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Health inequities, within and across countries, stand as a critical global challenge of our time. Over 1 billion people face preventable diseases and premature deaths due to limited access to [...]

The article discusses the role of digital health solutions in strengthening health systems and improving health care services. Topics discussed include the global challenge of health inequities with billions of people facing preventable diseases and premature deaths due to the lack of health care access, the interoperability of existing health data which is needed to implement digital solutions, and the periodical's calls for papers about digital health solutions.

The aim of this paper is to contribute technical arguments to the debate about the importance of health examination surveys and their continued use during the post-pandemic health financing crisis, and in the context of a technological innovation boom that offers new ways of collecting and analysing individual health data (e.g. artificial intelligence). Technical considerations demonstrate that health examination surveys make an irreplaceable contribution to the local availability of primary health data that can be used in a range of further studies (e.g. normative, burden-of-disease, care cascade, cost and policy impact studies) essential for informing several phases of the health planning cycle (e.g. surveillance, prioritization, resource mobilization and policy development). Examples of the use of health examination survey data in the World Health Organization (WHO) European Region (i.e. Finland, Italy, Malta and the United Kingdom of Great Britain and Northern Ireland) and the WHO Region of the Americas (i.e. Chile, Mexico, Peru and the United States of America) are presented, and reasons why health provider-led data cannot replace health examination survey data are discussed (e.g. underestimation of morbidity and susceptibility to bias). In addition, the importance of having nationally representative random samples of the general population is highlighted and we argue that health examination surveys make a critical contribution to external quality control for a country's health system by increasing the transparency and accountability of health spending. Finally, we consider future technological advances that can improve survey fieldwork and suggest ways of ensuring health examination surveys are sustainable in low-resource settings. [ABSTRACT FROM AUTHOR]

Despite widespread acknowledgement that trust is important in a pandemic, few concrete proposals exist on how to incorporate trust into preparing for the next health crisis. One reason is that building trust is rightly perceived as slow and challenging. Although trust in public institutions and one another is essential in preparing for a pandemic, countries should plan for the possibility that efforts to instil or restore trust may fail. Incorporating trust into pandemic preparedness means acknowledging that polarization, partisanship and misinformation may persist and engaging with communities as they currently are, not as we would wish them to be. This paper presents a practical policy agenda for incorporating mistrust as a risk factor in pandemic preparedness and response planning. We propose two sets of evidence-based strategies: (i) strategies for ensuring the trust that already exists in a community is sustained during a crisis, such as mitigating pandemic fatigue by health interventions and honest and transparent sense-making communication; and (ii) strategies for promoting cooperation in communities where people mistrust their governments and neighbours, sometimes for legitimate, historical reasons. Where there is mistrust, pandemic preparedness and responses must rely less on coercion and more on tailoring local policies and building partnerships with community institutions and leaders to help people overcome difficulties they encounter in cooperating with public health guidance. The regular monitoring of interpersonal and government trust at national and local levels is a way of enabling this context-specific pandemic preparedness and response planning. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) set up the messenger ribonucleic acid (mRNA) technology transfer programme in June 2021 with a development hub in South Africa and 15 partner vaccine producers in middle-income countries. The goal was to support the sustainable development of and access to life-saving vaccines for people in these countries as a means to enhance epidemic preparedness and global public health. This initiative aims to build resilience and strengthen local vaccine research, and development and manufacturing capacity in different regions of the world, especially those areas that could not access coronavirus disease 2019 (COVID-19) vaccines in a timely way. This paper outlines the current global vaccine market and summarizes the findings of a case study on the mRNA technology transfer programme conducted from November 2022 to May 2023. The study was guided by the vision of the WHO Council on the Economics of Health for All to build an economy for health using its four work streams of value, finance, innovation and capacity. Based on the findings of the study, we offer a mission-oriented policy framework to support the mRNA technology transfer programme as a pilot for transformative change towards an ecosystem for health innovation for the common good. Parts of this vision have already been incorporated into the governance of the mRNA technology transfer programme, while other aspects, especially the common good approach, still need to be applied to achieve the goals of the programme. [ABSTRACT FROM AUTHOR]

Climate change poses significant risks to health and health systems, with the greatest impacts in low- and middle-income countries - which are least responsible for greenhouse gas emissions. The Conference of Parties 28 at the 2023 United Nations Climate Change Conference led to agreement on the need for holistic and equitable financing approaches to address the climate and health crisis. This paper provides an overview of existing climate finance mechanisms - that is, multilateral funds, voluntary market-based mechanisms, taxes, microlevies and adaptive social protection. We discuss these approaches' potential use to promote health, generate additional health sector resources and enhance health system sustainability and resilience, and also explore implementation challenges. We suggest that public health practitioners, policy-makers and researchers seize the opportunity to leverage climate funding for better health and sustainable, climate-resilient health systems. Emphasizing the wider benefits of investing in health for the economy can help prioritize health within climate finance initiatives. Meaningful progress will require the global community acknowledging the underlying political economy challenges that have so far limited the potential of climate finance to address health goals. To address these challenges, we need to restructure financing institutions to empower communities at the frontline of the climate and health crisis and ensure their needs are met. Efforts from global and national level stakeholders should focus on mobilizing a wide range of funding sources, prioritizing co-design and accessibility of financing arrangements. These stakeholders should also invest in rigorous monitoring and evaluation of initiatives to ensure relevant health and well-being outcomes are addressed. [ABSTRACT FROM AUTHOR]

Despite increased advocacy and investments in mental health systems globally, there has been limited progress in reducing mental disorder prevalence. In this paper, we argue that meaningful advancements in population mental health necessitate addressing the fundamental sources of shared distress. Using a systems perspective, economic structures and policies are identified as the potential cause of causes of mental ill-health. Neoliberal ideologies, prioritizing economic optimization and continuous growth, contribute to the promotion of individualism, job insecurity, increasing demands on workers, parental stress, social disconnection and a broad range of manifestations well-recognized to erode mental health. We emphasize the need for mental health researchers and advocates to increasingly engage with the economic policy discourse to draw attention to mental health and well-being implications. We call for a shift towards a well-being economy to better align commercial interests with collective well-being and social prosperity. The involvement of individuals with lived mental ill-health experiences, practitioners and researchers is needed to mobilize communities for change and influence economic policies to safeguard well-being. Additionally, we call for the establishment of national mental wealth observatories to inform coordinated health, social and economic policies and realize the transition to a more sustainable well-being economy that offers promise for progress on population mental health outcomes. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) aims to reduce new leprosy cases by 70% by 2030, necessitating advancements in leprosy diagnostics. Here we discuss the development of two WHO's target product profiles for such diagnostics. These profiles define criteria for product use, design, performance, configuration and distribution, with a focus on accessibility and affordability. The first target product profile outlines requirements for tests to confirm diagnosis of leprosy in individuals with clinical signs and symptoms, to guide multidrug treatment initiation. The second target product profile outlines requirements for tests to detect Mycobacterium leprae or M. lepromatosis infection among asymptomatic contacts of leprosy patients, aiding prophylactic interventions and prevention. Statistical modelling was used to assess sensitivity and specificity requirements for these diagnostic tests. The paper highlights challenges in achieving high specificity, given the varying endemicity of M. leprae, and identifying target analytes with robust performance across leprosy phenotypes. We conclude that diagnostics with appropriate product design and performance characteristics are crucial for early detection and preventive intervention, advocating for the transition from leprosy management to prevention. [ABSTRACT FROM AUTHOR]

