than 50 health-related indicators from the Sustainable Development Goals and WHO’s Thirteenth General Programme of Work. It also highlights the findings from the Global health estimates 2021, notably the impact of the COVID-19 pandemic on life expectancy and healthy life expectancy.
National Patient Safety Implementation_Dr Ruchi Kushwaha.pptxDr Ruchi Kushwaha
This document outlines the National Patient Safety Implementation Framework (NPSIF) for India from 2018-2025. The key points are:
1. The NPSIF aims to improve patient safety across all levels of healthcare in India to progress toward universal health coverage. Its goals are to establish structural systems and a competent workforce to support patient safety.
2. Strategic objectives include improving safety systems at national and facility levels, establishing adverse event reporting, ensuring a trained workforce, preventing infections, implementing safety campaigns, and promoting research.
3. Action plans and principles focus on strengthening legislation, accreditation, communication, and patient-centered care to establish a culture of safety in Indian healthcare.
The Global Tuberculosis Report 2021 by the World Health Organization provides an overview of the state of the tuberculosis (TB) epidemic worldwide. Some key findings include that for the first time in over a decade, TB deaths have increased globally due to reduced access to TB diagnosis and treatment during the COVID-19 pandemic. Close to half of the estimated 10.6 million people who fell ill with TB in 2020 were not diagnosed or treated. The number of people treated for drug-resistant TB and those who received TB preventive treatment also declined significantly. The report emphasizes the need to address social determinants like poverty, inequity, and discrimination to help end TB. It provides data on TB trends in 197 countries to inform preparations for the second
This report provides the first global assessment of progress toward universal health coverage. It finds that while access to essential health services has increased globally, significant gaps remain. Coverage of key services like antiretroviral therapy and tuberculosis treatment is below 80%, and inequities exist both between and within countries. The report establishes a core set of tracer indicators to monitor coverage of reproductive, maternal, child, and infectious disease services. It highlights both successes in expanding coverage and the ongoing need to address remaining gaps to achieve universal access to quality health care.
Monitoring progress towards universal health coverage at country and global l...The Rockefeller Foundation
A movement towards universal health coverage (UHC) – ensuring that everyone who needs health services is able to get them, without undue financial hardship – has been growing across the globe (1). This has led to a sharp increase in the demand for expertise, evidence and measures of progress and a push to make UHC one of the goals of the post-2015 development agenda (2). This paper proposes a framework for tracking country and global progress towards UHC; its aim is to inform and guide these discussions and assessment of both aggregate and equitable coverage of essential health services as well as financial protection. Monitoring progress towards these two components of UHC will be complementary and critical to achieving desirable health outcome goals, such as ending preventable deaths and promoting healthy life expectancy and also reducing poverty and protecting household incomes.
This paper was written jointly by the World Health Organization (WHO) and The World Bank Group on the basis of consultations and discussions with country representatives, technical experts and global health and development partners (3). A draft of this paper was posted online and circulated widely for consultation between December 2013 and February 2014. Nearly 70 submissions were received from countries, development partners, civil society, academics and other interested stakeholders. The feedback was synthesized and reviewed at a meeting of country and global experts in Bellagio, Italy, in March 2014 (4). The paper was modified to reflect the views emerging from these consultations.
1
8
Compliance Policies
Name
Course
Professor
Date
Compliance Policies
In the previous project, two compliance plans were developed and a job description developed for safety and compliance manager. However, strength for any compliance programs depends on compliance policy and procedurals which outlines applicable laws, regulations and standards that should be followed to implement developed plans. Compliance policies should be clear and simple to eliminate confusion or difficulties which may be experienced by implementers of compliance plans. Considering there are two compliance plans, to enhance clarity on the developed compliance, each compliance plan would be considered individually constituting two sections for two compliance policies under each compliance plan.
