Organization's Global Strategy Research Articles

Semantic Interoperability of Electronic Health Records: Systematic Review of Alternative Approaches for Enhancing Patient Information Availability.

Semantic interoperability facilitates the exchange of and access to health data that are being documented in electronic health records (EHRs) with various semantic features. The main goals of semantic interoperability development entail patient data availability and use in diverse EHRs without a loss of meaning. Internationally, current initiatives aim to enhance semantic development of EHR data and, consequently, the availability of patient data. Interoperability between health information systems is among the core goals of the European Health Data Space regulation proposal and the World Health Organization's Global Strategy on Digital Health 2020-2025. To achieve integrated health data ecosystems, stakeholders need to overcome challenges of implementing semantic interoperability elements. To research the available scientific evidence on semantic interoperability development, we defined the following research questions: What are the key elements of and approaches for building semantic interoperability integrated in EHRs? What kinds of goals are driving the development? and What kinds of clinical benefits are perceived following this development? Our research questions focused on key aspects and approaches for semantic interoperability and on possible clinical and semantic benefits of these choices in the context of EHRs. Therefore, we performed a systematic literature review in PubMed by defining our study framework based on previous research. Our analysis consisted of 14 studies where data models, ontologies, terminologies, classifications, and standards were applied for building interoperability. All articles reported clinical benefits of the selected approach to enhancing semantic interoperability. We identified 3 main categories: increasing the availability of data for clinicians (n=6, 43%), increasing the quality of care (n=4, 29%), and enhancing clinical data use and reuse for varied purposes (n=4, 29%). Regarding semantic development goals, data harmonization and developing semantic interoperability between different EHRs was the largest category (n=8, 57%). Enhancing health data quality through standardization (n=5, 36%) and developing EHR-integrated tools based on interoperable data (n=1, 7%) were the other identified categories. The results were closely coupled with the need to build usable and computable data out of heterogeneous medical information that is accessible through various EHRs and databases (eg, registers). When heading toward semantic harmonization of clinical data, more experiences and analyses are needed to assess how applicable the chosen solutions are for semantic interoperability of health care data. Instead of promoting a single approach, semantic interoperability should be assessed through several levels of semantic requirements A dual model or multimodel approach is possibly usable to address different semantic interoperability issues during development. The objectives of semantic interoperability are to be achieved in diffuse and disconnected clinical care environments. Therefore, approaches for enhancing clinical data availability should be well prepared, thought out, and justified to meet economically sustainable and long-term outcomes.

Tanzania's and Germany's Digital Health Strategies and Their Consistency With the World Health Organization's Global Strategy on Digital Health 2020-2025: Comparative Policy Analysis.

In recent years, the fast-paced adoption of digital health (DH) technologies has transformed health care delivery. However, this rapid evolution has also led to challenges such as uncoordinated development and information silos, impeding effective health care integration. Recognizing these challenges, nations have developed digital health strategies (DHSs), aligning with their national health priorities and guidance from global frameworks. The World Health Organization (WHO)'s Global Strategy on Digital Health 2020-2025 (GSDH) guides national DHSs. This study analyzes the DHSs of Tanzania and Germany as case studies and assesses their alignment with the GSDH and identifies strengths, shortcomings, and areas for improvement. A comparative policy analysis was conducted, focusing on the DHSs of Tanzania and Germany as case studies, selected for their contrasting health care systems and cooperative history. The analysis involved a three-step process: (1) assessing consistency with the GSDH, (2) comparing similarities and differences, and (3) evaluating the incorporation of emergent technologies. Primary data sources included national eHealth policy documents and related legislation. Both Germany's and Tanzania's DHSs align significantly with the WHO's GSDH, incorporating most of its 35 elements, but each missing 5 distinct elements. Specifically, Tanzania's DHS lacks in areas such as knowledge management and capacity building for leaders, while Germany's strategy falls short in engaging health care service providers and beneficiaries in development phases and promoting health equity. Both countries, however, excel in other aspects like collaboration, knowledge transfer, and advancing national DHSs, reflecting their commitment to enhancing DH infrastructures. The high ratings of both countries on the Global Digital Health Monitor underscore their substantial progress in DH, although challenges persist in adopting the rapidly advancing technologies and in the need for more inclusive and comprehensive strategies. This study reveals that both Tanzania and Germany have made significant strides in aligning their DHSs with the WHO's GSDH. However, the rapid evolution of technologies like artificial intelligence and machine learning presents challenges in keeping strategies up-to-date. This study recommends the development of more comprehensive, inclusive strategies and regular revisions to align with emerging technologies and needs. The research underscores the importance of context-specific adaptations in DHSs and highlights the need for broader, strategic guidelines to direct the future development of the DH ecosystem. The WHO's GSDH serves as a crucial blueprint for national DHSs. This comparative analysis demonstrates the value and challenges of aligning national strategies with global guidelines. Both Tanzania and Germany offer valuable insights into developing and implementing effective DHSs, highlighting the importance of continuous adaptation and context-specific considerations. Future policy assessments require in-depth knowledge of the country's health care needs and structure, supplemented by stakeholder input for a comprehensive evaluation.

