The impact of economic sanctions on health and health systems in low-income and middle-income countries: a systematic review and narrative synthesis.

INTRODUCTION: Economic sanctions restrict customary commercial and financial ties between states to induce change in political constitution or conduct of the targeted country. Although the stated goals of sanctions often include humanitarian objectives, prospective procedures for health risk assessment are not regularly incorporated in their implementation. Moreover, past experience suggests that the burden of economic isolation may fall on the civilian population. We present key findings from a WHO-sponsored evidence review on the impact of economic sanctions on health and health systems in low-income and middle-income countries, aiming at comprehensive coverage and explicit consideration of issues of causality and mechanisms. METHODS: Broad searches of PubMed and Google Scholar (1970-2021) were designed to retrieve published and grey English-language literature expected to cut across disciplines, terminology and research methods. Studies providing an impact estimate were rated by a structured assessment based on ROBINS-I risk of bias domains, synthesised via vote counting and contextualised into the broader literature through a thematic synthesis. RESULTS: Included studies (185) were mostly peer-reviewed, mostly single-country, largely coming from medicine and public health, and chiefly concerned with three important target countries-Iraq, Haiti and Iran. Among studies providing impact estimates (31), most raised multiple risk-of-bias concerns. Excluding those with data integrity issues, a significant proportion (21/27) reported consistently adverse effects of sanctions across examined outcomes, with no apparent association to assessed quality, focus on early episodes or publication period. The thematic synthesis highlights the complexity of sanctions, their multidimensionality and the possible mechanisms of impact. CONCLUSION: Future research should draw on qualitative knowledge to collect domain-relevant data, combining it with better estimation techniques and study design. However, only the adoption of a risk assessment framework based on prospective data collection and monitoring can certify claims that civilians are adequately protected.

Prevention and control of non-communicable diseases in iran: the case for Investment.

BACKGROUND: Non-communicable diseases are imposing a considerable burden on Iran. This study aims to assess the Return on Investment (ROI) for implementation of Non-communicable diseases (NCDs) prevention program in Iran. METHODS: Four disease groups including cardiovascular diseases, diabetes, cancer, and respiratory diseases were included in our ROI analysis. The study followed four steps: 1) Estimating the total economic burden of NCDs using the Cost-of-Illness approach. 2) Estimating the total costs of implementing clinical and preventive interventions using an ingredient based costing at delivering level and a program costing method at central level.3) Calculating health impacts and economic benefits of interventions using the impact measures of avoided incidence, avoided mortality, healthy life years (HLYs) gained, and avoided direct treatment costs. 4) Calculating the ROI for each intervention in 5- and 15- year time horizons. RESULTS: The total economic burden of NCDs to the Iranian economy was IRR 838.49 trillion per year (2018), which was equivalent to 5% of the country's annual Gross Domestic Product (GDP). The package of NCD will lead to 549 000 deaths averted and 2 370 000 healthy life years gained over 15 years, and, financially, Iranian economy will gain IRR 542.22 trillion over 15 years. The highest ROI was observed for the package of physical activity interventions, followed by the interventions addressing salt, tobacco package and clinical interventions. Conclusions NCDs in Iran are causing a surge in health care costs and are contributing to reduced productivity. Those actions to prevent NCDs in Iran, as well as yielding to a notable health impact, are giving a good economic return to the society. This study underscores an essential need for establishment of a national multi-sectorial NCD coordination mechanism to bring together and strengthen existing cross-agency initiatives on NCDs.

Addressing the health-related SDGs in the Eastern Mediterranean Region: Regional Health Alliance strengthens collaboration towards better health.

The United Nations launched the Sustainable Development Agenda 2030 and its 17 Sustainable Development Goals (SDGs) in 2015, as a more detailed and ambitious follow-up to the Millennium Developments Goals (MDGs). Health and wellbeing of all, at all ages, is addressed by the third SDG (SDG3) and health-related targets of other SDGs. However, progress to date on the health-related SDGs in the Eastern Mediterranean Region (EMR) is not on track. Although there was progress in over half of the 50 health-related SDG targets and indicators between 2015 and 2019, there is still a long way to go. Progress is required, among others, in reducing maternal, child and neonatal mortality; increasing vaccination coverage; reducing the number of cases of malaria and HIV; and in tackling the increase in mortality rates due to noncommunicable diseases. Much progress is needed in many health-related SDGs considered as important social, economic and environmental determinants of health.

The Effect of the COVID-19 Pandemic on Non-Communicable Disease Prevention and Management Services in the Primary Health Care System of Iran.

