For almost 70 years, the World Health Organisation (WHO) has coordinated the norms and technical standards required to improve global health. This is the role people most often associate with WHO. However, the organisation’s constitution also calls on it to “furnish technical assistance and, in emergencies, necessary aid” to governments, a role WHO has played on countless occasions. Despite initial delays in the western Africa Ebola outbreak response, the tide of this unprecedented health crisis has now been turned. While still requiring intense and focused action to bring new cases to zero, the outbreak is now limited to only a few cases per week. Deficiencies in capacity, expertise and approach revealed by WHO’s response to Ebola suggest that organisation-wide change is needed:WHO must ensure it can prepare for and respond to outbreaks and emergencies in a way that genuinely supports national efforts and fully integrates with international partners. WHO has begun reviewing systems and capacities throughout the organisation to streamline the way it works in outbreaks and emergencies.These changes focus on six key areas: (i) a unified WHO platform for outbreaks and emergencies with health and humanitarian consequences; (ii) a global health emergency workforce, to be effectively deployed in support of countries; (iii) core capacities at country-level under the International Health Regulations; (iv) functioning, transparency, effectiveness and efficiency of the International Health Regulations; (v) a framework for research and development preparedness and capacity during outbreaks or emergencies; and (vi) adequate international financing for pandemics and other health emergencies, including a 100 million United States dollars contingency fund and a pandemic emergency financing facility. No single organisation can deliver the wide range of services and systems needed for a truly global mechanism that prepares for and responds to outbreaks and emergencies. This is why WHO will continue seeking advice from our partners inside and outside the UN system to make needed change. With their collaboration and support, WHO will be well positioned to deliver what the world needs when outbreaks and emergencies occur: a timely response that rapidly contains the consequences – for economies and societies as well as for human health.
Equitable health services
Current malaria control strategies rely heavily on repeated application of single neurotoxic insecticides that quickly kill adult mosquitoes, yet the effectiveness of insecticide-treated bed nets (ITNs) and indoor insecticide sprays to control adult mosquito vectors is being threatened by the spread of insecticide resistance. This narrow insecticide-based paradigm is beginning to fail, the authors of this paper argue, as it did in agriculture, as well as in previous malaria eradication campaigns of the '50s and '60s. They note that ITNs, indoor spraying programmes and other malaria control measures should be integrated in the same way as pest management is integrated in agriculture. Integrated approaches have the potential to provide more effective and durable pest management. To achieve the equivalent for malaria control requires additional tools to manage malaria vectors, as well as a better understanding of the impact of individual tools and their interactions, appropriate training for end users and strategies that maximise impact and fit the local ecological and socioeconomic context. Given the current lack of any clear alternative to the current insecticide paradigm, the authors urge researchers, policy makers, and funding agencies to act now to support this more diverse and adaptive approach.
As the Ebola outbreak in West Africa wanes, the author argues that it is time for the international scientific community to reflect on how to improve the detection of and coordinated response to future epidemics. The interdisciplinary author team identified key lessons learned from the Ebola outbreak that can be clustered into three areas: environmental conditions related to early warning systems, host characteristics related to public health, and agent issues that can be addressed through the laboratory sciences. In particular, they argue there is a need to increase zoonotic surveillance activities, implement more effective ecological health interventions, expand prediction modeling, support medical and public health systems in order to improve local and international responses to epidemics, improve risk communication, better understand the role of social media in outbreak awareness and response, produce better diagnostic tools, create better therapeutic medications, and design better vaccines. This list highlights research priorities and policy actions the global community can take now to be better prepared for future emerging infectious disease outbreaks that threaten global public health and security.
In this study commercial shopkeepers and groups of community leaders were trained to promote and sell ITNs in 19 sites in central Mozambique between 2000 and 2004. Pregnant women and children under 5 years of age comprised the target population. Sales records, household survey results and project experiences were examined to derive ‘lessons learned’. The authors conclude that this project failed to achieve adequate or equitable levels of ITN coverage in a timely manner in the programme sites. Its findings helped support a subsequent Mozambican decision to conduct targeted distribution of long-lasting nets to the neediest populations in the provinces where the project was conducted.