Compliance Plan For Covid protocols
The impact of Covid-19 has been felt in all sectors of economies and health sectors is not exceptional. Even though numerous professionals have been affected by the virus, significant healthcare providers have succumbed to the virus on the line of the duty. According to a study conducted that assess the impact of Covid-19 on the health sector, as of April 2020, countries that reported the significant number of healthcare providers that had succumbed to the virus are Italy with 44%, Iran with 15%, Philippines with 8%, Indonesia with 6%, and China, Spain, U.S each with 4% (Iyengar et al…,2020). Healthcare providers are the first line of defense at high risk of infection because they constantly engage and interact with Covid protocols. Given there is no cure for the virus, hospitals are implementing prevention measures to contain the spread of the virus, protect clients and also its staff. However, it has been noticed that staff members have been violating Covid protocols such as washing hands between patients necessitating the development of a Compliance plan for COVID. In the following two sections, compliance policies for the compliance plan for COVID are outlined.
Section 1: Compliance Standards for COVID Protocols
Healthcare providers should comply with standard precaution practices when treating patients regardless of the nature of diagnosis (Beyamo, Dodicho & Facha, 2019). In the healthcare facility, healthcare workers are at high risk of infection. Covid-19 is an infectious disease which means healthcare workers are at high risk of being exposed to the virus. For example, it is reported that more than 570,000 healthcare personnel had been infected with the virus in America (PAHO, 2020). This underscores need to take standard precaution which constitutes of policies which aimed at reducing the risk of transmitting infection in the healthcare (facility Beyamo et al…, 2019). Standard precautions are not selective to particular diseases because medical personal handles clients with a variety of infections.
To minimize the spread of Covid in the healthcare facility, standard precaution policies entail hand hygiene which requ ...
The World Health Organization's annual World Health Statistics report presents data on over 50 health indicators related to the Sustainable Development Goals and WHO's Triple Billion targets. The 2022 edition focuses on monitoring health in the context of the COVID-19 pandemic. It finds that as of April 2022, over 50 million COVID cases and 6 million COVID deaths had been reported, though excess mortality estimates suggest the actual death toll is around 15 million. The pandemic has disrupted essential health services. While life expectancy and healthy life expectancy have increased globally since 2000, inequalities persist and the pandemic may slow or reverse progress on some health measures. Risk factors like obesity, hypertension and air pollution also remain challenges.
This document provides a draft policy toolkit for building capacity to prevent and control healthcare-associated infections (HAIs) in the Asia-Pacific region. It recommends establishing a comprehensive national framework for HAI prevention, including designating a health agency responsible and establishing advisory committees. It also recommends requiring minimum infection control programs and surveillance/reporting of HAIs at healthcare facilities with oversight at the national level. Additional recommendations include including HAI prevention in facility licensing/accreditation standards, building training capacity through partnerships, and providing financial incentives/disincentives for HAI reduction efforts. The appendix provides examples of national HAI frameworks, advisory committees, and common HAIs like those caused by MRSA, C. difficile, multid
Why Data-Driven Healthcare Is the Best Defense Against COVID-19Health Catalyst
COVID-19 has given data-driven healthcare the opportunity to prove its value on the national and global stages. Health systems, researchers, and policymakers have leveraged data to drive critical decisions from short-term emergency response to long-term recovery planning.
Five areas of pandemic response and recovery stand out for their robust use of data and measurable impact on the course of the outbreak and the individuals and frontline providers at its center:
Scaling the hospital command center to pandemic proportions.
Meeting patient surge demands on hospital capacity.
Controlling disease spread.
Fueling global research.
Responding to financial strain.
This document is a handbook produced by the World Health Organization for monitoring the building blocks of health systems using indicators and measurement strategies. It contains six sections that outline indicators for monitoring different components of health systems, including: health service delivery, the health workforce, health information systems, access to essential medicines, health systems financing, and leadership and governance. The handbook was developed through collaboration with experts from around the world and aims to help countries track and evaluate their health systems and progress.
Who 2019-n cov-adjusting-ph-measures-2021CIkumparan
Public health and social measures are critical to limiting COVID-19 transmission and reducing deaths. This document provides guidance for implementing and adjusting measures based on transmission levels and health system capacity. It outlines indicators and thresholds to assess the situation and tailored measures at national and sub-national levels. Considerations include vaccine rollout, variants of concern, inequities in access, and impacts on society. Measures must be regularly reviewed and adapted based on ongoing assessments to control the virus while balancing other impacts.
