World Health Organization Policy Research Articles

Barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of oral health policies in the WHO Africa region: A scoping review protocol.

Evidence-informed oral health policies (OHP) can be instrumental in ending the neglect of oral health globally. When appropriately developed and implemented, OHP can improve the efficiency of healthcare systems and the quality of health outcomes. However, more than half of the countries in the World Health Organization (WHO) African region do not have an oral health policy or even the existence of a policy in need of additional and more national-specific OHP as part of non-communicable diseases and universal health coverage agendas. The objective of this protocol's study is to determine the barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of OHP in the WHO Africa region. We will conduct a systematic search in Global Health, Embase, PubMed, PAIS, ABI/Inform, Web of Science, Academic Search Complete, Scopus, databases that index gray literature, and the WHO policy repositories. We will include qualitative, quantitative, or mixed-methods research studies and OHP documents published since January 1, 2002, which address stakeholders' perceptions and experiences regarding barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of OHP in countries part of the WHO African region. We will produce descriptive statistics (frequencies and proportions) for quantitative data and conduct descriptive content analysis for qualitative data. To effectively establish evidence-based OHP in the WHO African region, it is crucial to recognize existing challenges and opportunities for progress. The findings of this review will be relevant for Chief Dental Officers at ministries of health, administrators of dental schools, or academic institutions in the WHO African region and will inform a stakeholder dialogue meeting in Kenya in November of 2023. Open Science Framework: https://doi.org/10.17605/OSF.IO/9KMWR.

Massive Transfusion/Hemorrhage Protocols Versus Goal-Directed Bleeding Management: Science Gone Eerie?

Key questions in bleeding management are “Why does my patient bleed?” and “How to fix it?” To answer the first question, the high negative predictive value of viscoelastic testing can be used to identify coagulopathic bleeding. Accordingly, goal-directed bleeding management (GDBM) guided by viscoelastic testing has been shown to be an effective and essential part of the second pillar of patient blood management (PBM) with the aim to improve patients’ outcomes and safety. Patient’s medical and drug history – with a focus on medication with oral anticoagulants and antiplatelet drugs – are important in emergency, urgent, and elective surgery. Furthermore, risk scores have been developed and validated for traumatic and obstetric hemorrhage and can be helpful tools to predict severe hemorrhage and the need for massive transfusion. Acidosis, hypocalcemia, anemia, and hypothermia (“diamond of death in trauma”) are important basic conditions for hemostasis and good predictors of coagulopathy and should be closely monitored by blood gas analysis and corrected in bleeding patients. Earlier time to hemostasis was associated with decreased mortality in trauma studies. Therefore, GDBM aims to stop the bleeding as soon as possible and avoid the main killers in blood transfusion: Transfusion-associated circulatory overload, transfusion-related acute lung injury, transfusion-related immune modulation, and thrombosis. Thromboelastometry-guided bleeding management follows the concepts of Good Medical Practice and Precision Medicine. Here, rotational thromboelastometry (ROTEM)-guided bleeding management algorithms are using a stepwise approach based on the sequence “Treat first what kills first:” (1) Fibrinolysis management, (2) clot firmness management, (3) thrombin generation management, and (4) avoidance of hypercoagulability and thrombosis. Here, thromboelastometry can not only identify patients with hypercoagulability and increased risk of thrombosis but also ROTEM-guided bleeding management can avoid thromboembolic complications, too. This may support the idea of personalized antithrombotic therapy guided by viscoelastic testing in the postoperative period. Finally, PBM is not about blood transfusion: It is about patients’ outcomes. Accordingly, several meta-analyses based on more than 20 randomized controlled trials on the effect of viscoelastic testing-guided perioperative bleeding management did not only demonstrate a significant reduction in transfusion requirements but also a significant reduction in mortality and postoperative acute kidney injury. The reduction in postoperative acute kidney injury again has a significant impact on long-term survival. Accordingly, recent PBM guidelines recommend the implementation of viscoelastic testing-guided bleeding management algorithms with a 1B or 1A recommendation. This is also addressed in the World Health Organization policy brief about the urgent need to implement PBM in all member states in a timely manner. However, even if the number of national activities is increasing, there is still a long way to go.

