Please see below a news release from the WHO website. This emphasises again the central importance of health systems, and in particular the health workforce, in achieving the new global health targets. ‘A strong and motivated health workforce is key to a resilient, integrated and people-centred health system. Without a fit for purpose workforce the world put’s itself at risk of not only failing to meet the ambitious targets of the SDGs, but of even reversing progress in the face of population growth and unexpected challenges such as the Ebola outbreak.’

INVESTING IN HEALTH WORKFORCES: THE PATH TOWARDS THE SDGS STARTS HERE

By Jim Campbell, Director, Health Workforce Department (WHO), Executive Director, Global Health Workforce Alliance.

http://www.who.int/hrh/news/2015/path-towards-SDGs/en/

This week marks a transition from one era of global health and development to the next. Seventeen Sustainable Development Goals (SDGs) will be agreed by 193 Heads of State and Government at the UN General Assembly in New York this week. As with the Millennium Development Goals (MDGs), health is rightly recognized as a fundamental human right and driver of development

Closing the gaps

Since 1990 we have seen unprecedented progress in improving global health outcomes, thanks in part to the priority given to health in the MDGs (3 out of 8 MDGs are focused on health). A 47% reduction in maternal mortality, and a 49% reduction in child mortality are just two of the extraordinary achievements of the past generation.

As we move now into the Post-2015 era, we know that to sustain and build upon on these past successes we must do more to address inequities in access to quality health care. Progress in achieving the MDGs has been uneven with the poorest and most marginalized people still being denied the most basic heath services. That is why SDG 3 – as with all the goals – moves away from targets that can be met whilst leaving the poorest behind, and instead calls on governments and other partners to ensure healthy lives and promote wellbeing for all.

Renewed focus on health systems

The quantity, skills and geographic distribution of the health workforce have long been recognized as factors that have held back even greater, and more equitable progress on the health-related MDGs. A strong and motivated health workforce is key to a resilient, integrated and people-centred health system. Without a fit for purpose workforce the world put’s itself at risk of not only failing to meet the ambitious targets of the SDGs, but of even reversing progress in the face of population growth and unexpected challenges such as the Ebola outbreak.

The need for greater priority to be given to health systems and human resources for health (HRH) is recognized in the new SDG targets. For example there are new targets to ‘achieve universal health coverage’ and to ‘substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries’.

A number of new strategies are also being launched in New York this week that will help translate the SDG goals into action. Two in particular have a focus on human resources for health –

Securing a Healthy Future: Resilient Health Systems to Fight Epidemics and Ensure Healthy Lives

“Roadmap: Healthy Systems – Healthy Lives”, a global initiative to strengthen health systems will be launched at a high-level side event on September 26, hosted by the Governments of Germany, Ghana and Norway. The Roadmap will be developed through a multi-stakeholder process that intends to facilitate a comprehensive understanding of health systems strengthening and agree on principles and approaches that will help countries build strong and resilient health systems. This process will be facilitated by Germany and the WHO, with a target date of completion for mid-2016.

A bold agenda for women’s, children’s and adolescents’ health

A new Global Strategy for Women’s, Children’s and Adolescents’ Health which will be launched on September 26, calls for an even more ambitious agenda of ending all preventable deaths within a generation by expanding equitable coverage of a broader range of reproductive, maternal, newborn, child, and adolescent health services.

As a recent paper, Improving the resilience and workforce of health systems for women’s, children’s, and adolescents’ health, published in the British Medical Journal highlighted, the updated Every Woman, Every Child Strategy must place health systems – and health workforces – at its heart, as their performance will decide success or failure for reproductive, maternal, newborn, child, and adolescent health in the next fifteen years. Clear guidance should be developed for countries so that they can build integrated and resilient healthcare delivery systems that meet the needs and expectations of all women and children.

The Global Strategy on HRH: building health workforces fit to deliver the SDGs

An extensive, global consultation on HRH has just been completed and the results are currently being translated into an updated draft of WHO’s Global Strategy on Human Resources for Health: Workforce 2030. This strategy will provide essential guidance for all partners looking to improve health outcomes related to the SDGs.

The Strategy highlights the increasing evidence that HRH offers a triple return on investment:

It drives improvement in population health outcomes;

It triggers broader socio-economic development with positive spill-over effects on the attainment of the SDGs, including education, gender equality and on the creation of decent employment opportunities and sustainable economic growth;

It serves as a first line of defense for individual countries to meet the International Health Regulations (2005) and promote global health security.

