Prevention and control of iodine deficiency in the WHO European Region: adapting to changes in diet and lifestyle: web annex D: iodine supplementation in pregnant women in the WHO European Region

Iodine deficiency, especially mild deficiency, is still a widespread problem in the WHO European Region. Since the last WHO report on iodine deficiency in the Region was published 15 years ago, a wealth of new data on iodine status has become available, particularly concerning vulnerable population groups. This report reviews the iodine status in the WHO European Region, as well as current scientific knowledge on the consequences of mild iodine deficiency, dietary sources of iodine and the present effectiveness of iodine deficiency prevention measures. This report is also unique as it combines information sourced not only from scientific publications and public health reports, but also animal husbandry science and reporting, and the food industry.

Disease-related malnutrition: a time for action

This fact sheet on disease-related malnutrition is intended for national and regional policymakers for health care. It provides a concise overview of the actions recommended by ESPEN in guidelines and position papers to strengthen nutritional care for the prevention and management of disease-related malnutrition in primary care and for hospital outpatients and inpatients. It includes a recommendation that health-care professionals be trained in nutritional care.

Guidance on developing national COVID-19 vaccination policy and integrating COVID-19 vaccination into national immunization programmes and broader health care delivery mechanisms in the WHO European Region: August 2023

The epidemiological situation of COVID-19 has evolved considerably over the past three years, with the emergence of new variants and the development of population-level immunity due to vaccination, infection-induced immunity or both (hybrid immunity). While SARS-CoV-2 virus continues to circulate, the third year of the pandemic has seen a marked reduction in rates of hospitalization, admission to ICU and deaths across all age groups, globally. Certain population groups continue to be at greater risk of severe disease. Aligned with the updated recommendations from the WHO Strategic Advisory Group of Experts on Immunization (SAGE), this document outlines considerations for the countries of the WHO European Region in developing their national COVID-19 vaccination policy, and planning, implementing and monitoring integration of COVID-19 vaccination into national immunization programmes and broader health systems. The efforts of the countries to integrate COVID-19 vaccination within their broader health systems will lay the grounds to operationalize the strategic priority of life-course vaccination of the European Immunization Agenda 2030.

Integrated brief interventions for noncommunicable disease risk factors in primary care: the manual: BRIEF project

Brief interventions are recognized by WHO as an effective measure to help people quit tobacco, reduce or stop alcohol use and increase physical activity. They can also help to achieve and maintain healthy eating behaviours and manage weight for those living with overweight and obesity. Brief interventions can translate to significant health benefits at population level when systematically applied to a large proportion of people. The uptake of these interventions in the WHO European Region, however, remains low. This manual is an integral part of the WHO European Office for the Prevention and Control of Noncommunicable Diseases BRIEF project. The manual provides a guide to implementing brief intervention programmes in primary care settings, highlighting facilitators and barriers to implementation. It emphasizes an integrated approach to brief interventions, dealing with all four main behavioural risk factors – tobacco use, alcohol use, unhealthy eating and physical inactivity – and the physiological risk factor of increased body mass index. The manual is in three parts: Part 1 describes the background and approaches to implementing primary care-based brief intervention programmes; Part 2 consists of annexes that present flow diagrams and more detailed guidance for delivery of brief interventions by primary care providers; and Part 3 presents supplementary materials that set out behavioural and cultural insights considerations on the use of brief interventions and examples of work being done on brief interventions in the Region.