The document describes the evolution and components of India's National AIDS Control Program (NACP). It began in 1992 and is now in its fourth phase (NACP-IV) from 2012-2017. Key aspects include:
- Integrated Counselling and Testing Centers (ICTCs) were established in 2006 by integrating earlier Voluntary Counselling and Testing Centers (VCTCs) and Prevention of Parent-to-Child Transmission centers.
- NACP-IV has 5 components: prevention services, expanding information/education, comprehensive care/support/treatment, strengthening institutional capacities, and a strategic information management system.
- Targeted interventions provide prevention, care, and treatment services focused on high-
Alternative approaches for sustaining the HIV and AIDS response in Dominican ...HFG Project
The purpose of this report is to capture and consolidate the suggestions of the Sustainability Group for consideration by the Government of Dominican Republic (GODR) and other relevant stakeholders. GODR will be able to draw from this report when developing its HIV sustainability strategy, revising the National Strategic Plan for HIV (PEN), and developing other planning and policy documents.
The document proposes an ontology-based adaptive sustainable healthcare insurance policy system called A-SHIP. A-SHIP aims to create customized healthcare insurance policies for patients based on their health status and needs. It analyzes patient electronic health records and other health data using an ontology and rules engine. The system generates insurance packages tailored to each patient's situation to both meet their needs and reduce costs for insurance companies. It was tested using a real patient dataset and aims to make healthcare more sustainable and personalized through innovative insurance policies and technologies like remote monitoring devices.
The document discusses the healthcare industry and provides context for analyzing delays in patient discharge processes at a hospital from May to July 2015. It describes the objectives of studying delays, the sample size, tools used, and limitations. It then provides an overview of the global healthcare industry, key segments including hospitals, providers and professionals, models for healthcare delivery, and the market size of the industry in different regions. Porter's five forces model is applied to analyze competition in the healthcare industry.
Steps for Effective Patient and Staff Contact Tracing to Defend Against COVID...Health Catalyst
While the world waits for a vaccine or effective treatment for COVID-19, managing disease spread is paramount. For health systems, patient and staff contact tracing is one of the top transmission-control strategies. Because the virus appears to spread mainly through respiratory droplets from person-to-person contact, knowing where infected individuals have been and with whom they’ve been in contact is an essential capability. With this insight, organizations can manage transmission with data-driven emergency planning and monitoring capabilities. The resulting appropriate and timely workflow modifications will serve disease control efforts during the 2020 pandemic and help health systems prepare for future outbreaks.
Universal health coverage (UHC)—ensuring that everyone has access to quality, affordable health services when needed—can be a vehicle for improved equity, health, financial well-being, and economic development. In its 2013 report, Global Health 2035, the Commission on Investing in Health (CIH) made the case that progressive (“pro-poor”) pathways towards UHC, which target the poor from the outset, are the most efficient way to achieve both improved health outcomes and increased financial protection (FP). Countries worldwide are now embarking on health system changes to move closer to achieving UHC, often with a clear pro-poor intent. While they can draw on guidance related to the technical aspects of UHC (the “what” of UHC), such as on service package design, there is less information on the “how” of UHC—that is, on how to maximize the chances of successful implementation.
Motivated by a shared interest in helping to close this information gap, a diverse international group of 21 practitioners and academics, including ministry of health officials and representatives of global health agencies and foundations, convened at The Rockefeller Foundation’s Bellagio Center for a three-day workshop from July 7–9, 2015. The participants shared their experiences of implementing UHC and discussed the limited evidence on how to implement UHC, focusing on a set of seven key “how” questions from across five domains of UHC.
DIRECTIONAL STRATEGIES REPORTDirectional strategies Report on the .docxmariona83
DIRECTIONAL STRATEGIES REPORTDirectional strategies Report on the CDC
Darlene Olurin
Capella University
Strategic healthcare Planning
May 2020
INTRODUCTION
The center for Disease, Control and Prevention (CDC) are a unique health organization with a unique mission. The CDC provide evidence-based medicine experience and assistance for domestic and global surveillance, laboratory, occupational health and epidemiology functions and health threats, such as the CoVID-19, infectious diseases, influenza etc. The CDC’s office of public health in preparedness and Response (OPHPR) provide strategic directions, support and coordination for activities across CDC as well as local, state, tribal, national, territorial and international public health partners (CDC, 2019).