There is increasing use of machine learning for the health financing functions (revenue raising, pooling and purchasing), yet evidence lacks for its effects on the universal health coverage (UHC) objectives. This paper provides a synopsis of the use cases of machine learning and their potential benefits and risks. The assessment reveals that the various use cases of machine learning for health financing have the potential to affect all the UHC intermediate objectives -- the equitable distribution of resources (both positively and negatively); efficiency (primarily positively); and transparency (both positively and negatively). There are also both positive and negative effects on all three UHC final goals, that is, utilization of health services in line with need, financial protection and quality care. When the use of machine learning facilitates or simplifies health financing tasks that are counterproductive to UHC objectives, there are various risks -- for instance risk selection, cost reductions at the expense of quality care, reduced financial protection or over-surveillance. Whether the effects of using machine learning are positive or negative depends on how and for which purpose the technology is applied. Therefore, specific health financing guidance and regulations, particularly for (voluntary) health insurance, are needed. To inform the development of specific health financing guidance and regulation, we propose several key policy and research questions. To gain a better understanding of how machine learning affects health financing for UHC objectives, more systematic and rigorous research should accompany the application of machine learning. [ABSTRACT FROM AUTHOR]

Protecting policy-making from tobacco industry influence is central to effective tobacco control governance. The inclusion of industry actors as stakeholders in policy processes remains a crucial avenue to corporate influence. This influence is reinforced by the idea that the tobacco industry is a legitimate partner to government in regulatory governance. Addressing the influence of the tobacco industry demands a focus on the government institutions that formalize relationships between industry and policy-makers. Industry involvement in government institutions is particularly relevant in tobacco-growing countries, where sectors of government actively support tobacco as an economic commodity. In this paper, we discuss how controlling tobacco industry influence requires unique consideration in tobaccogrowing countries. In these countries, there is a diverse array of companies that support tobacco production, including suppliers of seeds, equipment and chemicals, as well as transportation, leaf buying and processing, and manufacturing companies. The range of companies that operate in these contexts is particular and so is their engagement within political institutions. For governments wanting to support alternatives to tobacco growing (Article 17 of the Framework Convention for Tobacco Control), we illustrate how implementing Article 5.3, aimed at protecting tobacco control policies from tobacco industry interference, is fundamental in these countries. Integrating Article 5.3 with Article 17 will (i) strengthen policy coherence, ensuring that alternative livelihood policies are not undermined by tobacco industry interference; (ii) foster cross-sector collaboration addressing both tobacco industry interference and livelihood development; and (iii) enhance accountability and transparency in tobacco control efforts. [ABSTRACT FROM AUTHOR]

An introduction is presented to a series of papers focused on the scientific dialogue between sectors on health and economics, with topics including constitutional right to health, advancements in mental health as part of a well-being economy, and health taxonomy development to guide sustainable investment decisions.

The article discusses the importance of sexual health to the overall health and wellbeing of people. Topics include steps to make universal sexual and reproductive health rights a reality, reasons for obstacles to advancing sexual health as part of a comprehensive approach to sexual and reproductive health and rights, and the call for papers by the journal for a 2024 theme issue on sexual health and well-being.

Objective To demonstrate how the new internationally comparable instrument, the People's Voice Survey, can be used to contribute the perspective of the population in assessing health system performance in countries of all levels of income. Methods We surveyed representative samples of populations in 16 low-, middle- and high-income countries on health-care utilization, experience and confidence during 2022-2023. We summarized and visualized data corresponding to the key domains of the World Health Organization universal health coverage framework for health system performance assessment. We examined correlation with per capita health spending by calculating Pearson coefficients, and within-country income-based inequities using the slope index of inequality. Findings In the domain of care effectiveness, we found major gaps in health screenings and endorsement of public primary care. Only one in three respondents reported very good user experience during health visits, with lower proportions in low-income countries. Access to health care was rated highest of all domains; however, only half of the populations felt secure that they could access and afford high-quality care if they became ill. Populations rated the quality of private health systems higher than that of public health systems in most countries. Only half of respondents felt involved in decision-making (less in high-income countries). Within countries, we found statistically significant pro-rich inequalities across many indicators. Conclusion Populations can provide vital information about the real-world function of health systems, complementing other system performance metrics. Population-wide surveys such as the People's Voice Survey should become part of regular health system performance assessments. [phrase omitted] [phrase omitted] Objectif Montrer comment l'enquete People's Voice Survey, un nouvel instrument comparable au niveau international, peut etre utilise pour nourrir la perspective d'une evaluation des performances du systeme de sante par la population dans des pays de tous les niveaux de revenus. Methodes Nous avons interroge des echantillons representatifs d'habitants de 16 pays a revenu faible, intermediaire et eleve sur leur recours aux soins de sante, leur experience en la matiere et la confiance qu'ils y accordent sur la periode 2022-2023. Nous avons ensuite resume et visualise les donnees correspondant aux principaux domaines du cadre de l'Organisation mondiale de la Sante relatif a la couverture sanitaire universelle pour evaluer les systemes de sante. Enfin, nous avons examine la correlation avec les depenses individuelles en soins de sante en calculant les coefficients Pearson, ainsi que les disparites de revenus au sein de chaque pays a l'aide de l'indice de pente de l'inegalite. Resultats Dans le domaine de l'efficacite des soins, nous avons decele des lacunes considerables au niveau des examens medicaux et de l'approbation envers l'offre publique de soins de sante primaires. Seul un repondant sur trois a fait etat d'une excellente experience en tant que patient lors des visites sanitaires, le pourcentage etant moins eleve dans les pays a revenu faible. Tous domaines confondus, c'est l'acces aux soins de sante qui a recu la meilleure note; toutefois, a peine la moitie des personnes interrogees avaient la conviction de pouvoir beneficier de soins de qualite a prix abordable si elles venaient a tomber malades. La qualite des systemes de sante prives a ete jugee superieure a celle des systemes de sante publics dans la plupart des pays. Enfin, la moitie seulement des repondants se sent impliquee dans la prise de decisions (voire moins dans les pays a revenu eleve). Par ailleurs, nous avons trouve au sein de chaque pays des inegalites statistiquement significatives en faveur des categories les plus aisees et ce, pour de nombreux indicateurs. Conclusion Les populations peuvent fournir des informations vitales sur le fonctionnement reel des systemes de sante, ce qui permet de completer les autres mesures de performances. Les enquetes telles que People's Voice Survey, menees aupres de l'ensemble des habitants, devraient desormais etre integrees aux evaluations periodiques des performances des systemes de santes. [phrase omitted] Objetivo Demostrar como el nuevo instrumento de comparacion internacional, la People's Voice Survey, se puede utilizar para aportar la perspectiva de la poblacion al evaluar el desempeno del sistema sanitario en paises de todos los niveles de ingresos. Metodos Se encuestaron muestras representativas de poblaciones de 16 paises de ingresos bajos, medios y altos sobre la utilizacion de la atencion sanitaria, la experiencia y la confianza durante 2022 y 2023. Se resumieron y visualizaron los datos correspondientes a los ambitos clave del marco de cobertura sanitaria universal de la Organizacion Mundial de la Salud para la evaluacion del desempeno de los sistemas sanitarios. Se examino la correlacion con el gasto sanitario per capita calculando los coeficientes de Pearson y las desigualdades basadas en los ingresos dentro de los paises utilizando el indice de desigualdad de la pendiente. Resultados En el ambito de la eficacia de la atencion, se encontraron importantes deficiencias en los examenes de salud y en la aprobacion de la atencion primaria publica. Solo uno de cada tres encuestados declaro tener una experiencia de usuario muy buena durante las visitas sanitarias, con porcentajes mas bajos en los paises de ingresos bajos. El acceso a la atencion sanitaria fue el mejor valorado de todos los ambitos; sin embargo, solo la mitad de las poblaciones se sentian seguras de poder acceder y costearse una atencion de alta calidad en caso de enfermar. En la mayoria de los paises, la poblacion valoro mas la calidad de los sistemas sanitarios privados que la de los publicos. Solo la mitad de los encuestados se sentian implicados en la toma de decisiones (menos en los paises de ingresos altos). Dentro de los paises, se encontraron desigualdades estadisticamente significativas a favor de los mas ricos en muchos indicadores. Conclusion Las poblaciones pueden proporcionar informacion vital sobre el funcionamiento real de los sistemas sanitarios, como complemento de otras metricas de desempeno del sistema. Las encuestas poblacionales, como la People's Voice Survey, deberian formar parte de las evaluaciones periodicas del funcionamiento de los sistemas sanitarios., Introduction The notion that health systems should be people-centred seems unexceptional. Health systems are occupied with serving people, are funded by people and aim to improve people's health as their [...]

