Health workforce in the Eastern Mediterranean Region: From COVID-19 lessons to actions.

The COVID-19 pandemic has had a devastating and unprecedented impact on health and health systems globally leaving an indelible mark on health system infrastructures. The pandemic also clearly demonstrated the critical role of health workers for well-performing health systems, in particular during emergencies and have prompted the need to undergo a critical re-evaluation of health systems and health workforce design and implementation. As the year 2023 marks the halfway point of the 2030 Agenda for Sustainable development, the time is pertinent for action by governments and partners to scale up the health workforce to advance towards sustainable developement goal (SDG) 3 on health and well-being and other health-related SDGs, building on the lessons from COVID-19. Therefore, at the 70th session of World Health Organization Regional Committee for Eastern Mediterranean, Member States unanimously adopted a resolution to call for accelerated actions to address health workforce challenges through solidarity, alignment, and synergy of efforts in order to rebuild resilient health systems after the COVID-19 pandemic.

Health for all by all-pursuing multi-sectoral action on health for SDGs in the WHO Eastern Mediterranean Region.

The WHO Eastern Mediterranean Region is endowed with deep intellectual tradition, interesting cultural diversity, and a strong societal fabric; components of a vibrant platform for promoting health and wellbeing. Health has a central place in the Sustainable Development Goals (SDGs) for at least three reasons: Firstly, health is shaped by factors outside of the health sector. Secondly, health can be singled out among several SDGs as it provides a clear lens for examining the progress of the entire development process. Thirdly, in addition to being an outcome, health is also a contributor to achieving sustainable development. Realizing this central role of health in SDGs and the significance of collaboration among diverse sectors, the WHO is taking action. In its most recent General Program of Work 2019-2023 (GPW 13), the WHO has set a target of promoting the health of one billion more people by addressing social and other determinants of health through multi-sectoral collaboration. The WHO Regional Office for the Eastern Mediterranean Region, through Vision 2023, aims at addressing these determinants by adopting an equity-driven, leaving no one behind approach. Advocating for Health in All Policies, multi-sectoral action, community engagement, and strategic partnerships are the cornerstone for this approach. The focus areas include addressing the social and economic determinants of health across the life course, especially maternal and child health, communicable diseases, non-communicable diseases, and injuries. The aspirations are noteworthy - however, recent work in progress in countries has also highlighted some areas for improvement. Joint work among different ministries and departments at country level is essential to achieve the agenda of sustainable development. For collaboration, not only the ministries and departments need to be engaged, but the partnerships with other stakeholders such as civil society and private sector are a necessity and not a choice to effectively pursue achievement of SDGs.

Care providers' perceptions towards challenges and opportunities for service improvement at diabetes management clinics in public primary health care in Muscat, Oman: a qualitative study.

BACKGROUND: The literature has described several challenges related to the quality of diabetes management clinics in public primary health care centres in Oman. These clinics continue to face challenges due to the continuous growth of individuals diagnosed with type 2 diabetes. We sought to explore the challenges faced in these clinics and discuss opportunities for improvement in Oman. METHODS: This qualitative study was designed to include non-participant observations of diabetic patients and care providers during service provision at diabetes management clinics, as well as semi-structured interviews with care providers, at five purposively selected public primary health care centres. Care providers included physicians, nurses, dieticians, health educators, pharmacists, an assistant pharmacist, a psychologist, and a medical orderly. The data were analysed using qualitative content analysis. RESULTS: The study disclosed three different models of service delivery at diabetes management clinics, which, to varying degrees, face challenges related to health centre infrastructure, technical and pharmaceutical support, and care providers' interests, knowledge, and skills. Challenges related to the community were also found in terms of cultural beliefs, traditions, health awareness, and public transportation. CONCLUSION: The challenges encountered in diabetes management clinics fall within two contexts: health care centres and community. Although many challenges exist, opportunities for improvement are available. However, improvements in the quality of diabetic clinics in primary health care centres might take time and require extensive involvement, shared responsibilities, and implications from the government, health care centres, and community.

