Strengthening palliative care in the WHO Eastern Mediterranean Region.

Palliative care is an approach that improves the quality of lives of patients and their families when facing problems associated with life-limiting illness, whether physical, psychosocial, or spiritual. It is acknowledged as a crucial part of integrated, people-centered health services and a human right. In 2014, WHO Member States endorsed the World Health Assembly Resolution 67.19 on Strengthening of Palliative Care as a component of comprehensive care throughout the life course, recognizing the importance of palliative care for the attainment of Universal Health Coverage (UHC) and highlighting the opportunities to advance its integration into health systems through primary health care and home-based care services.

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.

'Health for All by All' during a pandemic: 'Protect Everyone' and 'Keep the Promise' of Universal Health Coverage in the Eastern Mediterranean Region.

The Universal Health Coverage (UHC) Day has been commemorated on 12 December every year since 2017. In 2019, the theme of the day was "Keep the Promise", referring to the Political Declaration on UHC endorsed by Heads of States at the United Nations General Assembly High-Level Meeting on 23 September 2019. In 2020, the theme is "Protect Everyone", emphasizing global and individual health security in the context of the COVID-19 pandemic, attributed to SARS-CoV 2 - a virus that infected more than 4 million people in the Eastern Mediterranean Region (EMR) and left over 100 000 dead in less than 12 months (6.6% and 7.1% of the global toll, respectively). Keeping the promise of UHC, while ensuring health security, is becoming a priority agenda of policy-makers and practitioners in the EMR in order to save lives, advance health and protect livelihoods.

From adversity to resilience in the COVID-19 era: strengthening mental health systems in the Eastern Mediterranean Region.

The global COVID-19 pandemic has demonstrated the impact of a major public health emergency on mental health, and the ways that individuals, communities, professionals and systems can react positively to such a crisis. The Eastern Mediterranean Region (EMR) has substantial experience in mental health and psychosocial support (MHPSS) in crises, and COVID-19 has driven further innovation to support mental health and well-being.Global and regional guidance has been developed quickly, applying lessons learnt from previous disease outbreaks to respond to the pandemic at a systems level, for different population groups, and for countries of different income levels. Preliminary results from a global rapid assessment survey to assess the impact of COVID-19 on MHPSS services, indicate that 20 of the 22 EMR Member States have MHPSS as integral components of national COVID-19 response plans; one-third have allocated additional funding. However, MHPSS services have been severely impacted by the pandemic, including psychotherapy, psychosocial interventions, community services, and services for children/adolescents. Innovative solutions such as crisis hotlines, tele-consultations, digital self-help platforms, novel approaches to ensure supply of psychotropic medicines, and task sharing/shifting for basic psychosocial support, are being used in many countries to overcome service disruptions and maintain care for those with mental conditions.

The integration and management of noncommunicable diseases in primary health care (Guest Editorial).

Noncommunicable diseases (NCDs) are a great burden in the Eastern Mediterranean Region (EMR) and, if no strategic intervention is taken, the burden is forecast to become even heavier, particularly with the additional impact of ageing populations. Currently, 62% of deaths in the EMR are due to NCDs. However, by 2030 this proportion is projected to increase to nearly 70%. The EMR is disproportionately affected by NCDs as a result of the Region's rapid urbanization and the globalization of unhealthy behaviours. Moreover, many of the EMR countries have health systems whose structures are not designed for the prevention, early detection and management of NCDs.

World No Tobacco Day 2018: towards a sustainable campaign involving the cardiovascular community (Editorial).

The movement to reduce tobacco use has been gathering pace in the Eastern Mediterranean Region (EMR), as governments aim at implementing legislation to encourage populations to turn away from tobacco consumption and avoid the associated health risks. Indeed, within the Region it was in 2007 that Egyptian cardiologist Prof. Hamdi El Sayed, former member of parliament and former head of the Medical Syndicate, successfully proposed legislation for the implementation of graphic health warnings on tobacco packets covering 50% of visible packaging. In 2011, cardiologist Dr George Saade, former focal point of tobacco control in the Lebanese Ministry of Health, proposed banning tobacco use in all public places in Lebanon - a country coined a "paradise for smokers" in local media - and witnessed the implementation of this ground-breaking legislation. Meanwhile, in 2013, cardiologist Dr Sania Nishtar, Pakistan, stood strongly in support of the tobacco control movement with regard to the adoption of legislation comprehensively banning tobacco advertising in Pakistan.

Institutional design and organizational practice for universal coverage in lesser-developed countries: challenges facing the Lao PDR.

There is now widespread acceptance of the universal coverage approach, presented in the 2010 World Health Report. There are more and more voices for the benefit of creating a single national risk pool. Now, a body of literature is emerging on institutional design and organizational practice for universal coverage, related to management of the three health-financing functions: collection, pooling and purchasing. While all countries can move towards universal coverage, lower-income countries face particular challenges, including scarce resources and limited capacity. Recently, the Lao PDR has been preparing options for moving to a single national health insurance scheme. The aim is to combine four different social health protection schemes into a national health insurance authority (NHIA) with a single national fund- and risk-pool. This paper investigates the main institutional and organizational challenges related to the creation of the NHIA. The paper uses a qualitative approach, drawing on the World Health Organization's institutional and Organizational Assessment for Improving and Strengthening health financing (OASIS) conceptual framework for data analysis. Data were collected from a review of key health financing policy documents and from 17 semi-structured key informant interviews. Policy makers and advisors are confronting issues related to institutional arrangements, funding sources for the authority and government support for subsidies to the demand-side health financing schemes. Compulsory membership is proposed, but the means for covering the informal sector have not been resolved. While unification of existing schemes may be the basis for creating a single risk pool, challenges related to administrative capacity and cross-subsidies remain. The example of Lao PDR illustrates the need to include consideration of national context, the sequencing of reforms and the time-scale appropriate for achieving universal coverage.