This week, we all have an opportunity to set off on the right path towards the achievement of the SDGs in 2030. Ensuring that we create the conditions for employment in the health and social sectors, addressing global deficits and improving access to care is surely the smartest place to start the journey.

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

ABSTRACT: The last decade of the MDG era witnessed substantial focus on reaching the bottom economic quintiles in low and middle income countries. However, the inordinate focus on reducing financial risk burden and increasing coverage without sufficient focus on expanding quality of services may account for slow progress of the MDGs in many countries. Human Resources for Health underlie quality and service delivery improvements, yet remains under-addressed in many national strategies to achieve Universal Health Coverage. Without adequate investments in improving and expanding health professional education, making and sustaining gains will be unlikely. The transition from the Millennium Development Goals (MDG) to the Sustainable Development Goals (SDG), with exciting new financing initiatives such as the Global Financing Facility brings the potential to enact substantial gains in the quality of services delivered and upgrading human health resources. This focus should ensure effective methodologies to improve health worker competencies and change practice are employed and ineffective and harmful ones eliminated (including undue influence of commercial interests).

KEY MESSAGES

– The last decade of the MDG era witnessed substantial focus on reaching the bottom economic quintiles in low and middle income countries (LMIC).

– There is a compelling need to shift what has been an inordinate emphasis on reducing financial risk burden towards policy and increased coverage to expand quality of services.

– As the SDG era emerges onto the global scene, countries will be increasingly called upon to address long-standing challenges.

SELECTED EXTRACTS:

In contrast to common perceptions, quality usually means basic services and interventions, not high tech/high cost care. Poor hand hygiene is rampant among health workers in lower- and middle-income countries and is a grossly underestimated cause of deaths of babies and mothers alike. For simplicity, quality means providing an appropriate health-care service in the right quantity and at the right time.

The Know-Do gap, i.e. what health workers know vs what they do, is large. Clinicians in Delhi, India were found in public clinics to practice just over one-tenth what they described as their standard practice. The same clinicians practiced one-third what they described in private clinics (Das and Hammer 2014).

Meanwhile, overuse of technology often increases the risk of death. For example, keeping a stable pre-term baby in an incubator doubles the risk of death compared with in direct skin contact with the mother (‘Kangaroo Mother Care’)

In the context of our current discussion on Achieving the new global health targets, I was interested to read this paper, which argues for a shift of emphasis from coverage to quality and ‘methodologies to improve health worker competencies’.

CITATION: Quality at the centre of universal health coverage

Howard L. Sobel, Dale Huntington and Marleen Temmerman

Health Policy Plan. (2015) doi: 10.1093/heapol/czv095

First published online: September 29, 2015 The full text is freely available here:

http://heapol.oxfordjournals.org/content/early/2015/09/28/heapol.czv095.full?papetoc

Contact E-mail: sobelh@wpro.who.int

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Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

One of the fundamental requirements for rapid progress is the ability to measure such progress. In no area is this more important than in maternal, newborn and child health.

‘Although the Millennium Development Goals (MDGs) sparked an increase in data collection, most countries still do not have timely data about how many of the women, adolescents, children, and newborns who need effective interventions are receiving them. This is unacceptable, and the global health community can do better…’

This is the key message of a Comment in next week’s issue of The Lancet (16 October 2015). The authors say: ‘What is needed is a core set of coverage indicators (ie, about 15) that are informative, feasible, and cost effective to collect, to continue the work of Countdown and the independent Expert Review Group of the Commission on Information and Accountability for Women’s and Children’s Health. Each indicator must be accompanied by standard measurement methods, and the whole package should be agreed on by global normative agencies including the UN, major donors, and national governments.’

CITATION: Maternal, newborn, and child health and the Sustainable Development Goals—a call for sustained and improved measurement

John Grove, Mariam Claeson, Jennifer Bryce, Agbessi Amouzou, Ties Boerma, Peter Waiswa, Cesar Victora, Kirkland Group

The Lancet, Volume 386, No. 10003, p1511–1514, 17 October 2015

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00517-6/fulltext

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

This paper in The Lancet is a reminder that indicators for the health-related SDGs have not yet been agreed. Christopher Murray of the Institute for Health Metrics notes that ‘the indicators chosen for each Sustainable Development Goal (SDG) target will probably determine the amount of action and attention each target receives’.