Over the years, the CDC has developed a working and effective plan to tackle infectious diseases. A good example was the global response to the 2009 H1N1 influenza pandemic that affected more than 214 countries and territories. The CDC’s response at the time, was the most rapid and effective response to an influenza pandemic in history. Through an international donation program, the vaccine was made available to 86 countries. The experience of the2009 H1N1 influenza response, continues to inform preparedness efforts for other future pandemic and public health emergencies. However, federal and state budget cuts threaten the kind of success previously seen, as is evident during this current COVID-19 pandemic. The current presidential administration, shortly after being sworn in made some serious changes that affected the CDC’S response to the pandemic by getting rid of the teams put in place to tackle pandemics this greatly slowed the U’S’s response and lead to a wider spread of this virus. Also, innovation and creativity need to be increased to best utilize existing funds.
VISON, MIISSION AND VALUES OF THE CDC
The vision of the CDC is to create a healthier, safer world that is able to detect prevent and respond to public health threats (CDC, 2019).
The mission statement is to protect all Americans and people of the nations worldwide from public health threats by working with partners to build capacity, advance research and respond in times of crisis like during this current COVID-19 pandemic (CDC, 2019).
The CDC provide technical help, assistance and resources to state and local public health agencies to support the efforts in building and preparing resilient communities (CDC,2011).
To achieve the vision of the CDC, it is vital that stakeholders as across, public health, partners, private sectors, emergency department and other related bodies, work hand in hand.
The CDC will demonstrate leadership in public health preparedness and response by adhering to the following values they have in place:
· Engaging partners on and leveraging collaboration (a strength the TOWS matrix)
· Basing decisions on the best available science
· Encouraging effective communications and inform.
The Fight Against COVID-19: A National Patient RegistryHealth Catalyst
Comprehensive COVID-19 understanding is a critical asset for adapting to pandemic needs, directing resources, developing vaccines, and planning for surges in a timely, informed manner. Because common barriers have impeded the progress of comprehensive data repositories, researchers have relied on surveillance data from population-level viral testing, which has proven insufficient. To significantly advance COVID-19 understanding, the medical community needs a digital patient registry that captures national-level data on how the virus impacts individuals differently according to comorbidities, lifestyle factors, and more. These essential insights lie in real-world evidence, which a registry can only deliver when it applies value sets to leverage clinical and claims data from health systems across the United States.
Similar to Who 2019-n cov-essential-health_services-2020.1-eng (20)
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How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
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Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
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Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
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Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
4. COVID-19: Operational guidance for maintaining core health services during an outbreak
1
Introduction and overview2
Section 1: Establish simplified purpose-designed governance 3
and coordination mechanisms to complement
response protocols
Section 2: Identify context-relevant essential services 4
Section 3: Optimize service delivery settings and platforms 6
Section 4: Establish effective patient flow (screening, triage, 7
and targeted referral) at all levels
Section 5: Rapidly re-distribute health workforce capacity, 8
including by re-assignment and task sharing
Section 6: Identify mechanisms to maintain availability of 10
essential medications, equipment and supplies
Table of Contents
5. COVID-19: Operational guidance for maintaining core health services during an outbreak
2
Introduction and overview
Health systems are being confronted with rapidly increasing demand generated by the COVID-19 outbreak.
When health systems are overwhelmed, both direct mortality from an outbreak and indirect mortality from
vaccine-preventable and treatable conditions increase dramatically. Analyses from the 2014-2015 Ebola
outbreak suggest that the increased number of deaths caused by measles, malaria, HIV/AIDS, and
tuberculosis attributable to health system failures exceeded deaths from Ebola.[1,2]
A system’s ability to
maintain delivery of essential health services will depend on its baseline capacity and burden of disease, and
the COVID-19 transmission context (classified as no cases, sporadic, clusters, or community transmission).
Maintaining population trust in the capacity of the health system to safely meet essential needs and to
control infection risk in health facilities is key to ensuring appropriate care-seeking behavior and adherence to
public health advice. A well-organized and prepared health system has the capacity to maintain equitable
access to essential service delivery throughout an emergency, limiting direct mortality and avoiding increased
indirect mortality.
