...health ministries will be invited to convene experts in their countries to design specific programmes of action for improving safety in each of four domains in which a medications can cause ...inadvertant harm: health care professionals' behaviour; systems and practices of medication; medicines; patients and the public. ...WHO will use its global convening and advocacy role to pursue successful outcomes in a range of areas, including: strengthening the quality of data to monitor medication-related harm; providing guidance and developing strategies, plans, and tools to ensure that the medication process has the safety of patients at its core in all health-care settings; producing a strategy for setting out research priorities; monitoring and evaluating the impact of the challenge; continuing to engage with regulatory agencies and international actors to improve medication safety through improved packaging and labelling; and designing tools and technologies that empower patients to safely manage their own medications. 2 MA Safren, A Chapanis, A critical incident study of hospital medication errors, Hospitals, Vol. 34, Iss. 53, 1960, 65-66, 68 3 B Allegranzi, J Storr, G Dziekan, The first global patient safety challenge “Clean care is safer care”: from launch to current progress and achievements, J Hosp Infect, Vol. 65,...
...the end of the pandemic is only possible when vaccines that are effective against circulating variants are distributed equitably across the world. ...for surveillance of the circulation of ...SARS-CoV-2 variants, sharing of variant-specific PCR primers could help to monitor their spread, particularly in resource-limited countries. ...a central repository of samples of sera and cells from individuals with past infection or past immunisation with available COVID-19 vaccines should be established for seroneutralisation and cellular immunity functional testing against newly discovered variants.
The current Ebola virus disease outbreak in western Africa highlights how an epidemic can proliferate rapidly and pose huge problems in the absence of a strong health system capable of a rapid and ...integrated response. The outbreak began in Guinea in December 2013 but soon spread into neighbouring Liberia and Sierra Leone. In early August 2014, Ebola was declared an international public health emergency. The last decade has seen increased external health-related aid to Guinea, Liberia and Sierra Leone. If this Ebola outbreak does not trigger substantial investments in health systems and adequate reforms in the worst-affected countries, pre-existing deficiencies in health systems will be exacerbated.
Universal health coverage (UHC) has been defined as the desired outcome of health system performance whereby all people who need health services (promotion, prevention, treatment, rehabilitation, and ...palliation) receive them, without undue financial hardship. UHC has two interrelated components: the full spectrum of good-quality, essential health services according to need, and protection from financial hardship, including possible impoverishment, due to out-of-pocket payments for health services. Both components should benefit the entire population. This paper summarizes the findings from 13 country case studies and five technical reviews, which were conducted as part of the development of a global framework for monitoring progress towards UHC. The case studies show the relevance and feasibility of focusing UHC monitoring on two discrete components of health system performance: levels of coverage with health services and financial protection, with a focus on equity. These components link directly to the definition of UHC and measure the direct results of strategies and policies for UHC. The studies also show how UHC monitoring can be fully embedded in often existing, regular overall monitoring of health sector progress and performance. Several methodological and practical issues related to the monitoring of coverage of essential health services, financial protection, and equity, are highlighted. Addressing the gaps in the availability and quality of data required for monitoring progress towards UHC is critical in most countries.
The international Ebola emergency Briand, Sylvie; Bertherat, Eric; Cox, Paul ...
The New England journal of medicine,
2014-Sep-25, Letnik:
371, Številka:
13
Journal Article
Summary Background rVSV-ZEBOV is a recombinant, replication competent vesicular stomatitis virus-based candidate vaccine expressing a surface glycoprotein of Zaire Ebolavirus. We tested the effect of ...rVSV-ZEBOV in preventing Ebola virus disease in contacts and contacts of contacts of recently confirmed cases in Guinea, west Africa. Methods We did an open-label, cluster-randomised ring vaccination trial (Ebola ça Suffit!) in the communities of Conakry and eight surrounding prefectures in the Basse-Guinée region of Guinea, and in Tomkolili and Bombali in Sierra Leone. We assessed the efficacy of a single intramuscular dose of rVSV-ZEBOV (2×107 plaque-forming units administered in the deltoid muscle) in the prevention of laboratory confirmed Ebola virus disease. After confirmation of a case of Ebola virus disease, we definitively enumerated on a list a ring (cluster) of all their contacts and contacts of contacts including named contacts and contacts of contacts who were absent at the time of the trial team visit. The list was archived, then we randomly assigned clusters (1:1) to either immediate vaccination or delayed vaccination (21 days later) of all eligible individuals (eg, those aged ≥18 years and not pregnant, breastfeeding, or severely ill). An independent statistician generated the assignment sequence using block randomisation with randomly varying blocks, stratified by location (urban vs rural) and size of rings (≤20 individuals vs >20 individuals). Ebola response teams and laboratory workers were unaware of assignments. After a recommendation by an independent data and safety monitoring board, randomisation was stopped and immediate vaccination was also offered to children aged 6–17 years and all identified rings. The prespecified primary outcome was a laboratory confirmed case of Ebola virus disease with onset 10 days or more from randomisation. The primary analysis compared the incidence of Ebola virus disease in eligible and vaccinated individuals assigned to