Christopher J L Murray. Choosing indicators for the health-related SDG targets. The Lancet, Vol. 386, October 3, 2015

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)00382-7.pdf

‘In the era of the Millennium Development Goals (MDGs), regular reporting of specific health indicators drew public and policy attention, and ultimately resources, to causes such as maternal and child health. On the basis of the lessons learned from the MDGs, the indicators chosen for each Sustainable Development Goal (SDG) target will probably determine the amount of action and attention each target receives. Shortening the long lists of proposed indicators for various targets will be a challenging task; for good reasons, advocacy groups will want their component of the target reflected in the selected indicator.’

SELECTED EXTRACTS (selected by Neil PW)

‘What basic properties should be fulfilled by the high-level indicators for the health-related SDGs? First, the indicators should not only measure the intended effect of a target but should also be important for population… Second, any indicator should be easily interpreted and communicated… The meaning and value of

the indicator should also be clear to the public, decision makers, and the scientific community. Third, it should be affordable to produce valid, timely, local, and comparable measurements of an indicator. Fourth, wherever possible and relevant indicators should be disaggregated…’

‘The table [see article] shows a list of the health-related SDG targets and the indicators that I propose for them.’

[for example, against Target 3.4 ‘Achieve universal health coverage…’, Chris Murray recommends ‘(a) % of households with catastrophic health

expenditures in a year; and (b) % of the population with effective coverage of a package of basic health care’]

‘Irrespective of the indicators selected for the health-related SDGs, monitoring the indicators will benefit from publicly available data, pluralistic data synthesis and analysis, and vigorous public debate about the findings.’

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Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

‘Universal health coverage — the widely accepted quest of health systems — must include access to pain control and palliative care with financial protection as a fundamental goal.’ An editorial in The Lancet (26 August) makes me wonder if universal health coverage (global health target 3.8) has been fully defined and agreed, or if countries are free to interpret the wording as they wish: “Target 3.8 – Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. I would be interested to hear from any HIFA members who can shed any light on this.

Currently, ‘most of the world’s population has little or no access to pain control and palliative care, forcing patients and families to endure a tremendous burden of avoidable suffering’, says the editorial. ‘High-income countries account for less than 15% of the world’s population and 94% of global morphine consumption.’

‘In clinical medicine, the obsession with extension of life and treatment of disease, at any pecuniary or emotional cost, displaces adequate attention to human dignity and quality of life.11, 12 Terminal illness is stigmatised, and dying patients are too often expelled or excluded from health-care systems.’

CITATION: Closing the divide: the Harvard Global Equity Initiative–Lancet Commission on global access to pain control and palliative care.

Felicia M Knaulemail, Paul E Farmer, Afsan Bhadelia, Philippa Berman, Richard Horton.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60289-6/fulltext

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Further to Chris Zielinski’s message (13 October) on the Know-do gap, and Richard Smith’s earlier message (PACK: A package to improve primary care in underserved areas) I was interested to read an editorial in the BMJ (16 October). Below are extracts. The full text is restricted-access.

‘The sustainable development goals launched last month commit the world to achieving universal health coverage by 2030. Achievement will depend on providing high quality primary healthcare… We need better integrated, concise, and user friendly materials that can help health workers manage the wide range of problems seen in primary care.’

‘The most widely implemented of these tools, the Integrated Management of Childhood Illness, covered the five commonest life threatening conditions in children under 5 years and has been adopted in more than 100 countries… two decades on the integrated management booklet remains the main resource for primary care workers caring for children in low and middle income countries.’

‘An example of a programme with wider coverage is the Practical Approach to Care Kit (PACK) developed over the past 15 years in primary care health services in South Africa.13 It is based on a concise (100 page) set of algorithms and checklists for the commonest 40 symptoms and 20 chronic conditions among adults presenting to primary care facilities in low and middle income countries. It integrates content on communicable diseases, non-communicable diseases, mental illness, and women’s health and uses short (1.5 hour) onsite training sessions to familiarise health workers with its content and to support scalable implementation.’

‘The studies also show that health workers use the tools regularly and feel empowered by them. Recently, the University of Cape Town and BMJ have partnered to address some of the shortcomings of such programmes… The partnership will also test new models for adapting PACK for sustainable use in other countries. Work is under way in Brazil, Nigeria, Uganda, and Bangladesh. It may even be useful in high income countries struggling with staff shortages in primary care.’

It is unclear whether PACK will be made available on an open access license, thereby allowing others to freely use, reproduce, adapt and translate the package as needed. If so, it could be a game-changer. If not, its impact will be limited.

