World Health Report Research Articles

Coexistence of Iron Deficiency Anaemia (IDA) and Beta Thalassaemia Trait (B-TT)

Background: The WHO estimates that about 7% of the world population are thalassaemia trait and increasing number of cases are being detected. The world population of carrier of b thalassamia is reported to be more than 100 million. Bangladesh also lies in thalassaemic Belt. A conservative world health report estimates that 3% of our populations are carrier of b thalassaemia which means that there are 3-6 million of b thalassaemia are in Bangladesh. To manage thalassaemia and thalassaemia trait, our traditional concept is not to give iron or iron conaining food. But concomitant iron deficiency anaemia in thalassaemia trait patient may be fatal. Those patients should be evaluated by serum ferritin or by the iron profile and treatment should be supplemented with rational amount of iron. Methodology: This cross sectional observational study was carried out on 75 patients from 03 to 59 years of age of both sex of Beta Thalassaemia Trait, in the department of Medicine and Haematology of Dhaka Medical College Hospital (DMCH) and Bangabandhu Sheikh Mujib Medical University (BSMMU) from January, 2015 to December, 2015. The patients previously diagnosed as Beta Thalassaemia Trait was included in study population. Result: In this study out of 75 Beta Thalassaemia Trait patients, 21 had evidence of Iron Deficiency Anaemia (IDA) and 54 patiens had no evidence of IDA. Thus the frequency of coexistent Beta Thalassaemia Trait and IDA in this study is 28%. The mean Hb concentration was 9.66 gm/dL (±1.54) which is 8.48 gm/dL (±1.43) and 10.12 gm/dL(±1.34) in Beta Thalassaemia Trait with IDA patients and Beta Thalassaemia Trait without IDA patients respectively. So the Hb concentration is significantly lower in b-TT with IDA patients than those without IDA (p-value < 0.001). The mean of Hb A2 level was 4.87(%) (±0.54) which is 4.44(%) (±0.40) and 5.03(%) (±0.50) in Beta Thalassaemia Trait with IDA patients and Beta Thalassaemia Trait without IDA patients respectively. So the Hb A2 level is significantly lower in Beta Thalassaemia Trait with IDA patients than those without IDA (p-value < 0.001). Conclusion: From this study, it could be concluded that the frequency of IDA in Beta Thalassaemia Trait is about 28%. The degree of anaemia is more severe and the level of Hb A2 is much lower in Beta Thalassaemia Trait with IDA patients than Beta Thalassaemia Trait without IDA. J Dhaka Med Coll. 2022; 31(2) : 182-186

Assessment of Urban ASHA workers: Unveiling Urban Dynamics

Background: The World Health Report highlighted the critical role of human resources in health systems, especially noting the human resource crisis in low-income countries due to various challenges such as migration and illness of health workers. The study aims to assess the performance of urban ASHA workers in Meerut and identify factors affecting their performance. Specific objectives include evaluating the delivery of essential services by ASHA workers and understanding the various individual, occupational, and environmental factors that influence their effectiveness. Methodology: The study was conducted with 40 ASHAs from the urban areas of Meerut. Data was collected through interviews using pretested schedules and performance assessments based on structured scales. Beneficiaries were also interviewed to gauge service delivery effectiveness. Chi-square and Fisher exact tests were used to analyze data and understand the association between various factors and ASHA performance. Results & Conclusion: The results were categorized into performance grades based on the ASHAs' scores, showing a distribution among different performance levels. Factors such as age, education, training frequency, occupation, and timely receipt of incentives were found to significantly affect the performance of ASHA workers. The study revealed that younger, better-educated, and regularly trained ASHAs with timely incentives showed better performance.

Die Bevölkerungsperspektive in der Bewertung der Leistungsfähigkeit des deutschen Gesundheitssystems: Ergebnisse einer Querschnittsbefragung GKV-Versicherter