Background: The COVID-19 pandemic has caused significant disruptions in the provision of non-communicable disease (NCDs) prevention and control services in many countries, and there is a concern that it would lead to long-term complications of the diseases. The aim of this study is to assess the changes in the provisions of selected NCD services before and after the COVID-19 epidemic in Iran's primary healthcare system. Methods: In this descriptive-analytical retrospective study, the number of eight NCD services provided during the first 10 months of the COVID-19 pandemic from Feb 2020 to Dec 2020 were compared with the same period in the previous year using the data from the Iranian integrated electronic health record system (SIB) and also the association between the number of deaths due to COVID-19 and a sample of NCD services were assessed using cross-correlation analysis. The statistical analysis was performed in Stata Software v.14. Results: The NCD services have decreased by an average of 18.89% compared to the same period in the previous year; this decline was much more severe at the beginning of the epidemic period (up to 75% in some services) and was greater in physician-provided services than in non-physician services. Also, examining the course of the selected services during this period, a gradual compensation was evident after the initial reduction. Conclusion: The general trend of the selected services of prevention and control of NCDs in the PHC system of Iran within 10 months after the onset of COVID-19 showed a sharp decline and subsequent gradual compensation. Although the process of compensation in some services may be considered somewhat reassuring, in the case of some essential services, more effort and attention to the implementation of programs or compensatory policies seem necessary.

Kazakhstan can achieve ambitious HIV targets despite expected donor withdrawal by combining improved ART procurement mechanisms with allocative and implementation efficiencies.

BACKGROUND: Despite a non-decreasing HIV epidemic, international donors are soon expected to withdraw funding from Kazakhstan. Here we analyze how allocative, implementation, and technical efficiencies could strengthen the national HIV response under assumptions of future budget levels. METHODOLOGY: We used the Optima model to project future scenarios of the HIV epidemic in Kazakhstan that varied in future antiretroviral treatment unit costs and management expenditure-two areas identified for potential cost-reductions. We determined optimal allocations across HIV programs to satisfy either national targets or ambitious targets. For each scenario, we considered two cases of future HIV financing: the 2014 national budget maintained into the future and the 2014 budget without current international investment. FINDINGS: Kazakhstan can achieve its national HIV targets with the current budget by (1) optimally re-allocating resources across programs and (2) either securing a 35% [30%-39%] reduction in antiretroviral treatment drug costs or reducing management costs by 44% [36%-58%] of 2014 levels. Alternatively, a combination of antiretroviral treatment and management cost-reductions could be sufficient. Furthermore, Kazakhstan can achieve ambitious targets of halving new infections and AIDS-related deaths by 2020 compared to 2014 levels by attaining a 67% reduction in antiretroviral treatment costs, a 19% [14%-27%] reduction in management costs, and allocating resources optimally. SIGNIFICANCE: With Kazakhstan facing impending donor withdrawal, it is important for the HIV response to achieve more with available resources. This analysis can help to guide HIV response planners in directing available funding to achieve the greatest yield from investments. The key changes recommended were considered realistic by Kazakhstan country representatives.

Инвестиции в интересах здоровья и благополучия: анализ общественной эффективности инвенций в стратегии общественного здравоохранения для поддержки выполнения Целей в области устойчивого развития на основе политики Здоровье-2020

Правительствам стран Европейского региона ВОЗ необходимо принять срочные меры для преодоления растущих проблем в области общественного здравоохранения, неравенств, а также экономических и экологических вызовов для того, чтобы добиться устойчивого развития (т.е. удовлетворить нынешние потребности без ущерба для способности будущих поколений удовлетворять свои собственные потребности) и гарантировать здоровье и благополучие нынешнему и будущим поколениям. На основе оценки масштабов осуществляемой деятельности авторы доклада делают вывод о том, что нынешняя инвестиционная политика и практика (“работа в привычном режиме”) является неустойчивой и влечет за собой высокие издержки для отдельных граждан, их семей, сообществ, обществ, национальной экономики и всей планеты. Инвестиции в реализацию мер общественного здравоохранения, которые опираются на ценностные ориентиры и фактические данные, обеспечивают эффективные и рациональные, инклюзивные и инновационные решения, которые могут служить стимулом для обеспечения социальной, экономической и экологической устойчивости. Инвестиции в интересах здоровья и благополучия стимулируют и делают возможным устойчивое развитие (и наоборот), что позволяет обеспечить наивысший достижимый уровень здоровья для всех людей. Эта публикация была представлена для обсуждения в качестве справочного документа на Шестьдесят седьмой сессии Европейского регионального комитета, Будапешт, 11–14 сентября 2017 г.

Key policies for addressing the social determinants of health and health inequities

Evidence indicates that actions within four main themes (early child development, fair employment and decent work, social protection, and the living environment) are likely to have the greatest impact on the social determinants of health and health inequities. A systematic search and analysis of recommendations and policy guidelines from intergovernmental organizations and international bodies identified practical policy options for action on social determinants within these four themes. Policy options focused on early childhood education and care; child poverty; investment strategies for an inclusive economy; active labour market programmes; working conditions; social cash transfers; affordable housing; and planning and regulatory mechanisms to improve air quality and mitigate climate change. Applying combinations of these policy options alongside effective governance for health equity should enable WHO European Region Member States to reduce health inequities and synergize efforts to achieve the United Nations Sustainable Development Goals. This publication was tabled as a background document during the Sixty-seventh session of the Regional Committee for Europe, Budapest, 11–14 September 2017.