CITATION: Lara Fairall, Kieran Walsh. Practical tools for improving global primary care

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h5361 (Published 13 October 2015)

Cite this as: BMJ 2015;351:h5361

http://www.bmj.com/content/351/bmj.h5361

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Sustainable Development Goals: commendable but pie-in-the-sky

Médecins Sans Frontières (MSF), 25 September, 2015

https://www.msf.org.za/msf-publications/sustainable-development-goals-commendable-pie-sky

‘The aspirations of the SDGs are commendable, but Doctors Without Borders (MSF) is concerned that they lack a concrete plan to accelerate progress and address existing gaps in healthcare. Daily MSF medics witnesses the real world outcomes of government policy decisions, actions and inactions on people’s health. From our perspective there is a disconnect between the SDGs and people’s health needs, context and country variations and a serious lack of political will and leadership to make health central among other concerns in the SDGs.’

‘MSF’s Key Concerns:

– The SDG ambitions are at odds with the reality of the people. Significant gaps in health care provision continue to destroy lives and cripple communities.

– Health gains of the last 15 years are at risk.

– Inadequate support for research and development (R&D) and lack of access to vaccines and medicines.

– Funding for health care is being reduced.         

– Lack of political will and leadership on health…’

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

The UN Sustainable Development Summit formally agreed the Sustainable development Goals, and this summary provides a record of the contributions made by heads of state worldwide. With thanks to HESP Newsletter.

Summary of the UN Sustainable Development Summit: 25-27 September 2015

by Rishikesh Bhandary, Faye Leone, Leila Mead et al.

International Institute for Sustainable Development (IISD), 30 September 2015

http://www.iisd.ca/download/pdf/enb3224e.pdf

‘From the speeches at the UN Sustainable Development Summit, it was clear that the implementation of the Sustainable Development Goals (SDGs) has already begun; the sense of ownership over the negotiated outcome has extended into stakeholders’ commitment to implement the 2030 Agenda. Governments reported that they have taken steps to assess how the SDGs will be implemented within their ministries. Others said they had referred to the SDGs while developing their intended natio

ally determined contributions (INDCs) to address climate change. Intergovernmental and nongovernmental organizations enumerated the SDGs addressed in their mandates. And representatives from the pbility assessments.’

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Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

This new paper is from Australia but the approach potentially has wide applicability. The authors conclude: ‘Communities of practice can offer an effective workforce development strategy for rural and remote practitioners and should be considered by employers and workforce planners as a way of developing the public health nutrition workforce to more effectively manage population nutrition and health issues into the future.’

CITATION: Citation: Holden S, Ferguson M, Brimblecombe J, Palermo CE.  Can a community of practice equip public health nutritionists to work with remote retail to improve the food supply? Rural and Remote Health 15: 3464. (Online) 2015. Available: http://www.rrh.org.au

Full text is freely available here: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=3464

ABSTRACT

Introduction:  This study aimed to determine the influence on practice of a community of practice designed for public health nutritionists who work with retail stores in remote Indigenous communities in Australia.

Methods:  A descriptive evaluation of the community of practice participants’ perspectives using the most significant change technique and individual in-depth interviews was conducted. Data were analysed using thematic and content analysis with a focus on answering the evaluation questions.

Results:  Twelve public health nutritionists employed to work with remote Indigenous community stores were involved. The community of practice was reported to develop competence through problem solving, knowledge sharing and building confidence for innovative work. Building competence was achieved through accessible and timely professional support. Sharing stories and being encouraged to reflect on practice was valued and supported the participant’s practice. Working to improve the food supply is challenging but there is value in being supported by like-minded colleagues to stay focused on this work.

Conclusions:  Most participants perceived the community of practice intervention to be an effective strategy to improve their work. These findings provide evidence of a promising intervention for building the public health nutrition workforce in remote Indigenous community store retail settings.

SELECTED EXTRACTS

‘Participants believed that they were equipped to ask the right questions of the right people with power and influence to make change. They explained that this was a difference in their thinking that could not be found by reading the literature alone.’

“I think, without being … involved in the community of practice, I probably would never have been able to get to where I am now.” (Quote from participant)

‘The community of practice assisted practice through the following four key functions:

– Shared problem solving, knowledge sharing…

– Building confidence for practice…

– Accessible professional support through sharing and reflective practice…

– Support by like-minded colleagues to stay focused…’

‘The participants described feeling more valued for the work they do through connecting with others.’