IntroductionSince the World Health Report in 2000, Health System Performance Assessment (HSPA) has been established as a tool for the evaluation and evidence-informed governance of health systems. So far, the population perspective has not been integrated into HSPA in a systematic manner, although people's experiences and expectations are of great importance to improve health systems and especially to strengthen patient-centered care. Therefore, this study aims to conduct an HSPA of Germany's health system from the population's perspective covering all eight goals of WHO’s Health Systems Framework, and to identify strengths and needs for improvement. MethodsIn 2018, 32,000 people insured with the German sickness fund ‘AOK Nordost’ were invited by mail to participate in the survey. The questionnaire contained a total of 43 items covering the eight goals of WHO's Health Systems Framework (e.g., access, quality, safety) plus socioeconomics and other characteristics of the insured persons. The data on the health system goals were analyzed descriptively and by subgroups (age, sex, income, chronic conditions, health literacy). ResultsThe sample (n=1,481; response rate 4.6%) was 54.8% female and had a mean age of 59.1 years (±18.5). Altogether, the participants saw several needs for improvement within the German health system. For instance, 60.0% found quality differences between hospitals to be big, and between 3.9% and 8.5% reported mistakes related to their treatment or prescription medication in the previous two years. A big need for reform was especially seen regarding out-of-pocket payments (51.5%) and the coordination of ambulatory care physicians among each other (44.2%) and with hospitals (41.9%). In addition, big subgroup differences were seen, especially for income and health literacy. Of the participants in the lower income group, 37.2% reported a (very) strong financial burden due to out-of-pocket payments (vs. 20.7%). People with limited health literacy (52.1%) assessed the access to care generally as not being good, and they perceived greater quality differences and needs for reform, compared to their counterparts. For instance, 36.6% had experienced discrimination in the previous year (vs. 19.9%). DiscussionThe survey results provide a comprehensive picture of Germany's health system from the population perspective. In some areas, previous findings were confirmed (e.g., a lack of coordination between providers). Other results expand existing knowledge (e.g., the role of health literacy in health care provision) or raise new questions (e.g., the difference between the subjectively assessed burden from out-of-pocket payments and the objective measures currently used). The great differences between subgroups are a call to action on the level of both politics and practice to better consider the individual's needs in order to make health better for everyone. Further research could provide deeper insights in this regard. ConclusionStrengthening the population perspective in HSPA allows for a better understanding and evaluation of health systems and, in particular, helps to identify areas for improvement in patient-centered care.

A Comparative Study Evaluated the Performance of Two-class Classification Algorithms in Machine Learning

Worldwide, heart attacks, also called myocardial infarctions, are a leading cause of death. Early detection and accurate prediction of heart attacks are crucial for effective medical intervention and patient care. In recent years, machine learning techniques have shown great promise in aiding the diagnosis and prediction of heart attacks. The Organization for World Health (WHO) reports that around 17 million individuals worldwide pass away from cardiovascular diseases (CVD), notably heart attacks and strokes, each year. In this study, 1026 patients, both men and women, are almost equally affected by CVDs. While heart attacks and strokes remain among the leading causes of mortality worldwide, the use of machine learning for predicting heart disease could potentially prevent premature deaths. A comparative study evaluated the performance of five well-known two-class classification algorithms: two-class boosted decision trees, two-class decision forests, two-class locally deep SVMs, two-class neural networks, and two-class logistic regression. Among these algorithms, the Two-Class Boosted Decision Tree method demonstrated outstanding prediction ability, achieving a 100% accuracy rating. Its exceptional recall and precision rates highlight its effectiveness in handling challenging classifications. To facilitate the development and deployment of machine learning models, Azure Machine Learning offers a range of tools and services. By leveraging Azure Machine Learning's capabilities, researchers and healthcare professionals can analyze large datasets containing patient information and medical records to identify patterns and risk factors associated with heart attacks.

Fruit and vegetable consumption across population segments: evidence from a national household survey

BackgroundThe 2002 World Health Report documented that low fruit and vegetable intake are among the top ten risk factors contributing to attributable mortality and up to three million lives could be saved each year by adequate consumption of F&V across the globe, leading an examination of behavioral preferences of the individual and family social, environmental, and behavioral factors that constitute perceived barriers to fruit and vegetable consumption.ObjectiveThe study examines factors affecting the choice of eating fruits and vegetables by household members and calculates eating frequency probabilities of different population-origin associated with personal attributes and behavior.MethodTurkish Health Survey (THS) 2019 data from the Turkish Statistical Institute (TSI) national representative household panel is applied. Estimating a random-effect bivariate probit model of fruit and vegetable choice, we calculated marginal probabilities of choosing fruits and vegetables, the joint probability of choosing both, and conditional probabilities between choosing to eat either, detecting consumption synergy.ResultsThe role of uncontrolled variables in choosing to eat fruits and vegetable (F&V) differs between the decision of an average family and the decision of individual family members. The attitude is positive for an average family and contrasts with the negative attitude among some family members. Most individual and family attributes inversely affect fruit and vegetable choice across different groups, while a positive relationship exists between the likelihood of fruit and vegetable choice and attributes such as age, marital status, education, weight, having health insurance, income, and time and forms of physical activity.Conclusion and recommendationInstead of a general policy for the implementation of a healthy and balanced nutrition program to improve fruit and vegetable eating frequency, it appears more effective to adopt programs with distinct characteristics that segregate society into different cohorts. We suggest appropriate policies and offer suitable approaches to reach targeted groups.

