Addressing health inequalities in Europe: key messages from the Joint Action Health Equity Europe (JAHEE).

Health inequalities within and between Member States of the European Union are widely recognized as a public health problem as they determine a significant share of potentially avoidable mortality and morbidity. After years of growing awareness and increasing action taken, a large gap still exists across Europe in terms of policy responses and governance. With the aim to contribute to achieve greater equity in health outcomes, in 2018 a new Joint Action, JAHEE, (Joint Action Health Equity Europe) was funded by the third EU Health Programme, with the main goal of strengthening cooperation between participating countries and of implementing concrete actions to reduce health inequalities. The partnership led by Italy counted 24 countries, conducting actions in five policy domains: monitoring, governance, healthy living environments, health systems and migration, following a three-step implementation approach. Firstly, specific Policy Frameworks for Action (PFA) collecting the available evidence on what practice should be done in each domain were developed. Second, different Country Assessments (CAs) were completed to check the country's adherence to the recommended practice in each domain. The gap between the expected policy response (PFA) and the present policy response (CA) guided the choice of concrete actions to be implemented in JAHEE, many of which are continuing even after the end of JA. Final recommendations based on the best results achieved during JAHEE were elaborated and agreed jointly with the representatives of the involved Ministries of Health. The JAHEE initiative represented an important opportunity for the participating countries to work jointly, and the results show that almost all have increased their level of action and strengthened their capacities to address health inequalities.

The WHO Prison Health Framework: a framework for assessment of prison health system performance.

BACKGROUND: The Health in Prisons European Database (HIPED) aims to periodically collect data on prison health systems, services and health outcomes to inform equivalence of care for people living in prison. Recognized as the United Nations hub for health data in prisons, HIPED lacked an established framework to define its domains and indicators to measure progress. Therefore, the objectives of developing this framework were to inform surveillance systems at prison, local, regional, national and international level and to use it to guide improvement of prison health systems and cross-country comparison. METHODS: The framework was conceptualized through identification of policy priorities and existing frameworks, notably the WHO Health System Framework. A consultation with a range of WHO stakeholders was conducted evaluating the components of existing frameworks and their relevance to the prison health context, as well as identifying areas needing further emphasis. The final stage identified the structure of the framework. RESULTS: The framework consists of three main building blocks. The first captures the system-level aspects of prison health care (or inputs) whilst the second captures delivery aspects of prison health care (or outputs). These building blocks are in turn modified by two influencing factors. Ultimately, all these elements impact on the third building block, health outcomes. In addition, two cross-cutting principles associated with all these building blocks and influencing factors are included. CONCLUSIONS: A new framework for assessing prison health system performance is now available, crucial to support informed decision-making for policy design and implementation for prisons and other places of detention.

Strengthening the primary health care response to COVID-19: an operational tool for policymakers.

AIMS: The aim of this paper is to introduce an operational checklist to serve as a tool for policymakers in the WHO European Region to strengthen primary health care (PHC) services and address the COVID-19 pandemic more effectively and to present the results from piloting the tool in Armenia. BACKGROUNDS: PHC has the potential to play a fundamental role in countries' responses to COVID-19. However, this potential remains unrealized in many countries. To assist countries, the WHO Regional Office for Europe developed a guidance document - Strengthening the Health Systems Response to COVID-19: Adapting Primary Health Care Services to more Effectively Address COVID-19 - that identifies strategic actions countries can take to strengthen their PHC response to the pandemic. Based on this guidance document, an operational checklist was developed to serve as a tool for policymakers to operationalize the recommended actions. METHODS: The operational checklist was developed by transforming key points in the guidance document into questions in order to identify potentially modifiable factors to strengthen PHC in response to COVID-19. The operational checklist was then piloted in Armenia in June 2020 as part of a WHO mission to provide technical advice on strengthening Armenia's PHC response to COVID-19. Two WHO experts performed semi-structured, face-to-face interviews with nine key informants (both facility managers and clinical staff) in three PHC facilities (two in a rural and one in an urban area). The data collected were analyzed to identify underlying challenges limiting PHC providers' ability to effectively and efficiently respond to COVID-19 and maintain essential health services. FINDINGS: The paper finds that making adjustments only to health services delivery will be insufficient to address most of the challenges identified by PHC providers in the context of COVID-19 in Armenia. In particular, strategic responses to the pandemic were missed, due, in part, to the absence of COVID-19 management teams at the facility level. Furthermore, the absence of PHC experts in Armenia's national pandemic response team meant that health system issues identified at the facility level could not easily be communicated to or addressed by policymakers. The checklist therefore helps policymakers identify critical challenges - at both the facility and health system level - that need to be addressed to strengthen the PHC response to the COVID-19 pandemic.

Reorienting health systems and services with health promotion criteria: a critical component of health sector reforms

Documento oficial da 5th Global Conference on Health Promotion, realizada em 2000 na Cidade do México, disponibilizado pela Organização Pan-Americana de Saúde - OPAS, em formato DOC. Apresenta objetivos e estratégias para a reorientação de serviços de saúde, especialmente na atenção básica, em direção à promoção da saúde e outras funções essenciais da Saúde Pública.