Objective To explore the definition and operationalization of resilience in health system performance assessments in European Union countries. Methods We conducted multiple empirical case study analyses. We identified relevant cases through a literature review from 2014 to 2023 using Google Scholar and through a snowball technique to retrieve additional information. We included only documents that explicitly mentioned resilience in health system performance assessments. We performed a content analysis to identify common patterns in defining resilience. Findings The final sample consisted of six countries: Belgium, Croatia, Czechia, Estonia, Ireland and Italy. Each country adopted a distinct approach to conceptualizing resilience, with countries prioritizing specific aspects based on lessons learnt from the coronavirus disease 2019 (COVID-19) pandemic. Some countries focused on maintaining essential health-care services and protecting vulnerable groups. Other countries prioritized management capacity, staff preparedness, digital health utilization and strengthening of primary health care. Content analysis revealed six resilience definitions derived from the key performance indicators: addressing unmet needs and maintaining outcomes; protecting vulnerable groups; acquiring and using resources; having trained and prepared staff in place; using digital health; and strengthening primary health care. Conclusion Integration of resilience into the health profiles of European Union countries preceded its inclusion in national health system performance assessments, the latter of which became more prominent after the COVID-19 pandemic. Variations in interpretations within health system performance assessments reflect differences in indicators and policy responses. [phrase omitted] [phrase omitted] Objectif Explorer la definition et la mise en reuvre de la resilience dans l'evaluation des performances des systemes de sante au sein des pays de l'Union europeenne. Methodes Nous avons effectue plusieurs analyses d'etudes de cas empiriques. Nous avons identifie les cas pertinents en procedant a une revue de la litterature publiee entre 2014 et 2023 sur Google Scholar et en appliquant la technique de type <> pour obtenir des informations supplementaires. Nous n'avons retenu que les documents qui mentionnaient explicitement la resilience dans les evaluations des performances des systemes de sante. Enfin, nous avons examine les contenus afin de reperer les modeles les plus courants dans la definition de la resilience. Resultats Lechantillon final etait compose de six pays : la Belgique, la Croatie, l'Estonie, l'Irlande, l'Italie et la Republique tcheque. Chacun de ces pays a adopte une approche differente dans sa conceptualisation de la resilience, certains ayant donne la priorite a des aspects specifiques en fonction des lecons qu'ils ont tirees de la pandemie de maladie a coronavirus 2019 (COVID-19). Quelques-uns se sont concentres sur le maintien des services de sante essentiels et la protection des groupes vulnerables. D'autres ont privilegie les capacites de gestion, la preparation du personnel, l'utilisation des technologies numeriques et le renforcement des soins de sante primaires. Lanalyse des contenus a revele six definitions de la resilience derivees des indicateurs cles de performance : repondre aux besoins non satisfaits et assurer le maintien des resultats ; proteger les groupes vulnerables ; acquerir et exploiter les ressources ; disposer de personnel forme et prepare ; deployer des technologies numeriques ; et enfin, consolider les soins de sante primaires. Conclusion La resilience figurait dans les profils sanitaires de certains pays de l'Union europeenne avant d'etre integree dans les mecanismes d'evaluation des performances des systemes de sante nationaux, ayant gagne en importance apres la pandemie de COVID-19. Les divergences d'interpretation observees dans le cadre de ces evaluations refletent les variations au niveau des indicateurs et des solutions politiques. [phrase omitted] Objetivo Explorar la definicion y la puesta en practica de la resiliencia en las evaluaciones del rendimiento de los sistemas sanitarios en los paises de la Union Europea. Metodos Se realizaron multiples analisis de estudios de casos empiricos. Se identificaron casos relevantes mediante una revision bibliografica de 2014 a 2023 utilizando Google Scholar y mediante una tecnica de bola de nieve para recuperar informacion adicional. Se incluyeron solo los documentos que mencionaban explicitamente la resiliencia en las evaluaciones del rendimiento del sistema sanitario. Se realizo un analisis de contenido para identificar patrones comunes en la definicion de resiliencia. Resultados La muestra final estaba formada por seis paises: Belgica, Croacia, Chequia, Estonia, Irlanda e Italia. Cada pais adopto un enfoque distinto para conceptualizar la resiliencia, dando prioridad a aspectos especificos basados en las lecciones aprendidas de la pandemia de la enfermedad por coronavirus de 2019 (COVID-19). Algunos paises se centraron en mantener los servicios sanitarios esenciales y proteger a los grupos vulnerables. Otros paises priorizaron la capacidad de gestion, la preparacion del personal, la utilizacion de la salud digital y el fortalecimiento de la atencion primaria. El analisis de contenido revelo seis definiciones de resiliencia derivadas de los indicadores clave de rendimiento: abordar las necesidades insatisfechas y mantener los resultados; proteger a los grupos vulnerables; adquirir y utilizar recursos; contar con personal capacitado y preparado; utilizar la salud digital; y fortalecer la atencion primaria de salud. Conclusion La integracion de la resiliencia en los perfiles sanitarios de los paises de la Union Europea precedio a su inclusion en las evaluaciones del rendimiento de los sistemas sanitarios nacionales, estas ultimas mas destacadas tras la pandemia de la COVID-19. Las variaciones en las interpretaciones dentro de las evaluaciones del rendimiento de los sistemas sanitarios reflejan diferencias en los indicadores y las respuestas politicas., Introduction The coronavirus disease 2019 (COVID-19) pandemic posed a considerable challenge for governments, affecting health, the economy and citizens' well-being. (1) The pandemic exposed weaknesses in health systems, such as [...]

