Developing Standard Treatment Workflows-way to universal healthcare in India.

Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80-90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC.

Turning commitments into actions: perspectives on emergency preparedness in South-East Asia.

Emergency preparedness is a continuous process in which risk and vulnerability assessments, planning and implementation, funding, partnerships and political commitment at all levels must be sustained and acted upon. It relates to health systems strengthening, disaster risk reduction and operational readiness to respond to emergencies. Strategic interventions to strengthen the capacities of countries in the World Health Organization (WHO) South-East Asia Region for emergency preparedness and response began in 2005. Efforts accelerated from 2014 when emergency risk management was identified as one of the regional flagship priority programmes following the pragmatic approach "sustain, accelerate and innovate". Despite increased attention and some progress on risk management, the existing capacities to respond to health emergencies are inadequate in the face of prevailing and increasing threats posed by multiple hazards, including climate change and emerging and re-emerging diseases. The setting up of a "preparedness stream" under the South-East Asia Regional Health Emergency Fund in July 2016 was an important milestone. The endorsement of the Five-year regional strategic plan to strengthen public health preparedness and response - 2019-2023 by Member States was another step forward. Furthermore, ministerial-level commitment, in the form of the Delhi Declaration on Emergency Preparedness, adopted in September 2019 in the 72nd session of the WHO Regional Committee for South-East Asia, is in place to facilitate Member States to invest resources in the protection and safety of people and systems and in overall emergency risk management through national action plans for health security. It is essential now to turn these commitments into actions to strengthen emergency preparedness in countries of the region.

Strengthening risk communication systems for public health emergencies in the WHO South-East Asia Region.

Risk communication and community engagement are critical aspects of public health emergency preparedness and response and therefore one of the eight original core capacities of the International Health Regulations (2005). Joint external evaluations in eight out of eleven countries of the World Health Organization South-East Asia Region reveal that there is considerable variation in risk communication capacities among countries. Of the five areas evaluated - risk communication systems, internal and partner coordination, public communication, community engagement and listening, and risky behaviour and misinformation - the strongest areas, across the region, are partner coordination and community engagement, while risk communication systems is the weakest area and needs further strengthening. For strong and sustainable risk communication for public health emergencies in the WHO South East Asia Region, institutionalized capacity-building supported by increased budgetary allocations to this area is needed. There is a strong need for advocacy to and sensitization of key policy-makers and decision-makers at country level regarding the importance and advantages of being prepared on risk communication plans and systems.

Operationalization of One Health and tripartite collaboration in the Asia-Pacific region.

One Health refers to the collaborative efforts of multiple disciplines working locally, nationally and globally to attain optimal health for people, animals and our environment. The One Health approach is increasingly popular in the context of growing threats from emerging zoonoses, antimicrobial resistance and climate change. The Food and Agriculture Organization of the United Nations, World Organisation for Animal Health and World Health Organization have been working together in the wake of the avian influenza crisis in the Asia-Pacific region to provide strong leadership to endorse the One Health concept and promote interagency and intersectoral collaboration. The programme on highly pathogenic emerging diseases in Asia (2009-2014) led to the establishment of a regional tripartite coordination mechanism in the Asia-Pacific region to support collaboration between the animal and human health sectors. The remit of this mechanism has expanded to include other priority One Health challenges, such as antimicrobial resistance and food safety. The mechanism has helped to organize eight Asia-Pacific workshops on multisectoral collaboration for the prevention and control of zoonoses since 2010, facilitating advocacy and operationalization of One Health at regional and country levels. The tripartite group and international partners have developed several One Health tools, which are useful for operationalization of One Health at the country level. Member States are encouraged to develop a One Health strategic framework taking into account the country's context and priorities.

Strengthening emergency preparedness through the WHO emergency medical team mentorship and verification process: experience from Thailand.

The World Health Organization (WHO) emergency medical team (EMT) mentorship and verification process is an important mechanism for providing quality assurance for EMTs that are deployed internationally during medical emergencies. To be recommended for classification, an organization must demonstrate compliance with guiding principles and core standards for international EMTs and all technical standards for their declared type, in accordance with a set of globally agreed minimum standards. A rigorous peer review of a comprehensive documentary evidence package, combined with a 2-day verification site visit by WHO and independent experts, is conducted to assess an EMT's capacity. Key requirements include having sufficient systems, equipment and procedures in place to ensure an EMT can deploy rapidly, providing clinical care according to internationally accepted standards, being able to be fully self-sufficient for a period of 14 days and being able to fully integrate into the emergency response coordination structure and the health system of the country affected during deployment. Through the WHO mentorship programme, each EMT is provided with a mentor team, which guides and supports it during the preparatory process. The process typically takes around 1 to 2 years to complete. The Thailand EMT is the first team from the WHO South-East Asia Region to successfully complete the WHO mentorship and verification process. The experience of this process in Thailand can serve as an example for other countries in the South-East Asia Region and encourage them to strengthen their emergency preparedness and operational readiness by getting their national EMTs verified.

Building operational readiness for responding to emergencies in the WHO South-East Asia Region.

