Data-driven policy-making and sharing of information on a common platform

Evidence-informed policy-making is essential for achieving the SDGs and other health-related goals. Governments and decision-makers at all levels need reliable and timely information for the formulation and implementation of effective and relevant policies and programmes to secure the health and well-being of their peoples. Limited and/or fragmented data makes it challenging for decision-makers to identify and prioritize the health and socioeconomic issues and problems, allocate resources effectively, track progress, evaluate intervention outcomes, and make evidence-based decisions regarding policy and programme design.Health information systems (HIS) are a key edifice of robust health systems, and are central to the collection, compilation and analysis of health data essential for population health and well being. HIS support the monitoring and improvement of health-care quality and systems performance, as well as the fostering of research and innovation for better outcomes. An enabling environment for robust HIS is critical to ensure effective use of health data for policy-making and public health actions. Countries in the Region are investing in strengthening their HIS capacities, coverage and performance tracking. Integrated health information platforms at all levels should be designed to leverage emerging and innovative technologies, cross-sectoral partnerships, and data analytics that can improve HIS performance, including public health surveillance to promote evidence-informed policies. The integrated platforms can build on experiences and best practices of well-established data and knowledge-sharing platforms. This encompasses strategic investment, robust data architecture, strong data-sharing policies and data governance mechanisms.This Agenda item was proposed by the Directorate-General of Health Services of the Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, through a letter dated 14 September 2023 to the Chair of the Working Group for identification of the Regional Resolutions and Decisions of the Seventy-Sixth Session of the WHO Regional Committee of South-East Asia.This Working Paper is envisaged to support Member State deliberations on promoting evidence-driven policy-making and the creating or bolstering shared integrated platforms that can support and enable Member States in using data for policy-making, improving transparency, accountability, adaptability and risk assessments, and making rational, equitable and efficient resource allocations.The overarching objective is to leverage the wealth of information generated by governments, businesses and individuals at national and subnational levels, and also harness the power of responsible machine-learning and artificial intelligence to drive decision-making processes at all levels of the health system. This Working Paper is being presented to the Seventy sixth Session of the Regional Committee for its consideration, seeking its views and recommendations.

Educação permanente no sistema único de saúde: concepções de profissionais da gestão e dos serviços / Continuing permanent education in the brazilian national health system: conceptions from management and care professionals / Educación continua en el sistema único de salud brasileño: concepciones de los profesionales de gestión y servicios

Este artigo pretende compreender as concepções de profissionais da gestão e dos serviços do Sistema Único de Saúde (SUS) sobre Educação Permanente em Saúde (EPS), bem como seus desafios e potencialidades. Utilizou-se de grupo focal para coleta, seguido de análise lexical do tipo classificação hierárquica descendente com auxílio do software Iramuteq. Os resultados delinearam quatro classes: a) EPS - entendimentos e expectativas; b) entraves à EPS; c) ETSUS e EPS por meio de cursos e capacitações; e d) dispositivos de EPS: potencialidades e desafios. Os participantes apontaram equívocos de entendimentos acerca da EPS ao equipará-la à Educação Continuada (EC) voltada à transferência de conteúdo, com repercussões negativas na prática de EPS. Discute-se o risco em centralizar o responsável pela concretização dessa proposta, que deveria ser coletiva e compartilhada entre diferentes atores. Reivindica-se, portanto, uma produção colaborativa, que possa circular entre os envolvidos, de modo que cada um experimente esse lugar e se aproprie da complexidade de interações propiciadas pela Educação Permanente em Saúde.(AU)

This article aims to understand the conceptions of professionals from the management and services of the Unified Health System (SUS) on Permanent Education in Health (EPS), as well as its challenges and potential. A focus group was used for data collection, followed by a lexical analysis of the descending hierarchical classification type using the Iramuteq software. The results delineated four classes: a) EPS - understandings and expectations; b) obstacles to EPS; c) ETSUS and EPS by courses and training; and d) EPS devices: potentialities and challenges. Participants pointed out misunderstandings about EPS, when equating it with Continuing Education (CE) focused on content transfer, with negative repercussions on EPS practice. The risk of centralizing the person responsible for implementing this proposal, which should be collective and shared among different actors, is discussed. Therefore, a collaborative production is claimed for, which can circulate among those involved, so that each one experiences this place and appropriates the complexity of interactions provided by Permanent Education in Health.(AU)