With a relatively limited COVID-19 caseload, health systems may have the capacity to maintain routine service
delivery in addition to managing COVID-19 cases. When caseloads are high, and/or the health workforce is
reduced due to infection of health workers, strategic shifts are required to ensure that increasingly limited
resources provide maximum benefit for a population.
Countries will need to make difficult decisions to balance the demands of responding directly to COVID-19,
while simultaneously engaging in strategic planning and coordinated action to maintain essential health
service delivery, mitigating the risk of system collapse. Many routine and elective services may be postponed
or suspended. In addition, when routine practice comes under threat due to competing demands, simplified
purpose-designed governance mechanisms and protocols can mitigate outright system failure. Establishing
effective patient flow (including screening, triage, and targeted referral of COVID-19 and non-COVID-19 cases)
is essential at all levels.
Successful implementation of these strategic shifts will require transparency and frequent communication with
the public, specific protections to ensure access for socially vulnerable populations, active engagement of
communities and other stakeholders, and a high degree of cooperation from individuals.
This document expands on the content of the Operational planning guidelines to support country
preparedness and response. It provides guidance on a set of targeted immediate actions that countries
should consider at national, regional, and local level to reorganize and maintain access to essential quality
health services for all. It complements existing and forthcoming WHO guidance on the wider implications of
COVID-19 for health systems and cross-government strategies for responding to the COVID-19 outbreak,
including region-specific technical guidance being developed by WHO Regional Offices.
1. Elston, J. W. T., Cartwright, C., Ndumbi, P., Wright, J. (2017). The health impact of the 2014–15 Ebola outbreak. Public Health, 143, 60-70.
2. Parpia, A. S., Ndeffo-Mbah, M. L., Wenzel, N. S., Galvani, A. P. (2016). Effects of response to 2014–2015 Ebola outbreak on deaths from
malaria, HIV/AIDS, and tuberculosis, West Africa. Emerging infectious diseases, 22(3), 433.
Introduction
6. COVID-19: Operational guidance for maintaining core health services during an outbreak
3
Section 1
Section1
Establish simplified purpose-designed governance and coordination
mechanisms to complement response protocols
A designated focal point for essential health services should be a member of the COVID-19 Incident
Management Team. In the early stages of the epidemic, when COVID-19 caseload can still be managed and
routine services are not yet compromised, this focal point can assist in repurposing human, financial, and
material resources from routine services and mobilizing additional resources.
When routine services begin to be compromised, the essential health services focal point leads on triggering
a phased reprioritization of services, as described in the sections below, working through relevant authorities
to coordinate with public and private service providers, and reorient referral pathways.
KEY ACTIONS:
† Establish (or adapt) simplified mechanisms and protocols to govern essential health service delivery in
coordination with response protocols.
† Establish triggers/thresholds that activate a phased reallocation of routine comprehensive service
capacity towards essential services, through the specific mechanisms identified below.
† Assess and monitor ongoing delivery of essential health services to identify gaps and potential need to
dynamically remap referral pathways.
7. COVID-19: Operational guidance for maintaining core health services during an outbreak
4
Section2
Section 2
Identify context-relevant essential services
Countries should identify essential services that will be prioritized in their efforts to maintain continuity of
service delivery. High-priority categories include:
• Essential prevention for communicable diseases, particularly vaccination;
• Services related to reproductive health, including care during pregnancy and childbirth;
• Care of vulnerable populations, such as young infants and older adults;
• Provision of medications and supplies for the ongoing management of chronic diseases, including mental
health conditions;
• Continuity of critical inpatient therapies;
• Management of emergency health conditions and common acute presentations that require time-sensitive
intervention;
• Auxiliary services, such as basic diagnostic imaging, laboratory services, and blood bank services.
The selection of priorities will be guided by health system context and the local burden of disease, but should
initially be oriented to preventing communicable disease, averting maternal and child morbidity and mortality,
preventing acute exacerbations of chronic conditions by maintaining established treatment regimens, and
managing emergency conditions that require time-sensitive intervention. Routine health promotion visits may
be limited, and delivery of vaccinations and antenatal care will likely need to be adapted (see optimizing
platforms and task sharing below). Specific guidance on immunization in the context of COVID-19 is under
development and will shortly be available. Strengthening supply chains to ensure continuity of established
treatment regimens for key chronic diseases can limit acute exacerbations, reduce the need for provider
encounters, and minimize unscheduled attendance at emergency departments
Since availability of referral services may be limited in the context of increasing demands on the health system
associated with COVID-19, all health workers should be prepared, including through targeted in-service
training and in line with scopes of practice, to take on additional responsibilities related to the initial
management for key life-threatening syndromes (difficulty breathing, shock, altered mental status, and injury
in patients of all ages—see WHO/ICRC Basic Emergency Care). And emergency units at first-level hospitals
may become the primary location for maintaining care for common symptomatic presentations, such as fever,
pregnancy-related bleeding, chest pain, and headache.