The World Health Organization and Global Health Inequality: Strategies and Results Analysis under the Socio-economic Background

Nowadays, the overall health status of countries has greatly improved with economic development, but health inequality has become a global health problem. With the continuous acceleration of globalization and the deepening of China's participation in international affairs, and through rapid development in recent years, China's position as an economic powerhouse has gradually been recognized and consolidated. China's role and influence in the development of international health services have also become increasingly evident, fully reflecting the status and responsibility of a major country. This article attempts to analyze the strategies and outcomes of the WHO(World Health Organization) in the context of global health inequality in the socio-economic context. In the significant adjustment of the WHO's policy towards member states from "assistance" to "cooperation", the connotation has undergone extremely profound changes. Under the coordination of WHO, we will strengthen cooperation in research, knowledge dissemination, capacity building, technology development, and policy support on social determinants of health issues, share experiences, and continuously strive to improve social determinants of health worldwide.

Lessons from the field: Supporting infection prevention and control and antimicrobial stewardship in Amman, Jordan

BackgroundTo reduce antimicrobial resistance (AMR), appropriate antimicrobial prescribing is critical. In conjunction with Infection Prevention & Control (IPC) programs, Antimicrobial Stewardship Programs (ASP) have been shown to improve prescribing practices and patient outcomes. Low- and middle-income countries (LMIC) face challenges related to inadequate ASP policies and guidelines at both the national and healthcare facility (HCF) levels. MethodsTo address this challenge, the World Health Organization (WHO) created a policy guidance and practical toolkit for implementation of ASPs in LMIC. We utilized this document to support a situational analysis and two-day ASP-focused workshop. In follow-up, we invited these attendees, additional HCF and hospital directors to attend a workshop focused on the benefits of supporting these programs. ResultsOver the course of a total three days, we recruited hospital directors, ASP team members, and IPC officers from fifteen different healthcare facilities in Jordan. We describe the courses and coordination, feedback from participants, and lessons learned for future implementation. ConclusionsFuture efforts will include more time for panel-type discussion. which will assist in further delineating enablers and barriers. Also planned is a total three-day workshop; with the first two days being with ASP/IPC teams, and the final third day being with hospital directors and leadership. The WHO policy guidance and toolkit are useful tools to address overuse of antimicrobial agents. Strong leadership support is needed for successful implementation of ASP and IPC. Discussions on quality/safety, as well as cost analyses, are important to generate interest of stakeholders.

Assessing Influenza Vaccine Adherence Among Pregnant Women: A Health Center-Based Study in Qatar

The World Health Organization (WHO) issues recommendations regarding influenza vaccine utilization, with a focus on safeguarding the most vulnerable and high-risk segments of the population against severe disease [1]. WHO's policy report on influenza vaccine, published in 2022, specifically designates pregnant women as a priority group for nations expanding their influenza vaccination initiatives, underlining the vaccine's capacity to confer protection to both mothers and their newborns for up to six months postpartum, shielding them from influenza infections [2]. Extensive evidence attests to the safety of administering influenza vaccines to pregnant women, with studies revealing a substantial reduction in laboratory-confirmed influenza cases, ranging from 35% to 70% for mothers and 28% to 61% for infants under six months of age [3,5]. The Ministry of Public Health (MOPH) in Qatar recommends that pregnant women receive a single dose of the influenza vaccine during any trimester of pregnancy, and this guidance is implemented across Antenatal clinics, including the Rawadat al Khail Health Center. Adherence to both local and WHO guidelines in clinical practice is of paramount importance. Thus, this study endeavors to ascertain the degree of adherence exhibited by healthcare professionals and pregnant women to the recommendations pertaining to influenza vaccination during pregnancy.

Barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of oral health policies in the WHO Africa region: A scoping review protocol

Background: Evidence-informed oral health policies (OHP) can be instrumental in ending the neglect of oral health globally. When appropriately developed and implemented, OHP can improve the efficiency of healthcare systems and the quality of health outcomes. However, more than half of the countries in the World Health Organization (WHO) African region did not have an oral health policy or even the existence of a policy in need of additional and more national-specific OHP as part of non-communicable diseases and universal health coverage agendas. The objective of this protocol’s study is to determine the barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of OHP in the WHO Africa region. Methods: We will conduct a systematic search in Global Health, Embase, PubMed, PAIS, ABI/Inform, Web of Science, Academic Search Complete, Scopus, databases that index gray literature, and the WHO policy repositories. We will include qualitative, quantitative, or mixed-methods research studies and OHP documents published since January 1, 2002, which address stakeholders' perceptions and experiences regarding barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of OHP in countries part of the WHO African region. We will produce descriptive statistics (frequencies and proportions) for quantitative data and conduct descriptive content analysis for qualitative data. Discussion: To effectively establish evidence-based OHP in the WHO African region, it is crucial to recognize existing challenges and opportunities for progress. The findings of this review will be relevant for Chief Dental Officers at ministries of health, administrators of dental schools, or academic institutions in the WHO African region and will inform a stakeholder dialogue meeting in Kenya in November of 2023. Registration: Open Science Framework: https://doi.org/10.17605/OSF.IO/9KMWR