Objective To assess the availability of information on indicators of the World Health Organization and United Nations Children's Fund primary health-care measurement framework in Bangladesh, India, Nepal, Pakistan and Sri Lanka and to outline the opportunities for and challenges to using the framework in these countries. Methods We reviewed global and national data repositories for quantitative indicators of the framework and conducted a desk review of country documents for qualitative indicators in February-April 2023. We assessed data sources and cross-sectional survey tools to suggest possible sources of information on framework indicators that were not currently reported in the countries. We also identified specific indicators outside the framework on which information is collected in the countries and which could be used to measure primary healthcare performance. Findings Data on 54% (32/59) of the quantitative indicators were partially or completely available for the countries, ranging from 41% (24/59) in Pakistan to 64% (38/59) in Nepal. Information on 41% (66/163) of the qualitative subindicators could be acquired through desk reviews of country-specific documents. Information on input indicators was more readily available than on process and output indicators. The feasibility of acquiring information on the unreported indicators was moderate to high through adaptation of data collection instruments. Conclusion The primary health-care measurement framework provides a platform to readily assess and track the performance of primary health care. Countries should improve the completeness, quality and use of existing data for strengthening of primary health care. [phrase omitted] [phrase omitted] Objectif Etudier la disponibilite des informations concernant les indicateurs du cadre devaluation des soins de sante primaires de l'Organisation mondiale de la Sante et du Fonds des Nations Unies pour l'enfance au Bangladesh, en Inde, au Nepal, au Pakistan et au Sri Lanka, mais aussi presenter les opportunites et enjeux de l'application d'un tel cadre dans ces pays. Methodes Nous avons explore les referentiels de donnees nationaux et internationaux a la recherche d'indicateurs lies au cadre, puis nous avons effectue un examen preliminaire des documents de chaque pays pour y trouver des indicateurs qualitatifs entre fevrier et avril 2023. Nous avons evalue la provenance des donnees et les outils d'enquete transversale en vue de suggerer des sources potentielles d'informations sur certains indicateurs relatifs au cadre qui n'apparaissaient pas encore dans les pays susmentionnes. Nous avons par ailleurs identifie des indicateurs specifiques en dehors du cadre, sur lesquels les pays collectent des informations et qui pourraient servir a mesurer les performances des soins de sante primaires. Resultats Des donnees sur 54% (32/59) des indicateurs quantitatifs etaient partiellement ou entierement disponibles dans les differents pays, allant de 41% (24/59) au Pakistan a 64% (38/59) au Nepal. Des examens preliminaires de documents propres a chaque pays ont permis de recueillir des informations sur 41% (66/163) des sous-indicateurs qualitatifs. Il etait plus facile d'obtenir des precisions sur les indicateurs de moyens que sur les indicateurs de processus et de resultats. Enfin, le degre de faisabilite de l'acquisition d'informations sur les indicateurs non mentionnes etait modere a eleve, a condition d'adapter les instruments de collecte de donnees. Conclusion Le cadre d'evaluation des soins de sante primaires offre une plateforme permettant d'evaluer et de suivre aisement les performances en la matiere. Les pays devraient ameliorer l'exhaustivite, la qualite et l'utilisation des donnees existantes pour renforcer les soins de sante primaires. [phrase omitted] Objetivo Evaluar la disponibilidad de informacion sobre los indicadores del marco de medicion de la atencion primaria de salud de la Organizacion Mundial de la Salud y el Fondo de las Naciones Unidas para la Infancia en Bangladesh, India, Nepal, Pakistan y Sri Lanka, y exponer las oportunidades y los desafios que plantea la aplicacion del marco en estos paises. Metodos Se revisaron los repositorios de datos mundiales y nacionales para los indicadores cuantitativos del marco y se realizo una revision preliminar de los documentos de los paises para los indicadores cualitativos entre febrero y abril de 2023. Se evaluaron las fuentes de datos y las herramientas de encuestas transversales para sugerir posibles fuentes de informacion sobre los indicadores del marco que actualmente no se comunican en los paises. Tambien se identificaron indicadores especificos ajenos al marco sobre los que se recopila informacion en los paises y que se podrian aplicar para medir los resultados de la atencion primaria. Resultados Los datos sobre el 54% (32/59) de los indicadores cuantitativos estaban parcial o totalmente disponibles para los paises, oscilando entre el 41% (24/59) de Pakistan y el 64% (38/59) de Nepal. La informacion sobre el 41% (66/163) de los subindicadores cualitativos se pudo obtener mediante revisiones preliminares de documentos especificos de cada pais. La informacion sobre los indicadores de insumos fue mas facil de obtener que sobre los indicadores de procesos y productos. La viabilidad de adquirir informacion sobre los indicadores no declarados fue de moderada a alta mediante la adaptacion de los instrumentos de recopilacion de datos. Conclusion El marco de medicion de la atencion primaria proporciona una plataforma para evaluar y seguir facilmente el rendimiento de la atencion primaria. Los paises deben mejorar la exhaustividad, la calidad y el uso de los datos existentes para reforzar la atencion primaria., Introduction Health is central to the 2030 agenda of the United Nations (UN) sustainable development goals (SDG), and primary health care is a strategy to achieve most of the SDG [...]

Objective To conduct a systematic review on the effects of multisectoral interventions for health on health system performance. Methods We conducted a systematic review according to the preferred reporting items for systematic review and meta- analysis protocols. We searched for peer-reviewed journal articles in PubMed[R], Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and the Cochrane Database of Systematic Reviews on 31 August 2023 (updating on 28 February 2024). We removed duplicates, screened titles and abstracts, and then conducted a full-text eligibility and quality assessment. Findings We identified an initial 1118 non-duplicate publications, 62 of which met our inclusion and exclusion criteria. The largest proportions of reviewed studies focused on multisectoral interventions directly related to specific health outcomes (66.1%; 41 studies) and/or social determinants of health (48.4%; 30 studies), but without explicit reference to overall health system performance. Most reviewed publications did not address process indicators (83.9%; 52/62) or discuss sustainability for multisectoral interventions in health (72.6%; 45/62). However, we observed that the greatest proportion (66.1%; 41/62) considered health system goals: health equity (68.3%; 28/41) and health outcomes (63.4%; 26/41). Although the greatest proportion (64.5%; 40/62) proposed mechanisms explaining how multisectoral interventions for health could lead to the intended outcomes, none used realistic evaluations to assess these. Conclusion Our review has established that multisectoral interventions influence health system performance through immediate improvements in service delivery efficiency, readiness, acceptability and affordability. The interconnectedness of these effects demonstrates their role in addressing the complexities of modern health care. [phrase omitted] [phrase omitted] Objectif Realiser une revue systematique consacree a l'impact des interventions multisectorielles sur la performance des systemes de sante. Methodes Nous avons procede a une revue systematique en appliquant les elements de rapport privilegies dans les protocoles de revues systematiques et meta-analyses. Nous avons explore PubMed[R], Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature, ainsi que la Base de donnees Cochrane des revues systematiques le 31 aout 2023 (mise a jour le 28 fevrier 2024), a la recherche d'articles de revue evalues par des pairs. Ensuite, nous avons supprime les doublons, passe les titres et resumes au crible, puis determine la qualite et l'admissibilite des articles complets. Resultats Nous avons initialement identifie 1118 publications non dupliquees; 62 d'entre elles repondaient a nos criteres d'inclusion et d'exclusion. Une grande partie des etudes examinees portaient sur des interventions multisectorielles en lien direct avec des resultats de sante specifiques (66,1%; 41 etudes) et/ou des determinants sociaux de la sante (48,4%; 30 etudes), sans toutefois faire explicitement reference a la performance globale des systemes de sante. La majorite des publications ne mentionnaient aucun indicateur de processus (83,9%; 52/62) et n'abordaient pas la durabilite des interventions multisectorielles dans le domaine de la sante (72,6%; 45/62). Nous avons neanmoins constate qu'en general, elles tenaient compte des objectifs relatifs aux systemes de sante (66,1%; 41/62): l'equite en sante (68,3%; 28/41) et les resultats de sante (63,4%; 26/41). Bien que la plupart (64,5%; 40/62) proposent des mecanismes visant a expliquer comment les interventions multisectorielles en matiere de sante pourraient amener aux resultats escomptes, aucune n'avait recours a des evaluations realistes pour les mesurer. Conclusion Notre revue nous a permis d'etablir que les interventions multisectorielles influencaient la performance des systemes de sante a travers des ameliorations immediates en termes d'efficacite, de disponibilite, d'acceptation et d'abordabilite des prestations de services. L'interdependance entre ces effets temoigne de l'importance qu'ils revetent lorsqu'il s'agit d'apprehender les rouages complexes des soins de sante modernes. [phrase omitted] Objetivo Realizar una revision sistematica sobre los efectos de las intervenciones multisectoriales en favor de la salud sobre el rendimiento de los sistemas sanitarios. Metodos Se realizo una revision sistematica de acuerdo con los items de informe preferidos para los protocolos de revision sistematica y metanalisis. Se realizaron busquedas de articulos de revistas con revision por pares en PubMed[R], Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature y la Base de Datos Cochrane de Revisiones Sistematicas el 31 de agosto de 2023 (actualizacion el 28 de febrero de 2024). Se eliminaron los duplicados, se examinaron los titulos y los resumenes y, a continuacion, se realizo una evaluacion de la elegibilidad y la calidad del texto completo. Resultados Se identificaron 1118 publicaciones iniciales no duplicadas, 62 de las cuales cumplian los criterios de inclusion y exclusion. El mayor porcentaje de estudios revisados se centro en intervenciones multisectoriales directamente relacionadas con resultados sanitarios especificos (66,1%; 41 estudios) o determinantes sociales de la salud (48,4%; 30 estudios), pero sin referencia explicita al rendimiento general del sistema sanitario. La mayoria de las publicaciones revisadas no abordaron indicadores de proceso (83,9%; 52/62) ni discutieron la sostenibilidad de las intervenciones multisectoriales en salud (72,6%; 45/62). Sin embargo, se observo que el mayor porcentaje (66,1%; 41/62) tenia en cuenta los objetivos del sistema sanitario: equidad sanitaria (68,3%; 28/41) y resultados sanitarios (63,4%; 26/41). Aunque el mayor porcentaje (64,5%; 40/62) propuso mecanismos que explicaban como las intervenciones multisectoriales para la salud podian conseguir los resultados previstos, ninguno empleo evaluaciones realistas para evaluarlos. Conclusion La revision que se realizo ha demostrado que las intervenciones multisectoriales influyen en el rendimiento de los sistemas sanitarios a traves de mejoras inmediatas en la eficiencia, la disponibilidad, la aceptabilidad y la asequibilidad de la prestacion de servicios. La interconexion de estos efectos demuestra su funcion a la hora de abordar las complejidades de la atencion sanitaria moderna., Introduction There is unequivocal recognition that health and well-being are determined by non-medical factors, including structural, social and commercial determinants of health. (1) Addressing those determinants is a task for [...]

