Dear all,

Please find below an email from World Health Organization inviting you to participate in a global survey about the new WHO global strategy on people-centred and integrated health services.

Looking forward to your feedback!

With kind regards,

Mart Leys

HIFA profile – Mart Leys is a Consultant for WHO in Geneva, Switzerland. leysm AT who.int

From KELLEY, Edward Talbott

Sent 05 June 2015 17:44

Subject Public consultation on the WHO global strategy on people-centred and integrated health services (PCIHS)

Dear Madam, Dear Sir,

As you may know, the World Health Organization launched the WHO global strategy on people-centred and integrated health services at the 15th International Conference for Integrated Care that took place in Edinburgh in March 2015 as an interim report. The Strategy promotes a paradigm shift in the way health services are funded, managed and delivered, and responds to the need to put people at the centre of service delivery and to foster integration across the care continuum. As we all know, this is urgently needed to meet the challenges being faced by health systems around the world, whether in high, middle or low income countries.

The final version of the Strategy will be submitted for discussion at the 138th meeting of the Executive Board to the 69th World Health Assembly in 2016. Before this official submission, we are expecting additional contributions from the WHO Regional Offices and experts in the field to enrich and revise the current interim documents.

It is with great pleasure that I announce that the Strategy is now ready for public consultation. We would like to engage individuals and organizations who have an interest in people-centred and integrated health services, with the aim of undertaking a critical review of the Strategy’s strengths and weaknesses and receiving valuable inputs to help inform its implementation. For this purpose, we have designed an online survey that deals with different sections of the Strategy. The survey will close on 15 July 2015, and the results will be compiled in a report to be published in the coming months. You can find all the information regarding this initiative and the online survey via the following link http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/

On behalf of the Service Delivery and Safety department, I am pleased to invite you to contribute to this public consultation process.

We look forward to your active and enthusiastic involvement and encourage you to spread the message widely in your network.

We thank you very much for your collaboration.

Yours faithfully,

Dr. Edward Kelley

Director

Service Delivery and Safety

World Health Organization

20 Avenue Appia

1211 Geneva 27, Switzerland

+41 22 791 2472 (phone)

+41 22 791 4769 (fax)

kelleye@who.int

__________

To send a message to the HIFA forum, simply send an email to: HIFA2015@dgroups.org

Please see below. I look forward to your thoughts. The key messages are valid, but I would argue for a different perspective: The knowledge system underpinning healthcare is not fit for purpose and *must be strengthened* (not ‘must change’). The authors point to well-known issues regarding quality of research, failure to publish, publishing bias, and reliability of systematic reviews. They suggest that ‘including only prospectively registered trials in systematic reviews will improve validity and readability’. It seems to me that a review is more likely to be valid if it takes into account all available evidence, and then uses criteria (including registration among many others) to assess the validity of each piece of research in the systematic review process, as is currently the norm.

A further personal comment is that the healthcare knowledge system is about much more than research, publishing of research, and systematic reviews. HIFA uses a simple model for the global healthcare knowledge system, based on the Lancet article 2004 Can we achieve health information for all by 2015?

http://www.hifa2015.org/about/the-strategy-for-achieving-our-goal/

—

The BMJ have published an article critiquing the current healthcare knowledge system.

The full article can be read here (subscription required or a free 14 day subscription option is available).

http://www.bmj.com/content/350/bmj.h2463

Roberts Ian, Ker Katharine, Edwards Phil, Beecher Deirdre, Manno Daniela, Sydenham Emma et al. The knowledge system underpinning healthcare is not fit for purpose and must change BMJ 2015; 350 :h2463

Correspondence to: Ian Roberts: ian.roberts@lshtm.ac.uk

The authors argue that medical literature is biased and inundated with poor quality trials. The article explains how these problems affect systematic reviews and how they might be overcome.

It identifies problems with systematic reviews, including the bias created by unpublished trials, low quality – single centred trials, and the fact that most meta analysis – even when they cover 15 or more trials – actually only have a small number of overall trial participants.

The key messages identified in the article are:

Because the medical literature is biased, systematic reviews based on it are also biased. Many reviews are out of date and unreadably long

Including only prospectively registered trials in systematic reviews will improve validity and readability

Insisting that authors of doubtful trials provide the original trial data for statistical checking will improve validity

Requiring review authors to specify an estimated information size based on plausible treatment effects will reduce the risk of false positive conclusions and make reviews more reliable

Trial registries should include full protocols and datasets to facilitate the conduct of valid systematic reviews

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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  

This post is co-authored with Sonia Sachs on behalf of the 1 Million CHW Campaign.

[Read online here: http://1millionhealthworkers.org/2015/06/15/a-call-to-scale-up-community-health-workers/ ]

Public health officials and practitioners from around Africa and from international public and private organizations, businesses, and universities, met in Accra, Ghana June 9-11 to consider ways to scale-up the coverage of high-quality community health worker (CHW) systems in our countries to achieve universal health coverage (UHC). In the meeting they pledged to work together to speed the scale-up of CHW systems in sub-Saharan Africa, and issued the following urgent appeal.