PENGARUH PENERAPAN CHSE DAN PROMOSI TERHADAP KEPUTUSAN TAMU UNTUK MENGINAP PADA HOTEL SANTIKA

The determination of the Covid-19 pandemic by the World Health Organization and government policies related to the PSBB policy had a major impact on room occupancy rates, this condition caused worry for guests to carry out activities in the hotel area. To prevent a significant decrease in the number of room occupancy rates, the Ministry of Tourism and Creative Economy issued a CHSE guidance program for the hotel industry to ensure that health protocols are in place and provide a sense of security for hotel guests who come, so that guests feel comfortable deciding to stay at the hotel. However, the phenomenon that occurred at Hotel Santika for the 2019- 2021 period was a decrease in the average occupancy from 69% before the pandemic to 43% and fluctuations occurred in the following years. The purpose of this study was to analyze the influence of the implementation of CHSE and promotions on the decision for guests to stay overnight, the data source of this research is primary data derived from samples, namely hotel guests. Data collection used a saturated sample by distributing questionnaires to 109 respondents. Research using multiple linear regression analysis method. The results of this study indicate that; CHSE in guest entrance, lobby front desk, restaurant, rest room & meeting room has a positive effect on the decision to stay and CHSE in the guest room, although the promotion variable does not have a significant effect on the decision to stay of guests at Hotel Santika, because during the pandemic many hotels reduced room prices simultaneously.

Assessment of solid and liquid wastes management and health impacts along the failed sewerage systems in capital cities of African countries: case of Abidjan, Côte d'Ivoire

The management of domestic wastewater and rainwater is a major concern for the population of Yopougon. The study presents the causes of wastewater discharge from dysfunctional sewers and their health impacts on the population. It also highlights the environmental and health risk associated with poor solid and liquid waste management. This was based on literature search, semi-participatory workshop, physicochemical and bacteriological characterization of wastewater and finally through a household survey. The field survey was conducted on 245 household heads obtained using the Canadian statistical guidelines. The results obtained indicated that all main pollution indicators were; total nitrogen (TN, 525 ± 0.02 to 3077 ± 0.3 mg/l), nitrates (NO3, 146 ± 0.01 to 1347 ± 0.12 mg/l), biochemical oxygen demand (BOD, 278 ± 195.16 to 645 ± 391.74 mg/l), chemical oxygen demand (COD, 940 ± 650.54 to 4050.5 ± 71.42 mg/l) and total dissolved solids (TDS, 151 ± 9.9 to 766 ± 237.59 mg/l) which were above the values recommended by the World Health Organization (WHO) and Cote d'Ivoire national policy guidelines standards for the discharge of effluents into the environment. The analysis of the bacterial flora of the effluents revealed that the concentrations of Total Coliforms and fecal streptococci exceeded the values recommended by the WHO and national policy guidelines standards. This means that the populations of this area are prone to infectious diseases. Diseases such as malaria (84.53%), respiratory infections (61%), diarrhea (48.66%), intestinal diseases (44.5%), and typhoid fever (28.84%) were prevalent in the surveyed households.

Predictors of optimal uptake of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine and outcome of pregnancy in selected health facilities: a cross-sectional study in Northern Ghana