Product Line Engineering for Digital Product‐Services

ABSTRACTDigitizing the value chain brings along new business opportunities to organizations wishing to adopt a service‐oriented approach. This trend, referred to as digital transformation, has taken over the business world in recent years. Digital technologies allow a company to move towards outcome‐based commitments, pricing, and contracts with its customers. However, these technologies can also make product portfolio management more challenging. Whereas transforming a product offering into a product‐service offering through digitization does not in itself revolutionize product line systems engineering processes and methods, it is of the utmost importance to consider this transformation concerns more than a new culture or using new technology and requires, first and foremost, an alignment with an organization's global strategy and structure.In this paper, we present a conceptual framework that helps define a high‐level strategy to implement a product‐service offer in an organization. The distinctive framework aspects include the Product‐Service Product Line or PSPL concept (a product line of product‐services), the elements to define the PSPL business model (pricing model, pricing metrics, and commitment types), a product‐services typology, and a product line engineering method extension for architecting the PSPL (notably, a specific service building block type to support a composable design approach and a feature model including service‐related, socio‐technical features).

Health labour markets: an overview of some human factors that influence demand and supply

Abstract Background The global demand for health workers is expected to double by 2030 and it is estimated that if need is taken into account, there will be a deficit as high as 18 million according to the World Health Organization's Global Strategy on Human Resources for Health: Workforce 2030. Combined with inequities in the access to qualified health workers, this impedes progress towards the achievement of universal health coverage, global health security and the SDGs. This paper addresses health labour market deficiencies. It aims to provide guidance for a comprehensive analysis of health labour market dynamics, including the political and social factors that, in addition to economic ones influence the behaviour of health workers and of employers. Methods This paper uses the material of the WHO Health Labour Market Analysis Guidebook, which is based on the most recent literature on the demand and supply of health workers and on factors that affect them. It also draws from empirical analysis conducted recently by WHO in four regions of the world. Results On the supply side, the paper illustrates how social norms, such as those related to gender, influence the decision to become a health professional, the choice of a specialty, the choice of a practice location, and labour market participation. As to demand, examples are given of how professional interest groups' political actions (councils, trade unions) influence the division of tasks and which types of jobs will be offered. Conclusions The analysis of the dynamics of health labour markets must include human factors to achieve a better understanding of the forces that drive health worker shortages and surpluses, skills-mix and geographical imbalances, and suboptimal performance and to develop effective policies to address these issues.

A qualitative exploration of the Thai alcohol policy in regulating alcohol industry's marketing strategies and commercial activities.