A Survey Report to Identify the Risk of Hypertension Among Adults Who Are Residing at Pathanpura, Meerut, U.P

Abstract: Blood pressure is the force of blood pushing against the walls of arteries as the heart pumps blood. When a health care professional measures your blood pressure, they use a blood pressure cuff around your arm that gradually tightens. The results are given in two numbers. The first number, called systolic blood pressure, is the pressure caused by your heart contracting and pushing out blood. The second number, called diastolic blood pressure, is the pressure when your heart relaxes and fills with blood. A blood pressure reading is given as the systolic blood pressure number over the diastolic blood pressure number. Blood pressure levels are classified based on those two numbers. Hypertension is an important public health problem worldwide. Analysis of the global burden of hypertension revealed that over 25% of the world's adult population had hypertension in 2000, and the proportion is expected to increase to 29% by 2025.According to the World Health Report 2002, cardiovascular disease accounted for 9.2% of total deaths in the African region in 2001 , and hypertension remains the mostimportant risk factor with national prevalence levels ranging from 25% to 35% in adults aged 25–64 years . Growing evidence suggests that high blood pressure constitutes the basis for the CVD epidemic in sub-Saharan Africa .

Governance for Health: A Critical, but Poorly Understood, Health System Component

The paper by Bernal-Sundiang et al.1 in this issue of Acta Medica Philippina provides one of the more extensive and in-depth empirical discussion of governance in the health sector. Utilizing data collected over a one-year period as part of the Philippine Primary Care Studies in urban, rural, and remote settings, the authors reported on challenges their team encountered in project implementation as it relates to leadership and governance. One strength of the paper is that it situates leadership and governance as a health system keystone that links to all the other components of infrastructure and supply chains, information system, health workforce, financing, and stakeholder engagement, and monitoring and evaluation. This harks back to the framework posited in the World Health Report 20002, highlighting the interaction between governance and the other system elements.Despite this critical role of governance, however, it has been characterized as being poorly understood, and often difficult to operationalize, not least because of poor capacities of different institutions and actors to bring to the fore the good governance agenda.3 For instance, it has been suggested that good governance, regardless of the sector, is “accountable, transparent, responsive, equitable and inclusive, effective and efficient, participatory, consensus-oriented and follows the rule of law.”4This characterization assumes the existence of traditions and institutions that places the common good front and center, something which may not be present, if not willfully disregarded, in many jurisdictions. Another set of related buzzwords for governance is that it entails a “whole-of-government” and “whole-of-society” approaches, which means the mobilization of public agencies,on the one hand, and private sector and civil society organizations, on the other, towards the realization of shared goals.5 Aside from the need for conceptual and operational clarity on these two terms, the reality of token participation and siloed working environments remain barriers to achieving true multisectoral approaches in health and other areas.Relatedly, I wish to bring to the discussion one insight from our case study of tuberculosis program implementation.6 In this research, we identified facilitating and hindering factors to the successful implementation of the tuberculosis prevention and control program in cities and municipalities, and we posited that these factors were rooted in a common source of governance for health. We further extended the argument by stating that focusing on the local chief executive as the responsible entityfor good governance is a myopic view of the issue as it only covers the levels that can be labelled as “broader governance environment” and “public policies.”7 The more fine-grained institutional or sectoral governance is within the ambit of the local health officer, while what we propose to refer to as “program-level” governance is the realm of the program coordinator. The scope and specificity of governance as exercised across these levels, and consequent access to precise information, differ, which highlights the shared responsibility of these three principal actors at the local level in so far as exercise of good governance is concerned.Good governance in health has been an aspirational goal for many decades, and was identified as an important constituent in our quest for better health and sustainable development. The recommendations outlined by Bernal-Sundiang et al.1 provide a starting point on how we can gradually improve the health sector to come closer to this ambition. However, embedding good governance in institutions and society at large will be critical in sustaining such gains moving forward.
 Carl Abelardo T. Antonio, MD, MPHDepartment of Health Policy and AdministrationCollege of Public HealthUniversity of the Philippines Manila
 