BackgroundGhana adopted the 2012 World Health Organization (WHO) policy on intermittent preventive treatment of malaria in pregnancy (IPTp) and implemented it in 2014 in all regions of Ghana. Despite the implementation of this policy, there has been an unacceptably low percentage of eligible women receiving the optimal dose of IPTp in Ghana which leaves millions of pregnant women unprotected from malaria. The study, therefore, assessed the predictors of three or more doses (optimal dose) of sulfadoxine-pyrimethamine (SP) in Northern Ghana.MethodsA cross-sectional study was conducted among 1188 women in four selected health facilities in Northern Ghana from September 2016 to August 2017. Information on socio-demographic and obstetric characteristics reported SP use, and maternal and neonatal outcomes were collected which was double-checked from the maternal health book as well as the antenatal care register. Pearson chi-Square and ordered logistic regression were used to determine the predictors of reported optimal SP use.ResultsOut of the 1146 women, 42.4% received 3 or more doses of IPTp-SP as recommended by the national malaria control strategy. SP uptake was significantly associated with antenatal care (ANC) attendance (aOR 0.49, 95% CI 0.36–0.66, P < 0.001), primary education (aOR 0.70, 95% CI 0.52–0.95, P = 0.022), four or more antenatal care visits (aOR 1.65, 95% CI 1.11–2.45, P = 0.014), ANC care visit in second trimester (aOR 0.63, 95% CI 0.49–0.80, P < 0.001) and third trimester (aOR 0.38, 95% CI 0.19–0.75, P = 0.006) and malaria infection during late gestation (aOR 0.56, 95% CI 0.43–0.73, p < 0.001).ConclusionThe percentage of pregnant women who received three or more doses is below the target of the National Malaria Control Programme (NMCP). The push factors for the optimal use of SP are higher educational attainment, four or more ANC visits, and early initiation of ANC. The study also confirmed earlier findings that IPTp-SP uptake of three or more doses prevents malaria in pregnancy and improves birth weight. The uptake of IPTp-SP among expectant women will be informed and increased by encouraging formal general education beyond the primary level and encouraging early initiation of ANC visits.

Help me to come out gracefully! Working with lesbian, gay, and bisexual, people affected by cancer to develop a national practitioner guide supporting inclusive care

IntroductionThe healthcare support needs of the lesbian, gay, bisexual (LGB) and transgender community are becoming an emerging area of healthcare research. Providing person-centred care is World Health Organisation policy and as such it is important that Radiography services can demonstrate areas in which they are working with people to design, develop and feedback on the services that they receive. This research aimed to establish how cancer treatment impacted on the identities of LGB people, their experiences of care, and their engagement with developing a practitioner guide. MethodsThis cooperative inquiry is underpinned by person-centred philosophy and participatory research principles. Participants were nine lesbian, gay, and bisexual people affected by cancer. Each engaged in two facilitated, audio-recorded conversations to explore their experiences of cancer care. An analytical framework based on Mezirow's Transformational Theory was used to organise the data, followed by detailed content analysis to develop themes. ResultsParticipants included men and women, aged 45–68, who had experienced different cancers. They explored how cancer treatment had impacted on them, and worked with the researcher and stakeholders to establish a seven-recommendation practitioner guide aimed at improving LGB people's care experiences. Their accounts revealed a broad range of issues that both corroborate and build on existing evidence. Themes highlighted expectations and experiences of both assumptions and prejudice in healthcare interactions. These experiences, along with misinterpretation of relationships with significant others, led to feelings of discomfort and reserve about self-expression. Findings of the research are presented in the following key areas: Dilemmas of attending oncology appointments; Inclusive experiences of care; and Formulation of the practitioner guide. ConclusionThe research findings enabled development of a national practitioner guide with the participants and key stakeholders to raise awareness of the needs of LGB persons affected by cancer and support better care. Implications for practiceBy providing real-life accounts this research adds to understanding of how LGB persons interact with services, developing evidence to support cultural competence within the profession of Radiography and oncology services more broadly.

Spatial repellents: The current roadmap to global recommendation of spatial repellents for public health use

Spatial repellent (SR) products are envisioned to complement existing vector control methods through the continual release of volatile active ingredients (AI) providing: (i) protection against day-time and early-evening biting; (ii) protection in enclosed/semi-enclosed and peri-domestic spaces; (iii) various formulations to fit context-specific applications; and (iv) increased coverage over traditional control methods. SR product AIs also have demonstrated effect against insecticide-resistant vectors linked to malaria and Aedes-borne virus (ABV) transmission. Over the past two decades, key stakeholders, including World Health Organization (WHO) representatives, have met to discuss the role of SRs in reducing arthropod-borne diseases based on existing evidence. A key focus has been to establish a critical development path for SRs, including scientific, regulatory and social parameters that would constitute an outline for a SR target product profile, i.e. optimum product characteristics. The principal gap is the lack of epidemiological data demonstrating SR public health impact across a range of different ecological and epidemiological settings, to inform a WHO policy recommendation. Here we describe in brief trials that are designed to fulfill evidence needs for WHO assessment and initial projections of SR cost-effectiveness against malaria and dengue.

