La transformación digital como estrategia para el fortalecimiento de las funciones esenciales de salud pública en las Américas / Digital transformation as a strategy to strengthen essential public health functions in the Americas / Transformação digital como estratégia de fortalecimento das funções essenciais de saúde pública nas Américas

[RESUMEN]. En el presente artículo se sistematizaron las principales acciones de transformación digital (TD) de los sistemas de salud que abordan a las funciones esenciales de la salud pública (FESP). Se realizó una revisión narrativa, donde se interrelacionó el marco conceptual de las funciones esenciales de la salud pública renovadas con los ocho principios rectores de la transformación digital del sector de la salud. En las publicaciones seleccionadas, se halló que las principales acciones de la TD comprenden la historia clínica electrónica, la telemedicina, la legislación en salud digital, la alfabetización digital, los portales del paciente, las tecnologías de código abierto y la gobernanza de datos. Estas acciones posibilitan aumentar la calidad y la eficiencia de los sistemas de salud, favorecer la accesibilidad y mejorar los resultados de salud.

[ABSTRACT]. This article systematizes the main actions taken to address the essential public health functions (EPHF) in the context of the digital transformation of health systems. A narrative review was conducted, in which the conceptual framework of the renewed EPHF was linked to the eight guiding principles of the digital transformation of the health sector. In the selected publications, the main actions in digital transformation included electronic health records, telemedicine, digital health legislation, digital literacy, patient portals, open-source technologies, and data governance. These actions make it possible to increase the quality and efficiency of health systems, promote accessibility, and improve health outcomes.

[RESUMO]. Este artigo sistematiza as principais ações de transformação digital (TD) dos sistemas de saúde relacionadas às funções essenciais de saúde pública (FESP). Foi realizada uma revisão narrativa, interrelacionando o marco conceitual das FESP renovadas com base nos os oito princípios orientadores da transformação digital do setor da saúde. Nas publicações selecionadas, constatou-se que as principais ações de TD incluem prontuários eletrônicos, telemedicina, legislação de saúde digital, letramento digital, portais para pacientes, tecnologias de código aberto e governança de dados. Essas ações permitem aumentar a qualidade e a eficiência dos sistemas de saúde, aprimorar a acessibilidade e melhorar os resultados de saúde.

Estudio piloto sobre la afectación de los servicios de las residencias medicalizadas de ancianos por efecto de la Covid-19 / Pilot study on the impact of COVID-19 on the services provided in nursing homes for the elderly

Objetivo: la COVID-19 ha azotado con virulencia a las residencias de ancianos en España. Los numerosos contagios y fallecimientos, la afectación sobre la salud física y mental de los profesionales o las medidas sanitarias de protección y prevención, han afectado a ciertos servicios fundamentales para los usuarios, empeorando su salud y calidad de vida. El presente estudio pretende identificar los servicios afectados por la pandemia, determinar el grado de afectación de los mismos y establecer posibles diferencias de opinión en función de los datos sociodemográficos y laborales de los profesionales respondientes. Método: muestreo intencional, 49 profesionales de dos residencias medicalizadas en Morón de la Frontera (Sevilla), metodología de encuesta, diseño cuasiexperimental y transversal, análisis descriptivos e inferenciales (contrastes de medias) con el programa SPSS. Resultados: muchos servicios se han visto afectados, aunque en distinto grado. En grado alto, las relaciones sociales y terapias ocupacionales; en grado medio, la salud física y mental, ABVD y educación social. En menor grado, AIVD y recursos sociales. Así mismo, no se hallaron diferencias significativas en las respuestas debidas al sexo, edad, formación, profesión o residencia (p-valor ≥.05 en todos los casos), mostrando así un alto grado de acuerdo en las opiniones de los profesionales. Conclusiones: numerosos servicios y rutinas, fundamentales para la calidad de vida de los usuarios, resultaron multi-afectados por efecto de la pandemia en ambos centros residenciales para personas mayores. (AU)

Objective: COVID-19 has hit nursing homes in Spain with virulence. The numerous infections and deaths, the impact on the physical and mental health of the professionals and the health protection and prevention measures have affected certain essential services for users, worsening their health and quality of life. The present study aims to identify the services affected by the pandemic, to determine the degree to which they have been affected and to establish possible differences of opinion according to the sociodemographic and occupational data of the responding professionals. Method: purposive sampling, 49 professionals from two medical residences in Morón de la Frontera (Seville), survey methodology, quasi-experimental and cross-sectional design, descriptive and inferential analysis (mean contrasts) with the SPSS program. Results: many services have been affected, albeit to varying degrees. To a high degree, social relations and occupational therapies; to a medium degree, physical and mental health, BADL and social education. To a lesser degree, IADL and social resources. Likewise, no significant differences were found in the responses due to sex, age, training, profession or residence (p-value ≥.05 in all cases), thus showing a high degree of agreement in the opinions of the professionals. Conclusions: numerous services and routines, fundamental to the quality of life of users, were multiply affected by the pandemic in both residential centers for the elderly. (AU)

Abordagem de narrativas como método de pesquisa em saúde pública: aproximações conceituais e contribuições da psicanálise / Narrative research in public health: conceptual approximations and contributions from psychoanalysis / Enfoque en narrativas como método de investigación en salud pública: aproximaciones conceptuales y aportaciones del psicoanálisis

Este artigo refere-se à parte de uma pesquisa de doutorado, realizada em hospital de alta complexidade do Sistema Único de Saúde, cujos participantes são os profissionais de saúde. O objetivo deste artigo é analisar o potencial da abordagem das narrativas como método de pesquisa e intervenção nos serviços de saúde, traçando aproximações com a teoria psicanalítica. Sua relevância no campo da Saúde Pública está calcada no reconhecimento do papel do sujeito como agente de mudanças. O texto divide-se em duas partes: na primeira, explora as especificidades do trabalho na área da saúde, o paradigma da saúde pública no que concerne à gestão e possíveis contribuições da clínica ampliada para esse modelo. Na segunda parte, analisa o uso das narrativas como método de pesquisa nesse campo e as aproximações conceituais entre a narrativa em Walter Benjamin e a psicanálise em Freud. Busca na literatura referências sobre experiências análogas que fundamentem a proposta ora realizada e conclui pela importância de, no momento atual, apostar na força germinativa das narrativas como fonte criativa de novas formas de cuidar.(AU)

This article derives from a PhD research conducted with health professionals at a high-complexity public hospital from the Brazilian Unified Health System (SUS). It analyzes the potential of the narrative as a research and intervention method in health services, outlining approximations with psychoanalysis. In the field of Public Health, the narrative approach acknowledges the individual as an agent of change. The text is divided into two parts. The first presents an overview of the peculiarities involved in healthcare, the Public Health paradigm regarding service management and possible contributions from the expanded clinic to this model. The second analyzes the use of narratives as a research method in this field and the conceptual approximations between Benjamin's narrative and Freud's psychoanalysis. It searches the literature for references on similar experiences to support the present proposal and concludes by highlighting the importance of betting on the creative power of narratives as a source for new ways to care.(AU)

Este artículo es parte de una investigación doctoral, realizada con los profesionales de la salud de un hospital de alta complejidad del Sistema Único de Salud de Brasil. Su propósito es analizar el potencial del enfoque en narrativas como método de investigación e intervención en los servicios de salud, esbozando aproximaciones entre las narrativas y la teoría del psicoanálisis. Su relevancia en el campo de la salud pública se basa en el reconocimiento del rol del sujeto como agente de cambio. El texto se divide en dos partes: La primera investiga las especificidades del trabajo en el área de la salud, el paradigma de la salud pública en la gestión de los servicios y las posibles contribuciones de la clínica ampliada a este modelo. En la segunda parte, analiza el uso de narrativas como método de investigación en este campo y las aproximaciones conceptuales entre la narrativa de Walter Benjamin y el psicoanálisis de Freud. Este estudio busca en la literatura referencias sobre experiencias similares que apoyen la propuesta ahora realizada y concluye con la importancia de, en el momento actual, apostar por el poder de las narrativas como fuente creadora de nuevas formas de cuidar.(AU)

A covid-19 como um analisador do sofrimento de enfermeiras: um ensaio teórico / Covid-19 as a suffering analyzer for female nurses: a theoretical essay / El covid-19 como analizador de sufrimiento de enfermeras: un ensayo teórico

Este ensaio propõe que a Covid-19 pode operar como um analisador, dentro da perspectiva da análise institucional, iluminando um determinado modo de organização social que promove profundas desigualdades e ameaça a vida em diversos níveis e revelando as condições sociais, institucionais e políticas de produção de sofrimento no corpo profissional de Enfermagem. A pandemia desvelou um conjunto de marcas relacionadas à profissão, agravadas pela crise sanitária, reforçando a naturalização das relações de cuidado atribuídas ao feminino, bem como um conjunto de clivagens e hierarquias internas à profissão a partir da sinergia de marcadores da diferença, como gênero, cor/raça, classe e geração. Além disso, este trabalho mostra a presença de uma necropolítica nas respostas à pandemia que banaliza a vida e permite morrer determinados grupos sociais. A ideia de "profissionais de linha de frente" é criticada em suas metáforas bélicas, mas tomada como figura de linguagem em sua potência para afirmar que existem corpos que, pelas marcas sociais e históricas e pela interdependência do cuidado, são mais presentes e exigidos e, portanto, mais vulneráveis à doença e ao sofrimento dela decorrente.(AU)

The essay proposes that Covid-19 can operate as an analyzer, within the perspective of institutional analysis, illuminating a certain mode of social organization that promotes profound inequalities and threatens life at various levels, revealing the social, institutional and political conditions for the production of suffering in the professional nursing body. The pandemic would unveil a set of marks related to the profession, aggravated by the sanitary crisis, reinforcing the naturalization of the care relations attributed to the feminine, as well as a set of cleavages and internal hierarchies to the profession from the synergy of markers of difference as gender, color/race, class and generation. The work shows the presence of necropolitics in responses to the pandemic, which trivializes life and allows certain social groups to die. The idea of "front-line professionals" is criticized in its war metaphors, but taken as a figure of speech in its potency to affirm that there are bodies that by social and historical marks, and by the interdependence of care, are more present and demanded, and therefore more vulnerable to disease and the resulting suffering.(AU)