Technical brief on strengthening the nursing and midwifery workforce to improve health outcomes: Government Chief Nursing and Midwifery Officers (GCNMOs) in the WHO European Region

Recognizing the critical contribution of the nursing and midwifery professions to health systems, population health and efforts to achieve the SustainableDevelopment Goals and universal health coverage,and in response to World Health Assembly resolution WHA 74.15, this technical brief aims to: support governments to strengthen government chief nursing and midwifery officers (GCNMOs) in their countries; identify the current roles and responsibilities of GCNMOs and senior nursing and midwifery leaders in the WHO European Region; and explore the enablers to support GCNMOs and/or senior nursing and midwifery leaders to work more effectively to support improved health outcomes. The ultimate goal is to increase the impact of GCNMOs and senior nursing and midwifery leaders on health, social care and health workforce policy to improve health outcomes

A guide to establishing national public health institutes through mergers

Many national public health institutes were established in the second half of the 20th century. Since they were established, the public health landscape has changed considerably, with new challenges, priorities, structures, technologies, skills, holistic approaches and funding and budget pressures. Multiple organizations related to public health have often been created in countries according to local needs, to implement different essential public health functions and operations and host specific disciplines.This guide aims to take advantage of the good practices, success factors and strategies of these institutes. The purpose is practical; it is intended to offer an initial source of information for merger initiatives and to raise awareness among decision-makers and key individuals of how complex this is. It also offers a step-by-step action plan for decision-makers and workshop facilitators to successfully prepare and implement the reorganization or merger of their national public health institute.This guide focuses its action points at the level of political decision-makers, health ministries and other key institutes and on their mission and vision: strategic and operational goals; professional development and leadership; project portfolios; validation processes; communication; and legal aspects.

Health and well-being and the 2030 agenda for sustainable development in the WHO European region: an analysis of policy development and implementation. Report of the first survey to assess Member States’ activities in relation to the WHO European region roadmap to implement the 2030 agenda for sustainable development

This report presents an analysis of policy, governance and implementation arrangements to achieve health and well-being for all at all ages and the Sustainable Development Goals (SDGs) in Member States of the WHO European Region. The analysis was based on a survey in 2019 that was completed by 29 Member States. Results show that Member States have prioritized implementation of the 2030 Agenda for Sustainable Development and integration of the SDGs into relevant planning frameworks. Integration has been facilitated through the creation or adaptation of institutional arrangements with leadership from high levels of government and participation of all sectors of society. More action is required to advance governance and leadership for health and well-being through a more holistic lens that encompasses a life-course approach, considers the determinants of health and invests in preparedness, prevention and resilience. Mechanisms were identified that facilitated intersectoral collaboration and improved accountability. The findings can be used by health stakeholders to identify solutions that can be adapted to the specific contexts of their institution, community or country to support achievement of the health and well-being goals and ultimately the SDGs. Findings can also be used by multilateral organizations and development partners to inform their role in fostering change and creating an enabling environment for the achievement of the SDGs.

Building better together: roadmap to guide implementation of the Global Strategic Directions for Nursing and Midwifery in the WHO European Region.

Nurses and midwives comprise half of the professional health workforce globally, interact with people frombirth to death across all types of settings and account for about 90% of contacts between patients andhealth professionals. They can deliver safe, high-quality, effective and efficient health services, particularly forvulnerable, disadvantaged and hard-to-reach groups. Enabling and supporting nurses and midwives to work totheir full potential is essential to achieving the Sustainable Development Goals and supporting universal healthcoverage, and to meeting current and future population health needs. This Roadmap reflects the priorities ofthe WHO European Programme of Work to set out activities organized according to the four areas of focusof the WHO Global strategic directions for nursing and midwifery 2021−2025 report (education, jobs, leadershipand service delivery) across 12 policy priorities. It proposes activities for Member States of the WHO EuropeanRegion and outlines specific areas of technical support the WHO Regional Office for Europe can provide.