Objective To examine how a general inpatient satisfaction survey functions as a hospital performance measure. Methods We conducted a mixed-methods pilot study of the Hospital Consumer Assessment of Health Providers and Systems survey in Odisha, India. We divided the study into three steps: cognitive testing of the survey, item testing with exploratory factor analysis and content validity indexing. Cognitive testing involved 50 participants discussing their interpretation of survey items. The survey was then administered to 507 inpatients across five public hospitals in Odisha, followed by exploratory factor analysis. Finally, we interviewed 15 individuals to evaluate the content validity of the survey items. Findings Cognitive testing revealed that six out of 18 survey questions were not consistently understood within the Odisha inpatient setting, highlighting issues around responsibilities for care. Exploratory factor analysis identified a six-factor structure explaining 66.7% of the variance. Regression models showed that interpersonal care from doctors and nurses had the strongest association with overall satisfaction. An assessment of differential item functioning revealed that patients with a socially marginalized caste reported higher disrespectful care, though this did not translate into differences in reported satisfaction. Content validity indexing suggested that discordance between experiences of disrespectful care and satisfaction ratings might be due to low patient expectations. Conclusion Using satisfaction ratings without nuanced approaches in value-based purchasing programmes may mask poor- quality interpersonal services, particularly for historically marginalized patients. Surveys should be designed to accurately capture true levels of dissatisfaction, ensuring that patient concerns are not hidden. [phrase omitted] [phrase omitted] Objectif Examiner le fonctionnement d'une enquete generale de satisfaction des patients hospitalises en tant que mesure de la performance des hopitaux. Methodes Nous avons mene une etude pilote mixte de l'enquete Hospital Consumer Assessment of Health care Providers and Systems a Odisha, en Inde. Nous avons subdivise l'etude en trois etapes: tests cognitifs de Lenquete, test par items avec analyse factorielle exploratoire et indexation de la validite du contenu. Les tests cognitifs concernaient 50 personnes, qui ont discute de leur interpretation des questions de l'enquete. Lenquete a ensuite ete soumise a 507 patients hospitalises dans cinq hopitaux publics d'Odisha, puis a fait l'objet d'une analyse factorielle exploratoire. Enfin, nous avons interroge 15 personnes pour evaluer la validite du contenu des questions de Lenquete. Resultats Les tests cognitifs ont revele que six des 18 questions de Lenquete n'etaient pas toujours comprises par les patients hospitalises a Odisha, ce qui met en evidence les problemes lies aux responsabilites en matiere de soins. Une analyse factorielle exploratoire a permis d'identifier une structure a six facteurs expliquant 66,7% de la variance. Des modeles de regression ont mis en evidence que les soins interpersonnels prodigues par des medecins et des infirmieres avaient le plus grand impact sur la satisfaction globale. Une evaluation du fonctionnement differentiel des items a revele que les patients appartenant a une caste socialement marginalisee signalaient davantage d'irrespect dans les soins, bien que cela ne se traduise pas par des differences au niveau de la satisfaction declaree. L'indexation de la validite du contenu a suggere que la discordance entre les experiences d'irrespect dans les soins et les evaluations de satisfaction pourrait etre due a la faiblesse des attentes des patients. Conclusion L'utilisation devaluations de la satisfaction sans approches nuancees dans les programmes d'achat bases sur la valeur est susceptible de masquer des services interpersonnels de mauvaise qualite, en particulier pour les patients historiquement marginalises. Les enquetes doivent etre concues de maniere a saisir avec precision les veritables niveaux d'insatisfaction, en evitant de masquer les preoccupations des patients. [phrase omitted] Objetivo Examinar el funcionamiento de una encuesta general de satisfaccion de los pacientes hospitalizados como medida de rendimiento de los hospitales. Metodos Se realizo un estudio piloto de metodos mixtos de la encuesta de Evaluacion del consumidor hospitalario sobre proveedores y sistemas de atencion sanitaria en Odisha (I ndia). Se dividio el estudio en tres pasos: prueba cognitiva de la encuesta, prueba de elementos con analisis factorial exploratorio e indexacion de la validez del contenido. La prueba cognitiva consistio en que 50 participantes discutieran su interpretacion de los elementos de la encuesta. A continuacion, se administro la encuesta a 507 pacientes ingresados en cinco hospitales publicos de Odisha, tras lo cual se realizo un analisis factorial exploratorio. Por ultimo, se entrevisto a 15 personas para evaluar la validez de contenido de los elementos de la encuesta. Resultados Las pruebas cognitivas revelaron que seis de las 18 preguntas de la encuesta no se comprendian de forma coherente en el entorno hospitalario de Odisha, lo que evidenciaba problemas relacionados con las responsabilidades de la atencion. El analisis factorial exploratorio identifico una estructura de seis factores que explicaban el 66,7% de la varianza. Los modelos de regresion mostraron que la atencion interpersonal por parte de medicos y personal de enfermeria presentaba la mayor asociacion con la satisfaccion general. Una evaluacion del funcionamiento diferencial de los elementos revelo que los pacientes de una casta socialmente marginada informaron de una atencion mas irrespetuosa, aunque esto no se reflejo en diferencias en la satisfaccion declarada. La indexacion de la validez de contenido sugirio que la discordancia entre las experiencias de atencion irrespetuosa y los indices de satisfaccion podria deberse a las bajas expectativas de los pacientes. Conclusion El uso de indices de satisfaccion sin enfoques matizados en los programas de compras basadas en el valor puede enmascarar servicios interpersonales de mala calidad, en particular para pacientes historicamente marginados. Las encuestas deben disenarse para captar con precision los verdaderos niveles de insatisfaccion, de forma que no se oculten las preocupaciones de los pacientes., Introduction In 2018, the Indian government launched the world's largest health insurance scheme, Pradhan Mantri Jan Arogya Yojana. (1) The scheme aims to cover secondary and tertiary care for 500 [...]