El ensayo propone que el Covid-19 puede funcionar como analizador, desde la perspectiva del análisis institucional, revelando las condiciones sociales, institucionales y políticas de producción de sufrimiento de enfermeras. La pandemia revela algunas marcas relacionadas con la profesión, agravadas por la crisis de salud, reforzando la naturalización de la atribución del cuidado a lo femenino y un conjunto de jerarquías internas de la profesión. El trabajo también muestra la presencia de una necropolítica en las respuestas a la pandemia. La idea de "profesionales de primera línea" es criticada, pero tomada como una figura del lenguaje en su potencia para afirmar que hay cuerpos que, por las marcas sociales e históricas y por la interdependencia del cuidado, están más presentes y demandados, y por lo tanto más vulnerables a la enfermedad.(AU)

Grupo operativo com psicólogos do SUS: das armadilhas ao brincar / Operative group with SUS psychologists: from traps to play / Grupo operativo con psicólogos del SUS: de la trampa al juego

Desenvolver habilidades para coordenar grupos é requisito importante do trabalho desenvolvido por psicólogos, especialmente quando vinculados a instituições de saúde pública. Este estudo foi uma pesquisa-ação amparada no enfoque clínico-qualitativo e desenvolvida a partir do dispositivo dos grupos operativos. O objetivo geral foi compreender como psicólogos percebem o trabalho grupal que oferecem em suas práticas laborais, a partir de vivências em grupos operativos de aprendizagem. Participaram 10 psicólogos atuantes em uma Unidade Ambulatorial de Atendimento Psicossocial - equipamento secundário da Rede de Atenção Psicossocial - de um município do interior de Minas Gerais. A ordenação de dados ocorreu a partir de emergentes grupais surgidos durante três sessões, e foram analisados a partir do diálogo com a literatura sobre grupos, em especial grupos em cenários institucionais. O processo grupal vivido fomentou recursos profissionais para lidar com a grupalidade. Expressões sobre dificuldades profissionais enfrentadas na coordenação de intervenções grupais apareceram e foram discutidas. O dispositivo "grupo" foi pensado como ferramenta possível de ser empregada para facilitar transformações e fomentar potenciais encontros humanos. Estudos futuros poderão ser direcionados a novas formas de compreender o trabalho grupal desenvolvido por esses e outros psicólogos, de realidades distintas da retratada.(AU)

Developing skills to coordinate groups is an important requirement for psychologists, especially when linked to public health institutions. This action research, supported by the clinical-qualitative approach, was developed based on the Operative Groups device. It sought to understand how psychologists perceive the group work they offer, based on experiences in operative learning groups. Ten psychologists, working in an Outpatient Psychosocial Care Unit - a secondary facility of the Psychosocial Care Network - in a city in rural Minas Gerais, participated in the study. Data ordering occurred from emerging groups listed during three group sessions, and were analyzed based on the literature on groups, especially groups in institutional settings. The group process experienced fostered professional resources for addressing groupness. Expressions about professional difficulties faced in coordinating group interventions emerged and were discussed. The "group" device was thought of as a possible tool to be employed to facilitate transformations and foster potential human encounters. Future studies may be directed to new ways of understanding the group work developed by these and other psychologists, from different realities from the one portrayed.(AU)

El desarrollo de habilidades en la coordinación de grupos es un requisito importante en el trabajo de los psicólogos, especialmente cuando están vinculados a instituciones de salud pública. Este estudio fue una investigación-acción respaldada por el enfoque clínico-cualitativo y desarrollada a partir del dispositivo de grupos operativos. Su objetivo general fue comprender cómo los psicólogos perciben el trabajo grupal que ofrecen en sus prácticas laborales a partir de experiencias en grupos de aprendizaje operativo. Participaron en el estudio diez psicólogos que laboran en una Unidad de Atención Psicosocial Ambulatoria (equipamiento secundario de la Red de Atención Psicosocial) de un municipio del estado de Minas Gerais, en Brasil. Se ordenaron los datos a partir de grupos emergentes que surgieron durante las tres sesiones grupales realizadas y analizadas con base en el diálogo con la literatura sobre grupos, especialmente en contextos institucionales. El proceso grupal experimentado ha potenciado los recursos profesionales para afrontar la agrupación. Surgieron y discutieron expresiones sobre las dificultades profesionales experimentadas en la coordinación de intervenciones grupales. Se pensó en el dispositivo "grupal" como una posible herramienta que se utilizaría para facilitar transformaciones y fomentar posibles encuentros humanos. Los estudios futuros pueden dirigirse a nuevas formas de entender el trabajo en grupo desarrollado por estos y otros psicólogos a partir de realidades distintas a la retratada.(AU)

Essential health services delivery status during COVID-19 pandemic in Ethiopia: A national mixed-methods survey of primary healthcare units

BACKGROUND: Essential health services are a package of services critical to improve health outcomes. COVID-19 pandemic disrupts essential health services. However, the level of essential health service disruption due to COVID-19 in Ethiopia is not clear. This study aimed at measuring the status of delivery of essential health services in Ethiopia during COVID-19. METHODS: A national mixed-methods cross-sectional survey was conducted. It was undertaken in Amhara (10 districts), Oromia (eight districts), Sidama (six districts), Southern Nations, Nationalities, and People's Region (16 districts), and Dire Dawa City Administration. A total of 452 health facilities were surveyed. Data were collected using face-to-face interview. Descriptive analysis was undertaken. Qualitative data was analyzed thematically. RESULTS: The woredas (districts) and health facilities which adopted essential health services before the COVID-19 pandemic were 81.4% and 51.2%, respectively. Nearly all health centers provided antenatal care services. Blood pressure measuring apparatus and delivery set were available in all health centers. However, only 50% of health centers had radiant warmer. Malnutrition services were provided by 47% of rural health centers. Moreover, a functional incinerator was available in only 41% of health centers. The provision of cardiovascular disease management was at 27.2%. Furthermore, HIV/AIDS treatment was provided by 43.5% of health facilities. CONCLUSION: The adoption of lists of essential health services was optimal. The status of delivery of essential health services was high for maternal healthcare. Neonatal care at birth, malnutrition treatment, and cardiovascular disease management were low. The district health system should strive more to maintain essential health services.

Atendimento psicológico grupal: experiências de usuários de serviços do Sistema Único de Saúde / Group psychological care: experiences of users of the Sistema Único de Saúde services / Atención psicológica grupal: experiencias de los usuarios de los servicios del Sistema Único de Saúde

O emprego de práticas grupais tem sido descrito como um recurso útil para a atuação profissional de psicólogos e uma alternativa qualificada nos serviços em saúde. Nesse estudo, objetivou-se compreender como usuários atendidos por psicólogos, em modalidades terapêuticas grupais em serviços do Sistema Único de Saúde (SUS), experienciam e significam o uso dessa ferramenta. Vinte usuários participaram da investigação e entrevistas individuais foram estratégias utilizadas para acessar suas experiências. A participação em grupos terapêuticos, em equipamentos de Atenção Primária ou Secundária, há mais de um mês, foram critérios para inclusão dos entrevistados. Os entrevistados relataram aprendizagens quando em grupos, legitimando atendimentos grupais como facilitadores da construção de vínculos com seus pares e promotores de saúde. Eles recuperaram o modelo de atendimento individual como parâmetro de atenção psicológica e apresentaram a questão do sigilo como um desafio a ser trabalhado nas realidades grupais. Novas pesquisas sobre experiências de usuários de atendimento grupal psicológico nos equipamentos de saúde do SUS permitirão ampliação dos achados.

The use of group practices has been described as a useful resource for the professional work of psychologists and a qualified alternative in health services. In this study, the objective was to understand how users cared for by psychologists, in group psychotherapeutic interventions, offered in services of the Sistema Único de Saúde (SUS) in Brazil, experience and signify the use of these devices. Twenty users participated in the investigation and individual interviews were strategies used to access their experiences. Participation in therapeutic groups, in Primary or Secondary Care equipment, for more than a month, were criteria for the inclusion of respondents. Respondents reported learning when in groups, legitimizing group care as facilitators of building bonds with their peers and as health promoters. They recovered the individual care model as a parameter of psychological care and presented the issue of secrecy as a challenge to be worked on in group realities. New research on the experiences of users of psychological group care in SUS health equipment will allow an expansion of the findings.

El uso de prácticas grupales se ha descrito como un recurso útil para la práctica profesional de los psicólogos y una alternativa calificada en los servicios de salud. En este estudio, el objetivo fue comprender cómo los usuarios atendidos por psicólogos, en intervenciones psicoterapéuticas grupales, ofrecidas en los servicios del Sistema Único de Saúde (SUS) en Brasil, experimentan y significan el uso de estos dispositivos. Veinte usuarios participaron de la investigación y las entrevistas individuales fueron estrategias utilizadas para acceder a sus experiencias. La participación en grupos terapéuticos, en equipos de Atención Primaria o Secundaria, durante más de un mes, fueron criterios de inclusión de los encuestados. Los encuestados informaron que aprendieron cuando estaban en grupos, legitimando el cuidado grupal como facilitadores de la construcción de vínculos con sus pares y promotores de salud. Recuperaron el modelo de atención individual como parámetro de la atención psicológica y presentaron el tema del secreto como un desafío a trabajar en las realidades grupales. Una nueva investigación sobre las experiencias de los usuarios de la atención psicológica grupal en los establecimientos de salud del SUS permitirá ampliar los hallazgos.