The recognition of the association between the use of alcohol and negative health outcomes have led to the endorsement of the World Health Organization's global strategy to reduce the harmful use of alcohol. Given the capacities, capabilities and sociocultural contexts of Thailand, this study aims to examine the Thai alcohol policy against the global strategy's recommended policy measures for marketing control and identify areas for further policy development. Semi-structured interviews were conducted with the stakeholders from three sectors: the government, academia and civil society. Their perceptions of the Thai alcohol policy in regulating alcohol industry's commercial strategies and activities were discussed. Audio data were transcribed verbatim, systematically coded and thematically analysed. Although the Thai Alcohol Control Act meticulously regulates the content of direct alcohol marketing, the volume of marketing and indirect alcohol marketing have become problematic and difficult for the government to address. The industry has worked to normalise the consumption of alcohol through repetitive brand exposure and their suggestion that drinking was integral for socialisation. The control of alcohol sponsorship was politically sensitive and legally ambiguous because alcohol sponsorship seemed to provide economic and social benefits and further reinforced the industry's positive image. Despite the strict alcohol policy, gaps in the marketing regulations exist. Future policy development should place greater emphasis on alcohol sponsorship and branding through evidenced-based interventions. The interactions between the government and the industry should be monitored and restricted. Rigorous regulations, as seen for tobacco, are encouraged for alcohol marketing.

Responsive Feeding: Strategies to Promote Healthy Mealtime Interactions.

Responsive feeding is a derivative of responsive parenting that has been applied to infant and young child feeding. With a theoretical basis in the reciprocal interactions between parents and children, responsive feeding is particularly relevant during complementary feeding as young children progress from an exclusively milk-based liquid diet to the family diet and self-feeding. The period of complementary feeding includes multiple developmental changes that may threaten a successful transition and lead to growth and feeding problems. In spite of high rates of global childhood underweight, stunting, overweight, and obesity, and the inclusion of responsive feeding in the World Health Organization's Global Strategy for Infant and Young Child Feeding, there have been few intervention trials of responsive feeding. The aim of this chapter is to examine how parents and young children navigate the progression in feeding, with an emphasis on complementary feeding, and to address the following topics: (1) navigating the progression of feeding development, (2) provision of responsive feeding, (3) preventing or resolving growth and feeding problems, (4) responsive feeding research, and (5) strategies to promote healthy mealtime interactions. To advance responsive feeding research and practice, clarity is needed in both measurement and intervention strategies, guided by the reciprocity between parent and child interactions inherent in the theoretical basis of responsive feeding.

The Effect of Using Nutritional and Herbal Supplements on Uterine Fibroids as an Alternative Community Based Management in Kisumu

For a long time, community based alternative methods of treating illnesses/conditions has not been given much weight that it deserves, as it is also contributing considerably towards health care and many people in the communities are using the alternative ways. In Kenya nearly 80% of the populations including the Maasai are still dependent on herbal medicine; it remains an important source of treatment, particularly for rural communities. The World Health Organization's global strategy includes popularizing and incorporating herbal medicine in the national health systems of member countries. However, knowledge on community based alternative management of fibroids is still not well understood by many in the population. The purpose of the study was to determine the various methods of alternative fibroid management using nutritional and herbal supplements at community level and their effectiveness at eliminating uterine fibroids. The main objective of the study was to find out the types of community based nutritional and herbal supplements that women use to manage fibroids. There was therefore the need to find out the activities of the alternative medicine practitioners with specific interest on nutritional and indigenous herbal supplements treatment and determine whether the supplements and herbal medicines being administered were effectively eliminating uterine fibroids. There was an existing gap in the naming of the local herbs being used, quantities of drug being administered, the ratios of different drugs mixed in a given concoction, effectiveness and documentation of the local herbs used for alternative management of fibroids in this country.

Alcohol and alcohol-related harm in China: policy changes needed.