Este artículo tiene por objetivo comprender las concepciones de los profesionales de la gestión y servicios del Sistema Único de Salud (SUS) sobre Educación Continua en Salud (EPS), así como sus desafíos y potencialidades. Se utilizó un grupo focal para la recolección de datos, seguido por un análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Iramuteq. Los resultados delinearon cuatro clases: a) EPS: entendimientos y expectativas, b) Barreras para EPS, c) ETSUS y EPS a través de cursos y capacitación, y d) Dispositivos EPS: potencialidades y desafíos. Los participantes informaron que existen malentendidos sobre EPS al equipararla a Educación Continua, con repercusiones negativas en la práctica de EPS, orientada a la transferencia de contenidos. Se discute el riesgo de elegir a un solo organismo como responsable de implementar esta propuesta colectiva, que debería ser colectiva y compartida entre los diferentes actores. Se aboga por un liderazgo colaborativo, que pueda circular entre los involucrados, para que cada uno experimente este lugar y se apropie de la complejidad de interacciones que brinda la Educación Continua en Salud.(AU)

Addressing mental health through primary care and community engagement in the WHO South-East Asia Region

Twenty years after WHO published its landmark World Health Report 2001: Mental Health – new understanding, new hope,1 the recommendations made then remain valid today.Many advances have been made since but there is still a long way to go. The recentlylaunched World Mental Health Report 2022: Transforming Mental Health for all2 argues for a transformation that is possible and required to ensure better mental health for all, with the underlying premise that ‘there is no health without mental health’. The Sixty-sixth World Health Assembly adopted the WHO Comprehensive Mental Health Action Plan 2013−2020 in May 2013. In 2019, the Action Plan was extended until 2030 by the Seventy-second World Health Assembly.3 To achieve the Action Plan’s objectives, we need to transform our attitudes, actions and approaches to promote and protect mental health and ensure that services reach all those in need, closer to where they live and without incurring financial hardship. Improving mental health of populations leads to increased economic productivity and greater social development.Currently there are almost 1 billion people living with different mental health disorders around the world. In the South-East Asia Region, 13.2% of the population live with mental health conditions.4 Yet, treatment gaps continue to be very high. Key challenges include lack of investment, scarcity of human resources, stigma, inadequate prevention and promotion programmes, paucity of data and lack of mental health services in primary care settings.There have been many Executive Board and World Health Assembly Decisions and resolutions on mental health during the last two decades. A list of these and the texts areavailable in the WHO MiNDbank5 database. There have been several important resolutions promulgated by the WHO Regional Committee for SE Asia related to mental health. Among these are SEA/RC59/R8 on alcohol consumption control – Policy options; SEA/RC65/R5 onnoncommunicable diseases, mental health and neurological disorders; SEA/RC65/R8 on comprehensive and coordinated efforts for the management of autism spectrum disorders (ASD) and developmental disabilities; and SEA Regional Action Plan to implement the Global Strategy to reduce harmful use of alcohol (2014–2025) (SEA/RC67/R4).WHO has also published various technical and policy documents and action plans on this issue. These include the Mental Health Atlas 2020, mhGAP Guidelines, LIVE LIFE, Quality Rights and EQUIP to help Member States transform mental health policies and services, in line with the principle of universal health coverage to strengthen acceptable, accessible and equitable primary mental health-care services. The paths to transformation specified in the World Mental Health Report 2022 include the required shifts to drive the agenda of mental health forward, including a focus on primary care, renewed community engagement, more priority for prevention andpromotion, adoption of whole-of-society and whole-of-government approaches, multistakeholder initiatives, and a shift from a biomedical to a holistic bio−psycho−social approach to services along with greater utilization of non-specialized workers.The UN Convention on the Rights of Persons with Disabilities (UNCRPD), adopted in 2006 and having come into force in 2008, has been ratified by all Member States of the SEA Region.6It identifies the rights and freedoms of persons with disabilities and binds countries to promote, protect and ensure those rights.This Working Paper was presented to the High-Level Preparatory Meeting for its review and deliberation. The HLP Meeting reviewed the paper and made the followingrecommendations.Actions by Member States(1) Integrate mental health into primary health care as a key strategy to reduce the treatment gap in countries.(2) Ensure that MHPSS is a key component of the emergency response.(3) Increase mental health budgets and orient funds towards community-based mental health networks and integration of mental health into PHC.Actions by WHO(1) Support countries in strengthening the delivery of mental health services in non specialized settings through task-sharing, capacity-building and technical support. (2) Provide technical support to strengthen MHPSS to address psychosocial needs during emergencies. (3) Engage with relevant stakeholders to identify modalities of financing for mental health. This Working Paper and the HLP Meeting recommendations are submitted to the Seventy-fifth Session of the WHO Regional Committee for South-East Asia for its consideration and decision, if any.