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

We are delighted to release our latest film, about an antiseptic gel called chlorhexidine: Chlorhexidine for Umbilical Cord Care.  This film has been produced for the global Chlorhexidine Working Group with support from GSK.7.1% Chlorhexidine has been shown to be highly effective in reducing neonatal mortality related to newborn sepsis as well as umbilical cord infection.  We’ve produced this short animation for the Chlorhexidine Working Group to demonstrate how to provide safe umbilical cord care using this simple and effective, life-saving antiseptic.

Click here to view and download the film: http://medicalaidfilms.org/our-films/newborn-child-health/?v=135684121

The Chlorhexidine Working Group (CWG) is an international collaboration of organizations committed to the use of 7.1% chlorhexidine digluconate (delivering 4% chlorhexidine) for umbilical cord care in low income countries through advocacy and technical assistance.  To learn more, visit the Chlorhexidine for Umbilical Cord Care Hub: http://www.healthynewbornnetwork.org/page/chlorhexidine-umbilical-cord-care-hub

This film is intended to inform health workers and communities across Sub-Saharan Africa and other low resource settings about chlorhexidine, and how it should be used as part of safe umbilical cord care immediately after birth.

With thanks to GSK who generously supported this film, and to the Chlorhexidine Working Group for their input and expertise.

Please let us know what you think by sending us your feedback to josie@medicalaidfilms.org

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Josie Gallo

Content Co-ordinator Medical Aid Films

Office: +44 (0) 20 7396 5327 Mobile: +44 (0) 7790 047694

16 Lincoln’s Inn Fields, London, WC2A 3ED, UK www.medicalaidfilms.org

There is considerable excitement about the Sustainable Development Goals and their relevance to child health and child rights. This was the focus of the recent International Society for Social Pediatrics and Child Health meeting in Geneva which was addressed by the new Director of Maternal, Newborn, Child and Adolescent Health at WHO, Dr Anthony Costello.

The first of the new Goals is to end poverty in all its forms everywhere, and Goal 10 is to reduce inequality within and among countries. All would agree with these goals and the increase in inequalities across the globe and within most countries, including industrialised countries, is stark. Many would feel that the increase in wealth, whereby now (according to a January 2014 report by Oxfam) the 85 wealthiest individuals in the world have a combined wealth equal to that of the bottom 50% of the world’s population, or about 3.5 billion people, is a criminal injustice.

Can inequalities in health and severe poverty be eradicated simply by creating more growth,as the Goals seem to suggest?

Here is another anomaly in the Goals, how to combine growth (Goal 8 Promote sustained, inclusive and sustainable economic growth) with action to tackle climate change (Goal 13 Take urgent action to combat climate change and its impacts). Sustainable growth is hard to define but certainly can’t include using more fossil fuels or scarce resources or increased consumption, without massive increase in carbon emissions.

Is it possible to both reduce poverty and tackle climate change? Indeed it is – but only if wealth is seen as part of the problem rather than the solution. I recommend an excellent article in the Guardian this week by Zoe Williams and the cartoon she describes by a Swedish band – together with the more academic paper by Woodward on Incrementum ad Absurdum.

I encourage CHIFA members to provide some answers to these difficult questions.

http://wer.worldeconomicsassociation.org/files/WEA-WER-4-Woodward.pdf

http://www.filmsforaction.org/articles/swedish-band-the-knife-nail-central-flaw-of-the-uns-sustainable-development-goals/

http://www.theguardian.com/commentisfree/2015/oct/19/un-poor-wealth-sustainable-development-goals

https://www.oxfam.org/en/pressroom/pressreleases/2014-01-20/rigged-rules-mean-economic-growth-increasingly-winner-takes-all

Tony Waterston

A paper in The Lancet (10 October 2015) looks at the quality of cardiovascular health care in China. Below is the citation and summary. I also reproduce here the authors’ succinct description of the broader concept of ‘quality of care’:

‘In a health system with high quality of care, patients get the care they need at the right time, without having to undergo unnecessary or inappropriate treatments. High-quality care not only provides patients with the best opportunity to achieve the outcomes they seek, but also avoids inefficiency and waste. Countries with few resources especially need to focus on what care is best and how it is provided, and strengthen health-care delivery systems to produce high-level performance as efficiently as possible.’