Aportes del nuevo marco para las funciones esenciales de salud pública a la lucha contra la pandemia de COVID-19

[RESUMEN]. En el presente artículo se utiliza una perspectiva de rectoría de la salud, con el fin de interpretar las fortalezas y los obstáculos relativos a las capacidades de las autoridades nacionales de salud para responder ante la pandemia de COVID-19, a través del marco renovado de las funciones esenciales de salud pública (FESP). Sobre la base de una revisión bibliográfica, se sostiene que las capacidades institucionales que necesitan los países de la Región de las Américas para responder ante la pandemia de COVID-19 incluyen las cuatro etapas del nuevo ciclo de políticas en las FESP: la evaluación, la formulación de políticas, la asignación de recursos y el acceso. Aunque las autoridades de salud proporcionaron las funciones esenciales (por ejemplo, análisis de datos, diálogos intersectoriales en materia de políticas y asignación de fondos adicionales), las intervenciones que se implementaron estuvieron sujetas a las estructuras institucionales de cada país. Las autoridades de salud tuvieron que hacer frente a desafíos considerables como la fragmentación y la falta de capacidades institucionales y de personal, lo que pone en peligro la ejecución de actividades de respuesta eficaces y equitativas. Además, la respuesta a la pandemia ha sido desigual debido a algunas debilidades en la capacidad central de liderazgo y coordinación, la politización de las actividades de respuesta y las diferencias en la capacidad de respuesta a nivel subnacional. Esos desafíos son el reflejo de deficiencias estructurales que ya existían antes de que comenzara la pandemia, así como de la asignación de una priori- dad baja a la salud pública en la agenda para el fortalecimiento de los sistemas de salud. En las agendas que se elaboren en el futuro debe darse prioridad a mejorar los elementos estructurales, fortalecer las capacida- des de rectoría de las autoridades de salud y crear estructuras institucionales que garanticen tanto el acceso universal a la atención de salud como la cobertura universal de salud.

[ABSTRACT]. This article uses a health stewardship perspective to interpret the strengths of and challenges to national health authorities' capacities to respond to the COVID-19 pandemic through the renewed essential public health functions (EPHF) framework. Based on a literature review, this article argues that the institutional capacities required by countries to respond to the COVID-19 pandemic in the Americas included all four stages of the new EPHF policy cycle: assessment, policy development, allocation of resources and access. While health authorities provided these key functions (e.g. data analysis, intersectoral policy dialogues, allocation of additional funds), the interventions implemented depended on each ’country’s own institutional structures. Health authorities faced significant challenges including fragmentation and the lack of institutional and personnel capacities, thus compromising the delivery of an effective and equitable response. In addition, the response to the pandemic has been uneven due to weaknesses in central leadership and coordination capacity, the politicization of the response and differences in the capacity to respond at subnational levels. Such challenges reflect structural weaknesses that existed prior to the onset of the pandemic, as well as the low prioritization of public health in agendas for health systems strengthening. A future agenda should prioritize improving structural elements while strengthening the stewardship capacities of health authorities and developing institutional structures that guarantee access to and universal coverage of health care.

[RESUMO]. Este artigo utiliza uma perspectiva de gestão de saúde para interpretar os pontos fortes e os desafios das capacidades das autoridades nacionais de saúde na resposta à pandemia de COVID-19, por meio da estrutura renovada das funções essenciais de saúde pública (FESP). Com base em uma revisão da literatura, este artigo argumenta que as capacidades institucionais requeridas pelos países para responder à pandemia de COVID-19 nas Américas incluíram todas as quatro etapas do novo ciclo de políticas das FESP: avaliação, formulação de políticas, alocação de recursos e acesso. Embora as autoridades de saúde tenham fornecido essas funções essenciais (por exemplo, análise de dados, diálogos intersetoriais de política, alocação de fundos adicionais), as intervenções implementadas dependiam das próprias estruturas institucionais de cada país. As autoridades de saúde enfrentaram desafios significativos, incluindo a fragmentação e a falta de capacidades institucionais e de pessoal, comprometendo, assim, uma resposta eficaz e equitativa. Além disso, a resposta à pandemia tem sido desigual em decorrência de pontos fracos na liderança central e na capacidade de coordenação, da politização da resposta e de diferenças na capacidade de resposta nos níveis subnacionais. Tais desafios refletem as fragilidades estruturais que existiam antes do início da pandemia, bem como a baixa priorização da saúde pública nas agendas para o fortalecimento dos sistemas de saúde. Uma agenda futura deve priorizar a melhoria dos elementos estruturais, ao mesmo tempo em que fortalece as capacidades de gestão das autoridades de saúde e desenvolve estruturas institucionais que garantam o acesso à saúde e a cobertura universal de saúde.

Serviços essenciais [libras]

O vídeo apresenta informações sobre serviços essenciais. No caso do novo coronavírus, a lista de serviços essenciais pode aumentar ou diminuir, dependendo da necessidade e da situação de contágio pela doença. Criada pelo Planalto, a lista de serviços essenciais pode ser acessada na seguinte página: https://www4.planalto.gov.br/legislacao/imagens/servicos-essenciais-covid-19. O aplicativo FioLibras é um projeto do Instituto de Comunicação e Informação Científica e Tecnológica em Saúde da Fundação Oswaldo Cruz (Icict/Fiocruz), em parceria com o Núcleo de Estudos em Diversidade e Inclusão de Surdos da Universidade Federal Fluminense (Nuedis/UFF), e conta com financiamento do Fundo de Inovação da Fiocruz e do Ministério da Saúde, por meio do Programa Fiocruz de Fomento à Inovação (Inova Fiocruz).

Análise e utilização de dados de rotina no monitoramento dos efeitos da COVID-19 nos serviços essenciais de saúde. Um guia prático para os tomadores de decisão em nível nacional e subnacional. Orientação provisória. 14 de janeiro de 2021

A OMS lançou recentemente o guia Maintaining essential health services: operational guidance for the COVID-19 context [Manutenção de serviços essenciais de saúde: orientação operacional no contexto da COVID-19], que fornece uma estrutura integrada para orientar os países em seus esforços para reorganizar, adaptar e manter a prestação segura de serviços essenciais de saúde de alta prioridade no contexto da pandemia (1). Uma das estratégias operacionais recomendadas para a manutenção de serviços essenciais de saúde é fortalecer o monitoramento, por meio de rastreamento, análise e notificação regulares sobre a utilização e prestação de serviços essenciais de saúde durante o provável aumento e diminuição do surto. Na orientação mencionada, um conjunto de ações de alto nível e indicadores de amostra foram fornecidos para monitorar serviços essenciais de saúde que devem ser avaliados e divulgados regularmente.