Expanding arts therapies provision: a pilot project in Older Adult Mental Health Services, Aneurin Bevan University Health Board.

OBJECTIVES: The aim of the report is to summarise the progress made during a six-month pilot project expanding arts therapies provision from an inpatient service to community services, in a National Health Service health board's Older Adult Mental Health Services, in response to the need for direct therapy with older adults who have severe cognitive impairment and communication difficulties arising from dementia and/or complex mental health difficulties. STUDY DESIGN: This is a case report on a pilot project. METHODS: The level of need for the service was explored, and indicators of effectiveness were gathered using evaluation forms-observer feedback forms and ARM-5 (Agnew Relationship Measure - 5) - to indicate the therapeutic alliance, team review and feedback from colleagues. RESULTS: To gather indications about the level of need, we recorded the following: number of referrals (n = 125) and waiting list numbers at the end of the project (n = 34). CONCLUSIONS: This pilot project indicates that there is need for psychological interventions in older adult community mental health services that arts therapies provision can help address. The number of referrals is one indicator of the level of need, and positive feedback from clients, families and colleagues, is an indicator that the team delivered effectively. The areas of client need addressed in sessions as documented in observer feedback forms indicate that for these clients, arts therapies was a valuable resource in addressing challenges arising from mental health difficulties and/or dementia.

Programme Budget 2022−2023

The Programme Budget 2022–2023, approved by the Seventy-fourth World Health Assembly in May 2021 vide resolution WHA74.3 (SEA/SPPDM/2 Inf. Doc. 1), comes at a critical time in the world providing a unique opportunity with the global public health landscape for WHO. The world is currently grappling with health, social and economic consequences of the COVID-19 pandemic on an unprecedented scale. WHO is making every endeavour to rise to the challenge and adapt to the new reality so that it is fully equipped to support Member States now and in the future to ensure that the world will be able to cope better with such crisis in the days ahead.Four key areas of strategic focus shaped the Programme Budget 2022–2023, all of which are mutually reinforcing and clearly demonstrate how WHO is rising to the challenge of accomplishing its overarching mission. The overall approved Budget for 2022–2023 is US$ 6121.7 million, of which US$ 426.3 million was approved as Base Budget for the South-East Asia Region. In line with the Thirteenth General Programme of Work’s (GPW13) integrated health systems and results approach, the allocation of the budget for 2022–2023 is presented at the outcome level.This Working Paper presents an overview of the approved Programme Budget 2022–2023, details of the SEA Regional Programme Budget, and the way forward for its implementation in the Region. The full approved Programme Budget for 2022–2023 is provided as an Information Document (SEA/SPPDM/2 Inf. Doc. 2).The progress report of the Working Group on Sustainable Financing was submitted to the Seventy-fourth World Health Assembly in May 2021. A separate document on progress of the Sustainable Financing Working Group is presented as an addendum (SEA/SPPDM/2 Add. 1).The Working Paper was presented to the Fourteenth Meeting of the Subcommittee on Policy and Programme Development and Management (SPPDM) for its review and recommendations. The SPPDM reviewed the paper and made the following recommendations for consideration by the Seventy-fourth Session of the WHO Regional Committee for its review and consideration.Actions by Member StatesContinue active participation in discussions related to the Programme Budget 2022–2023 at the regional and global Governing Body meetings and support operational planning for Programme Budget 2022–2023 at the country level.Convene an informal meeting on 3 August 2021, following the Member States’ briefing on the WHO Output Scorecard, to discuss the response tothe five questions raised by the Working Group, to prepare for the discussions at the Regional Committee.Initiate a “Regional One Voice” statement in response to the questions of the Working Group on Sustainable Financing, to be presented to the Regional Committee.Actions by WHOShare the Concept Note for mid-term revision of the Programme Budget 2022–2023 with Member States immediately upon receipt from WHO headquarters.Continue to provide the required support to Member States through WHO country offices for timely finalization of operational workplans for Programme Budget 2022–2023 addressing the discussions during the Meeting of the Subcommittee on Policy and Programme Development and Management (SPPDM).Support the informal discussions of the Member States on 3 August 2021 on the response to the five questions from the Working Group on Sustainable Financing to the Regional Committees; and collect details from other regions and WHO headquarters to ensure that the Member States in the SEA Region are fully supported.This Working Paper and the HLP Meeting recommendations are submitted to the Seventy-fourth Session of the WHO Regional Committee for South-East Asia for its consideration.

