Integrated use of laboratory services for multiple infectious diseases in the WHO European Region during the COVID-19 pandemic and beyond.

Technical advances in diagnostic techniques have permitted the possibility of multi-disease-based approaches for diagnosis and treatment monitoring of several infectious diseases, including tuberculosis (TB), human immunodeficiency virus (HIV), viral hepatitis and sexually transmitted infections (STI). However, in many countries, diagnosis and monitoring, as well as disease response programs, still operate as vertical systems, potentially causing delay in diagnosis and burden to patients and preventing the optimal use of available resources. With countries facing both human and financial resource constraints, during the COVID-19 pandemic even more than before, it is important that available resources are used as efficiently as possible, potential synergies are leveraged to maximise benefit for patients, continued provision of essential health services is ensured. For the infectious diseases, TB, HIV, hepatitis C (HCV) and STI, sharing devices and integrated services starting with rapid, quality-assured, and complete diagnostic services is beneficial for the continued development of adequate, efficient and effective treatment strategies. Here we explore the current and future potential (as well as some concerns), importance, implications and necessary implementation steps for the use of platforms for multi-disease testing for TB, HIV, HCV, STI and potentially other infectious diseases, including emerging pathogens, using the example of the COVID-19 pandemic.

The evolution of community-based primary health care, Slovenia.

PROBLEM: Slovenia's model of primary health care relied on reactive, episodic care and was ill-equipped to address the country's burden of disease dominated by noncommunicable diseases. APPROACH: The government has developed a multidisciplinary, community-based, prevention-oriented service delivery model for primary health care. A compulsory family medicine residency programme was introduced in 2000, and from 2004 screening and control of chronic diseases were established in family medicine practices. Health promotion centres were established, providing group interventions to support healthy lifestyles. After 2011, registered nurses were introduced to conduct screening for chronic diseases, provide counselling and manage patients with stable noncommunicable diseases. LOCAL SETTING: In 1992, the government transformed Slovenia's health financing scheme to a social insurance system based on mandatory payroll taxes. The system enabled private provision of health services, although primary care was mostly provided by publicly funded community health centres. A strong gatekeeping role was introduced. RELEVANT CHANGES: Despite spending less on health than the European Union (EU) average, by 2013 Slovenia's life expectancy was higher than the average for EU countries. The increase was due in part to rapidly declining infant and under-five mortality and a faster decline in premature mortality due to chronic diseases. LESSONS LEARNT: Slovenia's approach was enabled by strong public health and governance structures, along with accountability mechanisms that monitored outcomes and took corrective action when necessary. New programmes were piloted, creating a strong evidence base that facilitated obtaining sustainable financing, while national roll-out was supported by regional branches of the National Institute of Public Health.

Assessing progress under Health 2020 in the European Region of the World Health Organization.

BACKGROUND: Health 2020 is the regional health policy framework of the World Health Organization (WHO) Regional Office for Europe. The goals of Health 2020 are to improve health and well-being, reduce health inequalities and strengthen public health. To gain insight into the Health 2020 targets needing extra attention in coming years, we assessed progress under Health 2020 in the WHO European Region. METHODS: Quantitative methods were used to assess progress in 50 out of 53 Member States of the WHO European Region in 2005, 2010 and 2015. The 16 quantitative Health 2020 indicators were rescaled from 1 to 100, with 1 indicating poor performance and 100 indicating good performance. The geometric mean of all 16 rescaled indicators was taken by Health 2020 target to compose a Health 2020 index. RESULTS: The Health 2020 index (2015) ranged from 82.8 in Sweden to 30.0 in Turkmenistan. A clear east-west gradient was observed in the WHO European Region, with countries in western parts performing relatively better than countries in eastern parts. Indicators with the largest increase between 2005 and 2015 were premature mortality, mortality external causes, life expectancy and infant mortality. However, all quintiles showed a decline on overweight. CONCLUSIONS: The Health 2020 index gives a relative overview regarding the past and present performance on the Health 2020 policy framework of countries in the WHO European Region. Although improvements have been observed between 2005 and 2015, challenges remain to improve health for all in the context of the United Nations 2030 Agenda for Sustainable Development.

Values Underpinning Integrated, People-Centred Health Services: Similarities and Differences among Actor Groups Across Europe.