Joint Call to Action

We have reviewed the national experiences and the scholarly evidence demonstrating that CHW systems are a critical, integral, cost-effective, and long-term part of effective overall health systems. CHWs save lives, promote public health and wellbeing, bridge health system gaps, improve the quality of life, and help to prevent and end epidemics like Ebola. As members of the communities they serve, CHWs are the health workers closest to households. CHW systems offer high-quality, meaningful employment for young people.

We know that effective national-scale CHW systems start at home. We urge all African governments, including Ministers of Finance and Health, to recognize the indispensable role of CHWs in public health and epidemic control, by taking the following steps:

Making and implementing plans for national-scale CHW systems;

Expanding the domestic funding available for CHW systems;

Ensuring that CHWs are properly trained, remunerated, supported by cutting-edge information systems, and empowered with the proper supplies, equipment, and training needed to provide both preventive and curative care with professional skills and to empower communities in their own health;

Preparing CHW systems to address the non-communicable disease challenges that will be central to the new Sustainable Development Goals (SDGs);

Supporting CHW systems with state-of-the-art information and communications systems made possible by breakthroughs in mobile broadband, telemedicine, remote monitoring, remote diagnostics, and other recent ICT innovations of great promise and significance;

Empowering communities to work effectively with CHW systems;

On the international side, we underscore the urgent need to scale-up international support for CHW systems, and to convert the fragmented global CHW funding into pooled financing that supports national CHW systems. We are concerned about donors supporting parallel programs rather than national programs. Because of such parallel programs, CHW systems are scattered across many projects, each with its own protocols, ICT systems, if any, varied durations, and inconsistent approaches on training and the range of activities of the CHWs.

We strongly urge donors to pool their CHW resources into a few pooled global funds, including the Global Fund to Fight AIDS, TB, and Malaria, GAVI, the new Global Finance Facility, and possibly a new Global Fund for Health Systems. These pooled funds should provide additional financing for CHWs in a flexible and timely manner. We call on the donor partners to end the donor fragmentation and the long delays in disbursements. The time for scale-up has arrived.

We note that two countries in Africa, Guinea and Sierra Leone, are still battling Ebola, while Liberia has succeeded in ending their Ebola epidemic in part through the successful deployment of community health workers. Ebola is a scourge that takes hold in places with under-financed and fragmented health systems that lack effective CHW system support. We call on the international community to support the Ebola-affected countries to scale-up their national health systems, including high-quality CHW systems, with full urgency.

We note that the world is on the verge of adopting the new SDGs, calling among other things for UHC as part of SDG 3. We also note that world leaders will assemble in Addis Ababa, Ethiopia next month to take steps to finance the new SDGs. We firmly believe and declare that success in universal health coverage will require the proper funding and scale-up of CHW systems in our countries and throughout Africa. We call on world leaders to heed the exciting opportunities at hand to save lives by the millions in the coming years through professionalized, high-quality CHW systems linked to overall high-quality health care systems.

We address this appeal to the leaders of national governments and the international health organizations. We kindly request the One Million Community Health Workers Campaign report back to the participating governments in advance of the UN SDG Summit in September 2015, so that we can move forward effectively and confidently together in an urgent and timely manner.

Accra

June 11, 2015

Adopted by acclamation with:

Government representatives from:

Ministry of Health, Burkina Faso

Ministry of Finance, Burkina Faso

Ministry of Health, Congo-Brazzaville

Government of Ghana

Ministry of Health, Ghana

Ministry of Finance, Ghana

Ghana Health Services

Ministry of Local Government and Rural Development, Ghana

Ministry of Health and Public Hygiene, Guinea

Ministry of Health, Kenya

Ministry of Health and Social Welfare, Liberia

Ministry of Finance, Liberia

Ministry of Health, Malawi

Ministry of Finance, Malawi

Ministry of Health, Mozambique

National Primary Health Care Development Agency, Nigeria

Ministry of Health, Rwanda

Ministry of Health and Social Action, Senegal

Ministry of the Economy, Finance, and Planning, Senegal

Ministry of Health and Sanitation, Sierra Leone

Ministry of Finance, Sierra Leone

Ministry of Health, Uganda

Ministry of Finance, Uganda

Ministry of Health and Social Welfare, Tanzania

Ministry of Finance, Tanzania

Ministry of Community Development, Zambia

Ministry of Health, Zambia

Representatives from:

BRAC

Brandeis University

Earth Institute at Columbia University

Moi University

Clinton Health Access Initiative, Zambia

Columbia Global Center East & Southern Africa

Columbia Global Center West & Central Africa

Global Health Workforce Alliance (GHWA)

Harvard University

Ifkara Health Institute

Johns Hopkins University

Last Mile Health

Living Goods

Management Sciences for Health, USA

Management Sciences for Health, Ghana

Management Sciences for Health, Rwanda

Millennium Development Goals Health Alliance

Millennium Promise Inc.