Prescription Patterns of Drugs Used in Patients with Coronary Artery Disease at Tertiary Care Hospital

Background: The Cardiovascular disease is emerging as one of the leading cause of morbidity and mortality worldwide. To determine the appropriateness of the prescriptions and various trends in treatment, so as to provide the basis for modification in the future drug usage in accordance with risk factors and clinical presentations and also assess the improvement of health-related quality of life of patients with coronary artery disease.&#x0D; Methods: A prospective, observational and cross-sectional study was conducted in Department of Pharmacology in collaboration with Department of Medicine of tertiary healthcare hospital. As per inclusion criteria, patients visiting Medicine Outpatient department (OPD) from November 2021 to January 2022 were enrolled in the study.&#x0D; Results: Total 360 prescriptions were analysed, most of them belonged to the age group of 61-75 years. The prevalence was higher in Females (54%) than males (46%). An average number of drugs per prescription was 4.5. All the drugs were prescribed by generic names. 90.63% drugs prescribed were included in World Health Organization (WHO) essential drugs list 2021. 98.40% drugs prescribed were included in National list of essential medicines (NLEM) 2015. Antiplatelets (99.44%) were the most commonly prescribed category of drugs, followed by hyperlipidaemic (96.67%).&#x0D; Conclusion: The overall analysis of prescription pattern suggests that most of the drugs were prescribed rationally according to current American College of Cardiology Federation/American Heart Association (ACC/ AHA) guidelines. The incidence of polypharmacy was in the normal limits as per WHO recommendation. Generic drugs were prescribed majorly, which promotes awareness amongst prescribers, supporting WHO policies.

Impact of the WHO Integrated Stewardship Policy on the Control of Methicillin-Resistant Staphyloccus aureus and Third-Generation Cephalosporin-Resistant Escherichia coli: Using a Mathematical Modeling Approach.

Methicillin-resistant Staphylococcus aureus (MRSA) and third-generation cephalosporin-resistant Escherichia coli (3GCREc) are community and hospital-associated pathogens causing serious infections among populations by infiltrating into hospitals and surrounding environment. These main multi-drug resistant or antimicrobial resistance (AMR) bacterial pathogens are threats to human health if not properly tackled and controlled. Tackling antimicrobial resistance (AMR) is one of the issues for the World Health Organization (WHO) to design a comprehensive set of interventions which also helps to achieve the end results of the developing indicators proposed by the same organization. A deterministic mathematical model is developed and studied to investigate the impact of the WHO policy on integrated antimicrobial stewardship activities to use effective protection measures to control the spread of AMR diseases such as MRSA and 3GCREc in hospital settings by incorporating the contribution of the healthcare workers in a hospital and the environment in the transmission dynamics of the diseases. The model also takes into account the parameters describing various intervention measures and is used to quantify their contribution in containing the diseases. The impact of combinations of various possible control measures on the overall dynamics of the disease under study is investigated. The model analysis suggests that the contribution of the interventions: screening and isolating the newly admitted patients, improving the hygiene in hospital settings, decolonizing the pathogen carriers, and increasing the frequency of disinfecting the hospital environment are effective tools to contain the disease from invading the population. The study revealed that without any intervention, the diseases will continue to be a major cause of morbidity and mortality in the affected communities. In addition, the study indicates that a coordinated implementation of the integrated control measures suggested by WHO is more effective in curtailing the spread of the diseases than piecemeal strategies. Numerical experiments are provided to support the theoretical analysis.

Comparison of 8 weeks standard treatment (rifampicin plus clarithromycin) vs. 4 weeks standard plus amoxicillin/clavulanate treatment [RC8 vs. RCA4] to shorten Buruli ulcer disease therapy (the BLMs4BU trial): study protocol for a randomized controlled multi-centre trial in Benin

BackgroundBuruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans that affects skin, soft tissues, and bones, causing long-term morbidity, stigma, and disability. The recommended treatment for BU requires 8 weeks of daily rifampicin and clarithromycin together with wound care, physiotherapy, and sometimes tissue grafting and surgery. Recovery can take up to 1 year, and it may pose an unbearable financial burden to the household.Recent in vitro studies demonstrated that beta-lactams combined with rifampicin and clarithromycin are synergistic against M. ulcerans. Consequently, inclusion of amoxicillin/clavulanate in a triple oral therapy may potentially improve and shorten the healing process.The BLMs4BU trial aims to assess whether co-administration of amoxicillin/clavulanate with rifampicin and clarithromycin could reduce BU treatment from 8 to 4 weeks.MethodsWe propose a randomized, controlled, open-label, parallel-group, non-inferiority phase II, multi-centre trial in Benin with participants stratified according to BU category lesions and randomized to two oral regimens: (i) Standard: rifampicin plus clarithromycin therapy for 8 weeks; and (ii) Investigational: standard plus amoxicillin/clavulanate for 4 weeks. The primary efficacy outcome will be lesion healing without recurrence and without excision surgery 12 months after start of treatment (i.e. cure rate). Seventy clinically diagnosed BU patients will be recruited per arm. Patients will be followed up over 12 months and managed according to standard clinical care procedures. Decision for excision surgery will be delayed to 14 weeks after start of treatment. Two sub-studies will also be performed: a pharmacokinetic and a microbiology study.DiscussionIf successful, this study will create a new paradigm for BU treatment, which could inform World Health Organization policy and practice. A shortened, highly effective, all-oral regimen will improve care of BU patients and will lead to a decrease in hospitalization-related expenses and indirect and social costs and improve treatment adherence. This trial may also provide information on treatment shortening strategies for other mycobacterial infections (tuberculosis, leprosy, or non-tuberculous mycobacteria infections).Trial registrationClinicalTrials.gov NCT05169554. Registered on 27 December 2021.

Development Practices in Senior Nursing and Midwifery Leadership: Pathways to Improvement in South Pacific Health Policy.

The Pacific Islands countries consist of thousands of isolated islands with a combined population of over 10 million people. It is a heterogeneous and diverse region culturally, linguistically economically and politically. Health challenges are considerable and healthcare systems are often overstretched. Framed in the context of the World Health Organisation's strategic directions and policy priorities, this paper describes an account of collaboration across these countries to develop leadership skills in the nursing and midwifery professions. It outlines lessons for nursing leadership, healthcare policy development and the valuable role of Government Chief Nursing and Midwifery Officers. The South Pacific Chief Nursing and Midwifery Officers Alliance (SPCNMOA) is a cooperative partnership, which was formed to improve the quality of healthcare in the region. It acts as an enabler to promote leadership skills and provide a safe space for learning, developing policy and the sharing of good practice. Through mentorship programs, international meetings and strong relationship-building, the SPCNMOA has strengthened partnerships within the region and improved community health services in even the most remote areas. By strengthening leadership and collaboration, these health professionals are now recognised by key policy makers as knowledgeable experts who have a legitimate role in guiding policy development, changing practice and delivering health policy improvements at local, country and international levels.

How are global health policies transferred to sub-Saharan Africa countries? A systematic critical review of literature

BackgroundMost sub-Saharan Africa countries adopt global health policies. However, mechanisms with which policy transfers occur have largely been studied amongst developed countries and much less in low- and middle- income countries. The current review sought to contribute to literature in this area by exploring how health policy agendas have been transferred from global to national level in sub-Saharan Africa. This is particularly important in the Sustainable Development Goals (SDGs) era as there are many policy prepositions by global actors to be transferred to national level for example the World Health Organization (WHO) policy principles of health financing reforms that advance Universal Health Coverage (UHC).MethodsWe conducted a critical review of literature following Arksey and O’Malley framework for conducting reviews. We searched EBSCOhost, ProQuest, PubMed, Scopus, Web of Science and Google scholar for articles. We combined the concepts and synonyms of “policy transfer” with those of “sub-Saharan Africa” using Boolean operators in searching databases. Data were analyzed thematically, and results presented narratively.ResultsNine articles satisfied our eligibility criteria. The predominant policy transfer mechanism in the health sector in sub-Saharan Africa is voluntarism. There are cases of coercion, however, even in the face of coercion, there is usually some level of negotiation. Agency, context and nature of the issue are key influencers in policy transfers. The transfer is likely to be smooth if it is mainly technical and changes are within the confines of a given disease programmatic area. Policies with potential implications on bureaucratic and political status quo are more challenging to transfer.ConclusionPolicy transfer, irrespective of the mechanism, requires local alignment and appreciation of context by the principal agents, availability of financial resources, a coordination platform and good working relations amongst stakeholders. Potential effects of the policy on the bureaucratic structure and political status are also important during the policy transfer process.

Community views on mass drug administration for filariasis: a qualitative evidence synthesis.