In China, alcohol consumption is increasing faster than anywhere else in the world. A steady increase in alcohol production has also been observed in the country, together with a rise in alcohol-related harm. Despite these trends, China's policies on the sale and consumption of alcoholic beverages are weak compared with those of other countries in Asia. Weakest of all are its policies on taxation, drink driving laws, alcohol sale to minors and marketing licenses. The authors of this descriptive paper draw attention to the urgent need for public health professionals and government officials in China to prioritize population surveillance, research and interventions designed to reduce alcohol use disorders. They describe China's current alcohol policies and recent trends in alcohol-related harm and highlight the need for health officials to conduct a thorough policy review from a public health perspective, using as a model the World Health Organization's global strategy to reduce the harmful use of alcohol.

Alcohol, diabetes, and public health in the Americas

This article describes epidemiological evidence on the association between alcohol use and diabetes, and the implications for clinical management and public health policies in the Americas. Heavy alcohol use is a risk factor for both diabetes and poor treatment adherence, despite evidence that moderate drinking can protect against type 2 diabetes under some circumstances. The burden of disease from diabetes associated with excessive alcohol consumption warrants both clinical and public health measures. On the clinical level, research on early interventions to prevent hazardous drinking shows that new screening, brief intervention, and referral techniques are effective ways to manage hazardous drinking in primary care settings. On the population level, restrictions on alcohol marketing and other alcohol control policies reduce the frequency and intensity of alcohol consumption in at-risk populations. These policy actions are recommended within the context of the World Health Organization's global strategy to reduce the harmful use of alcohol.

Análise custo-efetividade e índice de qualidade da refeição aplicados à Estratégia Global da OMS

To test the use of cost-effectiveness analysis as a decision making tool in the production of meals for the inclusion of the recommendations published in the World Health Organization's Global Strategy. Five alternative options for breakfast menu were assessed previously to their adoption in a food service at a university in the state of Sao Paulo, Southeastern Brazil, in 2006. Costs of the different options were based on market prices of food items (direct cost). Health benefits were estimated based on adaptation of the Diet Quality Index (DQI). Cost-effectiveness ratios were estimated by dividing benefits by costs and incremental cost-effectiveness ratios were estimated as cost differential per unit of additional benefit. The meal choice was based on health benefit units associated to direct production cost as well as incremental effectiveness per unit of differential cost. The analysis showed the most simple option with the addition of a fruit (DQI = 64 / cost = R$ 1.58) as the best alternative. Higher effectiveness was seen in the options with a fruit portion (DQI1=64 / DQI3=58 / DQI5=72) compared to the others (DQI2=48 / DQI4=58). The estimate of cost-effectiveness ratio allowed to identifying the best breakfast option based on cost-effectiveness analysis and Diet Quality Index. These instruments allow easy application easiness and objective evaluation which are key to the process of inclusion of public or private institutions under the Global Strategy directives.

The World Health Organization's global strategy for prevention and assessment of HIV drug resistance

Antiretroviral treatment (ART) for HIV is being scaled up rapidly in resource-limited countries. Treatment options are simplified and standardized, generally with one potent first-line regimen and one potent alternate first-line regimen recommended. Widespread HIV drug resistance (HIVDR) was initially feared, but reports from resource-limited countries suggest that initial ART programmes are as effective as in resource-rich countries, which should limit HIV drug resistance if programme effectiveness continues during scale-up. ART interruptions must be minimized to maintain viral suppression on the first-line regimen for as long as possible. Lack of availability of appropriate second-line drugs is a concern, as is the additional accumulation of resistance mutations in the absence of viral load testing to determine failure. The World Health Organization (WHO) recommends a minimum-resource strategy for prevention and assessment of HIVDR in resource-limited countries. The WHO's Global Network HIVResNet provides standardized tools, training, technical assistance, laboratory quality assurance, analysis of results and recommendations for guidelines and public health action. National strategies focus on assessments to guide immediate public health action to improve ART programme effectiveness in minimizing HIVDR and to guide regimen selection. Globally, WHO HIVResNet collects and analyses data to support evidence-based international policies and guidelines. Financial support is provided by major international organizations and technical support from HIVDR experts worldwide. As of December 2007, 25 countries were planning or implementing the strategy; seven countries report results in this supplement.