Social return on investment: accounting for value in the context of implementing Health 2020 and the 2030 Agenda for Sustainable Development (Investment for Health and Development Discussion Paper)

Social return on investment (SROI) is a concept to account for social value when evaluating investments. It goes beyond traditional economic evaluation tools, by considering value produced for multiple stakeholders in all three dimensions of development: economic, social and environmental. This discussion paper reviews the main features of SROI (stakeholder engagement, the theory of change and accounting for social value) and finds that they are coherent with the key features of the Health 2020 policy framework and the 2030 Agenda for Sustainable Development. It concludes that SROI represents an interesting opportunity to evaluate cross-sectoral investments which aim to promote health and development, in the WHO European Region and beyond. This publication was tabled as a background document during the Sixty-seventh session of the Regional Committee for Europe, Budapest, 11–14 September 2017.

Ключевые меры политики для воздействия на социальные детерминанты здоровья и сокращения неравенства в отношении здоровья

Согласно имеющимся фактическим данным, вмешательства в четырех сферах – раннее развитие в детском возрасте, реализация права на труд и достойные условия труда, социальная защита и условия жизни – в состоянии оказывать максимальное воздействие на социальные детерминанты здоровья и неравенства в здоровье. В ходе систематического поиска и анализа рекомендаций и руководств в отношении политики, опубликованных межправительственными организациями и международными структурами, авторы сформулировали несколько реалистичных вариантов политики, на которых могут основываться конкретные меры по воздействию на социальные детерминанты в пределах вышеуказанных четырех тем. Варианты политики в первую очередь затрагивают такие вопросы, как образование и уход в раннем детском возрасте, детская бедность, стратегии инвестиций в условиях инклюзивной экономики, активные программы для рынка труда, условия труда, социальные выплаты наличными средствами, доступное жилье и механизмы планирования и регулирования для улучшения качества воздуха и смягчения последствий изменения климата. Авторы полагают, что применение различных комбинаций таких вариантов политики, наряду с эффективным руководством в поддержку справедливости в здоровье, позволит государствам-членам в Европейском регионе ВОЗ сократить неравенства в здоровье и синхронизировать усилия по достижению Целей в области устойчивого развития ООН. Эта публикация была представлена для обсуждения в качестве справочного документа на Шестьдесят седьмой сессии Европейского регионального комитета, Будапешт, 11–14 сентября 2017 г.

Investment for health and well-being: a review of the social return on investment from public health policies to support implementing the Sustainable Development Goals by building on Health 2020

Governments across the WHO European Region need to take urgent action to address the growing public health, inequality, economic and environmental challenges in order to achieve sustainable development (meeting current needs without compromising the ability of future generations to meet their own needs) and to ensure health and well-being for present and future generations. Based on a scoping review, this report concludes that current investment policies and practices (doing business as usual) are unsustainable, with high costs to individuals, families, communities, societies, the economy and the planet. Investment in public health policies that are based on values and evidence provides effective and efficient, inclusive and innovative solutions that can drive social, economic and environmental sustainability. Investing for health and well-being is a driver and an enabler of sustainable development, and vice versa, and it empowers people to achieve the highest attainable standard of health for all. This publication was tabled as a background document during the Sixty-seventh session of the Regional Committee for Europe, Budapest, 11–14 September 2017.

The effectiveness of community based distribution of injectable contraceptives using community health extension workers in Gombe State, Northern Nigeria.

This study reports on findings of a pilot of community-based distribution (CBD) of injectable contraceptives in two local government areas (LGAs) of Gombe State, Nigeria. From August 2009 to January 2010, the project enrolled, trained and equipped community health extension workers (CHEWs) to distribute condoms, oral and injectable contraceptives in communities. The project mobilized communities and stakeholders to promote Family Planning (FP) services in the selected communities. Using anonymised unlinked routine service data, the mean couple years of protection (CYP) achieved through CBD was compared to that achieved in FP clinics. The CBD mean CYP for injectables- depo medroxy-progesterone acetate (DMPA) and norethisterone enantate was higher (27.72 & 18.16 respectively) than the facility CYP (7.21 & 5.08 respectively) (p < 0.05) with no injection related complications. The CBD's mean CYP for all methods was also found to be four times higher (11.65) than that generated in health facilities (2.86) (p < 0.05). This suggests that the CBD of injectable contraceptives is feasible and effective, even in a setting like northern Nigeria that has sensitivities about FP.