Introduction: In addition to the functional aspects of healthcare integration, an understanding of its normative aspects is needed. This study explores the importance of values underpinning integrated, people-centred health services, and examines similarities and differences among the values prioritised by actors across Europe. Methods: Explorative cross-sectional design with quantitative analysis. A questionnaire of 18 values was conducted across Europe. A total of 1,013 respondents indicated the importance of each of the values on a nine-point scale and selected three most important values. Respondents were clustered in four actor groups, and countries in four European sub-regions. Results: The importance scores of values ranged from 7.62 to 8.55 on a nine-point scale. Statistically significant differences among actor groups were found for ten values. Statistically significant differences across European sub-regions were found for six values. Our analysis revealed two clusters of values: 'people related' and 'governance and organisation'. Discussion and conclusion: The study found that all 18 values in the set are considered important by the respondents. Additionally, it revealed distinctions in emphasis among the values prioritised by actor groups and across sub-regions. The study uncovered two clusters of values that contribute to a conceptually based definition of integrated, people-centred health services.

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

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

Porcine Models of Biofilm Infections with Focus on Pathomorphology.

Bacterial biofilm formation is one of the main reasons for a negative treatment outcome and a high recurrence rate for many chronic infections in humans. The optimal way to study both the biofilm forming bacteria and the host response simultaneously is by using discriminative, reliable, and reproducible animal models of the infections. In this review, the advantages of in vivo studies are compared to in vitro studies of biofilm formation in infectious diseases. The pig is the animal of choice when developing and applying large animal models of infectious diseases due to its similarity of anatomy, physiology, and immune system to humans. Furthermore, conventional pigs spontaneously develop many of the same chronic bacterial infections as seen in humans. Therefore, in this review porcine models of five different infectious diseases all associated with biofilm formation and chronicity in humans are described. The infectious diseases are: chronic wounds, endocarditis, pyelonephritis, hematogenous osteomyelitis, and implant-associated osteomyelitis (IAO).

Lessons from 20 Years of Capacity Building for Health Systems Thinking.

In 2016, the Flagship Program for improving health systems performance and equity, a partnership for leadership development between the World Bank and the Harvard T.H. Chan School of Public Health and other institutions, celebrates 20 years of achievement. Set up at a time when development assistance for health was growing exponentially, the Flagship Program sought to bring systems thinking to efforts at health sector strengthening and reform. Capacity-building and knowledge transfer mechanisms are relatively easy to begin but hard to sustain, yet the Flagship Program has continued for two decades and remains highly demanded by national governments and development partners. In this article, we describe the process used and the principles employed to create the Flagship Program and highlight some lessons from its two decades of sustained success and effectiveness in leadership development for health systems improvement.

Улучшение показателей по неинфекционным заболеваниям: барьеры и возможности систем здравоохранения: Казахстан

Уровень преждевременной смертности от неинфекционных заболеваний (НИЗ) в Казахстане – одиниз наиболее высоких среди стран Европейского региона ВОЗ; в 2012 г. он составил 648,31 на 100 000человек населения в возрасте от 30 до 69 лет. Значительные социально-экономические последствияэтой ситуации для развития страны обусловливают необходимость срочного укрепления потенциаласистемы здравоохранения для эффективного реагирования на растущее бремя НИЗ. В Казахстанев этом направлении уже достигнут значительный прогресс, имеется также прочная политическаяприверженность, однако показатели по контролю НИЗ все еще нуждаются в улучшении. В настоящемдокладе приведен обзор проблем и возможностей системы здравоохранения Казахстана применительнок наращиванию основных услуг профилактики, ранней диагностики и лечения НИЗ. Также освещеныпримеры передовой практики в оказании помощи пациентам с инсультом, онлайновом использованиимедицинской информации и ведении регистров. По результатам оценки сформулированы рекомендациидля дальнейших действий.

Strategic planning for health: a case study from Turkey

This report explores the role of strategic planning in Turkey’s successful transformation of its health sector since 2002. It analyses the evolution of strategic planning for health from an informal tool to an official and highly structured process that closely follows the steps identified in accepted models of strategic planning. The report also analyses the process employed to prepare Turkey’s strategic plans for health, as well as their contents, including the vision for Turkey’s health system, the Ministry of Health’s mission, strategic goals, objectives and the monitoring and evaluation framework with its indicators and targets. In addition, the report documents that Turkey’s most recent strategic plan, Strategic Plan 2013–2017, is an example of the new European policy framework – Health 2020 – put into practice at the country level. It therefore serves as an role model for other countries wishing to develop their strategic planning capacity.