Millennium Villages Project, Ghana

CORE Group

National Health Insurance Fund, Ghana

Sanford International Clinics, USA

Sanford International Clinics, Ghana

Save the Children, Sierra Leone

Sustainable Development Solutions Network

University of Ghana School of Public Health

University of Washington

WHO AFRO

WHO Ghana

World Vision International

World Vision, Ghana

Follow Jeffrey Sachs on Twitter: www.twitter.com/JeffDSachs

MORE:Community Health WorkersUniversal Health CareAfricaEbolaChw

On behalf of the mHIFA Working Group (Mobile Healthcare Information For All), I would like to invite you to read our new short paper published in The Lancet Global Health:

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)00054-6/fulltext

This paper is the latest in a series of outputs from the mHIFA Working Group, a group of HIFA volunteers with an interest in mHealth, responsible for leading the HIFA community to achieve Mobile Healthcare Information For All: http://www.hifa2015.org/the-first-hifa-smart-goal-mobile-healthcare-information-for-all/

The paper (reproduced below for the benefit of those who may not have immediate web access) highlights the lamentably slow progress in terms of putting actionable healthcare information into the hands of citizens in low- and middle-income countries. In it, ‘we call on content providers, mobile phone manufacturers, network operators, application developers, and international health organisations to collaborate to empower citizens in low-resource settings with essential health care information’.  

Over the coming weeks we shall write to leading companies such as Samsung, Vodafone and others to invite them to read the article and join us to explore ways forward. We have also submitted an abstract for a presentation at the upcoming Global mHealth Forum in Washington DC in November 2015.

Best wishes,

Neil

CITATION: Mobile health-care information for all: a global challenge. Volume 3, No. 7, e356–e357, July 2015

Geoff Royston, Christine Hagar, Lesley-Anne Long, Dennis McMahon, Neil Pakenham-Walsh, Nand Wadhwani on behalf of the mHIFA Working Group (Mobile Healthcare Information For All)

DOI: http://dx.doi.org/10.1016/S2214-109X(15)00054-6

Access to health-care information for citizens is a key determinant to reach both the Millennium Development Goals (MDGs) and the emerging post-2015 Sustainable Development Goals, but this challenge has repeatedly been relegated to the sidelines.1 What might kickstart progress? An obvious candidate is the mobile phone, which is becoming ubiquitous in low-income and middle-income countries.

It is vital that citizens in these countries have access to actionable health-care information, largely because they typically have no access to trained health workers. People who need medical attention in such contexts are especially vulnerable to ineffective or even harmful treatment from parents, lay carers, or traditional healers; in these settings, mistreatment and delays in obtaining effective treatment can contribute to increased morbidity and mortality. For example, findings from a study in India2 showed that four in ten children with acute diarrhoea were incorrectly given less to drink than normal, potentially increasing their risk of death from dehydration.

We recently commissioned a survey of 1700 projects of mobile technology for health (known as mHealth).3, 4 Our findings showed that none of these services provided essential, actionable, offline guidance for direct use by citizens addressing the range of acute health-care situations commonly encountered in low-resource settings, and very few provided any such content at all (an example is HealthPhone, see below).

There is clearly a huge and growing opportunity for citizens to have health-care information on their phones, available offline as and when they need it. Up to now, this opportunity has been constrained by three challenges.

First, most mobile phones in low-resource settings are basic phones that can accommodate only voice and SMS text messaging with no internet connectivity or multimedia capability. Consequently there is a plethora of SMS messaging services that push short messages about health education to citizens. However, this approach is not appropriate to empower citizens with as-needed health-care information to deal with acute situations such as child illness, complications of pregnancy, and first aid. Additionally, text is not appropriate for people with low literacy. The situation is, happily, rapidly changing. Feature phones (basic phones that can accommodate a memory card, carrying video and other media (with or without wifi capability, but without full internet access) are becoming commonplace, and smartphones becoming more and more affordable.5

Second, there is a shortage of appropriate content. A few non-profit organisations such as Medical Aid Films and Global Health Media Project are producing open-access audio and video content in local languages, in collaboration with reputable international health organisations such as WHO and UNICEF. There is, however, little investment in such content. There is a real risk that the pharmaceutical industry and infant nutrition companies will take advantage of this gap in information provision to promote their own products, with potentially disastrous public health consequences. Indeed, the US health-care and pharmaceutical industry alone is already spending $373 million per year on advertising via mobile phones.6

Third, how to place the content onto individual phones? We believe the ideal approach is for handset manufacturers to preload health content onto mobile phones at the time of manufacture, in the same way that games and other content are currently made freely available. Content can also be made available on micro-SD cards, which cost just a few dollars each. HealthPhone, for example, is helping to make Medical Aid Films, Global Health Media Project, and other videos available in this way, and this year aims to directly reach more than 170 million people in India with information about nutrition, through a partnership with Indian Academy of Pediatrics, UNICEF, and the Government of India, and with support from Vodafone.

Additional content could also be made available free to download for offline use. More and more people are able to access the internet freely (eg, via wi-fi), or at low cost, continuously or at least intermittently. Health centres, public libraries, schools, community centres, and local non-governmental organisations could help to raise awareness and provide access points to guide people about what content to download and how to use it, or even provide local wi-fi hotspots to disseminate this content for free.

We call on content providers, mobile phone manufacturers, network operators, application developers, and international health organisations to collaborate to empower citizens in low-resource settings with essential health care information. Production and free availability of such applications to directly empower citizens in low-resource settings with essential, accessible, actionable health-care knowledge, as and when they need it, could open up a new chapter in global health. END [see online for references]

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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  

Below is the citation and abstract of a new paper in International Journal of Evidence Based Healthcare. Sounds like a good idea, but unfortunately the full text is restricted-access.