 REFERENCES
 1. Bernal-Sundiang N, De Mesa RYH, Marfori JRA, Fabian NMC,Calderon YT, Dans LF, et al. Governance in primary care systems:Experiences and lessons from urban, rural, and remote settings inthe Philippines. Acta Med Philipp. 2023;57(3):5-16. doi: 10.47895/amp.vi0.48342. World Health Organization. The world health report 2000. Healthsystems: Improving performance [Internet]. Geneva: World HealthOrganization. 2020 Jun 14 [cited 2022 Nov 2]. Available from:https://www.who.int/publications/i/item/924156198X3. Brinkerhoff DW, Bossert TJ. Health governance: principal-agentlinkages and health system strengthening. Health Policy Plan. 2014Sep;29(6):685-93. doi: 10.1093/heapol/czs132.4. Kickbusch I, Gleicher D. Governance for health in the 21st century[Internet]. Copenhagen: WHO Regional Office for Europe. 2012[cited 2022 Nov 2]. Available from: https://www.euro.who.int/__data/assets/pdf_file/0019/171334/RC62BD01-Governance-for-HealthWeb.pdf5. Ortenzi F, Marten R, Valentine NB, Kwamie A, Rasanathan K.Whole of government and whole of society approaches: call forfurther research to improve population health and health equity.BMJ Glob Health. 2022 Jul;7(7):e009972. doi: 10.1136/bmjgh2022-009972.6. Antonio CAT, Guevarra JP, Medina PVN, Roxas EA, Cavinta LL,Manalo JA, et al. Facilitators and barriers to the implementationof selected local tuberculosis control programs in the Province ofLaguna, Philippines. Philipp J Sci. 2021 Dec;150(6A):1501-1506.7. Fryatt R, Bennett S, Soucat A. Health sector governance: shouldwe be investing more? BMJ Glob Health. 2017 Jul;2(2):e000343.doi: 10.1136/bmjgh-2017-000343.

An assessment of the performance of the national health research system in Mauritius

BackgroundThe goal of universal health coverage (UHC) is that every individual has access to high-quality health services without running the consequences of financial hardship. The World health report 2013 "Research for universal health coverage" states a performant National Health Research Systems (NHRS) can contribute by providing solutions to challenges encountered in advancing towards UHC by 2030. Pang et al. define a NHRS as the people, institutions, and activities whose primary aim is to generate and promote utilization of high-quality knowledge that can be used to promote, restore, and/or maintain the health status of populations. The WHO Regional Committee for Africa (RC) adopted a resolution in 2015 urging member states to strengthen their NHRS to facilitate production and utilization of evidence in policy development, planning, product development, innovation, and decision-making. This study aimed to calculate NHRS barometer scores for Mauritius in 2020, identify the gaps in NHRS performance, and recommend interventions for boosting the Mauritius NHRS in the pursuit of UHC.MethodsThe study used a cross-sectional survey design. A semi-structured NHRS questionnaire was administered and complemented with a review of documents archived in pertinent Mauritius Government Ministries, universities, research-oriented departments, and non-governmental organizations websites. The African NHRS barometer developed in 2016 for countries to monitor the RC resolution implementation was applied. The barometer consists of four NHRS functions (leadership and governance, developing and sustaining resources, producing and utilizing research, financing research for health [R4H]), and 17 sub-functions, e.g., existence of a national policy on research for health (R4H), presence of a Mauritius Research and Innovation Council (MRIC), existence of knowledge translation platform.ResultsIn 2020, Mauritius had an overall average NHRS barometer score of 60.84%. The four NHRS functions average indices were 50.0% for leadership and governance, 77.0% for developing and sustaining resources, 52.0% for producing and utilizing R4H, and 58.2% for financing R4H.ConclusionThe performance of NHRS could be improved through the development of a national R4H policy, strategic plan, prioritized agenda, and national multi-stakeholder health research management forum. Furthermore, increased funding for the NHRS may nurture the human resources for health research capacities, hence the number of pertinent publications and health innovations.