Media briefing on COVID-19 - 11/01/2021

00:00:12 FC Hello, all. I am Fadela Chaib, speaking to you from WHO headquarters in Geneva and I welcome you to our global COVID-19 press conference today, Monday January 11th. Present in the room are Who Director-General, Dr Tedros, Dr Mike Ryan, Executive Director, health Emergencies, Dr Maria Van Kerkhove, Dr Mariangela Simao, Assistant Director-General, Access to Medicines and Health Products, Dr Soumya Swaminathan, our Chief Scientist, Dr Bruce Aylward, Special Advisor to the Director-General and Lead on the ACT Accelerator, and Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals. Welcome, all. We have simultaneous interpretation in the six UN languages plus Portuguese and Hindi. Now without further ado I will hand over to the Director-General, Dr Tedros, for his opening remarks. Dr Tedros, the floor is yours. TAG Thank you. Thank you so much, Fadela. Shukran. Good morning, good afternoon and good evening. One year ago the first death from COVID-19 was reported and WHO issued its first tranche of technical guidance. The comprehensive package included guidance on surveillance, lab testing, infection prevention and control, a readiness checklist and risk communication and community engagement. 00:01:52 A year on there have been almost two million deaths from the COVID-19 virus and while we're hopeful about the safe and effective vaccines that are being rolled out we want to see this sped up and vaccines allocated equitably in the coming weeks. Next week at the WHO executive board I will be encouraging all countries to fulfil their pledge to COVAX. I call for a collective commitment so that within the next 100 days vaccination for health workers and those at high risk in all countries is underway. Governments, manufacturers, civil society, religious and community leaders must come together to create the greatest mass mobilisation in history for equitable vaccination. WHO continues to ask vaccine manufacturers from around the world to move swiftly to provide the necessary data that will allow us to consider them for emergency use listings. I am pleased that the WHO team is in China currently working with the producers of the Sinovac and Sinopharm vaccines to assist with compliance with international quality manufacturing practice ahead of potential emergency use listing by WHO. To clarify, this is separate from the WHO origins mission. 00:03:25 We also look forward to Serum Institute of India submitting full data sets for rapid assessment so WHO can determine whether we can recommend their AstraZeneca vaccine for international use. These are just a couple of examples of work underway by WHO, GAVI, CEPI and other partners aimed at safe, rapid, equitable and wise allocation of vaccines. As I have said before and will say again, saving lives, livelihoods and economies depends on a global agreement to avoid vaccine nationalism. Over the weekend WHO was notified by Japan about a new variant of the virus. The more the virus spreads the higher the chance of new change to the virus. Most notably transmissibility of some variants of the virus appears to be increasing. This can drive a surge of cases and hospitalisations which is highly problematic for health workers and hospitals already closed to breaking point. This is especially true where public health and social measures have already broken down. 00:04:53 This can have a knock-on effect on other essential health services. At present the variants do not seem to show increased severity of disease. With new treatments coming down the pipeline we're hopeful that more lives of those with serious cases of COVID-19 can be saved. But we need to follow the public health basics now more than ever. Keep as much physical distance as you can from other people, keep rooms well-ventilated, wear a mask, keep your hands clean and cough away from others into your elbow. You might get fed up of hearing it but the virus is not fed up with us. Limiting transmission limits the chance of dangerous new variants developing. What's most critical is that we sequence the virus effectively so we know how it's changing and how to respond. For example while diagnostics and vaccines still seem to be effective against the current virus we may need to tweak them in the future. Last week WHO released a comprehensive implementation guide and risk monitoring framework to help countries set up high-impact sequencing programmes. 00:06:29 We call on all countries to increase the sequencing of the virus to supplement ongoing surveillance, monitoring and testing efforts and to share that data internationally. This helps us better understand when variants of concern are identified. We're aware that sequencing requires specialist equipment, a trained workforce and close collaboration between experts. Building upon our existing lab networks WHO is working with countries to enhance sequencing capacity and we extend our support to all countries who need it. We achieve much of this through our international network of labs for SARS-CoV2 and influenza flu lab network, both of which have been a beacon of science, solutions and solidarity in the last year. Tomorrow WHO's R&D blueprint group is convening scientists from around the world to set global research priorities for the year ahead including on virus variants and sequencing. This builds on a year's worth of work defining and delivering on an R&D roadmap for COVID-19. Just as we look forward on research and rolling out vaccines we continue work on the origins. We're pleased that an international team of scientists, distinguished experts from ten institutions and countries are commencing their travel to China to engage in and review scientific research with their Chinese counterparts on the origins of the virus. 00:08:30 I want to thank all GOARN partners and the countries supporting this mission. These include Australia, Denmark, Germany, Kenya, Japan, Netherlands, Qatar, Russia, Sudan, the United Kingdom, the United States of America and Vietnam and our colleagues from China. The studies will begin in Wuhan to identify the potential source of infection of the early cases. Scientific evidence will drive hypothesis, which will then be the basis for further long-term studies. This is important not just for COVID-19 but for the future of global health security and to manage emerging disease threats with pandemic potential. We will share more news as we have it but let's give this team of scientists the space to work with their Chinese counterparts effectively and let's wish them all well and express our respect and appreciation to these distinguished scientists and experts. I thank you. Fadela, back to you. 00:09:49 FC Thank you, Dr Tedros. I will now open the floor to questions from members of the media. I remind you that you will need to raise your hand using the function raise your hand in order to get in the queue. I would like now to invite Bayram Aturk from Anadolu news agency to ask the first question. Bayram, are you with us? BM Hi. Thank you, Fadela, for taking my question. I had a short question; as WHO have you set up a concrete date or timeline for delivering vaccines to the 92 low and middle-income countries through the COVAX facility? And if you answer yes which countries or regions are primary on your emergency list? What are your plans on this issue? Thank you. FC Thank you, Bayram. I would like to invite Dr Bruce Aylward to answer this question. Dr Aylward. BA Thank you very much for the question. As I think everyone on the call is aware, over 40 countries have now begun vaccinating against COVID-19 using five different COVID vaccines. However all of that vaccination or virtually all of it, as the Director-General has emphasised, was in the high-income and upper middle-income countries so far. 00:11:27 We're working very hard, as we discussed at last week's press conference, to try and accelerate now the roll-out of vaccines through the COVAX facility and especially for the AMC countries. We expect and we have strong confidence that we should be able to be vaccinating in February in these countries. We're doing everything possible to make sure in as many countries as possible but we cannot do that on our own. We require the co-operation of vaccine manufacturers to prioritise deliveries to the COVAX facility. We require the co-operation of our financiers to see through the financing necessary and we require the co-operation, as Dr Tedros said, of key suppliers to make sure that we have the necessary data to ensure these vaccines meet all of the criteria necessary in terms of efficacy, safety and quality. We are also looking at some extraordinary things we could do to even bring that timeline a little bit further ahead and we have a great ambition actually to try and do something even in January but again it requires the co-operation of a lot of other players, particularly the suppliers to prioritise the COVAX facility and not the COVAX facility but really the AMC countries to be receiving vaccines. 00:12:54 Because right now we have an inequitable situation where vaccines are going to high-income countries, upper middle-income countries and not yet to the lowest-income countries. This is not something that COVAX facility fully controls. We're doing everything possible to advance that. In terms of the specific countries, countries are at different levels of preparedness and readiness to roll out COVAX vaccines so we are in the process of working across all members of COVAX, especially the 92 what we call AMC countries. That's the advance market commitment countries or, for those of you who don't know, the countries who are eligible for support through COVAX for the vaccines. So we're working through all of those - and I'm going to ask Kate to say a word about that - to ensure their readiness. As we go out to countries they come back and they tell us when they would like to introduce their vaccines, when they will be ready to do that, what kind of vaccines and how many they might like to use, etc. So we have to take all of that information together to look at the scale of how the vaccines roll out. 00:14:03 Then we have to match that against the supply side, as I just mentioned. Just last week the COVAX facility wrote out to all of the countries again on 6th January asking for updates on their readiness plans and their ambition in this regard so we hope to actually have that roll-out plan of what countries and when later this month so all of these things are moving fast. The critical piece we need now is to work with the manufacturers to make sure we have the vaccines for these countries. Kate, you may wish to add on the readiness piece. KOB Thank you, Bruce. The country readiness; I think it's not lost on anybody how critical the country readiness is. We've been hearing about high-income countries that are working really hard but struggling to actually deploy the vaccines that they have and to deploy them with speed and with prioritisation that the countries have made. So I think we really cannot underestimate the task that it is for a country to be ready to start to deploy any of these vaccines, in particular vaccines like the Pfizer vaccine that does require special cold-chain processes and ultra-cold chain so keeping it at between -60 and -90 degrees so this is not for the faint of heart. 00:15:24 The areas of country readiness that we're working directly with countries on have to do with their regulatory process. Not only will products need to have this review by WHO but countries also need to have a way to authorise the importation of the products. We're working with countries on training of healthcare workers so that the dosing requirements, the engagement with patients is appropriate for the vaccines that we have. Countries do also need to choose what the priority groups will be. With these limited number of doses that will come initially there does have to be a decision in the country about what that prioritisation will be and we are of course very strongly recommending that it is health workers who are at high and very high risk of COVID disease and older age groups who are also at high and very high risk of serious disease or even of death. I mentioned the cold chain so every country does have to make a plan and start to execute the plan for assuring that there is capacity within the cold chain to handle the influx of the vaccines and safety monitoring of the administration of the vaccines, as we've assured and continue to emphasise that every vaccine programme has a safety monitoring system and doing everything that can be done in order to ensure from the very beginning that there is the monitoring of the doses that are administered and should there be an event that there is the capacity at the site to deal with that health issue. 00:17:14 Finally it sounds like a bit of a boring thing but the data system is really critical. Because these are two-dose regimens there does need to be a way for these adults to be recalled back for them to know when they need to get their second dose and for the whole programme to know whether those second doses are being given in the time frame they're supposed to be given and to make sure that the people who are being vaccinated are getting the full benefit of the vaccine programme. So these are all areas for which WHO is working very closely with UNICEF, with GAVI and other partners. We've developed guidance and training materials and frankly simulation exercises for countries to start to practice and to rehearse and to identify whether or not the systems are in place to be able to deliver these vaccines which are critical for the highest-priority groups to receive in the time and in the way that they need to be received. Those are the areas we're working on. 00:18:22 BA Thanks, Fadela. If I can just come back on one point, it sounds complicated but the reality is we are ready to start vaccinating in the AMC countries. The challenge is threefold; one, the manufacturers prioritising supply to the COVAX facility and also prioritising that they get the information to WHO to be able to ensure the safety, efficacy and quality of the vaccines. So far, as I think most of you are aware, there's only one manufacturer that had submitted those data early enough that we could make a decision on it. That was the Pfizer vaccine. We're delighted that others have now submitted full data. As the Director-General said, Sinopharm has submitted its full data and we're looking at others, we hope, in the near future so that's one piece. Second, the countries that do have access to and are controlling the supply of the products that we know are safe and efficacious, etc; they can be sharing doses or they can be donating doses through the COVAX facility so that we can roll out to other parts of the world. 00:19:36 Then the third piece is that the countries, as Kate would say, who will be using these products can actually put them to good use immediately and that's complicated because our motto is no dose lies idle anywhere in the world. But frankly the best measure of the world's commitment to the equitable roll-out of these products and our common commitment to this battle against COVID will be how quickly the COVAX facility can vaccinated because we need a world committed to that to make it happen. FC Thank you. I would like now to invite Corinne Gretler from Bloomberg to ask the next question. Corinne, the floor is yours. CO Thanks for taking my question. I have one for Mike today. In August you said Sweden did a good job in its fight against COVID. I just wanted to check if your views have changed in any way during the second wave, as in, was Sweden maybe too slow to implement non-voluntary measures? And what would you say are the lessons to be learned from the Swedish approach? Thank you. 00:20:55 MR August seems like such a long time ago. I think if I recall my comments at that time I was being asked about the Swedish approach and I was, I think, articulating at the time that each country had to define its own control measures based on the relationship and the social contract with its own population and that measures that governments would put in place had to be acceptable to citizens. I think at the time the Swedish Government in the first wave very much relied on its own population to implement the basic measures of physical distancing and hygiene and was relying too on the fact that many people in Sweden lived in single-person households, there wasn't as much mixing in that environment and to an extent was really relying on individuals and communities to implement behaviours that would reduce the risk of transmission. I think at the time I did reflect on the fact that that demonstrated the kind of relationship that governments needed with populations in order to be successful in sustaining a long-term process of this kind of new normal and I still stand by that. I still think we need those kinds of contracts where citizens implement without coercion and without being forced the kinds of measures that are in the interests of their health, their community's health, their family's health. 