CITATION: Int J Evid Based Healthc. 2015 Jun;13(2):52-7. doi: 10.1097/XEB.0000000000000036.

Format guidelines to make them vivid, intuitive, and visual: Use simple formatting rules to optimize usability and accessibility of clinical practice guidelines.

Versloot J, Grudniewicz A, Chatterjee A, Hayden L, Kastner M, Bhattacharyya O.

Abstract

AIM: We present simple formatting rules derived from an extensive literature review that can improve the format of clinical practice guidelines (CPGs), and potentially increase the likelihood of being used.

METHODS: We recently conducted a review of the literature from medicine, psychology, design, and human factors engineering on characteristics of guidelines that are associated with their use in practice, covering both the creation and communication of content. The formatting rules described in this article are derived from that review.

RESULTS: The formatting rules are grouped into three categories that can be easily applied to CPGs: first, Vivid: make it stand out; second, Intuitive: match it to the audience’s expectations, and third, Visual: use alternatives to text. We highlight rules supported by our broad literature review and provide specific ‘how to’ recommendations for individuals and groups developing evidence-based materials for clinicians.

CONCLUSION: The way text documents are formatted influences their accessibility and usability. Optimizing the formatting of CPGs is a relatively inexpensive intervention and can be used to facilitate the dissemination of evidence in healthcare. Applying simple formatting principles to make documents more vivid, intuitive, and visual is a practical approach that has the potential to influence the usability of guidelines and to influence the extent to which guidelines are read, remembered, and used in practice.

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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  

Below is the citation and abstract of a recent paper looking at political will and the use of data for health policy decision-making. The full text is freely available here:

http://www.ijgo.org/article/S0020-7292(14)00352-X/pdf

The Evidence for Action (E4A) programme looks very interesting and relevant to HIFA. I have invited the authors to join us.

CITATION: Establishing a baseline to measure change in political will and the use of data for decision-making in maternal and newborn health in six African countries.

Nove A, Hulton L, Martin-Hilber A, Matthews Z.

Int J Gynaecol Obstet. 2014 Oct;127(1):102-7. doi: 10.1016/j.ijgo.2014.07.003. Epub 2014 Jul 16.

http://www.ncbi.nlm.nih.gov/pubmed/25087175

E-mail address: a.nove@options.co.uk (A. Nove)

ABSTRACT

The Evidence for Action (E4A) program assumes that both resource allocation and quality of care can improve via a strategy that combines evidence and advocacy to stimulate accountability. The present paper explains the methods used to collect baseline monitoring data using two tools developed to inform program design in six focus countries. The first tool is designed to understand the extent to which decision-makers have access to the data they need, when they need it, and in meaningful formats, and then to use the data to prioritize, plan, and allocate resources. The second tool seeks the views of people working in the area of maternal and newborn health (MNH) about political will, including: quality of care, the political and financial priority accorded to MNH, and the extent to which MNH decision-makers are accountable to service users. Findings indicate significant potential to improve access to and use of data for decision-making, particularly at subnational levels. Respondents across all six program countries reported lack of access by ordinary citizens to information on the health and MNH budget, and data on MNH outcomes. In all six countries there was a perceived inequity in the distribution of resources and a perception that politicians do not fully understand the priorities of their constituents.

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

This set of infographics from the Overseas Development Institute (ODI), UK’s leading international development think tank, should encourage all of us to re-look at our efforts in using mobile data.

As Neil summarizes, “It’s further evidence on the importance (and opportunity) of creating and distributing reliable, actionable multimedia healthcare information content – and to do so with urgency to mitigate the inevitable boom in commercial misinformation, already being propagated by big pharma and others.”

10 things to know about development and the data revolution

The data revolution has the potential to lead to sharper, more targeted, better-monitored policies. It could even transform power relations between citizens, governments and businesses. Used well, data can help people reach a clearer picture of their lives – and use the evideence for progress. But people remain uncounted and big gaps in our knowledge remain. Explore development and the data revolution in these 10 infographics.

An example of an infographic:

MOBILE PHONE TRAFFIC WILL GROW TENFOLD BY 2019

In 2014 the number of mobile devices overtook the global population. By 2019, mobile phone data will grow nearly tenfold and most of this increase will happen in Middle East and Africa. Half of all phones will be smartphones. Mobile phone records can help measure population, migration and poverty. Phones can help conduct surveys more quickly and cheaply, and can reach the poorest people even in very poor countries, as shown in Afghanistan and Zimbabwe. However, researchers still struggle …

Download the complete pdf document here

http://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion-files/9659.pdf

be well,

nand

Nand Wadhwani

The Mother and Child Health and Education Trust

http://motherchildtrust.org  |  http://healthphone.org  |  http://iap.healthphone.org

Now that we can, we must!

Hesperian has a great deal of materials available that include sexual and reproductive health information. In particular, one of our newest titles, Health Actions for Women, focuses on a lot of issues that adolescent girls in particular face, and provides activities and information on addressing the social barriers to reproductive health for women and girls. There are a few sample chapters available to download on our website, including “Taking Action for Women’s Health” (http://hesperian.org/wp-content/uploads/pdf/en_haw_2015/en_haw_2015_01.pdf) and “Protecting Women’s Health with Family Planning” (http://hesperian.org/wp-content/uploads/pdf/en_haw_2015/en_haw_2015_07.pdf).  