8. COVID-19: Operational guidance for maintaining core health services during an outbreak
5
If the outbreak period is prolonged, authorities will need to regularly reconsider the status of outpatient
services that are time dependent and life saving, but not time sensitive on the order of hours to days.
Decisions about when to initiate cancer treatments, for example, may need to be integrated with an analysis
of the benefits of early treatment, the risk of immuno-compromise during an outbreak, and the estimated
duration of service limitations. And the priority for surgical procedures initially deemed elective may change
over time. Strategies for the restoration of comprehensive and elective services should be revisited and
revised periodically as the outbreak evolves.
KEY ACTIONS:
† Generate a country-specific list of essential services (based on context and supported by WHO guidance
and tools).
† Identify routine and elective services that can be delayed or relocated to non-affected areas.
† Create a roadmap for progressive phased reduction of services (see also governance above).
Section2
9. COVID-19: Operational guidance for maintaining core health services during an outbreak
6
Optimize service delivery settings and platforms
The settings where specific essential services are delivered may need to be modified for many reasons,
including:
• Existing service locations may be unavailable because they have been designated for the exclusive care of
people affected by COVID-19;
• Routine health service delivery may need to be adapted (e.g. vaccinations delivered by targeted
approaches; postnatal care delivered at home);
• Need to limit the number of provider encounters due to increased demand and decreased staff;
• The primary venue for maintaining acute care services may be shifted to first-level hospital emergency units
in order to concentrate services in a setting suited to high-volume high-acuity care available 24 hours per day.
KEY ACTIONS:
† Conduct a functional mapping of health facilities, including those in public, private, and military systems
(this is a shared action with Operational planning guidelines to support country preparedness and
response, Pillar 7: Case management).
† Taking into account re-purposed facilities, concentrate 24-hour acute care services at designated first-
level hospital emergency units (or similar) and ensure public awareness.
† Redirect chronic disease management to focus on maintaining supply chains for medications and
needed supplies, with a reduction in provider encounters.
† Establish outreach mechanisms as needed to ensure delivery of essential services.
Section3
Section 3
10. COVID-19: Operational guidance for maintaining core health services during an outbreak
7
Section4
Section 4
Establish effective patient flow (screening, triage, and targeted
referral) at all levels
People with and without COVID-19 will initially access the health system in the same way. Since people
present prior to having a diagnosis, there is overlap in patient flow for services directed to COVID-19 and for
other essential services. Basic infection-prevention measures (hand hygiene, respiratory etiquette, physical
distancing) should be promoted universally. In some settings, promotion of self-initiated isolation of those with
mild respiratory symptoms may be indicated to limit facility crowding. Frontline care sites—including primary
health centres, clinics, and hospital emergency units, as well as ad-hoc community settings (schools, etc) that
have been designated as care sites—will need to expand their capacity for screening, isolation and triage,
including with designated physical areas and appropriate security. All frontline sites will need to be ready to
assess and refer patients appropriately and safely to reduce transmission and ensure rational use of scarce
advanced care resources. In some settings, specific facilities may be designated for the care of patients
affected by COVID-19. In other settings, there may only be one hospital. Instituting targeted referral and
counter-referral criteria and processes will be crucial to keep the system from becoming overwhelmed.
KEY ACTIONS:
† Disseminate information to prepare the public and guide safe care-seeking behaviour.
† Establish screening of all patients on arrival at all sites using the most up-to-date COVID-19 guidance and
case definitions.
† Establish mechanisms for isolation of patients in all care sites using the most up-to-date COVID-19
guidance
† Ensure acuity-based triage at all sites providing acute care.