The World Health Organization (WHO) recommends mass drug administration (MDA), giving a drug at regular intervals to a whole population, as part of the strategy for several disease control programmes in low- and middle-income countries. MDA is currently WHO policy for areas endemic with lymphatic filariasis, which is a parasitic disease that can result in swollen limbs and disability. The success depends on communities adhering to the drugs given, and this will be influenced by the perception of the drug, the programme, and those delivering it. OBJECTIVES: To synthesize qualitative research evidence about community experience with, and understanding and perception of, MDA programmes for lymphatic filariasis. To explore whether programme design and delivery influence the community experience identified in the analysis. We searched CENTRAL, MEDLINE, Embase, and seven other databases up to 8 April 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies. This reviewsynthesized qualitative research and mixed-methods studies when it was possible to extract qualitative data. Eligible studies explored community experiences, perceptions, or attitudes towards MDA programmes for lymphatic filariasis in any country, conducted between 2000 and 2019. DATA COLLECTION AND ANALYSIS: We extracted data on study design including: authors, aims, participants, methods, and qualitative data collection methods. We also described programme delivery factors including: country, urban or rural setting, endemicity, drug regimen, rounds of MDA received at the time of the study, who delivered the drugs, how the drugs were delivered, use of health education, and sensitization and adherence monitoring. We conducted a thematic analysis and developed codes inductively using ATLAS.ti software. We examined codes for underlying ideas, connections, and interpretations and, from this, generated analytical themes. Weassessed the confidence in the findings using the GRADE-CERQual approach, and produced a conceptual model to display our findings. MAIN RESULTS: From 902results identified in the search, 29 studies met our inclusion criteria. The studies covered a broad range of countries in Africa, South-East Asia, and South America, and explored the views and experiences of community members and community drug distributors in low-income countries endemic for lymphatic filariasis. Four themes emerged. People weigh up benefits and harms before participating. People understand the potential benefits in terms of relief of suffering, stigma, and avoiding costs (high confidence); however, these theoretical benefits do not always mesh with their experiences (high confidence). In particular, adverse effects are frightening and unwelcome (high confidence); and these effects are amplified through rumour and social media (moderate confidence). Many people are suspicious of MDA programmes. When people lack a scientific explanation for the programme and their experiences of it, they often develop social explanations instead. These are largely shaped on the historical backdrop and level of trust people have in relevant authority figures (high confidence), although some have unwavering faith in their government and, by extension, the programme (moderate confidence). Programmes expect compliance, and this can become coercive and blaming. Health workers and community members stigmatize non-compliance, which can become coercive (moderate confidence), so communities may appear to comply publicly, but privately reject treatment (moderate confidence). Community distributors are often not respected or valued. They have little authority (moderate confidence), and the behaviour of some distributors damages the MDA programme's reputation (high confidence). Communities want information about programmes to help make decisions about participation, but drug distributors are not sufficiently informed, or skilled in this communication (high confidence). We intended to assess whether programme designs influenced communities' perceptions of the programme and decision to adhere but were unable to do so as few studies adequately reported the design and implementation of the local programme. We have moderate to high confidence in theevidencecontributing to the review themes and subthemes. Adherence with MDA for filariasis is influenced by individual direct experience of benefit and harm; social influences in the community; political influences and their relationship to government; and historical influences. Fear of adverse effects was frequently described and this appears to be particularly important for communities. When views were negative, we were surprised by the strength of feeling expressed. Enthusiasm for these schemes as a strategy in global policy needs debate in the light of these findings.

Policy Instruments for Health Promotion: A Comparison of WHO Policy Guidance for Tobacco, Alcohol, Nutrition and Physical Activity.

Policy is an important element of influencing individual health-related behaviours associated to major risk factors for non-communicable diseases (NCDs) such as smoking, alcohol consumption, unhealthy eating and physical inactivity. However, our understanding of the specific measures recommended in NCD prevention policy-making remains limited. This study analysed recent World Health Organization (WHO) documents to identify common policy instruments suggested for national NCD prevention policy and to assess similarities and differences between policies targeting different health-related behaviours. Evert Vedung's typology of policy instruments, which differentiates between regulatory, economic/ fiscal and soft instruments, served as a basis for this analysis. A systematic search on WHO websites was conducted to identify documents relating to tobacco, alcohol, nutrition and physical activity. The staff of the respective units at the WHO Regional Office for Europe conducted an expert validation of these documents. The resulting documents were systematically searched for policy instruments. A word frequency analysis was conducted to estimate the use of individual instruments in the different policy fields, followed by an additional in-depth coding and content analysis by two independent reviewers. Across all health-related behaviours, the following policy instruments were suggested most frequently in WHO guidance documents: laws, regulations, standards, taxes, prices, campaigns, recommendations, partnerships and coordination. The analysis showed that regulatory and economic/fiscal policy instruments are mainly applied in tobacco and alcohol policy, while soft instruments dominate in the fields of nutrition and especially physical activity. The study confirms perceived differences regarding recommended policy instruments in the different policy fields and supports arguments that "harder" instruments still appear to be underutilized in nutrition and physical activity. However, more comprehensive research is needed, especially with respect to actual instrument use and effectiveness in national-level NCD prevention policy.