Objective To explore the feasibility of building a primary care performance dashboard using DHIS2 data from Ethiopia's largest urban (Addis Ababa), agrarian (Oromia) and pastoral (Somali) regions. Methods We extracted 26 data elements reported by 12 062 health facilities to DHIS2 for the period 1 July 2022 to 30 June 2023. Focusing on indicators of effectiveness, safety and user experience, we built 14 indicators of primary care performance covering reproductive, maternal and child health, human immunodeficiency virus, tuberculosis, noncommunicable disease care and antibiotic prescription. We assessed data completeness by calculating the proportion of facilities reporting each month, and examined the presence of extreme outliers and assessed external validity. Findings At the regional level, average completeness across all data elements was highest in Addis Ababa (82.9%), followed by Oromia (66.2%) and Somali (52.6%). Private clinics across regions had low completeness, ranging from 38.6% in Somali to 58.7% in Addis Ababa. We found only a few outliers (334 of 816 578 observations) and noted that external validity was high for 11 of 14 indicators of primary care performance. However, the 12-month antiretroviral treatment retention rate and proportions of patients with controlled diabetes or hypertension exhibited poor external validity. Conclusion The Ethiopian DHIS2 contains information for measuring primary care performance, using simple analytical methods, at national and regional levels and by facility type. Despite remaining data quality issues, the health management information system is an important data source for generating health system performance assessment measures on a national scale. [phrase omitted] [phrase omitted] Objectif Determiner s'il est possible de creer un tableau de bord des performances de soins de sante primaires en utilisant les donnees du DHIS2 issues des plus grandes regions urbaines (Addis-Abeba), agricoles (Oromia) et pastorales (Somali) d'Ethiopie. Methodes Nous avons extrait 26 elements de donnees transmis au DHIS2 par 12 062 etablissements de sante pour la periode allant du 1er juillet 2022 au 30 juin 2023. En nous focalisant sur l'efficacite, la securite et l'experience vecue par les patients, nous avons defini 14 indicateurs de performances pour les soins de sante primaires, couvrant des domaines tels que la sante reproductive, maternelle et infantile, le virus de l'immunodeficience humaine, la tuberculose, la prise en charge des maladies non transmissibles et la prescription d'antibiotiques. Nous avons evalue l'exhaustivite des donnees en calculant le pourcentage d'etablissements produisant un rapport mensuel, avant d'examiner la presence de valeurs aberrantes extremes et la validite externe. Resultats A l'echelle regionale, c'est a Addis-Abeba (82,9 %) que l'exhaustivite moyenne pour l'ensemble des elements de donnees etait la plus elevee, suivie d'Oromia (66,2 %) et de Somali (52,6 %). Dans toutes les regions, les cliniques privees affichaient un faible taux d'exhaustivite compris entre 38,6 % au Somali et 58,7 % a Addis-Abeba. Nous n'avons trouve que quelques valeurs aberrantes (334 sur 816 578 observations) et avons constate un haut degre de validite externe pour 11 des 14 indicateurs de performances des soins de sante primaires. Toutefois, le degre de validite du taux de maintien du traitement antiretro viral sur 12 mois ainsi que de la proportion de patients avec une hypertension ou un diabete sous controle s'est revele moindre. Conclusion Le DHIS2 ethiopien contient des informations utiles pour mesurer les performances des soins de sante primaires a l'aide de methodes analytiques simples, tant au niveau national que regional et selon les types d'etablissements. Malgre les quelques problemes qui subsistent en termes de qualite, ce dispositif de gestion des informations sanitaires represente une precieuse source de donnees pour elaborer des outils permettant d'evaluer les performances du systeme de sante a l'echelle nationale. [phrase omitted] Objetivo Explorar la viabilidad de crear un tablero de rendimiento de la atencion primaria utilizando datos DHIS2 de las principales regiones urbanas (Addis Abeba), agrarias (Oromia) y pastorales (Somali) de Etiopia. Metodos Se extrajeron 26 elementos de datos notificados por 12 062 centros sanitarios a DHIS2 para el periodo comprendido entre el 1 de julio de 2022 y el 30 de junio de 2023. A partir de indicadores de eficacia, seguridad y experiencia de los usuarios, se elaboraron 14 indicadores del rendimiento de la atencion primaria que abarcan la salud reproductiva, materna e infantil, el virus de la inmunodeficiencia humana, la tuberculosis, la atencion de enfermedades no transmisibles y la prescripcion de antibioticos. Se evaluo la exhaustividad de los datos al calcular el porcentaje de centros que informaban cada mes y se examino la presencia de valores atipicos y de la validez externa. Resultados A nivel regional, el nivel medio de exhaustividad de todos los datos fue mas alto en Addis Abeba (82,9%), seguida de Oromia (66,2%) y Somalia (52,6%). Las clinicas privadas de todas las regiones presentaban un bajo nivel de exhaustividad, que oscilaba entre el 38,6% en Somalia y el 58,7% en Addis Abeba. Solo se encontraron unos pocos valores atipicos (334 de 816 578 observaciones) y se observo que la validez externa era alta para 11 de los 14 indicadores de rendimiento de la atencion primaria. Sin embargo, la tasa de retencion del tratamiento antirretroviral a los 12 meses y los porcentajes de pacientes con diabetes o hipertension controladas mostraron una escasa validez externa. Conclusion El DHIS2 etiope contiene informacion para medir el rendimiento de la atencion primaria, utilizando metodos analiticos sencillos, a escala nacional y regional y por tipo de centro. A pesar de los problemas de calidad de los datos que aun persisten, el sistema de informacion sobre la gestion sanitaria es una fuente de datos importante para generar medidas de evaluacion del rendimiento del sistema sanitario a escala nacional., Introduction Functioning primary care is essential for improving population health. A greater emphasis on primary care in the health-care system can reduce costs, improve access and reduce inequities in population [...]

The world faces global health risks that need to be effectively addressed in integrated, participatory efforts. (1,2) However, risk analysis frameworks do not account for the complex nature of systems [...]