Health Actions for Women, and also Where Women Have No Doctor and A Book for Midwives, which focus more on hands-on health information, are available for purchase on our web store (http://store.hesperian.org/), and also for free in many languages on our HealthWiki (http://en.hesperian.org/hhg/Healthwiki) and Resources by Language page (http://hesperian.org/books-and-resources/language-list/).

Some helpful chapters to read on the HealthWiki may be the “Sexual Health” chapter (http://en.hesperian.org/hhg/Where_Women_Have_No_Doctor:Chapter_12:_Sexual_Health) and the “Family Planning” chapter (http://en.hesperian.org/hhg/Where_Women_Have_No_Doctor:Chapter_13:_Family_Planning ) in Where Women Have No Doctor.

We also have an app available for both iPhones and Androids, called the Safe Pregnancy and Birth app, which provides information on a variety of maternity-related health issues. It is available for download for free through the Google Play store and the iTunes store.

I hope some of these resources will be useful for you. Please contact me if you have any questions about any of them, or if you have trouble finding something you’re looking for.

On June 10th we at Wikipedia launch the first version of our offline medical app. This is an easy to download offline version of all of English Wikipedia’s medical content for android avaliable for free at Google play https://play.google.com/store/apps/details?id=org.kiwix.kiwixcustomwikimed

The version is 466M and includes images. We plan to update it monthly and will be adding further language versions soon. We are also looking at a version without images to decrease the apps size and a version for Apple devices. We would encourage cell phone manufacturers to consider preloading this content onto devices before they ship them to the developing world. We would also encourage individuals and organization to join us in developing and improving the underlying content.

We view this as an important complement to Wikipedia zero, which currently provides access without data charges to 400 million people in the developing world. We realize that not all areas of the world have cellular access and not all carriers have signed up to free Wikipedia. https://wikimediafoundation.org/wiki/Wikipedia_Zero

—

James Heilman

MD, CCFP-EM, Wikipedian

Starting July 2015 I am a board member of the Wikimedia Foundation

My emails; however, do not represent the official position of the WMF

The Wikipedia Open Textbook of Medicine

www.opentextbookofmedicine.com

CHW Central [www.chwcentral.org] has been posting information on building large scale CHW programs based on the CHW Reference Guide developed by Henry Perry, et al [http://www.mchip.net/sites/default/files/mchipfiles/MCHIP_CHW%20Ref%20Guide.pdf].  We are operationalizing the Reference Guide to support the effort toward national CHW programs.  Each chapter is being summarized by CHW experts.   Chapter 3 [http://www.chwcentral.org/blog/chapter-3-national-planning-chw-programs] focuses on planning; Dr. Ranu S. Dhillon offers insights from his own experience in building large-scale CHW programs.  He notes that the planning stage is critical to ensure the program gets off to the right start.  National programs must be tailored to country-specific situations, which requires working with an entity that has the authority, structure, and understanding of the political economy and the local health system to get the right support.

Program planning also requires collaboration with multiple partners and a few key stakeholders committed to seeing the program established. Systems for finance, monitoring and evaluation, managing CHWs and supervision also need to be addressed. To complete each planning stage and implement a working model, a national CHW program requires in-depth engagement with the country’s information systems so that and data and that actions of CHWs can continuously improve and strengthen the health system.

Donna Bjerregaard

Senior Technical Advisor

Initiatives Inc.

264 Beacon Street

Boston, MA 02116

Tel:  617 262 0293

Fax: 617 262 2514

www.initiativesinc.com

www.chwcentral.org

‘An estimated 400 million people worldwide lack access to at least one of seven essential health services, ranging from pregnancy care to clean water, according to a report released on Friday by the World Health Organization and World Bank… The report suggested universal health coverage is an achievable goal and showed that progress has been made toward it. The aim has been controversial, particularly in some advanced nations including the United States, where debate persists over the structure, funding and feasibility of a universal program.’

http://www.reuters.com/article/2015/06/12/us-who-health-survey-idUSKBN0OS20T20150612

Best wishes, Neil

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

Tracking universal health coverage:  First global monitoring report

The World Health Organization, The World Bank Group

Released online: June 2015

Overview / Resumen:

Bringing universal health coverage (UHC) into focus: One of the main challenges faced in supporting UHC-oriented reform is the perception on the part of some decision-makers

that UHC is too diffuse a concept, and UHC-related progress unquantifiable. This first global monitoring report on tracking UHC is produced partly to challenge that notion. Most countries are already generating credible, comparable data on both health service and financial protection coverage, despite data blind spots on key public health concerns such as noncommunicable diseases (NCDs) and health service quality. Broadly defined, UHC means all people receiving the quality health services they need, without being exposed to financial hardship. UHC involves three coverage dimensions – health services, finance, and population – and is a dynamic, continuous process that changes in response to shifting demographic, epidemiological and technological trends, as well as people’s expectations […]