Iniciativa La salud pública en las Américas: una manera de mejorar la práctica de la salud pública en el continente americano / Initiative public health in the Americas: a way to improve the public health practice in the Americas

Para lograr dichos objetivos,la Organización Panamericana de la Salud (OPS) ha elaborado una iniciativa continental denominada "La salud pública en las América". Este documento presenta la definición y medición de las funciones esenciales de salud pública (FESP) como base para mejorar la práctica de la salud pública y fortalecer el liderazgo de la autoridad sanitaria en todos los niveles del Estado. La iniciativa, coordinada por la División de Desarrollo de Sistemas y Servicios de Salud, incluye a todas las unidades técnicas de la Sede y a las representaciones de la OPS/OMS. La Organización ha contado con la asesoría del Dr. Carlyle Guerra de Macedo, Director Emérito de la OPS, quién creó un instrumento para la medición del desempeño de las FESP, conjuntamente con los Centros para Control y la Prevención de Enfermedades de los Estados Unidos (CDD) y el Centro Latinoamericano de Investigación en Sistemas de Salud (CLAISS). Además, la iniciativa se ha beneficiado de la participación y los comentarios de una red internacional de instituciones y expertos en el ámbito de la salud pública

Reforme de los sistemas de salud en America Latin y el Caribe: situacion y tendencias / Health sector reform in Latin America and the Caribbean: situation and trends

In the early 1990s, most Latin American and Caribbean countries were beginning, or planning to begin, health sector reform processes. This paper presents the status and trends of health sector reform at the end of the 1990s. The authors relied on information in 20 health system and services profiles completed by the Pan American Health Organization between August 1998 and October 1999. The analysis, which follows a methodology that had been applied earlier, was organized on two different levels: (1) monitoring the reform processes (dynamics and content) and (2) evaluating their outcomes. In looking at the dynamics of the reform processes, the article examines the content in which they take place and the actors involved in their different phases: inception, design and negotiation, implementation, and evaluation. The description and analysis of the contents of health sector reform inititives are organized into 12 broad thematic areas. Outcomes evaluation was only possible in the eight countries that provided enough pertinent information, and should be viewed as preliminary. Nevertheless, the article does present detailed information on the outcomes of health sector reform in terms of equity, effectiveness and quality, efficiency, sustainability, and societal participation and control. The article also discusses the potential causes and determining factors for the observed outcomes (AU)

Las funciones esenciales de la salud publica: un tema emergente en las reformas del sector de la salud / The essential functions of public health: an emerging theme in health sector reforms

In the Americas, health sector reforms are facing the challenge of strengthening the steering and leadership role of health authorities. An important part of that role consists of fulfilling the essential public health functions (EPHFs) that are incumbent on all levels of government. For that, it's crucial to improve public health practice, as well as the instruments used to assess the current state of public health practice and the areas where it needs to be strengthened. For that purpose, the Pan American Health Organization has started an initiative called "Public Health in the Americas", with the objective of defining and measuring EPHFs, as a way of improving public health practice and strengthening the leadership provided by health authorities at all levels of government. This article summarizes conceptual and methodological aspects of defining and measuring EPHFs. The article also analyzes the implications that measuring performance on these public health roles, responsibilities, and activities would have for improving public health practice in the Americas (AU)

Reforma de los sistemas de salud en America Latina y el Caribe: situacion y tendencias / Health sector reform in Latin America and the Caribbean: situation and trends

A principios de la decada de los noventa, casi todos los paises de America Latina y el Caribe estaban iniciando, o considerando iniciar, reformas del sector de la salud. El presente trabajo presenta un an lisis de la situacion de dichas reformas y sus tendencias a finales de la decada de los noventa. Para ello los autores han partido de la informacion contenida en los 20 perfiles de sistemas de servicios de salud concluidos por la Organizacion Panamericana de la Salud entre agosto de 1998 y octubre de 1999. Siguiendo una metodologia empleada con anterioridad, el analisis se organiza en dos niveles: 1) seguimiento de los procesos (dinamica y contenidos) y 2) evaluacion de los resultados.En terminos de la dinamica de los procesos, el articulo presenta un analisis del contexto y de los actores involucrados en las distintas fases de las reformas: su genesis, diseno y negociacion, implementacion y evaluacion. Respecto a los contenidos de las reformas, se describen y analizan los hallazgos organizados en 12 grandes campos tematicos. La evaluacion de los resultados se hace sobre los ocho paises que proporcionaron informacion pertinente y debe considerarse preliminar. No obstante, el articulo presenta informacion detallada sobre los resultados de las reformas en terminos de equidad, efectividad y calidad, eficiencia, sostenibilidad y participacion y control sociales. Tambien examina las posibles causas y factores condicionantes de los resultados observados

Las funciones esenciales de la salud publica: un tema emergente en las reformas del sector de la salud / The essential functions of public health: an emerging theme in health sector reforms

En las Americas, las reformas del sector de la salud se enfrentan al desafio de fortalecer la funcion rectora de las autoridades sanitarias y una parte importante de este papel consiste en dar cumplimiento a las funciones esenciales de la salud publica (FESP) que competen al Estado en sus niveles central, intermedio y local. Para ello es crucial mejorar la practica de la salud publica y los instrumentos para valorar su estado actual y las areas en las que debe ser fortalecida. En virtud de lo anterior, la Organizacion Panamericana de la Salud (OPS) ha puesto en marcha la iniciativa "La salud publica en las Americas", dirigida a la definicion y medicion de las FESP como base para mejorar la practica de la salud publica y fortalecer el liderazgo de las autoridades sanitarias en todos los niveles del Estado. El presente articulo resume aspectos conceptuales y metodologicos relacionados con la definicion y medicion de las FESP y analiza las implicaciones de la medicion del desempeno de las mismas en el mejoramiento de las practicas de la salud publica en las Americas