00:22:25 I think the Swedish Government themselves, the Swedish officials did say, like many around the world, that a number of issues were missed during those first and possibly second waves; protection of older persons, particularly those living in long-term care facilities, the specific issues related to migrant communities that lived in different social circumstances; we saw this in Sweden; we saw this in the Emirates or in the Gulf states; we saw this in Singapore where particular groups, particularly migrant groups, were subject to higher levels of transmission because of the environments in which they were living; dormitory-type conditions, multi-family dwellings, etc. So all countries missed some of the key elements in a sense and learnt those lessons in the first and second waves and I do believe that this time around Sweden has implemented further measures and some of those measures have involved more government-mediated measures including the Government advising and going beyond advice to more strict enforcement of public health measures. 00:23:33 Again it still comes back to that idea of what a government believes is the right way to behave with regard to its own population. These are democratic states and they have to determine. Sweden has a very particular contract with its population. They believe they're acting in good faith and reflecting the will of their people. That changes over time as the severity of this pandemic has changed, as the implications of this pandemic have changed and I believe the Government of Sweden and its population have made good decisions in moving towards probably stricter measures because that is what the pandemic is telling them and because it has been difficult to sustain those purely voluntary measures at societal level, which would be true of every country. I think it is an example of how difficult it is to sustain public health and social measures that are purely determined by the individual's willingness or determination to carry out those measures. It somehow tells us, I think, at the beginning of 2021 how difficult and how challenging that environment is but we have no other choice. Right now we are faced with the prospect, as Kate and Bruce have so eloquently outlined; we have a real prospect, if the right things are done by governments, if the right things are done by companies, that we can begin to accelerate the delivery of vaccines. 00:24:57 But regardless of the success of that there is a period of time now in which older persons or people with underlying conditions still remain extremely susceptible to the negative impacts of being infected with this virus and can get very sick and die. We know that we can stop that, we know that we can interrupt that transmission at one level or another. We may not be able to eliminate transmission but we have demonstrated two to three times in the last year that that is possible. Many countries have had increases of incidence over the last couple of months. We are still discussing how much of that has been due to new variants but the fact remains that the vast majority of that increase in many countries has been down to increased social mixing, down to people not abiding by the basic measures to protect themselves, others and their communities and we need to redouble our efforts on that. 00:25:48 We will say that Sweden, like all countries, needs to redouble its efforts and its population but again it is not for WHO - I repeat that - it is not for WHO to prescribe what nation states do in their sovereign interests and in relation to the sovereign relationship that governments have with their populations. We fundamentally believe that the Swedish Government is acting in the best interests of its population with regard to the information that it has. All countries have to face this reality. We are there to advise, we are there to support. We are not here to criticise. FC Thank you. I would like know to invite a journalist from El Meyadin television, Moussa Asse, to ask the next question. Moussa, are you online? TR Yes. Can you hear me, Fadela? FC Yes, please go ahead. TR I will ask my question in Arabic. The question is as follows; currently we are seeing high-income countries making a lot of orders for vaccines but we see that poorer countries will not have enough access to the vaccines quickly enough. We have seen Lebanese doctors and nurses crying because they couldn't take on any more patients. So my question goes to the Director-General; has your call to share out the vaccines in an equitable manner failed? 00:27:54 FC Thank you, Moussa. Your question was on equitable access to vaccines and we'd like maybe to start with Dr Aylward, if he can provide an answer. BA Thank you very much, Moussa. I'd first like to highlight the importance of the point you made about health workers and indeed these people are at the front line, they're highly exposed to this virus because they're trying to save lives and take care of people with the disease. Indeed our first priority is working across the world with countries that have doses, with manufacturers to get initial doses that we can get out to all countries, not just high-income but right across all countries, for vaccination of that crucial group to ensure they are protected as they continue their important work. 00:28:50 Indeed everybody is making high orders for vaccines and I want to be very clear that the COVAX facility also has high orders. When you say that they're making high orders from high-income countries, we also are making high orders for the low-income and low middle-income countries. Through the COVAX facility we have contracted now or we have deals in place for just over two billion doses of vaccine for these countries and we actually have options and right of first refusal on over a billion doses more so the issue is not the lack of vaccines that we are ordering for the low and low middle-income countries. The crucial thing is the timing to get at least some of those doses early enough to protect, as you say, these healthcare workers on the front lines in these countries as well as, remember, the older populations and others who are at high risk of potentially dying of this disease. That's what's so important is as doses are now going out around the world countries continue to ensure that they don't have to be first in the queue for all of their population but rather for the crucial populations and we need to make sure they get vaccinated around the world. 00:30:07 In terms of the Director-General's call for equitable access I think it's been incredibly well heard. We've had multiple countries talking to us about if they can donate or share doses, when they may be able to do that once they get some initial crucial doses into their populations. We've had manufacturers now starting to speed up their work with us, recognising that we've got to get more of these vaccines properly assessed and quality-assured to get them out. So I think there has been a very, very good response. There's a tremendous commitment but what we need to see are vaccines going into people's arms in low-income, low middle-income countries. These vaccines have got to be efficacious, they've got to be safe and they've got to be of the highest quality. That's our commitment as the World Health Organization as a key part of the COVAX facility, to make sure we can guarantee those vaccines are and those doses are so that's part of what we're working toward. 00:31:06 So far there's been a lot of goodwill but remember, goodwill isn't going to protect people alone. We need the actual vaccine doses and we need them quickly to be able to make that work. SS Just to add, I think this is not the time to get disheartened. We've made incredible progress and a year ago nobody would have predicted that there would have been not one but several vaccines against this new virus that have been developed, manufactured, produced and distributed. This is testament to scientists around the world both in the private sector and in the public sector who've worked together, governments who've supported them, companies who've manufactured them but it does take time. It takes time to scale the production of doses not just in the millions but here we're talking about the billions. So we have to be a little bit patient. The vaccines are going to come; they're going to go to all countries but meanwhile we mustn't forget that there are measures that work and, as Mike was saying, I think it's really important to remind people, both governments as well as individuals, on the responsibilities and the measures that we continue to need to practise for the rest of this year at least because even as vaccines start protecting the most vulnerable we're not going to achieve any levels of population immunity or herd immunity in 2021 and even if it happens in a couple of pockets, in a few countries it's not going to protect people across the world. 00:32:39 So the public health and social measures which are tried, tested, known to work are important even as we start scaling vaccines starting from the most vulnerable and then expanding to cover the whole population. FC Thank you. I would like now to invite Jon Cohen from Science to ask the next question. Jon, are you with us? JO I am. Thank you. I well understand that different countries want to test vaccines to create confidence in them but can you point to any specific evidence that different races or different ethnicities or different genetic backgrounds have had different immune responses or side-effects to any vaccines against any disease? FC Thank you, Jon. Dr Swaminathan. 00:33:39 SS Yes, this is a really good question and I think it's something that should be debated with the regulators around the world because, as you rightly point out, this is a regulatory issue. Countries want to see data on their own subjects, thinking that there might be differences. I cannot think of any vaccine for that matter which has had differences in response in different ethnic groups. One might have a different side-effect profile but again this depends a lot on reporting and that's why we're putting in place systems to ensure that there's good adverse event reporting, especially from the countries where there's been early roll-out of vaccines, both from countries that have well-established pharmacovigilance systems but also from the others. So this is an area - and the Director-General mentioned a couple of meetings that will happen this week, the first one tomorrow looking at research priorities on the variants but the one on 15th, on Friday, will look at the research priorities around vaccines for 2021, acknowledging that we're in a different position today than we were in 2020. But there are lots of unanswered questions but I think your particular question, Jon, on whether we need trials in all countries is a good one and there isn't really a scientific basis for wanting that to happen. Maybe Kate would want to add something to this. 00:35:16 KOB Just to contribute to this; this is from a science perspective. As Soumya said, I think you lumped in in your question a lot of different variables. There are examples of vaccines that have variability in their vaccine effectiveness. Rotavirus is one example; pneumococcal vaccine and hib [?] vaccine are two others where we do see some variability of vaccine efficacy. But you pointed to ethnicity or genetics and where the variability has occurred is more likely to be around the burden of disease and the underlying conditions in the population that have affected the vaccine efficacy. For rotavirus of course this is a completely different vaccine than what we're talking about for COVID and certainly has to do with underlying gut immunity and those sorts of things. So there are in fact examples where it is important to evaluate vaccines especially for those populations that have the highest burden because we absolutely want to make sure that the hurdle that the vaccine has to jump is going to be that hurdle that is most impactful in the populations that need those vaccines the most. 00:36:34 I think the question really is, is there an underlying reason to believe for COVID vaccines that there would be variability according to any of these criteria and certainly evaluating vaccines, whether it's in the pre-licensure or pre-authorisation phase but certainly in the post-use phase, the post-deployment phase where we're measuring and quantifying the impact of those vaccines across a range of populations and across those variables that could have an impact on them so that we can improve the vaccines. There's almost no vaccine that has stayed static. We do always make an effort to improve all the characteristics of vaccines to make them ever more impactful and so we shouldn't also see that where we start from with a vaccine is necessarily the optimum vaccine either from a delivery perspective or from its impact perspective. So I think there is some reason but I really want to support what Soumya said; we should not be going down the route of requiring or expecting that each of these vaccines is going to be or needs to be evaluated before they're used across a broad range of populations. 00:37:56 I think we want to know that they work, they have the biologic effect that they're designed to have, that they're safe, that they can be manufactured at scale and at quality and to deploy them while we continue to learn about how to optimise. FC Thank you to both of you. I would like now to invite Dr Aylward to add. BA I just want to make one last point on this because it's so important. We look at three characteristics of these vaccines; the quality, which is a function of how these things are made and regulated, etc; then we look at the efficacy, as Kate was talking about. The third piece is the safety and what people are often worried about; is there a difference in the safety of these vaccines by the populations? There we have to be absolutely clear; no, we expect for vaccines the safety profile does not change by the populations in which they're used because that's what people are worried about. 00:38:53 Remember, you're giving these vaccines to healthy people and and they want to know. Sometimes there can be side-effects or problems that are related to other conditions that may be at different rates in the population but again, as Kate said, you asked, was there a difference by ethnicity or other and the bottom line is no. So if these are safe somewhere then they're going to be safe. If they have some sort of side-effect then you can expect and, as Soumya said, you have to look for it in those other places to make sure that you manage that as you roll it out. FC Thank you for this very comprehensive answer. I would like now to invite a journalist from the Chinese news agency, Du Yong, to ask the next question. The floor is yours. DU Thank you for the question. Can you hear me? FC Yes, very well. Go ahead, please. DU As COVID cases worldwide could be reaching 100 million within the next few days how can we bring the pandemic under control and how worried should we be in dealing with the new COVID variant? Thank you. 00:40:04 FC Thank you. Dr Ryan. MR Maria, please. Maria will certainly follow up. That milestone is a grim and shocking one as we do approach it. I think I said it in my previous comments; we have the prospect of vaccines that we fundamentally believe will have a major impact and relatively quickly once we have vulnerable populations vaccinated on severe disease and on mortality. That's the first thing we need to deal with; those who are getting severely ill and dying from this disease. We then believe that obviously vaccination at high enough levels can help us with controlling the disease but we have... Again many countries in the world have demonstrated that this disease has a high element of controllability and have actually gone on and done that. Others have not been so lucky for different reasons; the disease has come early, it has entered silently, they have been caught unawares, they haven't been able to sustain a response over a long period of time, surveillance systems have been weak, the populations have not been willing or able to implement long-term behavioural measures or comply with quarantine and isolation and the list goes on. 00:41:27 But again this disease can be significantly controlled by the application of the measures that we have been outlining here for a year, by the implementation of a comprehensive strategy that focuses on reducing transmission, on reducing mortality and on developing the tools that Bruce and so many others have been working on over the last year. I'd love to be here with new answers for you. I would love to be here saying, there are other things we can do. All we can do is pick ourselves up and take the fight back to the virus. For those of you who have the virus under control do not lose control, look at what other countries are suffering as they have lost control of the virus. So if you're in a low-incidence or zero-incidence situation keep it up, it is worth the effort. If you're in, as many countries are, a difficult transmission environment right now there are no other options but to do what you've done before. 