Intersectoral collaboration to end HIV, tuberculosis and viral hepatitis in Europe and central Asia: a framework for action to implement the United Nations Common Position

Many countries in the WHO European Region are facing significant challenges in ending the epidemics of HIV, tuberculosis (TB) and viral hepatitis. Addressing them demands a holistic approach, reaching beyond the health sector alone. In response to this, several United Nations agencies made a joint commitment to support Member States in scaling up cross-sectoral approaches to address the risk factors and determinants of these three diseases. The United Nations Common Position on Ending HIV, TB and ViralHepatitis through Intersectoral Collaboration was signed in May 2018; this included the recommendation to support countries inoperationalizing this approach. This first edition of the Framework for Action is intended to guide and support the country process of implementing intersectoral strategies to address the social, environmental, economic and other non-health determinants related to HIV, TB and viral hepatitis. This document builds on the respective regional action plans for the three diseases and the recommendations for intersectoral action contained therein. It is also intended to support countries in examining how various sectoral policies and legislation can help people live healthier lives, and more specifically reduce the risk of contracting HIV, TB and viral hepatitis and minimize the economic, social and health impacts for those affected by these diseases.

Meeting of Government Chief Nursing and Midwifery Officers, WHO collaborating centres and the European Forum of National Nursing and Midwifery Associations in the WHO European Region: Athens, Greece, 3–4 October 2018: meeting report

The overarching theme of the Meeting of Government Chief Nursing and Midwifery Officers (GCNMOs), WHO collaborating centres and the European Forum of National Nursing and Midwifery Associations in the WHO European Region was to review, discuss and accelerate progress in strengthening nursing and midwifery towards achieving the population health objectives of Health 2020. Participants from more than 40 Member States attended the meeting and provided an update on the progress in implementing the European strategic directions for strengthening nursing and midwifery towards Health 2020 goals (ESDNM). The participants contributed to technical sessions oriented around three key themes “include, invest and innovate”, themes developed for the 10th anniversary conference of the Tallinn Charter: Health Systems for Health and Wealth. The participants attended working groups on “action to accelerate progress”, sharing lessons learned in implementing the ESDNM and identifying opportunities to advance progress. A key point was the importance of strengthening national leadership and advocating for the role of GCNMOs in all governments.

Midwifery Assessment Tool for Education (MATE)

The Midwifery Assessment Tool for Education (MATE) was commissioned by the WHO Regional Office for Europe technical programme Human Resources for Health, Division of Health Systems and Public Health. The tool aims to support Member States wishing to develop midwifery education to strengthen the midwifery and nursing workforce across Europe and thereby accelerate progress in implementing the European strategic directions for strengthening nursing and midwifery towards 2020 goals. The purpose of MATE is to provide an evidence-based guide for Member States wishing to strengthen their midwifery education or to develop midwifery education where this has not existed previously. It offers a self-assessment tool, designed and tested with experts, which can stimulate and inform discussions within countries at early planning stages.

Primary health care organization, performance and quality in North Macedonia

This report presents the findings of the multipronged assessment of integrated health services deliveryfocusing on the organization, performance and quality of primary health care in North Macedonia. Policydirections for improvement of health services and the alignment of health system enablers are providedto inform and guide ongoing health sector reforms with specific action-oriented recommendations.

Serbia: health system review

This analysis of the Serbian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the Serbian population has improved over the last decade. Life expectancy at birth increased slightly in recent years, but it remains, for example, around 5 years below the average across European Union countries. Some favourable trends have been observed in health status and morbidity rates, including a decrease in the incidence of tuberculosis, but population ageing means that chronic conditions and long-standing disabilityare increasing. The state exercises a strong governance role in Serbia’s social healthinsurance system. Recent efforts have increased centralization by transferring ownership of buildings and equipment to the national level. The health insurance system provides coverage for almost the entire population (98%). Even though the system is comprehensive and universal, with free access to publicly provided health services, there are inequities in access to primary careand certain population groups (such as the most socially and economically disadvantaged, the uninsured, and the Roma) often experience problems in accessing care. The uneven distribution of health professionals across the country and shortages in some specialities also exacerbate accessibility problems. High out-of-pocket payments, amounting to over 40% of totalexpenditure on health, contribute to relatively high levels of self-reported unmet need for medical care. Health care provision is characterized by the role of the “chosen doctor” in primary health care centres, who acts as a gatekeeper in the system. Recent public health efforts have focused on improving access to preventive health services, in particular, for vulnerable groups. Health system reforms since 2012 have focused on improving infrastructure and technology, and on implementing an integrated health information system. However, the country lacks a transparent and comprehensive system for assessing the benefits of health care investments and determining how to pay for them.