The tracer health service indicators: The report presents the global and regional situation with regard to eight core tracer health service coverage indicators for: reproductive and newborn health (family planning, antenatal care, skilled birth attendance); child immunization (three doses of diphtheria, tetanus and pertussis (DTP)-containing vaccine); infectious disease (antiretroviral therapy (ART), tuberculosis (TB) treatment); and non-health sector determinants of health (improved water sources and improved sanitary facilities). The indicators have been chosen because they involve health interventions from which every individual in every country should benefit – no matter what the country’s level of socioeconomic development or epidemiological circumstances, and no matter what type of health system it may have – and because recent, comparable data are available for most countries. The picture they present is mixed. On the one hand more people have access to essential health services today than at any other time in history. In some cases, global population coverage already surpasses the 80% minimum proposed by the World Health Organization (WHO)/World Bank global monitoring framework […]

Moving forward: Notwithstanding the persistence of inequities in access to health services (400 million people lacking at least one of seven essential health services) and the relatively high level of impoverishment caused by health spending, it is apparent that UHC progress is a reality, and that key aspects of that reality are measurable. This first global monitoring report on tracking UHC shows that using a core set of tracer indicators of the kind recommended by the WHO/World Bank Group UHC monitoring framework, it is possible to track progress in key areas of financial protection and health services coverage not just for populations as a whole, but for critical subpopulations such as people living in rural areas and the poor.

Keywords / Palabras clave:

Universal Health Coverage; Delivery of Health Care; Healthcare Financing; Health Services Accessibility; Cost of Illness; Program Evaluation; Global Health

Access the full report / Acceso al Informe completo: click here.

http://www.who.int/healthinfo/country_monitoring_evaluation/universal_health_coverage/uhc_report_2015_en.pdf?ua=1

Visit the Portal/Blog of the PAHO/WHO Equity List & Knowledge network :http://equity.bvsalud.org/

Visite el Sítio/Blog de la Lista de Equidad y Red de Conocimiento: : http://equity.bvsalud.org/es/

For additional information of the Equity List or contributions, please contact Mrs. Eliane P. Santos – Advisor, Library and Information Networks – Department of Knowledge Management, Bioethics and Research (KBR). Pan American Health Organization, Regional Office of the World Health Organization – pereirae@paho.org

Pan American Health Organization – Regional Office of the World Health Organization for the Americas

Department of Knowledge Management, Bioethics and Research (KBR)

Office of the Assistant Director – http://www.paho.org

__________

To send a message to the HIFA forum, simply send an email to: HIFA2015@dgroups.org

For those of you who are interested in learning more about Dimagi’s open source mobile platform CommCare [https://www.commcarehq.org/home/], Dimagi is hosting a webinar and a workshop in July:

Our Latin America team will be leading a Spanish webinar about using case management in CommCare on July 1st. Feel free to pass along the webinar information [http://www.dimagi.com/blog/webinars-de-commcare-en-espanol/] to your Spanish speaking colleagues or contacts that are interested in mobile technology. If you have any questions, please email webinars@dimagi.com.

Our India team will be hosting a two-day CommCare workshop in Bangalore, India from July 9-10. The deadline is pretty soon (Monday, June 29th), so please make sure to send to your teams today. You can learn more about the workshop and register here. [http://www.dimagi.com/events/event/commcare-workshop-in-bangalore/] If you have any questions, please email workshops@dimagi.com.

Thanks so much, and have a good weekend!

HIFA profile: Gillian Javetski is a Senior Program Analyst at Dimagi, Inc., United States. gjavetski AT dimagi.com

You are invited to attend this free webinar

Description: Among other pressing challenges within medical education in Sub-Saharan Africa, the Medical Education Partnership Initiative has highlighted the shortage of teaching faculty within medical schools. SynDRME attempts to bridge this gap by providing medical students and faculty access to a repository of digital resources that supplements learning and teaching. Each resource is evaluated through several criteria before it is recommended to faculty and students. The resources cater to African medicine, and are recommended based on their adaptability and usefulness within the African medical school landscape. The website has been conceptualized and developed over the past two years and covers a range of topics and specialties an African medical student needs to learn during the course of his/her education. The product has tremendous potential for growth and expansion, and can potentially augment the education of medical students in Africa.

Link to the webinar:

http://us2.campaign-archive2.com/?u=f34b8fe5665ecff9e37fe6f9f&id=11eb9b6479

Here is the link to register:

http://mepinetwork.org/archived-webinars/upcoming-webinars

Link to the synDRME site: http://mepinetwork.org/synDRMEdemo/

We look forward to connecting with you at ths  interesting and timely  webinar.

Best

Seble

Seble Frehywot MD, MHSA

Associate Research Professor of Health Policy and Global Health

Department of Health Policy & Management and Department of Global Health

Milken Institute School of Public Health

The George Washington University

Tel: 202-994-4311

Fax: 202-994-3472

‘In 2014, the Maternal Health Task Force consulted 26 global maternal health researchers to identify persistent and critical knowledge gaps to be filled to reduce maternal morbidity and mortality and improve maternal health. Respondents emphasized the need for health systems research to identify models that can deliver what is known to be effective to prevent and treat the main causes of maternal death at scale in different contexts and to sustain coverage and quality over time.’