00:42:24 I see my own country, in Ireland, which has suffered a massive increase in cases over the last number of weeks, has done extremely well in surges of disease, has brought the disease under control and has suffered one of the most acute increases in disease incidence of any country in the world over the last number of months and not due to the variant, let me add, but mainly due to increased social mixing and reduction in physical distancing. The Government and the authorities and the community there have taken immediate action over the last two weeks and already the disease number's starting to drop, the positivity rate's starting to drop and we are seeing the National Reference Laboratory there doing superb surveillance for the new variant strains which they are tracking. They have not been the driver of new transmission but new variants can and will emerge. Some will be not significant in terms of transmission or in terms of severity. Some may be and that is why we need a comprehensive monitoring framework, to keep an eye on those and ensure that our measures are adapted as needed. 00:43:28 Right now there is no evidence that variants are driving any element of severity. There is some evidence that variants may be increasing or adding to transmission and in some sense giving some extra transmissibility to the virus. I was talking to my colleague, Tony Houlihan, the Chief Medical Officer in Ireland, earlier and we were almost saying that this was like adding a substitution in the second half of a football game; it doesn't change the rules of the game, it doesn't change what you do but it gives the virus some new energy, some new impetus, it adds to the challenge you face because the opposition is bringing on some new players to the field. It doesn't change the rules of the game. It doesn't change what we need to do to win. It just changes the strength of the opponent and in that sense we has to take from that that we just need to redouble our efforts. So thank you for the question. Maria, you may wish to add. MK I'm just laughing at your sports analogy because I'm terrible at sports analogies. I think the whole point is that this virus is controllable, even these variants that we are seeing. Having variants become identified because we have good sequencing that's happening globally and that's increasing globally, the fact that we are identifying variants that have increased transmissibility in some situations is not good. 00:44:53 It doesn't help the situation, it makes it that much harder but we still have control over this virus. There were increases in transmission in a number of countries before these variants were identified, before these variants were circulating and that was due to increased mixing of people. There's no way around that. Variants don't help these situations where they are now circulating and now are being identified in other countries. That's going to make it that much harder but we have tools in our toolbox that help us be able to break chains of transmission and we will continue to say this. What we do need are countries that are facing incredibly intense transmission; we should also note that that's not universal across the world. Transmission intensity is really concentrated in some countries. Just look at our website and you can look at our dashboard and see where transmission is most intense around the world and in many countries, some of those countries have shown us over the summer months in the northern hemisphere that they could bring transmission under control. 00:45:56 Transmission was down to single digits in most countries across Europe over the summer and we lost the battle because we changed our mixing patterns over the summer, into the fall and especially around the Christmas and New Year holiday. The number of contacts that individuals and their families had increased significantly over the Christmas and New Year holiday and that has had a direct impact on the exponential growth that you have seen in many countries. Some of the exponential countries we've seen in countries is almost vertical, it's not even at a slant, it's almost vertical but that doesn't mean we've lost the battle. We have to make sure that we as individuals do what we can to limit our contact with other families outside of our immediate family. The biggest thing that we can do right now is keep a physical distance from others and I know that's really difficult but it's true. We can increase our distance in some respects by wearing masks. We can make sure that governments provide a supportive environment so that if we are asked to stay home we can stay home, that our children can be looked after, that we can still put food on the table; all of that needs to be supported. 00:47:11 The fundamental aspects of the public health and social measures of active case finding, cluster investigation, isolation and clinical care of cases, quarantine which is supportive of all contacts; this is what breaks chains of transmission. We can look for the next shiny bullet, we can look for the next high that can help us but it all comes back to those public health and social measures. Vaccines and vaccinations are an incredibly powerful tool and, as you've heard all of us say, we don't just have one safe and effective vaccine, we have many but it is going to take time for those to come online. In the meantime there is much that we can do. We just have to do it and it will be hard and we're with you because we're in an area right now that also has intense transmission but we need to put in the work. So please do what you can as individuals, as communities, as leaders of your families, as religious leaders, government leaders to put a system in place to help people limit their contact with others while remaining socially connected with their loved ones. 00:48:15 But we can definitely do more to try to turn the corner and bring transmission down because many countries have shown us that they can do it already and, as Mike said, those countries that have brought transmission down, keep it down, do everything that you can to keep it down because many countries are showing us that they've found that balance of adjusting the public health and social measures while opening up and keeping transmission low. If any cases are identified or any clusters are identified really quick, rapid, aggressive investigation of those cases so that those small numbers of cases do not become community transmission. We have been shown over and over again that countries can do this and so even countries with intense transmission can turn it around. Vaccines will be another powerful tool but it will take some time so hang in there, remain focused and determined to do what you can to be part of the spike. 00:49:15 FC Thank you. Let's move now to Italy, inviting Sondra Marzano, Italian television channel 7, to ask the next question. Sondra, are you with us? SO Yes. Thank you for taking my question. My question concerns the issue of the report written by some researchers from the Venice office of WHO Europe. This report was published on 13th May and disappeared from the site of WHO after 24 hours. This paper has become very educated [?] [inaudible] Italy did not have an undated influenza plan and that in part the Italian response to the virus was chaotic, improvised. FC Sondra, can you just tell us, what is your question, please? SO Yes. I would like to ask you for a clear and definitive answer on what happened; was the report from the Venice office withdrawn because it disappointed the Italian Minister or because the Minister was not informed? In this case who should have informed the Minister, Mr Rani Iguera [?], who was sent by the Director-General to have direct relations with the Minister, or Francesco Zambon [?], who was responsible for this report? 00:50:55 FC Thank you, Sondra, for this question. MR I think we've dealt with these questions in the past and I'm not going to go back over the specific issues around what was posted on what website on what dates or not because I'll certainly get it wrong a month later. I would refer you to our colleagues in the European region, to Dr Hans Kluger's [?] staff who are dealing with this matter and I don't want to cut across them. It's not that I don't want to give you information. I just don't want to cut across what they have been doing to analyse and to clarify on these issues. So I'm sure we can follow up directly with you in the aftermath of this conference. I know Gabi Stern, our Director of Communications, has been dealing with colleagues in Euro and I'm sure Gabi and her staff will get you the information that you need. FC Thank you. The next question is from NSK. Shoko, are you with us? SH Hello, Fadela. Can you hear me? FC Yes, very well. Go ahead, please. 00:51:57 SH Thank you for taking my questions. Regarding the search for the origin of the virus, is WHO planning to send experts to any other countries apart from China at this stage? Thank you. MK Hi. Thank you for your question. We, our team - as you know, the Director-General has said our team is commencing their travel to work with Chinese counterparts on mainly looking at the initial cases and to find more information about those initial cases that were identified in Wuhan. There are a number of aspects that all of us across the world are looking at to really better understand this pandemic. The research, the studies begin in Wuhan. They begin where the first initial patients were identified and then there will be many more studies that will follow on from there. In addition to that, not at the expense of that but in addition to that we are also working with many different networks that we have set up at the start of this pandemic, one of which is our laboratory network that is following up on some studies that have been published that have looked at waste water samples, that have looked at seroprevalence studies or the studies of sera that were collected in 2019 and also tested for antibodies against the SARS-CoV2 virus; any publications that are coming out that had some results from 2019. 00:53:18 In each of those instances we have reached out to the authors of those papers or pre-prints to find out more information about the samples, more information about the tests that were done and in many cases working with the researchers in those countries to set up further evaluations of the samples that were tested in 2019. So there's a lot of work that is ongoing. All of us are working towards better understanding of this pandemic but again the studies that are commencing in Wuhan, that have been ongoing in Wuhan, especially looking at those initial patients that were first identified in December are really, really critical to help us better understand the beginning of this pandemic. MR If I just might add, the investigations in China may lead to hypotheses and may lead to the need to make further enquiries or investigations in other countries and again we as a member state organisation are there in the service, to serve our member states and we have launched well over 100 technical, operational support missions in country. 00:54:28 Our country offices are in 147 countries, 150 countries, I think, at this stage and we have been working very closely with each and every member state regarding their technical, operational, scientific and other needs and I know again the 100/100 initiative that Kate, Bruce and the COVAX colleagues have been leading again has been around delivering direct technical and operational support to countries to get ready for vaccination. That is the essence of what WHO does. With regard to international investigation and response to epidemics, again over a given year we launch so many missions in support of and in partnership with our member states, with our partners in the global outbreak alert and response network and our emergency medical teams networks around the world and our collaborating centre network. So we will go anywhere and everywhere to gather more information around the origins and impact of disease and stand ready if any country has any issues regarding its current epidemic response and even with all of the difficulties in terms of transport and moving people around the world over the last year we've actually increased the levels of engagement we have with our member states. 00:55:37 Obviously within that we've had previous missions on MERS, previous missions on SARS, many other - Ebola, Lassa, so many other emerging diseases and that is part of the day-to-day business of this organisation and we thank all the countries and partners who understand the importance of these kinds of mission. Understanding the origin of disease is not about finding somebody to blame. It is about finding the scientific answers about that very important interface and the interface between the animal kingdom and the human kingdom has now become and has been for many, many years - this is not a new thing. All of our influenza pandemics come from that interface. We've just finished fighting two or three of the worst Ebola outbreaks ever over the last three or four years. These are emerging disease that breach the barrier between animals and humans and cause devastation in human populations. 00:56:33 It is an absolute requirement that we understand that interface and what is driving that dynamic and what specific issues resulted in diseases breaching that barrier. That is not so as to find blame. If that's the case we can blame climate change, we can blame policy decisions made 30 years ago regarding everything from urbanisation to the way we exploit the forest. So if you're looking for someone to blame you can find people to blame in every level of what we're doing on this planet. So therefore the DG has said, let this mission and let other missions be about the science, not about the politics. We are looking for the answers here that may save us in future, not culprits and not people to blame. I'm sorry for being very direct about this but sometimes I get a sense that that is the drive. That doesn't help science and that creates barriers to WHO doing the work we need to do with member states because if the perception of our member states is that we are an investigation outfit, that we have some objective other than the science then it makes it very difficult for us to operate in these situations. 00:57:45 When we have the trust of our member states, when everyone believes that the objective is one of science and public health then we can make huge progress and we would like to thank, as the DG has, all of our partners and I mean all of our partners who've worked with us to ensure the success of this mission over the next couple of weeks and months. FC Thank you, Dr Ryan. It has been one hour since we started this press conference so I would like to hand over to Dr Tedros for any final comments. Over to you, DG. TAG Thank you so much, Fadela, and thank you to those who have joined us today. See you in our upcoming presser. Thank you. FC Thank you. We will be sending you the DG's opening remarks and the audio file just after this press conference. The full transcript will be posted tomorrow. Thank you all and as usual, apologies to journalists who were not able to ask their questions. Please be in contact with the WHO media team if you have any follow-up questions. Thank you and have a nice evening. 00:58:55