WHO collaborating centres in the Eastern Mediterranean Region: an agenda for action and improvement (Editorial).

The World Health Organization (WHO) is the key United Nations specialized agency dedicated to promoting population health and health outcomes. In order for the Organization to achieve its strategic objectives, WHO designates selected institutions as collaborating centres to assit with carrying out WHO core activities. The Eastern Mediterranean Region (EMR) currently hosts 45 collaborating centres (as of December 2018), which is only 5% of the 832 WHO collaborating centres located worldwide, and yet EMR countries host about 10% of the global population. The reason for this discrepency could be a reflection of the limited public resources allocated to health research in the Region. However, it may also highlight the fact that resources and opportunities for establishing effective collaborating centres in the EMR still remain untapped.

Implementing WHO's global strategy in the Eastern Mediterranean Region: what next? (Editorial).

In May 2018, the Seventy-first World Health Assembly, bringing together 194 Member States of the World Health Organization (WHO), unanimously adopted the Organization's thirteenth General Programme of Work) 2023-2019 GPW. (1) (13 GPW 13 will guide WHO's work for at least the next five years. It is closely linked to the 2030 Agenda for Sustainable Development: (2) essentially, it specifies strategic priorities and goals that need to be achieved globally by 2023 to keep on track with achievement of the health-related Sustainable Development Goals by 2030. (3).

Working together to improve lives in the Eastern Mediterranean Region (Editorial).

It was an immense honour when the World Health Organization Regional Office for the Eastern Mediterranean (WHO/EMRO) welcomed me as its new Regional Director on 1 June 2018. On this occasion, I would like to extend my sincere thanks and appreciation to the members of the WHO Executive Board during its 143rd session in Geneva, Switzerland, for giving me an opportunity to propose my agenda for change towards a stronger and healthier Region. I look forward to my tenure as Regional Director, and have been impressed by the support displayed by WHO/EMRO staff, the WHO Executive Board, and public health bodies further afield.

Cholera in Yemen: concerns remain over recent spike but control efforts show promise (Editorial).

October 2018 would be two years since the world came to know of the first case of cholera in war-torn Yemen. Soon after, the outbreak developed at an unprecedented scale and turned into one of the worst historical cholera events in terms of cases reported. By the end of September 2018, more than one million suspected cases had been reported across the country in all but one governorate, where approximately 60% of these cases remained concentrated in roughly half of the 330 districts in the country.

Awareness and implementation of nine World Health Organization's patient safety solutions among three groups of healthcare workers in Oman.

BACKGROUND: The pressing need to reduce burgeoning poor safety measures affecting millions worldwide has alerted World Health Assembly to set-up mechanisms to increase patient safety. In response to such needs, World Health Organization (WHO) formulated nine life-saving patient safety solutions that would be essential to lower reduce healthcare-related harm. There is a paucity of research examining awareness of such nine patient safety solutions. This study has been designed and conducted to compare self-estimated awareness and practice of the World Health Organization's nine "Life-saving Patient Safety Solutions" aide memoirs among different groups of healthcare workers in Oman. METHODS: All nationwide healthcare workers (nurses, physicians and allied health professionals) in hospitals and primary healthcare under the auspice of Ministry of Health were the target population of this survey. Participants were selected by a simple, systematic random sampling from the list of staff in each representative institution. The study was conducted from November 2012 to February 2013. A total of 800 participants (590 from health centers and 210 from hospitals) were invited to participate in this study. RESULTS: A total number of 763 healthcare professionals consented to participate. The overall response rate was 95 % with the majority being nurses, female staff and who had an average of more than 4 years of experience. Overall, 85 % of the participants self-estimated awareness of the nine life-saving patient safety solutions showed the nurses being the most aware, followed by physicians with the allied health professionals showing suboptimal awareness. The primary healthcare center staff demonstrated higher awareness compared to hospital staff. There was a complex relationship between health professional's age, place of work and awareness and practice. CONCLUSION: This study lays the foundation for international comparisons of self-estimated awareness and practice towards nine patient safety solutions. The data from Oman indicates the need for more attention to be directed towards heightening awareness and practice of the nine patient safety solutions.