immediate vaccination versus eligible contacts and contacts of contacts assigned to delayed vaccination. This trial is registered with the Pan African Clinical Trials Registry, number PACTR201503001057193. Findings In the randomised part of the trial we identified 4539 contacts and contacts of contacts in 51 clusters randomly assigned to immediate vaccination (of whom 3232 were eligible, 2151 consented, and 2119 were immediately vaccinated) and 4557 contacts and contacts of contacts in 47 clusters randomly assigned to delayed vaccination (of whom 3096 were eligible, 2539 consented, and 2041 were vaccinated 21 days after randomisation). No cases of Ebola virus disease occurred 10 days or more after randomisation among randomly assigned contacts and contacts of contacts vaccinated in immediate clusters versus 16 cases (7 clusters affected) among all eligible individuals in delayed clusters. Vaccine efficacy was 100% (95% CI 68·9–100·0, p=0·0045), and the calculated intraclass correlation coefficient was 0·035. Additionally, we defined 19 non-randomised clusters in which we enumerated 2745 contacts and contacts of contacts, 2006 of whom were eligible and 1677 were immediately vaccinated, including 194 children. The evidence from all 117 clusters showed that no cases of Ebola virus disease occurred 10 days or more after randomisation among all immediately vaccinated contacts and contacts of contacts versus 23 cases (11 clusters affected) among all eligible contacts and contacts of contacts in delayed plus all eligible contacts and contacts of contacts never vaccinated in immediate clusters. The estimated vaccine efficacy here was 100% (95% CI 79·3–100·0, p=0·0033). 52% of contacts and contacts of contacts assigned to immediate vaccination and in non-randomised clusters received the vaccine immediately; vaccination protected both vaccinated and unvaccinated people in those clusters. 5837 individuals in total received the vaccine (5643 adults and 194 children), and all vaccinees were followed up for 84 days. 3149 (53·9%) of 5837 individuals reported at least one adverse event in the 14 days after vaccination; these were typically mild (87·5% of all 7211 adverse events). Headache (1832 25·4%), fatigue (1361 18·9%), and muscle pain (942 13·1%) were the most commonly reported adverse events in this period across all age groups. 80 serious adverse events were identified, of which two were judged to be related to vaccination (one febrile reaction and one anaphylaxis) and one possibly related (influenza-like illness); all three recovered without sequelae. Interpretation The results add weight to the interim assessment that rVSV-ZEBOV offers substantial protection against Ebola virus disease, with no cases among vaccinated individuals from day 10 after vaccination in both randomised and non-randomised clusters. Funding WHO, UK Wellcome Trust, the UK Government through the Department of International Development, Médecins Sans Frontières, Norwegian Ministry of Foreign Affairs (through the Research Council of Norway's GLOBVAC programme), and the Canadian Government (through the Public Health Agency of Canada, Canadian Institutes of Health Research, International Development Research Centre and Department of Foreign Affairs, Trade and Development).
The WHO we want Nay, Olivier; Kieny, Marie-Paule; Marmora, Lelio ...
The Lancet (British edition),
06/2020, Letnik:
395, Številka:
10240
Journal Article
Recenzirano
Odprti dostop
...propose universal and standardised ways of collecting and reporting epidemiological data from countries. ...accelerate the evaluation, selection, and prequalification of diagnostic tests. ......support countries with fragile health systems to maintain continuity of routine health care, particularly for chronic diseases, and primary health care.
Cost-effectiveness thresholds: pros and cons Bertram, Melanie Y; Lauer, Jeremy A; De Joncheere, Kees ...
Bulletin of the World Health Organization,
12/2016, Letnik:
94, Številka:
12
Journal Article
Recenzirano
Odprti dostop
Cost-effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost-effectiveness ratio represents the magnitude of additional health gained per ...additional unit of resources spent. Cost-effectiveness thresholds allow cost-effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization's Commission on Macroeconomics in Health suggested cost-effectiveness thresholds based on multiples of a country's per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this - in addition to uncertainty in the modelled cost-effectiveness ratios - can lead to the wrong decision on how to spend health-care resources. Cost-effectiveness information should be used alongside other considerations - e.g. budget impact and feasibility considerations - in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost-effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair.
One attack on a health worker is one too many Kieny, Marie-Paule; Salama, Peter; Kenney, Erin ...
The Lancet (British edition),
03/2022, Letnik:
399, Številka:
10329
Journal Article
Recenzirano
In November, 2016, hospital destruction in eastern Aleppo deprived 250 000 people of access to health care.7 By December, 2016, 46% of hospitals in the country were reported to be damaged, 26% of ...assessed hospitals were not functioning, and 30% were only partly functioning.8 Data, reports, and evidence on the impact of attacks on health workers and health-care settings must be strengthened worldwide to better inform effective interventions.9 The 5 year action plan mandated by the High-Level Commission10 on Health Employment and Economic Growth to support implementation of WHO's Global strategy on human resources for health11 proposes to strengthen advocacy; gather best practices on the protection of health workers; and improve data collection tools, methods, and reporting on attacks and their public health consequences, and will be considered by the 70th World Health Assembly.12 Even one attack on health care is too many. Consistent data collection, advocacy with zero tolerance, and the promotion of concrete measures to prevent attacks are priority actions. Substantial health needs continue to be unmet and resources to support and strengthen the health workforce and health system in complex emergencies are stretched to the limit.
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