As a personal comment, I find this a pragmatic definition, and would be interested to know how embedded this approach is in different countries. I suspect that many if not most governments turn a blind eye to, or actively support, treatments that have not been demonstrated to be effective. There was recent controvery in the UK, for example, when it emerged that the UK National Health Service spends over 70 million US dollars a year on homeopathy, despite the lack of evidence that it works any better than placebo…

The current Lancet review article on cardiovascular care in China points out that around 290 million people in China are affected by cardiovascular disease. The quality of care they receive (and, even more important, their smoking behaviour) will have a massive impact not only on China, but on the global health target for NCDs: “3.4. By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being”

CITATION: Achieving best outcomes for patients with cardiovascular disease in China by enhancing the quality of medical care and establishing a learning health-care system. Lixin Jiang, Harlan M Krumholz, Xi Li, Jing Li, Shengshou Hu. The Lancet Volume 386, No. 10002, p1493–1505, 10 October 2015

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00343-8/fulltext

SUMMARY

‘China has an immediate need to address the rapidly growing population with cardiovascular disease events and the increasing number of people living with this illness. Despite progress in increasing access to services, China faces the dual challenge of addressing gaps in quality of care and producing more evidence to support clinical practice. In this Review, we address opportunities to strengthen performance measurement, programmes to improve quality of care, and national capacity to produce high-impact knowledge for clinical practice. Moreover, we propose recommendations, with implications for other diseases, for how China can immediately make use of its Hospital Quality-Monitoring System and other existing national platforms to assess and improve performance of medical care, and to generate new knowledge to inform clinical decisions and national policies.’

Interestingly, the authors do not suggest a role for traditional Chinese medicine. It would be interesting to know more about health professionals’ and health policymakers’ attitudes to Chinese traditional medicine, which continues to be a huge industry in China, presumably much of it funded by the Chinese public health system.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

This new paper in The Lancet emphasises the importance of evidence synthesis (especially systematic reviews). As a personal comment, it could be argued that far more priority should be given to synthesising the existing research literature. Indeed, others have proposed that no new research should be undertaken without first synthesising the existing evidence from past research.

CITATION: Responsibility and accountability for well informed health-care decisions: a global challenge

Gro Jamtvedt, Marianne Klemp, Berit Mørland, Magne Nylenna

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60855-8/fulltext

EXTRACTS (selected by Neil PW)

‘Despite large investments during past decades in health-care research, evidence synthesis, and clinical practice guidelines, too much research is wasted1 and too many decisions are still not well informed.2 Why is this, and what can we do about it? The following four conditions must be met.

‘First, relevant and reliable health-care research must exist and be disseminated…

‘Second, decision makers and patients must have access to reliable and relevant evidence synthesis…

‘Third, patients, clinicians, and policy makers must be encouraged to ask for and use evidence synthesis…

‘Fourth, to improve patient outcomes, recommendations and decisions must be put into action and be implemented in policy and practice…

‘John Eisenberg’s statement from 2002 is still relevant: “Globalize the evidence, localize the decision”.’

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

We are happy to announce another new brief, Adolescent-Friendly Contraceptive Services (AFCS): Mainstreaming Adolescent-Friendly Elements Into Existing Contraceptive Services. [https://www.fphighimpactpractices.org/afcs] This brief focuses on the elements of AFCS that are typically implemented within a service delivery setting. It describes how mainstreaming AFCS can address key challenges for contraceptive programs, discusses the existing evidence of adolescent-friendly elements, outlines key issues for planning and implementation, and identifies knowledge gaps.

The accompanying Improving Sexual and Reproductive Health of Young People: A Strategic Planning Guide [https://www.fphighimpactpractices.org/sites/fphips/files/asrh_strategic_planning_tool.pdf] is intended to lead program managers, planners, and decision makers through a strategic process to identify the most effective and efficient investments for improving the sexual and reproductive health of young people.

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Anne Ballard, MPH Program Officer

Johns Hopkins Bloomberg School of Public Health

111 Market Place, Suite 310 Baltimore, Maryland 21202

Phone: 410-659-2643  | Skype: anneballard.ccp

Email: anne.ballard@jhu.edu Web: ccp.jhu.edu | www.k4health.org

HIFA profile: Anne Ballard is a Program Officer at the John Hopkins Center for Communication Programs  in the United States. Email address: anne.ballard AT jhu.edu

A fundamental requirement for success to achieve the new global health targets of the SDGs is agreement on the terminology used, as well as time-bound goals. Target 3.8. – Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all – seems problematic in this respect. Unlike other targets, there is no set date. Also, it seems the definition of Universal Health Coverage is still open to interpretation?

The concept of Universal Health Coverage has been promoted by WHO for over 10 years, and until recently the emphasis has been been on financial affordability rather than quality of healthcare services. Access to surgical care, for example, was not ‘officially’ included until May 2015, when the 68th World Health Assembly passed a resolution on 22nd May 2015 on ‘Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage’.