Policy-makers need to rethink the connections between the economy and health. The World Health Organization Council on the Economics of Health for All has called for human and planetary health and well-being to be moved to the core of decision-making to build economies for health. Doing so involves valuing and measuring what matters, more and better health financing, innovation for the common good and rebuilding public sector capacity. We build on this thinking to argue that breastfeeding should be recognized in food and well-being statistics, while investments in breastfeeding should be considered a carbon offset in global financing arrangements for sustainable food, health and economic systems. Breastfeeding women nourish half the world's infants and young children with immense quantities of a highly valuable milk. This care work is not counted in gross domestic product or national food balance sheets, and yet ever-increasing commercial milk formula sales are counted. Achieving global nutrition targets for breastfeeding would realize far greater reductions in greenhouse gas emissions than decarbonizing commercial milk formula manufacturing. New metrics and financing mechanisms are needed to achieve the health, sustainability and equity gains from more optimal infant and young child feeding. Properly valuing crucial care and environmental resources in global and national measurement systems would redirect international financial resources away from expanding carbon-emitting activities, and towards what really matters, that is, health for all. Doing so should start with considering breastfeeding as the highest quality, local, sustainable first-food system for generations to come. [phrase omitted] Les responsables politiques doivent repenser les liens entre economie et sante. Le Conseil de Organisation mondiale de la Sante sur l'economie de la sante pour tous a demande que le bien-etre et la sante, aussi bien de l'humain que de la planete, soient desormais au creur du processus de prise de decisions afin de creer des economies au service de la sante. Il est donc imperatif d'identifier et de valoriser ce qui compte, d'accroitre et d'optimiser le financement de la sante, d'innover pour le bien commun et de renforcer les capacites du secteur public. En partant de cette reflexion, nous plaidons pour une reconnaissance de l'allaitement dans les statistiques relatives a l'alimentation et au bienetre, et estimons que tout investissement realise dans ce domaine devrait etre considere comme un credit-carbone dans le cadre des modalites financieres mondiales liees aux systemes economiques et sanitaires ainsi qu'a une alimentation durable. Les femmes allaitantes nourrissent la moitie des enfants en bas age dans le monde avec d'immenses quantites de lait extremement precieux. Ces activites de soins ne sont pas comptabilisees dans le produit interieur brut ou les bilans alimentaires nationaux, contrairement aux ventes de lait maternise en constante progression. Atteindre les cibles mondiales de nutrition pour l'allaitement contribuerait davantage a reduire les emissions de gaz a effet de serre que decarboner la production de lait maternise. De nouveaux parametres et mecanismes de financement sont necessaires pour beneficier des avantages en matiere de sante, de durabilite et d'equite qui decoulent d'une meilleure alimentation des nourrissons et jeunes enfants. Valoriser correctement les principales ressources consacrees a l'environnement et aux soins dans les systemes de mesure nationaux et mondiaux permettrait de detourner les moyens financiers internationaux du developpement d'activites a fort taux d'emissions pour les rediriger vers ce qui compte vraiment, c'est-a-dire la sante pour tous. Et pour y parvenir, la premiere etape consisterait a reconnaitre l'allaitement comme l'aliment de base, local, durable et de qualite pour les generations futures. [phrase omitted] Los responsables de formular las politicas deben volver a plantearse las conexiones entre la economia y la salud. El Consejo sobre la Economia de la Salud para Todos de la Organizacion Mundial de la Salud ha pedido que la salud y el bienestar humanos y del planeta se situen en el centro de la toma de decisiones a fin de desarrollar economias para la salud. Esto requiere valorar y medir lo que importa, mas y mejor financiacion sanitaria, innovacion para el bien comun y reconstruccion de la capacidad del sector publico. Nos basamos en este pensamiento para argumentar que la lactancia materna deberia reconocerse en las estadisticas de alimentacion y bienestar, mientras que las inversiones en lactancia materna deberian considerarse como una compensacion de emisiones de carbono en los acuerdos globales de financiacion para sistemas alimentarios, sanitarios y economicos sostenibles. Las mujeres lactantes alimentan a la mitad de los bebes y ninos pequenos del mundo con inmensas cantidades de una leche muy valiosa. Este trabajo de cuidados no se contabiliza en el producto interior bruto ni en los balances alimentarios nacionales y, sin embargo, si se contabilizan las ventas cada vez mayores de leche de formula comercial. Alcanzar los objetivos mundiales de nutricion para la lactancia materna supondria una reduccion mucho mayor de las emisiones de gases de efecto invernadero que descarbonizar la fabricacion de leche de formula comercial. Se necesitan nuevas metricas y mecanismos de financiacion para lograr los beneficios en materia de salud, sostenibilidad y equidad de una alimentacion mas optima de los bebes y los ninos pequenos. Una valoracion adecuada de los cuidados esenciales y de los recursos medioambientales en los sistemas de medicion globales y nacionales redirigiria los recursos financieros internacionales lejos de la expansion de las actividades que emiten carbono, y hacia lo que realmente importa, es decir, la salud para todos. En este contexto, habria que empezar por considerar la lactancia materna como el sistema de primera alimentacion de mayor calidad, local y sostenible para las generaciones futuras., Introduction Amid widespread health system weaknesses and inequities exposed by the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization (WHO) Director-General tasked the WHO Council on the Economics of [...]

Objective To obtain insights into reducing the shortfall in financing for pandemic preparedness and response measures, and reducing the risk of another pandemic with social and economic costs comparable to those of the coronavirus disease. Methods We conducted a systematic scoping review using the databases ScienceDirect, Scopus, JSTOR, PubMed[R] and EconLit. We included articles published in any language until 1 August 2023, and excluded grey literature and publications on epidemics. We categorized eligible studies according to the elements of a framework proposed by the World Health Organization Council on the Economy of Health for All: (i) root/structural causes; (ii) social position/foundations; (iii) infrastructure and systems; and (iv) communities, households and individuals Findings Of the 188 initially identified articles, we included 60 in our review. Most (53/60) were published after 2020, when academic interest had shifted towards global financing mechanisms. Most (37/60) addressed two or more of the council framework elements. The most frequently addressed element was infrastructure and systems (54/60), discussing topics such as health systems, financial markets and innovation ecosystems. The roots/structural causes were discussed in 25 articles; communities, households and individuals in 22 articles; and social positions/foundations in 11. Conclusion Our review identified three important gaps: a formal definition of pandemic preparedness and response, impeding the accurate quantification of the financing shortfall; research on the extent to which financing for pandemic preparedness and response has been targeted at the most vulnerable households; and an analysis of specific financial instruments and an evaluation of the feasibility of their implementation. [phrase omitted] Objectif Mieux comprendre comment lutter contre le manque de moyens alloues aux mesures de preparation et de riposte aux pandemies, et comment reduire le risque d'une nouvelle pandemie aux couts economiques et sociaux comparables a ceux engendres par la maladie a coronavirus. Methodes Nous avons effectue une revue systematique exploratoire dans les bases de donnees ScienceDirect, Scopus, JSTOR, PubMed[R] et EconLit. Nous avons inclus les articles rediges dans toutes les langues et publies avant le 1er aout 2023, mais ecarte la litterature grise et les publications relatives aux epidemies. Nous avons classe les etudes retenues en fonction des elements d'un cadre soumis par le Conseil de l'Organisation mondiale de la Sante sur l'economie de la sante pour tous: (i) causes profondes/structurelles; (ii) positions/fondements sociaux; (iii) infrastructures et systemes; et enfin, (iv) communautes, menages et individus. Resultats Sur les 188 articles identifies initialement, nous en avons selectionne 60 pour notre revue. La plupart (53/60) ont ete publies apres 2020, quand l'interet academique s'est tourne vers les mecanismes de financement mondiaux. Une grande partie (37/60) des articles mentionnaient au moins deux elements du cadre du Conseil. Lelement le plus souvent aborde etait celui des infrastructures et systemes (54/60), avec des themes tels que les systemes de sante, les marches financiers et les ecosystemes d'innovation. Les causes profondes/structurelles etaient evoquees dans 25 articles; les communautes, menages et individus dans 22 articles; et les positions/fondements sociaux dans 11 articles. Conclusion Notre revue a permis d'identifier trois grands absents: la definition officielle pour la preparation et la riposte aux pandemies, ce qui empeche de quantifier le manque de moyens avec precision; les recherches pour determiner dans quelle mesure le financement de la preparation et de la riposte aux pandemies a cible les menages les plus vulnerables; et pour terminer, une analyse des instruments financiers specifiques et une evaluation consacree a la faisabilite de leur mise en reuvre. [phrase omitted] Objetivo Comprender mejor como combatir la falta de recursos asignados a las medidas de preparacion y respuesta ante una pandemia, y como reducir el riesgo de una nueva pandemia con costes economicos y sociales comparables a los que causo el coronavirus. Metodos Se realizo una revision sistematica de alcance mediante las bases de datos ScienceDirect, Scopus, JSTOR, PubMed[R] y EconLit. Se incluyeron articulos publicados en cualquier idioma hasta el 1 de agosto de 2023, y se excluyo la literatura gris y las publicaciones sobre epidemias. Se categorizaron los estudios elegibles segun los elementos de un marco propuesto por el Consejo sobre la Economia de la Salud para Todos de la Organizacion Mundial de la Salud: (i) causas fundamentales/ estructurales; (ii) posiciones/fundamentos sociales; (iii) infraestructura y sistemas; y (iv) comunidades, hogares e individuos. Resultados De los 188 articulos identificados en un principio, se incluyeron 60 en la revision. La mayoria (53/60) se publicaron despues de 2020, cuando el interes academico se habia orientado hacia los mecanismos de financiacion mundial. La mayoria (37/60) abordaban dos o mas de los elementos del marco del Consejo. El elemento abordado con mas frecuencia fue la infraestructura y el sistema (54/60), en los que se trataban temas como los sistemas sanitarios, los mercados financieros y los ecosistemas de innovacion. Las causas fundamentales/estructurales se trataron en 25 articulos; las comunidades, hogares e individuos en 22 articulos; y las posiciones/fundamentos sociales en 11. Conclusion La revision identifico tres deficiencias importantes: una definicion formal de preparacion y respuesta ante una pandemia, lo que impide cuantificar con precision el deficit de financiacion; una investigacion sobre el grado en que la financiacion de la preparacion y respuesta ante una pandemia se ha dirigido a los hogares mas vulnerables; y un analisis de los instrumentos financieros especificos y una evaluacion de la viabilidad de su implementacion., Introduction The coronavirus disease 2019 (COVID-19) pandemic has been one of the deadliest emergencies in modern history, with a global death toll exceeding 14.9 million people. (1) Beyond the tragic [...]