This article discusses health sector reform experiences of four developing countries, including Tanzania, and identifies the lessons learned. Findings suggest that decentralisation works effectively while implementing primary and secondary health programmes. Decentralisation of power and authority to local authorities requires strengthening and supporting these units. Community participation facilitates recruitment and development of field workers, facility improvement and service delivery. For providing financial protection to the poor, there is a need to review user fees and develop affordable health insurance with an exemption mechanism. There is no uniform health sector reform approach for all countries – policy makers must examine the context and determine the reform measures that constitute the best means in terms of equity, efficiency and sustainability.
The EQUINET Steering Committee made a representation through the SADC Secretariat to the Health and Water Ministers meeting held in South Africa on 11 December 2008 on the cholera situation in the region, and particularly in Zimbabwe. The EQUINET Steering Committee called on SADC Ministers to strengthen the public health leadership of the response, supported by publicly reported and accurate information and effective communication on the epidemic from community to national level; and where necessary invoking public health laws to prioritise resources to prevent and manage the epidemic. The SC recognised the need for urgent measures to control and manage the epidemic, but also called for attention to longer term measures to address determinants of the epidemic.
The healthcare system in South Africa is based on the district health system through a primary healthcare approach. Although many vision and mission statements in the public healthcare sector in South Africa state that the service aspires to be holistic, it is at times unclear what exactly is meant by such an aspiration. The term ‘holism’ was coined in the 1920s and describes the phenomenon of the whole being greater than the sum of the parts. Over the past two decades the term has entered into many academic disciplines as well as popular culture. As part of a larger research study, the limitations to working holistically in the public sector in a rural sub-district in South Africa were explored. This study used a participatory action research design that allowed participants a large degree of influence over the direction of the study. The close relationship between difficulty in providing a holistic healthcare service and burnout was an important finding that deserves further exploration.
How have prior experiences with managing HIV prepared African countries for COVID-19? Drawing on qualitative methods, this article examines the impact of HIV interventions on the healthcare system in Malawi and its implications for addressing COVID-19. The author argues that the historical and continued influence of neoliberalism in global health manifests in the structures and routines of clinical practice. In Malawi’s health centres, a parallel NGO system of care has become grafted onto state healthcare, with NGOs managing HIV commodities and providing care to HIV patients. While HIV NGOs do support the work of government providers, it is limited to tasks that align with their programmatic goals. Outside of external funder priorities, the conditions of public healthcare are said to be lagging, and government providers struggle with shortages of staff, medical resources, and basic infrastructure, all of which has been compounded by COVID-19.
The authors of this article argue that a high prevalence of neglected tropical diseases (NTDs) in sub-Saharan Africa promotes susceptibility to the HIV virus and can worsen the clinical course and progression of AIDS. They highlight emerging evidence to provide a scientific rationale for combining treatment programmes for NTDs with programmes for the treatment of HIV andAIDS. They argue that improved NTD control could both decrease susceptibility to HIV infection and improve morbidity levels in seropositive individuals. Improved efficiency and cost- effectiveness of integrating NTD programmes into a wider framework to provide HIV care would require careful co-ordination and collaboration among concerned NGOs, private entities and Ministries of Health. Major stakeholders should be encouraged to establish operational links between HIV and AIDS and NTD activities.
Intermittent screening and treatment (IST) of school children for malaria is one possible intervention strategy that could help reduce the burden of malaria among school children. This study was conducted alongside a cluster-randomised trial to investigate local perceptions of school-based IST among parents and other stakeholders on the Kenyan south coast. Six out of the 51 schools receiving the IST intervention were purposively sampled, and 22 focus group discussions and 17 in-depth interviews were conducted with parents and other key stakeholders involved in the implementation of school health programmes in the district. Results showed that the use of alternative anti-malarial drugs with simpler regimens was generally preferred. General consensus was that health workers were best placed to undertake the screening and provide treatment, and although teachers' involvement in the programme is critical, most participants were opposed to teachers taking finger-prick blood samples from children. There was also a strong demand for the distribution of mosquito nets to augment IST. Future research should carefully consider the various roles of teachers, community health workers, and health workers, and the use of anti-malarial drugs with simpler regimens.