Capacity-building and continuing professional development in healthcare and rehabilitation in low- and middle-income countries—a scoping review protocol

BackgroundA recent world health report suggests that there is a growing rehabilitation human resource crisis. This review focuses on the capacity-building needed to meet present and future rehabilitation challenges in low- and middle-income countries (LMICs). Capacity-building is the process by which individuals and organizations obtain, improve, and retain the skills, knowledge, tools, equipment, and other resources needed to do their jobs competently. The objectives of this review are (1) to determine how capacity-building has been defined, implemented, and evaluated in LMICs and (2) to provide an overview of the effectiveness of capacity-building initiatives.MethodsIn the first of seven stages, we will refine and delimit the research. Then, we will identify relevant studies by searching five biomedical databases, two rehabilitation databases, three regional databases, and three databases of gray literature. Two independent reviewers will then select the studies using a priori selection criteria. We will exclude incomplete records, records published prior to 2000 for databases and 2010 for gray literature, and records written in languages other than English or Spanish. We will also exclude records focusing on entry-to-practice programs in academic settings. For Objective 1, using qualitative analysis software, we will extract and analyze text from included records that define or explains capacity building. For Objective 2, using an online file-sharing platform, one reviewer will extract data describing the effectiveness of capacity-building interventions and a second reviewer will verify the accuracy, with disagreements resolved by consensus. The results will be collated using tables and charts. After synthesizing the results, we will discuss the practicality and applicability of the findings with partners from Honduras and Colombia. We will use several formats and venues including presentations and publications in English and Spanish to present our results.DiscussionTo our knowledge, this will be the first attempt to systematically identify knowledge of capacity-building and rehabilitation in LMICs. This scoping review results will offer unique insights concerning the breadth and depth of literature in the area. It is anticipated that results from this scoping review will guide efforts in future capacity-building efforts in rehabilitation in LMICs.Review registrationBusch AJ, Deprez D, Bidonde J, Ramírez PA, Araque EP. Capacity building and continuing professional development in healthcare and rehabilitation in low- and middle-income countries—a scoping review. 2021. https://doi.org/10.17605/OSF.IO/7VGXU.

An Evolving HIV Epidemic in the Middle East and North Africa (MENA) Region: A Scoping Review

Human immunodeficiency virus (HIV) in the Middle East and North Africa (MENA) region is severely understudied despite the region's increase in new HIV infections since 2010. A key population that is particularly affected, due to the lack of adequate knowledge and proper interventional implementation, includes people who inject drugs (PWID). Furthermore, the paucity of HIV data (prevalence and trends) worsens an already critical situation in this region. A scoping review was conducted to address the scarcity of information and to synthesize the available data on HIV prevalence rates within the key population of PWID throughout the MENA region. Information was sourced from major public health databases and world health reports. Of the 1864 articles screened, 40 studies discussed the various factors contributing to the under-reporting of HIV data in the MENA region among PWID. High and overlapping risk behaviors were cited as the most prevalent reason why HIV trends were incomprehensible and hard to characterize among PWID, followed by lack of service utilization, lack of intervention-based programs, cultural norms, lack of advanced HIV surveillance systems, and protracted humanitarian emergencies. Overall, the lack of reported information limits any adequate response to the growing and unknown HIV trends throughout the region.

Show me the money: how do we justify spending health care dollars on digital health?

Show me the money: how do we justify spending health care dollars on digital health?

4.J. Workshop: Health system performance assessment in Europe – recent developments, evidence, and challenges

Abstract Assessing the performance of health systems is essential to initiate policy processes that further strengthen health systems to improve population health. Starting with WHO's World Health Report of 2000, Health System Performance Assessments (HSPA) gained increasing attention in research and policy. By now, several comparative HSPA initiatives of international organisations (e.g., OECD's Health at a Glance) and country specific HSPA (e.g., Sweden, Netherlands, Austria, Belgium) were implemented in Europe. Further countries are currently in the process of developing or piloting an HSPA (e.g., Germany). The objective of the workshop is to foster and strengthen the interchange of different HSPA initiatives in Europe and beyond. While each health system has its specifics, initiatives likely face similar challenges in the implementation and ongoing development, which holds a lot of potential for learning from each other. The workshop is supposed to be a platform for the exchange of and about HSPA initiatives and related topics by bringing together stakeholders of different countries and professions. Participants are supposed to gain new insights into recent activities in Europe and will be able to discuss challenges and lessons learned. The presentations give insights into recent activities of selected HSPA initiatives in Europe. One presentation originates from the Belgian HSPA which is well established. This presentation will focus on the transversal dimension of equity, on which a separate report was recently published. The second presentation is about the German HSPA which is still in development and currently tested in a pilot study. Both presentations represent HSPA initiatives at different stages, which provides a good basis for the following panel and discussion with all workshop participants. The two presentations of about 20 minutes each will be combined with a panel discussion. Afterwards, there will be room for exchange and discussions between all participants and presenters. Key messages • Recent developments of HSPA initiatives in Europe will be presented along two examples from Belgium and Germany and lessons learned and challenges will be discussed. • The workshop provides a platform for the exchange of and about HSPA initiatives and related topics by bringing together stakeholders of different countries and professions.