At a Moment's Notice: Community Advisory Board Perspectives on Biobank Communication to Supplement Broad Consent.

INTRODUCTION: To address ethical concerns about the of future research authorization, biobanks employing a broad model of consent can design ongoing communication with contributors. Notifying contributors at the time of sample distribution provides one form of communication to supplement broad consent. However, little is known about how community-informed governance might anticipate contributor responses and inform communication efforts. OBJECTIVE: We explored the attitudes of members of a three-site Community Advisory Board (CAB) network. CAB members responded to a hypothetical proposal for notifying biobank contributors at the time of sample distribution to researchers utilizing the biobank. METHODS: We used regularly scheduled CAB meetings to facilitate 3 large-group and 6 small-group discussions. Discussions were audio-recorded, transcribed, and analyzed for thematic content using descriptive thematic analysis. RESULTS: The results challenged our expectation of general support for the proposed communications. While CAB members identified some advantages, they were concerned about several potential harms to biobank contributors and the biobank. The CABs understood biobank communication in terms of an ongoing relationship with the biobank and a personal contribution to research. CONCLUSION: Our findings contribute to the emerging literature on community engagement in biobanking. Additional communication with biobank contributors can serve a variety of value-based objectives to supplement broad consent. Design of communication efforts by biobanks can be improved by CAB members' anticipation of the unintended consequences of additional contact with contributors. CAB members' holistic interpretation of communication efforts suggests that biobank leadership considers all communication options as part of a more comprehensive communications strategy.

A Retrospective Analysis of Clinical Trial Accrual of Patients Presented in a Multidisciplinary Tumor Board at a Tertiary Health Care Center and Associated Barriers.

INTRODUCTION: Cancer clinical trial accruals have been historically low and are affected by several factors. Multidisciplinary Tumor Board Meetings (MTBM) are conducted regularly and immensely help to devise a comprehensive care plan including discussions about clinical trial availability and eligibility. OBJECTIVES: To evaluate whether patient discussion at MTBM was associated with a higher consent rate for clinical trials at a single tertiary care center. METHODS: Institutional electronic medical records (EMR) and clinical trials management system (OnCore) were queried to identify all new patient visits in oncology clinics, consents to clinical trials, and MTBM notes between January 1, 2011 and December 31, 2015. The association between MTBM discussion and subsequent clinical trial enrollment within 16 weeks of the new patient visit was evaluated using a χ2 test. RESULTS: Between January 1, 2011 and December 31, 2015, 11,794 new patients were seen in oncology clinics, and 2,225 patients (18.9%) were discussed at MTBMs. MTBM discussion conferred a higher rate of subsequent clinical trial consent within 16 weeks following the patient's first consultation in an oncology clinic: 4.1% for those who were discussed at a MTBM compared to 2.8% for those not discussed (p < 0.01). CONCLUSIONS: This study provides evidence that MTBMs may be effective in identifying patients eligible for available clinical trials by reviewing eligibility criteria during MTBM discussions. We recommend discussion of all new patients in MTBM to improve the quality of care provided to those with cancer and enhanced clinical trial accrual.

Verifying the impact of corporate governance on hospital performance on HIV and malaria control: A structural equation modelling approach.

BACKGROUND: The research aims to study the impact of corporate governance on hospital performance regarding HIV and malaria control, using the Ghana health industry as a case. The nation is making frantic effort to control HIV and malaria, since they continue to be among the deadliest diseases that attract holistic attention; hence, there is the need to put structures in place to curb the spread. METHODS: A total of 1005 precoded questionnaires were administered to 125 hospitals, for responses from staff, managers, board, and chief executive officers (CEOs). The collated data were analysed using structural equation modelling approach. RESULTS: Our research revealed that corporate governance has a positive effect on hospital performance, regarding the control of the two deadly diseases (HIV and malaria). The interventions in Ghana health delivery have brought a level of improvement in malaria control, since the disease mortality has significantly declined from 19% in 2010 to 4% in 2016. Through the implementation of systems and policies, the national HIV prevalence has admirably reduced from 2.9% in 2000 to 1.6% in 2017. CONCLUSIONS: Hospitals are therefore encouraged to continue to implement effective corporate governance mechanisms to facilitate efficient, well-organised, and prudent practices that can deliver more institutional performance in HIV and malaria control.