43. MEASURING TRENDS IN STI SYNDROME AETIOLOGIES AND ANTIBIOTIC RESISTANCE PATTERNS: THE SOUTH AFRICAN EXPERIENCE

The World Health Organization's Global strategy for the prevention and control of sexually transmitted infections (STIs): 2006-2015 highlighted the need for STI surveillance as a cornerstone for national programmes. Yet, in many countries of the world, little or no surveillance exists and, when it does, it is often clinical in nature. Much of the world's resource-poor areas use the syndromic management approach, which includes a recommendation for periodic surveillance of antimicrobial resistance in Neisseria gonorrhoeae. It is also important to perform aetiological surveillance, to assess the common causes of the main STI syndromes, such as genital ulceration (GUS), male urethritis syndrome (MUS) and the vaginal discharge syndrome (VDS). This allows observation of trends and ensures that the drugs used in the syndromic management flow chart as still valid. South Africa started to build a national microbiological and clinical surveillance programme in 2004. Prior to that, microbiological data came from surveillance among particular core groups, such as miners, that could not be extrapolated to the general population. 30 sentinel sites (primary healthcare facilities) were set up in each of the country's nine provinces for the purpose of enhanced clinical surveillance. Data were collected on all the main syndromes in terms of episodes per year. At the same time, microbiological surveillance was initiated in the following provinces: the Northern Cape, Mpumalanga, the Western Cape and Gauteng. Plans are to conduct further surveillance in the Free State and possibly the Eastern Cape later in 2007. Within each province, one primary health care facility was chosen on the criteria of a large STO caseload and proximity to the laboratory doing the initial culturing of N. gonorrhoeae. Consecutive patients were recruited using informed consent and anonymous specimens collected. Patients were treated syndromically in the normal manner according to national STI management guidelines. Gonococcal isolates, obtained from men with urethral discharge, were tested for ciprofloxacin and ceftriaxone resistance using E tests. In addition, swabs were collected from MUS patients and VDS patients for multiplex polymerase chain reaction (M-PCR) based testing for the following four pathogens: N. gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium. Ulcer swabs were also tested by M-PCR for herpes simplex virus (HSV), Haemophilus ducreyi and Treponema pallidum. A separate PCR was used to test the extracted DNA for C. trachomatis L1-L3. Serum was taken from all participants and tested for syphilis (RPR plus TPPA), HSV-2 and HIV antibodies. Key findings have confirmed the decline of chancroid to below 1% of genital ulcers and the predominance of genital herpes as the major cause of genital ulceration in South Africa. Gonorrhoea continues to be the major cause of urethritis in men and prevalence far exceeds Chlamydial infection. Approximately 10% of men with MUS are also infected/colonized with T. vaginalis. Only about one third of VDS cases appear to be caused by sexually transmitted pathogens. HIV infection rates exceed those recorded in the annual antenatal surveys and are highest among genital ulcer patients (70%). RPR seropositivity in non-ulcer patients is around 5% and antibodies to HSV-2 occur in about 50!!60% of patients overall. The surveillance has also demonstrated alarming rises in the prevalence of ciprofloxacin resistant gonorrhoea since 2004.

World Health Organization's Global Strategy on diet, physical activity and health: the process behind the scenes

Some aspects of the difficulties and politics behind the making of a World Health Organization (WHO) Global Strategy on Diet, Physical Activity and Health are described. The main resistance came from sections of the food industry selling products high in sugar and salt. The article describes how these industries were lobbying both directly to the WHO and indirectly via member states. Their aim was to stall the work on the WHO Global Strategy; however, the Global Strategy was endorsed at the World Health Assembly in May 2004. Keywords: diet and health; food industry; food policy; non-communicable diseases; nutrient intake; physical activity; salt; saturated fats; sugar; World Bank; World Health Organization