† Establish clear criteria and protocols for targeted referral (and counter-referral) pathways.
11. COVID-19: Operational guidance for maintaining core health services during an outbreak
8
Rapidly re-distribute health workforce capacity, including by
re-assignment and task sharing
Many countries face existing health workforce challenges, including shortages, maldistribution, and mis-
alignment between population health needs and health worker competencies. Additional factors may limit the
availability of health workers to deliver essential services during the outbreak, including re-assignment of staff
to treat increasing numbers of patients with COVID-19, and loss of staff who may be quarantined, infected, or
required to care for infected friends and family. The combination of increased workload and reduced number
of health workers is expected to pose a severe strain on the capacity to maintain essential services. These
predictable challenges should be offset through a combination of strategies.
Critical support measures include ensuring appropriate working hours and enforced rest periods; providing
guidance, training and supplies to limit health worker exposures; providing physical security and psychosocial
support; monitoring for illness, stress and burnout; and ensuring timely payment of salaries, sick leave, and
overtime (including for temporary staff to eliminate perverse incentives for staff to report to work while ill).
Health workers in high-risk categories for complications of COVID-19 may need to be reassigned to tasks that
reduce risk of exposure. Offering accommodation arrangements to reduce staff travel time and protect health
workers’ families from exposure may be appropriate.
Mechanisms to identify additional health workforce capacity include:
• Request part-time staff to expand hours and full-time staff to work remunerated overtime;
• Re-assign staff from non-affected areas (ensuring alignment of clinical indemnity arrangements where
necessary);
• Utilize registration and certification records to identify additional qualified workers, including licensed
retirees and trainees for appropriate supervised roles;
• Mobilize non-governmental, military, Red Cross/Crescent, and private sector health workforce capacity,
including through temporary deployment to the public sector where relevant;
• Where appropriate, consider establishing pathways for accelerated training and early certification of
medical, nursing, and other key trainee groups, ensuring supportive supervision;
• Identify high-impact clinical interventions for which rapid training would facilitate safe task sharing, and
consider expansion of scopes of practice where possible;
• Utilize web-based platforms to provide key trainings (e.g., on management of time-sensitive conditions
and common undifferentiated presentations in frontline care), clinical decision support and direct clinical
services where appropriate.
Section5
Section 5
12. COVID-19: Operational guidance for maintaining core health services during an outbreak
9
Section5
• Formalize organized lay provider systems (such as Community First Aid Responders, Red Cross/Crescent
volunteers);
• Train and repurpose government and other workers from non-health sectors to support functions in health
facilities (administration, maintenance, catering, etc.);
• Increase home-based service support by appropriately trained, remunerated and supplied community
health workers;
• Increase capacity of informal care givers for home care support such as family, friends, and neighbors.
KEY ACTIONS:
† Map health worker requirements (including critical tasks and time expenditures) in the four COVID-19
transmission scenarios.
† Maximize occupational health and staff safety measures in all categories listed above.
† Create a roadmap for phased implementation of the strategies above for timely scale-up.
† Allocate finances for timely payment of salaries, overtime, sick leave, and incentives or hazard pay,
including for temporary workers.
† Initiate rapid training mechanisms and job aids for key capacities, including diagnosis, triage, clinical
management, and essential infection prevention and control.
13. COVID-19: Operational guidance for maintaining core health services during an outbreak
10
Section6
Section 6
Identify mechanisms to maintain availability of essential medications,
equipment, and supplies
The need to redirect supplies to the treatment of patients with COVID-19, compounded by general supply
chain disruptions due to the effects of the outbreak on other sectors, is likely to lead to stockouts of
resources needed to maintain essential services. Priority resource lists should be developed (or adapted from
existing lists), and planning should be executed in coordination with the overall outbreak response. Suppliers
and pharmacies (public and private) can be networked to allow dynamic inventory assessment and
coordinated re-distribution.
For details, see “Pillar 8: Operational support and logistics” of the Operational planning guidelines to support
country preparedness and response.
KEY ACTIONS:
† Map essential services list to resource requirements.
† Map public and private pharmacies and suppliers.
† Create a platform for reporting inventory and stockouts, and for coordination of re-distribution of supplies.
WHO/2019-nCoV/essential_health_services/2020.1