Total elbow arthroplasty: a prospective clinical outcome study of Discovery Elbow System with a 4-year mean follow-up.

BACKGROUND: Total elbow arthroplasty (TEA) is increasingly used for the treatment of advanced elbow conditions to reduce pain and improve function. However, TEA is still associated with a higher complication rate than total hip and knee arthroplasty despite advances in the design and surgical techniques. This prospective clinical study reports the outcome of the Discovery Elbow System (Biomet, Warsaw IN, USA), which has been in clinical use in the United Kingdom since 2003. METHODS: The study included a total of 100 Discovery Elbows (April 2003 to January 2010) with a minimum 2-year follow-up, including 75 primary and 25 revisions (60% women and 40% men; mean age, 62 years). Outcome was assessed by means of the Liverpool Elbow Score, pain experience, patient satisfaction, range of motion, and radiographic imaging. RESULTS: The mean follow-up period was 48.5 months (range, 24-108 months). The Liverpool Elbow Score improved from 3.79 to 6.36 (P < .001). The percentage of pain-free patients was substantially increased from 7% preoperatively to 64% at the final follow-up. The patient satisfaction rate was over 90%. The flexion-extension arc and pronation-supination arc increased from 72° to 93° and from 86° to 111°, respectively (P < .001). Major postoperative complications included deep infection (2%), progressive aseptic loosening requiring revision (primary, 5%; revision 12%), persistent ulnar neuropathy (3%), and periprosthetic fracture (primary, 6.8%; revision, 8%). CONCLUSION: The Discovery Elbow System resulted in improved function, reduced pain, and high patient satisfaction. Long-term results are required to assess the survivorship of this system.

Earthquakes as triggers for public health disasters: WHO and health systems' response.

The February 2023 earthquakes in Syria and Türkiye The earthquakes that hit southeast Türkiye and northwest Syria in February 2023 have been the most devastating among several earthquakes witnessed globally in the past decades. As of 28 February 2023, it had caused the death of over 50 000 people and affected more than 18 million others. In northwest Syria alone, the earthquakes affected at least 96 communities and 35 sub-districts, damaging or destroying more than 10 000 buildings, including 48 health facilities, and leaving over 11 000 people homeless (4). More than 45 000 deaths and 85 000 injuries have been reported in Harim, Afrin and Jebel Saman districts, and at least 50 000 families displaced in Aleppo, Homs, Hama, and Latakia.

Reviewing recent achievements and preparing for accelerated action on health: highlights of 70th Session of the WHO Regional Committee for the Eastern Mediterranean Region.

From 9 to 12 October 2023, WHO Member States in the Eastern Mediterranean Region came together at the Organization's regional office in Cairo, Egypt, for the 70th Session of its main regional governing body, the WHO Regional Committee for the Eastern Mediterranean. This year's meeting was particularly significant, marking not only the 75th Anniversary of WHO itself, but also my final session as Regional Director. As such, it was an important opportunity to take stock of the public health situation across the Region. With that aim in mind, participants were presented with 2 major new publications: an analysis of progress towards the health-related Sustainable Development Goals (SDGs) in the Region (1) and a report on the implementation of WHO's regional vision during my term (2).

Mitigating the resurgence of cholera in the Eastern Mediterranean Region.

Countries in the WHO Eastern Mediterranean Region (EMR) are currently experiencing a resurgence of cholera. As of 31 December 2022, 8 of the 22 Member States in the region - Afghanistan, Islamic Republic of Iran, Iraq, Lebanon, Pakistan, Somalia, Syria, and Yemen - were grappling with outbreaks of cholera and acute watery diarrhoea (AWD). More than 1 000 000 suspected AWD/cholera cases, more than 7500 laboratory-confirmed cases, and 375 cholera-associated deaths were reported across the region in 2022.