Catastrophic Expenditure for Health in the Philippines

Catastrophic Expenditure for Health in the Philippines

The Continuing Challenge of Maldistribution of Human Resources for Health

The Continuing Challenge of Maldistribution of Human Resources for Health

The Role of Scleraxis in Inducing Vascular Stiffness

Vascular fibrosis (VF) is one of the most significant pathologies related to blood vessel dysfunction. VF results in an impairment of vascular tone due to an increase in extracellular matrix proteins (ECM) and vascular smooth muscle synthesis within the vessel wall, thus increasing vascular stiffness and reducing lumen diameter. VF is both caused by and exacerbates numerous vascular diseases including diabetes, atherosclerosis and in particular, hypertension, which accounts for 13% of deaths globally (WHO World Health Report, 2002). Multiple studies have investigated various therapeutic approaches to interfere with VF, but to date this condition remains untreated, thus novel approaches to target fibrosis development and progression are urgently required.Our lab identified the transcription factor scleraxis as a novel master regulator of cellular phenotype conversion. We demonstrated that scleraxis is sufficient to induce fibroblast to myofibroblast phenotype conversion, a critical step in the development of fibrosis in many tissue types. Scleraxis also induces Epithelial to Mesenchymal Transition (EMT) and cell migration as part of development and cell differentiation. Some studies have shown that mechanical stretch in tendons increases expression of scleraxis, while additional studies reported that stretch in rabbit aorta induces the vascular smooth muscle proliferative phenotype. Our preliminary data has revealed that scleraxis is expressed in VSMCs in the arterial wall, and we have found elevated scleraxis expression in high pressure versus low pressure regions of vessels. We thus hypothesize that scleraxis is sufficient and necessary to induce vascular fibrosis.Our data shows that scleraxis overexpression increases thickness of the aortic vascular wall in scleraxis overexpression mice, via histological sections, thus contributing to the progression of vascular fibrosis. In vitro studies show that scleraxis overexpression in Human Aortic Smooth Muscle Cells (HAOSMC) induces their proliferation and migration using different assays (CCk8/Edu+ proliferation assay, Transwell migration assay, gene expression assays). Scleraxis overexpression also induces hypertrophy of HAOSMC shown via immunostaining. This suggests that scleraxis overexpression induces VSMC plasticity from contractile to synthetic‐proliferative phenotype, thus inducing VSMC hyperplasia.New & Noteworthy: Our findings indicate that scleraxis plays a role in VSMC plasticity via scleraxis‐ mediated transcriptional regulation of VSMC proliferation and migration. This work has potential relevance to many related diseases that feature VSMC activation, including atherosclerosis and restenosis.

Monitoring non-communicable diseases risk factors in national adult health surveys – a review of international experience

Introduction. Monitoring is an important tool for managing the epidemic of noncommunicable diseases. The insufficiency of the measures taken to create and strengthen national systems of epidemiological surveillance for noncommunicable diseases is recognized. In this regard, the search and development of rapid and cost-effective approaches to monitoring risk factors for noncommunicable diseases continues. Objective. To explore an approach to developing a national monitoring system for risk factors for noncommunicable diseases based on population health surveys in some countries of the world. Materials and methods. A content analysis of the documents of the World Health Organization, open data, scientific publications, regulations and reports of countries (India, USA, European countries, including Belgium and Finland) on the study of public health and risk factors for non-communicable diseases was carried out. Results. The possibility of incorporating elements of a monitoring study into population health surveillance systems that already exist at the national level is an important advantage for developing approaches to monitoring risk factors for noncommunicable diseases. In this regard, the World Health Organization's STEPS stepwise approach to risk factor surveillance has evolved. National population health surveys that include risk factor monitoring can be divided into health surveys and health surveys. There are also separate national studies (surveys and surveys) that focus on several behavioral risks or individual risk factors. Some monitoring systems that measure progress towards global noncommunicable disease targets also additionally cover late issues and emerging risk factors. Discussion. The studied international experience of national systems of research on public health and epidemiological surveillance of noncommunicable diseases indicates trends towards standardization and unification of tools for monitoring risk factors for noncommunicable diseases.