A recent Lancet Commission on Global Surgery reports findings from an international, multidisciplinary team of 25 commissioners, supported by advisors and collaborators in more than 110 countries and six continents.

CITATION: Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development

John G Meara et al. The Lancet, Volume 386, No. 9993, p569–624, 8 August 2015

Contact: john.meara@childrens.harvard.edu

Below are selected extracts. The full text is freely available here (after free registration): http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60160-X/fulltext

‘5 billion people do not have access to safe, affordable surgical and anaesthesia care when needed. Access is worst in low-income and lower-middle-income countries, where nine of ten people cannot access basic surgical care…’

‘Investing in surgical services in LMICs is affordable, saves lives, and promotes economic growth…’

‘Universal health coverage and the health aspirations set out in the post-2015 Sustainable Development Goals will be impossible to achieve without ensuring that surgical and anaesthesia care is available, accessible, safe, timely, and affordable…’

‘Maintenance of a motivated workforce in low-resource environments is essential for service provision, and ministries of health and professional societies should take active steps to ensure these clinicians are celebrated instead of neglected. To ensure that providers have the necessary instruments to practise is imperative, as are opportunities for continuing education and professional development. These resources include access to the internet, online clinical management resources, textbooks, and research literature…’

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Whether or not the new global health targets are achieved will depend largely on progress with the SDGs as a whole – the SDGs are interdependent.

To many observers, perhaps the most distinctive and innovative attribute of the SDGs is its basic principle of interconnectedness. “No goal stands alone”, says Amina Mohammed, special adviser to the UN Secretary-General on post-2015 development planning. “Every goal is inextricably linked to the rest.”

This creates a huge opportunity but also a huge challenge.

Jefferey Sachs (Earth Institute): “Governments are going to have to become multi-dimensional, multi-faceted. And that’s going to be difficult.” As a personal comment, it is not at all clear how governments in low- and middle-income countries will be supported to do this. Do any HIFA members have information on this?

Jefferey Sachs again: “What is deeply missing in the SDG agenda is concern about the financing of countries’ health systems”.

Source: UN set to change the world with new development goals. John Maurice.

The Lancet, Volume 386, No. 9999, p1121–1124, 19 September 2015

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00251-2/fulltext

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

On Tuesday, November 10th, 2015 from 11:30AM to 1:00PM ET, we will present a free webinar:

CSPro: Census and Survey Processing System

The Census and Survey Processing System (CSPro) is a public domain software package used by hundreds of organizations and tens of thousands of individuals in over 160 countries for entering, editing, tabulating, and disseminating census and survey data. CSPro is designed to be as user-friendly as possible, yet powerful enough to handle the most complex applications. It can be used by a wide range of people, from non-technical staff assistants to senior demographers and programmers.

CSPro now supports data collection on mobile devices including Android tablets and smart phones as well as Windows tablets.

Leading statistical agencies in the developing world use CSPro to process census and survey data. Non-governmental organizations (NGOs),colleges and universities, hospitals, acid:image001.png@01D10FD8.94DA1D90nd private sector groups also use CSPro for survey work. CSPro can be used to process censuses and surveys of any size and has been used to process the census data for both Djibouti (less than one million people) and Indonesia (more than 235 million).

Examples of uses of CSPro include:

• Censuses (population and housing; agriculture; and economic)
• Demographic and labor force surveys
• Household income and expenditure surveys
• Major international projects such as the Demographic and Health Surveys (DHS), Living Standards Measurement Study (LSMS), and Multiple Indicator Cluster Survey (MICS)
• Join Glenn Ferri, Assistant Division Chief, International Programs, Population Division at the U.S. Census Bureau, Stan Mierzwa, Director, Information Technology at Population Council, and their colleagues as they share the features and benefits of CSPro, especially for an iNGO audience.

To register for this free webinar: https://goo.gl/b0FS1h

Please feel free to share this webinar information with others at your organization that may have an interest in this topic.

‘Noncommunicable diseases have become the most common cause of morbidity and mortality worldwide. Consortium of Universities for Global Health Chair Dr Timothy Brewer highlights the organisation’s efforts to address these and  other global health challenges through research, training and advocacy’

‘THE CONSORTIUM OF Universities for Global Health (CUGH) was formed in 2008 to create a platform for academic-based individuals conducting global health research, global health education and global health service programmes to come together and share ideas and best practices. Essentially, the CUGH enables academics to exchange knowledge to better address complex and challenging health problems.’