Motivación por el servicio público de los profesionales de los centros de atención primaria: ¿qué es más importante el entorno o el apoyo directivo? / Public Service Motivation of the professionals of the primary care centers: What is more important the environment or the perceived supervisor support?

Objetivo: Explicar la Motivación por el Servicio Público de los profesionales sanitarios a partir de (a) el entorno social de su centro de trabajo y (b) el apoyo percibido por parte de sus supervisores. Diseño: Estudio observacional, de corte transversal, cuantitativo, retrospectivo, y no controlado. Emplazamiento: 40 centros de atención primaria pertenecientes al área de salud de Gran Canaria. Atención primaria. Participantes: 605 profesionales sanitarios de centros de atención primaria. 46% médicos y 54% enfermeros. Muestreo no probabilístico por conveniencia con tasa de respuesta del 53,3%. Mediciones principales: La variable dependiente es la Motivación por el Servicio Público de los profesionales sanitarios. Las variables independientes son el entorno social de los centros de atención primaria y el apoyo percibido por parte de los superiores. Los datos se analizaron mediante regresión lineal multinivel y regresión lineal múltiple. Resultados: Las variables del entorno de los centros de salud: renta de la población, porcentaje de personas mayores de 65 años, y la cantidad de población asignada a los centros, no influyen en la Motivación por el Servicio Público de los profesionales sanitarios. Por el contrario, el apoyo que estos perciben por parte de sus superiores sí impacta de forma significativa tanto en el factor compasión (β: 0,38; IC: 0,21-0,32) como en el compromiso por el interés público (β: 0,37; IC: 0,20-0,31). Conclusiones: El apoyo percibido por parte del supervisor ejerce una influencia significativa sobre la Motivación por el Servicio Público de los profesionales sanitarios. Sin embargo, el entorno social no afecta a este tipo de motivación.(AU)

Objective: Explain the Public Service Motivation of health professionals based on (a) the social environment of their workplace and (b) the perceived supervisor support. Design: Observational, cross-sectional, quantitative, retrospective, and uncontrolled study. Setting: Forty primary care centers belonging to the Gran Canaria health area, primary care. Participants: Six hundred and five health professionals from primary care centers. 46% doctors and 54% nurses. Non-probability convenience sampling with a response rate of 53.3%. Main measurements: The dependent variable is the Public Service Motivation of health professionals. The independent variables are the social environment of the primary care centers and the perceived supervisor support. Data were analyzed using multilevel linear regression and multiple linear regression. Results: The following variables of the environment of the healthcare centers: income of the population, percentage of people older than 65 years, and the amount of population assigned to the centers, do not influence the Public Service Motivation of health professionals. On the contrary, the support they receive from their superiors does have a significant impact on both the compassion factor (β: 0.38; CI: 0.21–0.32) and the commitment to the public interest (β: 0.37; CI: 0.20–0.31). Conclusions: The perceived supervisor support has a significant influence on the Public Service Motivation of health professionals. However, the social environment does not affect this type of motivation.(AU)

Trend of health worker's strike at a Tertiary Health Institution in North Central Nigeria

Objectives: Workers' strike is a global phenomenon since antiquity. In Nigeria, health-care sector has been rocked by series of strikes spanning variable periods with immeasurable losses. Ethical consideration and inter-professional rivalry are the main concern attracting much debate in the health sector. The objectives of the study were to determine the trend of health worker's strike actions, the main agitators, and to make some recommendations. Material and Methods: This was a retrospective study of the labor ward records of the Jos University Teaching Hospital from January 1, 1985, to December 31, 2019, duration of 35 years. The data were collated and analyzed using simple percentages and the figures corrected to the nearest decimal point. Results: A total of 42 strike actions, about 2 strikes/year. The trend shows a multi-modal pattern, with the highest peak of 5 strikes in 2004 and 2013. There were cumulatively 58.5 months of strikes out of the 442 months of the period of study, giving a percentage of 13.2%. While doctors had more frequent strikes (52.3%), non-doctors under the umbrella of Joint Health Sector Union and nurse/midwives accounted for over half (58.1%) of the duration of the strikes. The resident doctors are the main agitators of doctors' strike accounting for about half (45.2%) of the total health workers' strikes, while NMA accounted for only 3 (9.4.%). Most strike actions occur at the end of the year, with spill into the first quarter of the following year. Conclusion: Health workers' strike remains a perennial problem. Inter-professional rivalry is a major challenge in the health sector with far reaching implication without immediate government intervention. Addressing challenges in the residency training program will go a long way in reducing doctors' unrest in the health sector

Idosos vivendo com HIV/aids: a percepção de usuários e profissionais da Atenção Primária à Saúde / Elderly people living with HIV/aids: the perception of users and professionals of Primary Health Care

Considerando a rápida transição demográfica e epidemiológica que se tem vivenciado no Brasil e, sendo a Atenção Primária a porta de entrada preferencial aos serviços de saúde, esta pesquisa possui como objetivo geral avaliar, o cuidado de pessoas idosas vivendo com HIV/Aids no âmbito da Atenção Primária à Saúde. Estudo qualitativo, com abordagem metodológica do tipo estudo de caso, desenvolvido nas seguintes etapas: conhecimento do cuidado às pessoas idosas vivendo com HIV/Aids a partir da percepção dos enfermeiros da Atenção Primária à Saúde; identificação dos desafios para o cuidado a estas pessoas na percepção dos profissionais da Atenção Primária à Saúde; percepção de pessoas idosas que vivem com HIV/Aids sobre o seu tratamento; análise sobre a influência da acessibilidade geográfica dos serviços públicos de saúde no tratamento das pessoas idosas vivendo com HIV/Aids. A pesquisa foi realizada no município de Itaboraí, no estado do Rio de Janeiro. A coleta dos dados foi realizada por meio da entrevista semiestruturada com os profissionais no mês de novembro de 2019 a janeiro de 2020 e a entrevista com os idosos que vivem com HIV/Aids, devido à pandemia COVID-19, foi realizada entre o mês de setembro de 2020 a fevereiro de 2021. Ao conhecer o cuidado a partir da percepção dos enfermeiros emergiram as seguintes unidades de análise: 1- O cuidado integral visto essencialmente como acolhimento; 2- Para os enfermeiros a participação da equipe multiprofissional e a capacitação profissional conferem garantias do cuidado; 3- O cuidado integral é caracterizado pelos atributos essenciais da Atenção Primária à Saúde. Na identificação dos desafios para o cuidado aos idosos vivendo com HIV/Aids na percepção dos profissionais da Atenção Primária à Saúde o corpus foi desenvolvido com o discurso dos 56 profissionais (24 médicos e 32 enfermeiros) e na descrição do tratamento na percepção dos idosos que vivem com HIV/Aids, o corpus foi constituído com textos oriundos dos discursos de 15 usuários. Os dados foram organizados e processados com auxílio do software Iramuteq, analisados por meio da Classificação Hierárquica Descendente, análise de similitude e nuvem de palavras. Emergiram 10 classes nos discursos dos profissionais e 6 classes nos discursos dos usuários. O georreferenciamento foi realizado através do Google Earth e Google Maps. A percepção dos enfermeiros sobre o cuidado ainda é voltada para a dimensão técnica, sendo os aspectos biopsicossociais menoconsiderados como parte do trabalho junto à população. Na percepção dos profissionais da Atenção Primária o cuidado a essas pessoas apresenta como principais desafios o sigilo, estigma da doença, vínculo, manutenção de equipe multidisciplinar para apoio, educação permanente dos profissionais, acesso e a integralidade da assistência. Foi identificado que a distância entre a residência do idoso e o Serviço de Atenção Especializada chega a ser 30 vezes superior que a distância entre o usuário e a Unidade de Atenção Primária à Saúde. A necessidade de fortalecer serviços de Atenção Primária foi notária, tendo em vista que, como ordenadora da Rede de Atenção à Saúde, seu papel não ficou bem delineado, com grande fragilidade na integralidade da assistência e na própria resolubilidade da APS. Apesar do modelo de atenção fragmentado, longe do ideal recomendado pelas literaturas, os idosos sentem-se satisfeitos com o tratamento recebido para o HIV/aids, referindo vínculo e humanização no cuidado à sua saúde, independentemente da acessibilidade geográfica dos serviços de saúde.