Universal Health Coverage; A Way Forward

Universal health coverage means every person has access to quality health care without suffering financial hardships. The basis of universal health coverage lies in the primary health care concept, which was envisioned way back in 1978, as mentioned in Alma Ata Declaration1. The "World Health Report" published by the World Health Organization (WHO) in 2008 structures primary health care reforms in four groups. One of the crucial reforms was universal coverage reform to improve health equity2. WHO and UNICEF in 2018 documented how primary health care will be in the 21st century? The approach was towards universal health coverage and sustainable development goals. Sustainable development goals were to be achieved by 2030, and they were a continuation of millennium development goals 2000–20153. The resolution on Transforming our world: the 2030 Agenda for Sustainable Development adopted the target of universal health coverage by 2030, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all4. Currently, many developing nations do not have access to health services. About 100 million people are pushed into extreme poverty each year because of out-of-pocket spending on health. To make health for all, we need individuals and communities to have high-quality health services to take care of their families health. Skilled health workers providing quality, people-centred care and policy-makers should be committed to investing in universal health coverage. Universal health coverage should be based on intense, people-centred primary health care. Good health systems are rooted in the communities they serve. They focus not only on preventing and treating disease and illness but also on helping to improve well-being and quality of life5. Pakistan, the developing country, is struggling to provide good quality health services, mostly availed from the out-of-pocket expenditure.
 Both private and public sector hospitals were trying to deliver health services, but poor people failed to have access to many services due to poverty. To overcome this obstacle and address indicator 3.8 of SDGs, the current government developed a five-year program to improve the targeted population's health by increasing their access to quality health services. The initiative will also reduce poverty, as the government will cover most of their health budget through the "Sehat Sahulat Program". The program was part of the National vision to ensure Universal Health Coverage (UHC) for all Pakistani families. No one is denied quality healthcare services only because of financial constraints. Initially, it was piloted in selected four districts of Khyber Pakhtunkhwa, which was later extended to all over the province. Currently, 7.2 million families are getting free in-patient health care services, and the program's annual cost is 18 billion. It was a bold initiative of the current government, which helped improve access to UHC, thus addressing one of the sustainable development goals6,7.

Public financing for primary health care is the key to universal health coverage and strengthening health security

Public financing for primary health care is the key to universal health coverage and strengthening health security

Commitment and innovation on the road to people-centred PHC financing

Commitment and innovation on the road to people-centred PHC financing

A situational analysis of the mental health system of the West Region of Cameroon using the World Health Organization\u2019s assessment instrument for mental health systems (WHO-AIMS)

BackgroundThe publication of the World Health Report of 2001 by the World Health Organization (WHO) raised awareness of mental health worldwide. It reported a higher burden of mental illnesses in developing countries, with fewer resources to address the conditions. Since then, many initiatives have been taken in Cameroon to improve the mental health of the population, but these efforts lack local scientific evidence to support them. This study aims to describe the mental health services available in the West Region of Cameroon and to provide evidence-based support to this process.MethodWe used the World Health Organization Assessment Instrument for Mental Health systems (WHO-AIMS) version 2.2 to collect, analyze, and report the data on mental health services offered in 2020 in the West Region of Cameroon. We extracted our data from the registers of 10 mental health facilities of the region, and we interviewed the staff in these facilities and at the Ministry of Public Health.ResultsThe region is divided into 20 health districts, of which six offered mental health services. As a whole, Cameroon had a mental health policy, mental health plan, but no mental health legislation or emergency plan. There was no specific budget for mental health in the country. In the West Region there were not any psychiatrists. Mental health services were provided by nurses, psychologists, general practitioners, and neurologists. There were 1.87 human resources in mental health facilities per 100,000 population, of which 1.4 were nurses. 1 in 1.4 of these nurses worked in the main city. There was no formal link of mental health services with other sectors and no publication in the previous five years about mental health in the region referenced on PubMed.ConclusionIn 2020, the access to mental health services in the West Region of Cameroon was inequitable. The approach to mental health system development was not inclusive and not supported by enough scientific evidence.