Below is the citation, abstract and selected extracts. The full text is freely available here:

http://www.reproductive-health-journal.com/content/12/1/55/abstract

CITATION: Reprod Health. 2015 Jun 5;12(1):55. [Epub ahead of print]

Critical maternal health knowledge gaps in low- and middle-income countries for the post-2015 era.

Kendall T, Langer A.

ABSTRACT

Effective interventions to promote maternal health and address obstetric complications exist, however 800 women die every day during pregnancy and childbirth from largely preventable causes and 90 % of these deaths occur in low and middle income countries (LMIC). In 2014, the Maternal Health Task Force consulted 26 global maternal health researchers to identify persistent and critical knowledge gaps to be filled to reduce maternal morbidity and mortality and improve maternal health.

The vision of maternal health articulated was comprehensive and priorities for knowledge generation encompassed improving the availability, accessibility, acceptability, and quality of institutional labor and delivery services and other effective interventions, such as contraception and safe abortion services.

Respondents emphasized the need for health systems research to identify models that can deliver what is known to be effective to prevent and treat the main causes of maternal death at scale in different contexts and to sustain coverage and quality over time. Researchers also emphasized the development of tools to measure quality of care and promote ongoing quality improvement at the facility, district, and national level. Knowledge generation to improve distribution and retention of healthcare workers, facilitate task shifting, develop and evaluate training models to improve “hands-on” skills and promote evidence-based practice, and increase managerial capacity at different levels of the health system were also prioritized.

Interviewees noted that attitudes, behavior, and power relationships between health professionals and within institutions must be transformed to achieve coverage of high-quality maternal health services in LMIC. The increasing burden of non-communicable diseases, urbanization, and the persistence of social and economic inequality were identified as emerging challenges that require knowledge generation to improve health system responses and evaluate progress. Respondents emphasized evaluating effectiveness, feasibility, and equity impacts of health system interventions. A prominent role for implementation science, evidence for policy advocacy, and interdisciplinary collaboration were identified as critical areas for knowledge generation to improve maternal health in the post-2015 era.

EXTRACTS (selected by Neil PW)

‘With respect to new opportunities, the most frequently mentioned was the potential for information and communication technologies to enhance decision-making by women, healthcare providers and policymakers.’

“There has been more focus on the drugs and the magic bullets, there has been a lot of focus on the interventions and inventions—the need [now] is to focus less on the inventions and more on implementation research.” [quote from respondent]

‘They [respondents] identified policymakers’ lack of knowledge about public health and maternal health as critical barriers to the development of evidence-informed policy and allocation of funds for maternal health.’

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

A statement (below) by the Cochrane Collaboration notes that WHO has substantially improved its processes for guideline development, but says there is still room for improvement. In particular, it points to the need for research on ‘how to create guidelines for urgent public health problems where evidence may be very scarce or of poor quality’.

As a personal comment, this latter point is clearly the responsibility of the entire health research (and publishing and information sciences) community, and not of WHO specifically. If one is to look specifically at how better to appraise and synthesise evidence that may be scarce of of poor quality, perhaps the first priority is to ensure that all relevant research is indeed identified, so as to avoid the possibility that guidelines fail to include existing research.

Looking more broadly, a holistic approach is needed that not only makes the best use of ‘scarce or poor quality’ research, but also addresses the many underlying *causes* of the scarcity of high quality research – to move progressively towards a global research agenda that aligns with global health priorities.

(This statement is all about the quality of WHO guidelines. The elephant in the room is, of course, not the quality of WHO guidelines but the gap between WHO guidelines and actual policy and practice.)

I look forward to hear from HIFA members on these important issues.

—

Cochrane issues statement on WHO guidelines development and governance

http://www.cochrane.org/news/cochrane-issues-statement-who-guidelines-development-and-governance

Cochrane is an international organization that produces high-quality, relevant, accessible systematic reviews and other synthesized research evidence, and promotes evidence-based decision-making.  Cochrane has been an NGO in official relations with the World Health Organization (WHO) since 2011 and an important part of our workplan involves support for the WHO guideline development process.

Cochrane contributors published some of the earliest critiques of the WHO guideline process (Oxman, 2007) which called for guidelines to use reliable, independent research summaries that are free of conflicts of interest (Boyd, 2006).  WHO responded to these criticisms by developing a uniform review process in developing guidelines. This included implementing procedures to manage conflicts of interest. Recent analyses of WHO guidelines (Sinclair, 2013; Burda, 2014) have shown that editorial independence and use of reliable evidence have increased markedly since WHO has implemented these reforms, and highlight that these high standards are essential for WHO’s credibility.

WHO guideline panels have implemented procedures to make the link between recommendations and the underlying evidence more transparent.  There is room for improvement (Alexander, 2013).  Further research is needed to improve methods to create guidelines for urgent public health problems where evidence may be very scarce or of poor quality. Cochrane will continue to offer methodological support and training to WHO as it tackles these challenges.

Cochrane urges WHO to continue strengthening the use of evidence following a rigorous methodology in guideline development.  We recognize that panels should be cognizant of public and member state commentary on the issues, but the guidelines process needs to remain independent and separate from any individual or body with potential conflicts of interest. Involving participants with conflicts of interest in guideline development is likely to influence recommendations, make them less evidence based and impact on their credibility (Cosgrove, 2013).  Cochrane urges the WHO to protect against the influence of conflicts of interest in the guideline development process to ensure that the identification and evaluation of the best available evidence remains at its core.