Country assessment framework for the integrated delivery of long-term care: working document: WHO European Framework for Action on Integrated Health Services Delivery

This document aims to provide guidance for assessing the integrated delivery of health and social services for long-term care. The assessment framework, which takes on a services and system perspective, serves as a blueprint for collecting data, structuring country visits, synthesizing information and drafting an assessment report. The framework identifies the main components for an assessment according to care needs, entitlements, health and social services, care pathways, the organization of providers and system enablers. Gender and human rights are streamlined throughout the framework and its taxonomy. The document also includes pointers for initial desk research, with a rich list of sources to access data and conduct research, with questionnaires for administrating interviews and outlines for conducting workshops and focus groups.

Intersectoral action: the arts, health and well-being: sector brief on arts

The Health 2020 policy framework has been adopted by all Member States of the WHO European Region to address Europe’s great social and health challenges, calling upon the health sector to reach out to and work with all the various sectors and parties in the continuing work of improving people’s health and well-being. A recently published WHO Health Evidence Network synthesis report (The role of the arts in improving health and well-being in the WHO European Region) demonstrates how arts interventions can help improve health and well-being, contribute to the prevention of a variety of mental and physical illnesses and support in the treat mentor management of a range of acute and chronic conditions arising across the life-course. As such, arts interventions are often low-risk, highly cost effective, integrated and holistic treatment options for complex health challenges to which there are no current solutions.

Glossary of terms: WHO European Primary Health Care Impact, Performance and Capacity Tool (PHC-IMPACT)

This glossary of terms aims to provide clarifying definitions related to the WHO European Primary Health Care Impact, Performance and Capacity Tool (PHC-IMPACT). PHC-IMPACT sets out to support the monitoring and improvement of primary health care in the European Region and the measurement of progress towards the services delivery component of global universal health coverage targets.The framework underpinning PHC-IMPACT has been guided by the WHO European Framework for Integrated Health Services Delivery. This glossary of terms accompanies PHC-IMPACT’s Indicator Passports – a resource providing detailed information for the use of the full suite of indicators that make up the tool. Importantly, the definitions included here have relied as far as possible on existing international classifications including the International Classification for Health Accounts, International Standard Classification of Occupations and International Standard Classification of Education.

Indicator passports: WHO European Primary Health Care, Impact, Performance and Capacity Tool (PHC-IMPACT): version 1

This document of indicator passports aims to provide a detailed technical description of indicators for use in the WHO European Primary Health Care Impact, Performance and Capacity Tool (PHCIMPACT). PHC-IMPACT sets out to support the monitoring and improvement of primary health care in the European Region and measurement of progress towards the services delivery component of global universal health coverage targets.The framework underpinning PHC-IMPACT has been guided by the WHO European Framework for Integrated Health Services Delivery. For each indicator passport included here, the following details are specified: alignment to the framework (domain, subdomain, feature), indicator/question title, indicator/question definition, numerator/denominator or answer choices, unit of measurement, rationale, relevant definitions, disaggregation, known limitations and possible data sources. Key terms underlined in the passports are found an accompanied Glossary of terms – a resource providing clarifying definitions according to existing definitions and international classifications as far as possible.

Situation updates: Turkey and northern Syria: July–August 2018: situation report # 4

Turkey hosts 3.5 million Syrian refugees, the highest number of refugees globally.Continuous influxes of people due to escalating conflict in Syria challenge the capacity of the Turkish health system. At the beginning of the crisis, the Government of Turkey decided to protect and assist all Syrians in need. Registered Syrians in Turkey are eligible to receive the same health services as Turkish nationals. Syrian health professionals provide these services in a linguistically and culturally sensitive way.