The World Health Organization (WHO) has an essential role to play in supporting Member States to prepare for, respond to and recover from emergencies with public health consequences. Operational readiness for known and unknown hazards and emergencies requires a risk-informed and structured approach to building capacities within organizations such as WHO offices and national ministries of health. Under the flagship priority programme on emergency risk management of the WHO Regional Office for South-East Asia, a readiness training programme consisting of four modules was implemented during 2017-2018, involving staff from WHO country offices as well as from the regional office. The experience of and lessons learnt from designing, developing and delivering this phased training programme have fed into improvements in the curriculum and training methodology. The training programme has also facilitated the development of business continuity plans and contingency plans in some of the 11 Member States of the region and has increased the readiness of WHO staff for swift deployment in recent emergencies. It is recommended that the strengthening of operational readiness for responding to emergencies in the region be sustained and accelerated through the development of a regional training consortium that can scale the training programme up at national level, taking into account country contexts, national health systems and the needs of populations. The resilience of the populations and health systems in the region will be increased if disaster risk reduction and emergency preparedness and response activities are supported by operational readiness.

Pandemic influenza preparedness in the WHO South-East Asia Region: a model for planning regional preparedness for other priority high-threat pathogens.

Pandemic influenza preparedness has contributed significantly to building, strengthening and maintaining countries' core capacities to prepare for health emergencies. The Pandemic influenza preparedness framework for the sharing of influenza viruses and access to vaccines and other benefits (the PIP framework) was adopted by the World Health Assembly in 2011. The experiences and lessons learnt from the implementation of the PIP framework have provided insights that can be used to strengthen preparedness for epidemics of other priority high-threat pathogens in the World Health Organization (WHO) South-East Asia Region in line with obligations under the International Health Regulations, 2005 (IHR). Implementation has established policies, strategies, action plans, strengthened systems and operational readiness to promptly diagnose influenza virus strains with pandemic potential and ensure timely event notifications and management in compliance with the IHR. WHO collaborating centres and the annual bi-regional meeting of national influenza centres and influenza surveillance have strengthened the influenza laboratory diagnostic knowledge network in the region. After action reviews following influenza outbreaks have documented best practices, strengths, constraints and areas for improvement in pandemic preparedness. The pandemic in 2009 and recent seasonal influenza outbreaks have offered real-life scenarios for testing national pandemic influenza preparedness plans and deploying vaccines. The successful implementation of the PIP framework, along with strengthening of health systems and operational procedures and continued technical collaboration with global centres of excellence, should be tapped into to strengthen preparedness to respond to epidemics of other high-threat pathogens based on the influenza model. The political commitment reflected in the Delhi Declaration on Emergency Preparedness, signed by all ministers of health in September 2019 and supported by the Five-year regional strategic plan to strengthen public health preparedness and response - 2019-2023, should be a catalyst for guidance and support in developing a broad, long-term strategic plan for preparedness and response to high-threat pathogens in the region.

Assessment of drought resilience of hospitals in Sri Lanka: a cross-sectional survey.

Background: Drought is an extreme weather event. Drought-related health effects can increase demands on hospitals while restricting their functional capacity. In July 2017, Sri Lanka had been experiencing prolonged drought for around a year and data on the resilience of hospitals were required. Methods: A cross-sectional survey was done in five of the most drought-affected and vulnerable districts using two specially developed questionnaires. Ninety hospitals were assessed using the Baseline Hospital Drought Resilience Assessment (BHDRA) tool, of which 24 purposefully selected hospitals were also assessed using the more detailed Comprehensive Hospital Drought Resilience Assessment (CHDRA) tool and observation visits. Results: Of the hospitals assessed, 73 and 77 reported having adequate supplies of drinking and non-drinking water, respectively. Of the 24 hospitals studied using the CHDRA tool, bacteriological water quality testing was done in 8, with samples from only 4 hospitals being satisfactory. Adequate electricity supply was reported by 77 hospitals, of which 72 had at least one generator. None of the hospitals used rainwater or storm water harvesting, water recycling, or solar or wind power. Of the 24 hospitals selected for detailed analysis, awareness materials on safeguarding water or electricity and avoiding wasting water or electricity were displayed in only 6 hospitals; disaster preparedness plans were available in 9; and drought was considered as a hazard only in 6. Conclusion: The findings indicate that drought needs to be considered as an important hazard in hospital risk assessments. Drought preparedness, response and recovery should be embedded in hospital disaster preparedness plans to ensure the continuity of essential health services during emergencies.

Animal welfare, One Health and emergency preparedness and response in the Asia-Pacific region.

The Asia-Pacific region is vulnerable to a wide range of emergencies and natural disasters that are becoming more frequent because of seismic activity, climate change and changes in human development. For the rural poor in low-income settings, animals are valued beyond their financial worth as a fundamental part of human existence and livelihoods. Despite this recognition, animals are rarely included in national disaster plans and investments, and their needs are rarely factored into relief operations. Any natural disaster has short-term and long-term consequences that affect animals along with humans. For example, post-disaster community rehabilitation programmes may be strengthened by factors such as compensation for livestock losses. Emergency and disaster preparedness, response and recovery planning should follow the One Health approach by considering animal welfare, including rehabilitation and economic recovery.

Disaster risk reduction through strengthened primary health care

Crises that affect communities have become more pronounced in recent years for various reasons. Challenges, old and new, such as unaddressed poverty, shifts in populations and changes in behaviours put forth by drivers such as globalization of economies and health services/products, climate change and information technology, confront the concept of primary health care (PHC) as a level of delivery ofservices and as an approach1. It is known that the first responders to needs in any crisis are people in the affected community, and regarding health, a large part of those needs relate to health services at theprimary level. The paper dissects the impact of disasters and crises on health systems and discusses whether investments in PHC contribute to disaster risk reduction. It also presents a few examples to show that PHC facilities, staff and services that are improved and provided for prior to disasters, provideeffective response and support recovery interventions much faster. (AU)