—

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

The Cochrane Collaboration has published an updated priority list, which ‘includes new titles from the Effective Practice & Organisation of Care, Eyes and Vision, Oral Health, and Public Health Groups. Twenty-two titles on the list have been published – seven protocols, eight reviews, and seven updates. Three of the published reviews/updates were press released – Interventions for enhancing medication adherence, Comparison of routes for achieving parenteral access with a focus on the management of patients with Ebola Virus Disease, and Chlorhexidine skin or cord care for prevention of mortality and infections in neonates.’

More information on the new list, and the list itself, can be downloaded here: http://www.cochrane.org/news/updated-list-cochrane-priority-reviews-now-available

A previous version was published in January 2015 and was discussed on HIFA. Below are some of the comments from HIFA members about the previous version:

‘The consultation appears to have relatively higher input from high-income countries as compared with low- and middle-income countries. It would be interesting for an independent reviewer to ‘review the review list’ to assess correlation with, for example, global burden of disease.’ Neil Pakenham-Walsh, UK

‘It would also be interesting to review the extent of input from patients and carers into the compilation of this list.’ Caroline Struthers, UK

‘None of these countries are developing countries and cannot comment on the priorities of a developing country. This has to be decided by a group and consortium of healthcare professionals and organization based and working in low resourced developing countries… Cochrane library should engage more researchers and patient groups from low resourced countries in order to make this exercise of systematic reviews more meaningful. Otherwise it will only be an academic exercise which might benefit few patients in the developed world without any meaningful real time impact on majority of the patients in the low resourced countries’ Farooq Rathore, Pakistan

‘One of the important things to note about the priority topics identified by Cochrane that no standard methodology was applied by different review groups. Different Cochrane review groups adopted different methods which they assessed suited their best interest and as per the resources available with them.’ Soumyadeep Bhaumik, India

‘Decision-makers and funders have begun to increasingly engage representatives of patients and healthcare consumers to ensure that research becomes more relevant. However, disadvantaged groups and their needs may not be integrated into the priority-setting process since they do not have a ‘political voice’ or are unable to organise into interest groups… Few strategies address the question of engaging and meeting the needs of disadvantaged groups, despite the fact that previous studies have shown that disadvantaged groups value health problems differently.’ (Bhaumik, Soumyadeep et al. Ethics and equity in research priority-setting: stakeholder engagement and the needs of disadvantaged groups. Indian Journal of Medical Ethics, [S.l.], mar. 2015. ISSN 0975-5691. Available at: http://ijme.in/index.php/ijme/article/view/2195/4699 )

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 read this article on the BBC Health website and wanted to share it with the community. http://www.bbc.co.uk/news/health-32914227

“A smartphone app is as effective at testing eyesight as an optician’s clinic, a trial suggests. The team, at the London School of Hygiene and Tropical Medicine, hopes it can transform eye care for millions of people in remote parts of the world. Trials on 233 people in Kenya, published in JAMA Ophthalmology, showed the phone produced the same results as eye charts. More than 285 million people around the world are blind or visually impaired. It is often easy to treat with something as simple as a pair of glasses or cataract surgery. But too often people are beyond the reach of even a basic eye exam.

The team in London, with colleagues in Scotland, modified a smartphone to develop a series of eye tests that could be used with little training and were easily portable. The Portable Eye Examination Kit (Peek) uses the phone’s camera to scan the lens of the eye for cataracts. Its “Acuity App” uses a shrinking letter which appears on screen and is used as a basic vision test. It uses the camera’s flash to illuminate the back of the eye to check for disease. The first clinical data from tests in Kenya show the vision test gives the same results as the rows of letters pinned to an optician’s wall. Their eyes were examined both in their homes and at an eye clinic. Further results on scanning the retina are about to be published and are described as ‘compelling’.

Dr Andrew Bastawrous, who led the project, told the BBC: “The main reason for most people not getting eye treatment is simply that they don’t access the services and that’s usually because the services are so far away from them or are unaffordable. “If we can detect people with visual impairment much earlier on then we have a much greater chance of increasing awareness and ensuring they have appropriate treatment. “So something as simple as a vision test can be part of that journey.” The phone is relatively cheap, costing around £300 rather than using bulky eye examination equipment costing in excess of £100,000. The International Agency for the Prevention of Blindness believes the app could be a “game changer”. It has previously said: “We simply don’t have the trained eye health staff to bring eye care services to the poorest communities. This tool will enable us to do that with relatively untrained people.” But even if everyone could be tested it would leave the massive problem of who is going to pay for millions of people to be treated?”

Deborah Jackson

HIFA profile: Deborah Jackson is the HIFA Country Representative Coordinator and is based in Finstock, Oxfordshire, UK. http://www.hifa2015.org/how-individuals-support-hifa2015/hifa2015-country-representatives/

crc AT hifa2015.org

Hi

HIFA members may be interested in this excellent course at the University of Aberdeen, which is now available free and online.

https://www.futurelearn.com/courses/africa-sustainable-development

Best wishes

Carolyn

Student demographics are shifting, but academic staff remain predominantly white…more