What You Don't Know About the Codex Can Hurt You: How Trade Policy Trumps Global Health Governance in Infant and Young Child Nutrition.

Background: International food standards set by the Codex Alimentarius Commission (CAC), have become more prominent in international trade politics, since being referenced by various World Trade Organization (WTO) agreements. We examine how this impacts implementation of the World Health Organization (WHO) International Code of Marketing of Breast-milk Substitutes. Methods: Using trade in commercial milk formulas (CMFs) as a case study, we collected detailed data on interventions across various WTO bodies between 1995 and 2019. We used language from these interventions to guide data collection on member state and observer positions during the CAC review of the Codex Standard for Follow-up Formula (CSFUF), and during CAC discussions on the relevance of WHO policies and guidelines. Results: Exporting member states made 245 interventions regarding CMFs at the WTO, many citing deviations from standards set by the CAC. These did not occur in formal disputes, but in WTO Committee and Accession processes, toward many countries. In Thailand, complaints are linked to weakened regulation. Exporters also sought to narrow the CSFUF at the CAC in a way that is at odds with recommendations in the International Code. Tensions are growing more broadly within the CAC regarding relevance of WHO recommendations. Countries coordinated during WTO committee processes to advocate for reapportioning core WHO funding to the CAC and in order to further influence standard-setting. Conclusion: The commercial interests of the baby food industry are magnifying inconsistencies between health guidelines set by the WHO, standard-setting at the CAC, and functions of the WTO. This poses serious concerns for countries’ abilities to regulate in the interests of public health, in this case to protect breastfeeding and its benefits for the health of infants, children and mothers.

Politics of Covid-19: A Study of the Role of the Global Powers in Combatting the Pandemic

The Covid-19 pandemic, having convincingly proved its deadliness, has become the most significant global calamity experienced to date in the 21st century. The Covid-19 virus outbreak besides affecting the health of people across the world seriously has also badly disrupted the economies of all countries, and the livelihoods of their citizens. The most recent data from the United Nations Industrial Development Organization (UNIDO) has indicated that most of the lower to upper-middle-income countries have been significantly impacted by the rampaging COVID-19 pandemic. This has prompted a concerted effort by the World Health Organization (WHO) and the major world powers to combat the spread of the Covid-19 global pandemic. In combating this pandemic, the world powers have a responsibility to collaborate with the WHO, as they wield a lot of power in the decision-making process at a global level. The aim of this study is to examine the international cooperation that has been taken forward to combat the ‘Covid-19’ pandemic in the context of management of major calamities by the global powers. The study focuses on the 18-month period from December 2019 when the pandemic first broke out, to June 2021. The study is based entirely on secondary data collected from the reports and documents of involved organizations and the media. The leaders and people of the USA and some Western countries did not provide adequate support to contain the outbreak of the Covid-19 pandemic in the early stages. They used the disparaging term ‘Chinese Virus’ to refer to the deadly virus, which President Trump wholly underestimated and treated as a minor irritant. Further, avoidable mass gatherings contributed to repeated outbreaks of the virus, which spread from country to country. Mass rallies were held protesting the lockdowns by raising the issues of liberal democracy and individual freedom. Although several high-income Western countries developed vaccines to arrest the pandemic, the distribution of vaccines was not done in a fair and equitable manner. The WHO policy on the distribution of vaccines was undermined due to the “Vaccine Politics” of the world powers. The other aspect of Covid-19 politics was that the pandemic had given rise to a ‘cold war’ between the major Western powers and the burgeoning Chinese power and influence at the global level. Finally, it must be understood that the global cooperation required to combat the Covid-19 pandemic was badly hampered due to the politicization of the programs planned for this purpose during the first year of the pandemic.