Considering the rapid demographic and epidemiological transition that has been experienced in Brazil and, since Primary Care is the preferred gateway to health services, this research has the general objective of evaluating the care of elderly people living with HIV/AIDS within the scope of Primary Health Care. Qualitative study, with a case study methodological approach, developed in the following stages: knowledge of care for elderly people living with HIV/AIDS from the perception of nurses in Primary Health Care; identification of challenges for the care of these people in the perception of Primary Health Care professionals; perception of elderly people living with HIV/AIDS about their treatment; analysis of the influence of geographic accessibility of public health services in the treatment of elderly people living with HIV/AIDS. The research was carried out in the municipality of Itaboraí, in the state of Rio de Janeiro. Data collection was carried out through a semi-structured interview with professionals from November 2019 to January 2020 and the interview with the elderly living with HIV/AIDS, due to the COVID-19 pandemic, was carried out between the month of September 2020 to February 2021. When knowing care from the nurses' perception, the following units of analysis emerged: 1- Comprehensive care seen essentially as embracement; 2- For nurses, the participation of the multidisciplinary team and professional training provide guarantees of care; 3- Comprehensive care is characterized by the essential attributes of Primary Health Care. In identifying the challenges for the care of elderly people living with HIV/AIDS in the perception of Primary Health Care professionals, the corpus was developed with the speech of 56 professionals (24 doctors and 32 nurses) and in the description of the treatment in the perception of the elderly living with HIV/AIDS, the corpus was constituted with texts from the speeches of 15 users. Data were organized and processed using the Iramuteq software, analyzed using Descending Hierarchical Classification, similarity analysis and word cloud. 10 classes emerged in the professionals' discourses and 6 classes in the users' discourses. Georeferencing was performed using Google Earth and Google Maps. Nurses' perception of care is still focused on the technical dimension, with biopsychosocial aspects being less considered as part of working with the population. In the perception of Primary Care professionals, care for these people presents as main challenges confidentiality, stigma of the disease, bonding, maintenance of a multidisciplinary team for support, permanent education of professionals, access and comprehensive care. It was identified that the distance between the elderly person's residence and the Specialized Care Service is up to 30 times greater than the distance between the user and the Primary Health Care Unit. The need to strengthen Primary Care services was evident, taking into account given that, as coordinator of the Health Care Network, her role was not well defined, with great fragility in the integrality of care and in the very solvability of Primary Health Care. Despite the fragmented care model, far from the ideal recommended by the literature, the elderly feel satisfied with the treatment received for HIV/AIDS, referring to bonding and humanization in their health care, regardless of the geographic accessibility of health services.

Utilidad de las Funciones Esenciales de la Salud Pública para afrontar la COVID-19 / Usefulness of the Essential Functions of Public Health for Confronting COVID-19

La humanidad ha sido testigo, desde sus orígenes, de una infinidad de hechos que, en determinados momentos de su historia, afectaron considerablemente a grandes grupos poblacionales. Las guerras, los desastres naturales, las hambrunas y las epidemias, entre otras, han sido las causas de grandes calamidades a escala global.1 En febrero de 2020, la Organización Mundial de la Salud (OMS) denomina una nueva enfermedad, la COVID-19, causada por el SARS-CoV-2 (por la sigla en inglés de coronavirus 2 - síndrome respiratorio agudo severo), un nuevo virus descubierto en Wuhan, Hubei, China, a finales de diciembre de 2019.2,3 Este virus es el séptimo miembro de la familia Coronaviridae, que se sabe infecta a los humanos.4 La rápida propagación de COVID-19 puede significar grandes problemas, ya que incluso los países con sistemas de salud avanzados pueden verse saturados por la gran cantidad de casos. Esta situación ha condicionado un enorme desafío para todos los sistemas nacionales de salud, especialmente los de los países de medianos y bajos ingresos. La mayoría de ellos no responde de manera eficiente, por lo que están en riesgo de colapsar debido a que cuentan con recursos limitados. Ante esta situación varios países buscan aplanar la curva de la pandemia. En otras palabras, prevenir y retrasar la propagación del virus para que grandes porciones de la población no estén enfermas al mismo...(AU)

Segunda onda ­ fatores envolvidos / Second wave -factors involved

A pandemia da infecção causada pelo novo coronavírus (SARS-CoV-2) que teve início na China no ano de 2019, com grande número de pacientes hospitalizados e óbitos, vem registrando aumento no número de notificações de novos casos da doença COVID-19 o que tem sido chamado de "Segunda Onda", gerando um novo alerta para a população, órgãos de saúde e governantes ao redor do mundo.

The pandemic of infection caused by the new coronavirus (SARS-CoV-2) that started in China in year 2019, with a large number of hospitalized patients and deaths, has been recording increase in the number of notifications of new cases of the disease COVID-19 what has been called the "Second Wave", generating a new alert for the population, health agencies and rulers around the world.

Impacto de la COVID-19 en la prestación de los servicios de salud esenciales en Paraguay

[RESUMEN]. Objetivo. Determinar la magnitud del impacto de la actual pandemia de enfermedad por el nuevo coronavirus (COVID-19) en la prestación de servicios de salud esenciales en todos los niveles de atención de Paraguay. Métodos. Investigación observacional descriptiva y transversal. Se utilizaron indicadores de servicios del Ministerio de Salud Pública y Bienestar Social que se monitorean en el país. Para comparar el comportamiento de dichos indicadores en el tiempo, se utilizaron datos del primer cuatrimestre (enero-abril) de los años 2017-2020. Para el cálculo del impacto en cada indicador se comparó el mismo cuatrimestre de 2019 y de 2020, y se calcularon los porcentajes de incremento o decremento entre estos años. Resultados. Desde el año 2017, se ha incrementado el número de consultas en todos los indicadores; sin embargo, en 2020 casi todos han disminuido en grado variable. Los más afectados (más de 30% de reducción) son la atención por alteraciones digestivas, hemolinfopoyéticas y oculares. Para los indicadores control de diabetes mellitus y control de salud en menores de 5años se observó un incremento del número de consultas de 10,5% y 3,9%, respectivamente. Conclusiones. La atención sanitaria en servicios esenciales se ha visto afectada por la pandemia debido a la reducción del número de consultas por causas ajenas a la COVID-19, lo que debe servir de alerta el sistema de salud a fin no perder el terreno ganado en este frente.

[ABSTRACT]. Objective. To determine the magnitude of the impact of the current COVID-19 pandemic on the delivery of essential health services at all levels of care in Paraguay. Methods. Descriptive and cross-sectional observational research. Indicators of services of the Ministry of Public Health and Social Welfare monitored in the country were analyzed. To compare the behavior of these indicators over time, data from the first four months (January-April) of 2017-2020 were used. To calculate the impact on each indicator, the same four-month period of 2019 and 2020 was compared, and the percentages of increase or decrease between these years were calculated. Results. Since 2017, the number of visits has increased for all indicators; however, in 2020 visits related to almost all indicators have decreased to a variable degree. The most affected indicators (more than 30% decrease) were visits for digestive, hemolymphopoietic and ocular conditions. The number of visits related to the indicators control of diabetes mellitus and health control in children under 5 years increased 10.5% and 3.9%, respectively. Conclusions. Health care related to essential services has been affected by the pandemic with a reduction of visits for non-COVID-19 causes, which should serve as an alert for the health system in order not to lose the ground gained on this front.

Harmonized health service capacity assessments in the context of the COVID-19 pandemic: interim guidance - 2 November 2020

Countries face a multitude of questions and decisions that must be addressed to prepare for and respond directly to the COVID-19 pandemic while simultaneously maintaining the delivery of other health services. Key decisions and actions to mitigate the risk of potential health system collapse must be informed by accurate and timely data collected through ongoing monitoring of health service delivery and utilization throughout all phases of the COVID-19 pandemic. Rapid and accurate assessments of health service capacities ­ including management structures and processes, health worker capacity and protection, resources, supply-chain management, and community needs ­ are essential for planning high-quality service delivery and the related redistribution of resources. This suite of modules is designed to meet country needs throughout the different phases of COVID-19 preparedness, response and recovery, and is aligned and consistent with all published WHO guidance on COVID-19. Its primary aim is to support rapid and accurate assessments of the current, surge and future capacities of health facilities, so that they are prepared for and responsive to COVID-19 while maintaining the delivery of essential health services throughout all phases of the pandemic.

“Now I feel safe to come to the hospital.”: how WHO helped Ghana respond to COVID-19 pandemic

During the COVID-19 pandemic, WHO is supporting authorities in Ghana to continue providing essential health services to the population, including material and child care.