‘CUGH members are working with partners to build healthcare capacity in low-resource settings and to create research programmes addressing pressing societal questions relating to health. These could include new treatments for chronic diseases, for example. Eighty per cent of all deaths in the world from noncommunicable diseases occur in low- and middle-income countries, and there are inadequate systems in place to treat pain, cancer or cardiovascular disease. CUGH-affiliated universities explore these and other topics. Our job is to generate knowledge and to train the next generation of researchers, educators and practitioners; that is what we do. At CUGH our aim is to bring together people who share common interests and make discoveries that result in practical solutions for the world’s challenges.’

I was interested to learn more about CUGH through a recent article by the chair of the CUGH board, Dr Timothy Brewer. He outlines how CUGH is working to build global  healthcare capacity to address non-communicable disease. You can download his article here: http://www.internationalinnovation.com/building-global-healthcare-capacity-2/

CITATION: Identifying Interprofessional Global Health Competencies for 21st-Century Health Professionals.

Kristen Jogerst, BS, Brian Callender, MD, Virginia Adams, RN, PhD, Jessica Evert, MD, Elise Fields, PharmD, Thomas Hall, MD, DrPH, Jody Olsen, PhD, MSW, Virginia Rowthorn, JD, Sharon Rudy, PhD, Jiabin Shen, M.Ed, Lisa Simon, DMD, Herica Torres, MSN, Anvar Velji, MD, Lynda L. Wilson, MSN, PhD.

http://www.sciencedirect.com/science/article/pii/S221499961501156X

Email contact: LyndaWilson@uab.edu

ABSTRACT

Background: At the 2008 inaugural meeting of the Consortium of Universities for Global Health (CUGH), participants discussed the rapid expansion of global health programs and the lack of standardized competencies and curricula to guide these programs. In 2013, CUGH appointed a Global Health Competency Subcommittee and charged this subcommittee with identifying broad global health core competencies applicable across disciplines.

Objectives: The purpose of this paper is to describe the Subcommittee’s work and proposed list of interprofessional global health competencies.

Methods: After agreeing on a definition of global health to guide the Subcommittee’s work, members conducted an extensive literature review to identify existing competencies in all fields relevant to global health. Subcommittee members initially identified 82 competencies in 12 separate domains, and proposed four different competency levels. The proposed competencies and domains were discussed during multiple conference calls, and subcommittee members voted to determine the final competencies to be included in two of the four proposed competency levels (global citizen and basic operational level – program oriented).

Findings: The final proposed list included a total of 13 competencies across 8 domains for the Global Citizen Level and 39 competencies across 11 domains for the Basic Operational Program-Oriented Level.

Conclusions: There is a need for continued debate and dialog to validate the proposed set of competencies, and a need for further research to identify best strategies for incorporating these competencies into global health educational programs. Future research should focus on implementation and evaluation of these competencies across a range of educational programs, and further delineating the competencies needed across all four proposed competency levels.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

I wanted to share some exciting news, the Economist has launched a short-film series.

Of relevance to the group are:

What would the world be like if Malaria Drugs Stop Working? (15min)

Health without Wealth – can doctors save lives at the same time as saving money? (Preview)

24 and Ready to Die – Emily is 24 years old and physically healthy. But she wants her doctors to end her life. Exploring the right to die (Preview).

Check them out at http://www.films.economist.com/

All the best,

Rob Davies MPH

Senior Health Research Analyst Bazian Ltd, an Economist Intelligence Unit business

20 Cabot Square, London E14 4QW +44 (0)20 7576 8164

‘Mass media play an important role in documenting national responses to crises like Ebola. Reviewing media documentation helps a country better prepare for current and future public health challenges. Ebola articles first appeared in the Liberian press in March 2014. Our objectives were to determine the frequency of newspaper accounts and the major issues covered…’

‘News reports frequency paralleled the incidence pattern of the disease. Major themes included the state of the epidemic, health care, psychosocial issues, international aid, political response, prevention, and local support. Overall political response to Ebola and the impact of Ebola on health workers received the most attention. In the early days common themes were border security and requests for aid…’

Full text: http://malariamatters.org/documenting-the-response-to-the-ebola-epidemic-in-liberia-through-the-perspective-of-the-local-press/

As a personal comment, I would be very interested to know something about the quality and reliability of practical healthcare information disseminated by the newspapers in Ebola-affected countries. To what extent did the newspapers promote health behaviours that would help prevent spread of the disease and encourage early referral for treatment? How might the MoH’s in affected countries be better supported in future to collaborate with the mass media?

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org