Protocol for a mixed methods realist evaluation of regional District Health Board groupings in New Zealand.

INTRODUCTION: Achieving effective integration of healthcare across primary, secondary and tertiary care is a key goal of the New Zealand (NZ) Health Strategy. NZ's regional District Health Board (DHB) groupings are fundamental to delivering integration, bringing the country's 20 DHBs together into four groups to collaboratively plan, fund and deliver health services within their defined geographical regions. This research aims to examine how, for whom and in what circumstances the regional DHB groupings work to improve health service integration, healthcare quality, health outcomes and health equity, particularly for Maori and Pacific peoples. METHODS AND ANALYSIS: This research uses a mixed methods realist evaluation design. It comprises three linked studies: (1) formulating initial programme theory (IPT) through developing programme logic models to describe regional DHB working; (2) empirically testing IPT through both a qualitative process evaluation of regional DHB working using a case study design; and (3) a quantitative analysis of the impact that DHB regional groupings may have on service integration, health outcomes, health equity and costs. The findings of these three studies will allow refinement of the IPT and should lead to a programme theory which will explain how, for whom and in what circumstances regional DHB groupings improve service integration, health outcomes and health equity in NZ. ETHICS AND DISSEMINATION: The University of Otago Human Ethics Committee has approved this study. The embedding of a clinician researcher within a participating regional DHB grouping has facilitated research coproduction, the research has been jointly conceived and designed and will be jointly evaluated and disseminated by researchers and practitioners. Uptake of the research findings by other key groups including policymakers, Maori providers and communities and Pacific providers and communities will be supported through key strategic relationships and dissemination activities. Academic dissemination will occur through publication and conference presentations.

Serving on a Board of Nursing: Pursuing Justice, Mercy, and Humility.

What is it like to serve on a State Board of Nursing (BON)? How does one deal with the weight of the responsibility, the discomfort of inexperience in the role, and integrate personal faith with the professional expectations of administering justice and discipline? The author defines the patients cared for in the BON role and the balance of discipline with care for nurses.

ETHICS, EVIDENCE AND THE ANTI-VACCINATION DEBATE.

On 11 October 2016 the Nursing and Midwifery Board of Australia (NMBA) released a position statement on 'Nurses, midwives and vaccination' (www.nursingmidwiferyboard. gov.au/News/2016-10-11-position-statement-vaccination.aspx).

Sponsorship's Rich, Complex Spirituality.

Spirituality" names an important domain of human experience that has contours influenced by varied religious traditions, but it is not always tied to any religious tradition in particular. It is influenced by the vast array of individual experiences of inner life, especially as transformed by the transcendent.¹ These individual expressions sometimes become part of religious traditions, spiritual classics handed on from generation to generation.²

Health Partners of Western Ohio: Integrated Care Case Study.

Health centers are unique health care delivery organizations in which multiple disciplines, such as primary care, dental, behavioral health, pharmacy, podiatry, optometry and alternative medicine, are often located at the same site. Because of this characteristic, many health centers have developed systems of integrated care. This paper describes the characteristics of health centers and highlights the integrated health care delivery system of one early adopter health center, Health Partners of Western Ohio.

Governance Resilience: The Presbyterian Journey.

Presbyterian Healthcare Services, based in Albuquerque, New Mexico, is the state's only private, not-for-profit integrated healthcare system. It was founded in 1908 as a sanitorium for tuberculosis patients who came to the arid Southwest in search of a cure. Today, Presbyterian is thriving as a twenty-first-century integrated healthcare system, serving one in three New Mexicans in its statewide hospital system; it also includes a 440,000-member health plan and a 700-plus provider medical group. Presbyterian remains dedicated to its singular purpose of improving the health of the patients, members, and communities it serves. Just as Presbyterian has progressed and grown during its 106-year history, its governance system has evolved over time. Presbyterian has always believed that the New Mexico communities it serves deserve not just good governance but great governance and relies on strong structure and processes to lead it to superior outcomes. The ebb and flow of change, our ability to learn from trial and error, and our commitment to success in spite of obstacles make up the story of Presbyterian's strong governance system.