Sustainable Consumption of Food: A Framework for Analyzing Scenarios about Changes in Diets

SummaryThis article describes the integration of life‐cycle assessment methods with a new input‐output model of the world economy to analyze the environmental and economic implications of alternative future diets. The article reviews findings by industrial ecologists about the energy and land required for the production and consumption of alternative foods and diets in several European countries. It also reviews attributes of foods and diets identified by nutritionists as reducing the risks of obesity and major chronic diseases related to the diets of the affluent. The predominantly plant‐based Mediterranean‐type diet emerges as a dietary scenario that could satisfy both sets of concerns. The likely implications for agriculture and for farm policies of a shift toward this diet from the current average diet in the United States are discussed and shown to be substantial. The one‐country studies reviewed in the article provide substantial insights into the potential ramifications of dietary change. Many of the limitations of these studies could be overcome by conducting the analysis in a global framework that represented the relationships among consumption, production, and trade and the physical constraints within which they operate. Analysis of the environmental and economic implications of alternative scenarios describing healthy diets can help stimulate more intensive dialogue, debate, and action among the interested parties; such analysis can both benefit from and contribute to initiatives such as the World Health Organization's global strategy on diet and health, which intends to enlist the support of governments, corporations, and civil society.

Keys to Effective Virtual Global Teams

The article discusses a study of global virtual teams in which researchers examined teams responsible for making and/or implementing decisions important to their organization's global strategy, used technology-supported communication substantially, and whose members worked and lived in different countries. The researchers conducted a 21-month study of three global virtual teams in an eastern United States company and two of its strategic partners. Teams were judged according to effectiveness and additional factors that may affect team outcomes. The importance of appropriate communication methods and media to facilitate task delegation is mentioned.

A global perspective on disability: a review of efforts to increase access and advance social integration for disabled persons

Disability has emerged as a major public health problem worldwide, common to nations presenting disparate levels of socioeconomic development. Failure to integrate social welfare programmes within national development planning exacerbates difficulties arising from limited resources, with a disproportionate impact on disabled persons and other vulnerable groups. Such policy failure allows flagrant inequalities and social injustice to persist. Strategies are emerging, however, that are useful for solving common international problems. Community-based disability prevention and rehabilitation is one emerging solution that has attracted considerable attention worldwide, including in the United States. Following a review of global estimates of disability, which reveal the magnitude of the problem and provide background information for this report, I will summarize major international initiatives designed to prevent disability and ensure comprehensive rehabilitation for disabled persons. I will also analyse the relationships between health, socioeconomic development, and disability. Finally, I will describe community-based rehabilitation, an innovative approach evolving from the World Health Organization's Global Strategy for Health for All by the Year 2000, an approach with potential to eliminate barriers to equal opportunities and social integration for disabled persons.

An economic evaluation of "Health for All".

The World Health Organization's 'Global Strategy' is an ambitious vision, but to achieve its goals it must first be implemented. Implementation will require careful and detailed planning. This paper evaluates the possibilities of transforming the Global Strategy from a laudable policy initiative into an actual 'Plan for Health', from the point of view of a health economist. This economic evaluation assesses the probable costs of implementing various activities of the Strategy, and the likelihood that developing countries will be able to afford these costs, either on their own, or with the assistance of the developed countries. A final section considers the current global situation and presents trends over the last two decades. The numbers of countries that have already achieved the goals of the Strategy, that can be expected to achieve the goals of the Strategy by the year 2000, and that are unlikely to achieve these goals (on the basis of current trends) are shown. The WHO 'success indicator' based on numbers of countries is compared to a more epidemiological one based on deciles of the world's population. It is argued that, even several years after the initiation of the Global Strategy, insufficient information exists on the next logical step of transforming the Policy into a Plan. Unless adequate attention is paid to this vital step, implementation of the Strategy will inevitably be ad hoc and patchy. Further research on the costs of the activities proposed by the Global Strategy, and the probable effects on health of those activities, is desperately needed.