The international community increasingly acknowledges the contribution of health systems to climate change and environmental degradation: globally, the health sector contributed approximately 5% to greenhouse gas emissions in 2019. (1) [...]

Objective To examine the influence of varying articulations of the right to health under domestic constitutions, legislation and jurisprudence on the scope of legal protection for health. Methods We investigated legal recognition of the right to health, by conducting a three-level search. First, we searched databases containing constitutional texts. Second, we did a thematic analysis of those constitutional texts with explicit constitutional recognition of health rights, employing NVivo for coding. For the 54 World Health Organization (WHO) Member States without explicit constitutional provisions, we explored statutory paths, judicial constructions and instances where both methods contributed to the acknowledgement of health rights. Lastly, we confirmed evidence of jurisprudence constructing a right to health based on a combination of domestic law and international human rights norms incorporated directly into the text. Findings We identified 140 WHO Member States with a constitutionalized right to health. Our analysis suggests there are notable variations in the legal scope of protection for health, including breadth of entitlements and the possibility of enforcing these rights through the legal system. We also highlight the critical importance of constitutional acknowledgement, legislative measures, and judicial interpretations in shaping the legal entitlements to health-care services, affecting their accessibility and financial support. Conclusion The analysis offers insights for policy-makers to assess different approaches to health-related entitlements, with implications for health financing and the evaluation of Member States' strides towards universal access to comprehensive care. This analysis also illuminates how distinct formulations of the right to health have varied effects on reducing health disparities. [phrase omitted] Objectif Etudier l'impact de diverses formulations du droit a la sante selon les constitutions, la legislation et la jurisprudence nationales sur le champ d'application de la protection juridique en matiere de sante. Methodes Nous avons examine la reconnaissance juridique du droit a la sante en effectuant une recherche a trois niveaux. Tout d'abord, nous avons explore des bases de donnees contenant des textes constitutionnels. Ensuite, nous avons procede a une analyse thematique de ces textes constitutionnels reconnaissant explicitement les droits a la sante, en utilisant NVivo pour le codage. Pour les 54 Etats Membres de l'Organisation mondiale de la Sante (OMS) depourvus de dispositions constitutionnelles, nous avons passe en revue les parcours legaux, instances et interpretations judiciaires oU les deux methodes ont contribue a la reconnaissance de droits a la sante. Enfin, nous avons corrobore les preuves de jurisprudence formulant un droit a la sante fonde sur la combinaison, directement integree dans le texte, d'une legislation nationale et de normes internationales en matiere de droits humains. Resultats Nous avons identifie 140 Etats Membres de l'OMS ayant constitutionnalise le droit a la sante. Notre analyse suggere qu'il existe des variations considerables dans le champ d'application de la protection juridique en matiere de sante, notamment dans la portee de ces droits et la possibilite de les faire respecter par la voie legale. Nous soulignons en outre l'importance cruciale de la reconnaissance constitutionnelle, des mesures legislatives et des interpretations judiciaires dans la formulation des droits juridiques aux services de soins de sante, du fait de son impact sur leur accessibilite et sur le soutien financier. Conclusion La presente analyse fournit des informations aux responsables politiques afin qu'ils puissent examiner plusieurs approches relatives aux droits de la sante, avec des implications en termes de financement de la sante et l'evaluation des progres realises par les Etats Membres dans le cadre de l'acces universel a des soins complets. Elle met egalement en lumiere la diversite des effets qu'exercent les differentes formulations du droit a la sante sur la reduction des inegalites en la matiere. [phrase omitted] Objetivo Examinar la influencia de las diferentes articulaciones del derecho sobre la salud en las constituciones, la legislacion y la jurisprudencia nacionales sobre el alcance de la proteccion juridica de la salud. Metodos Se investigo el reconocimiento juridico del derecho sobre la salud mediante una busqueda en tres niveles. En primer lugar, se buscaron bases de datos que incluyeran textos constitucionales. En segundo lugar, se realizo un analisis tematico de los textos constitucionales con reconocimiento constitucional explicito de los derechos sobre la salud, utilizando NVivo para la codificacion. En el caso de los 54 Estados Miembros de la Organizacion Mundial de la Salud (OMS) sin disposiciones constitucionales explicitas, se exploraron las vias estatutarias, las construcciones judiciales y los casos en que ambos metodos contribuyeron al reconocimiento de los derechos sobre la salud. Por ultimo, se confirmaron los casos en los que la jurisprudencia habia establecido un derecho sobre la salud basado en una combinacion de legislacion nacional y normas internacionales de derechos humanos incorporadas directamente al texto Resultados Se identificaron 140 Estados Miembros de la OMS con un derecho sobre la salud constitucionalizado. El analisis sugiere que existen notables variaciones en el alcance juridico de la proteccion de la salud, incluida la extension de los derechos y la posibilidad de hacerlos valer a traves del sistema juridico. Tambien se destaca la importancia decisiva del reconocimiento constitucional, las medidas legislativas y las interpretaciones judiciales en la configuracion de los derechos legales a los servicios de atencion sanitaria, que afectan a su accesibilidad y apoyo financiero. Conclusion El analisis ofrece informacion para que los responsables de formular las politicas evaluen los diferentes enfoques de los derechos relacionados con la salud, con implicaciones para la financiacion sanitaria y la evaluacion de los avances de los Estados Miembros hacia el acceso universal a una atencion integral. Este analisis tambien aclara como las diversas formulaciones del derecho sobre la salud tienen efectos variados en la reduccion de las disparidades sanitarias., Introduction In 1946, the newly drafted Constitution of the World Health Organization (WHO) recognized the fundamental right to enjoy the highest attainable standard of health without distinction of race, religion, [...]

High-quality evaluation is critical for health systems because it enables the best use of scarce resources and helps policy-makers learn what works best in their setting. What works cannot be [...]

To assess the performance of a health system, understanding its structures and functions is necessary. This understanding requires an in-depth description and analysis of the health system, which can be [...]

Researchers and policy-makers have long compared health system performance. (1,2) International comparisons raise awareness of health systems' relative strengths and shortcomings, prompting policy debates and informing policy decisions. Yet determining [...]

Objective To explore the impact of mosquito collection methods, sampling Intensity and target genus on molecular xenomonitoring detection of parasites causing lymphatic filariasis. Methods We systematically searched five databases for studies that used two or more collection strategies for sampling wild mosquitoes, and employed molecular methods to assess the molecular xenomonitoring prevalence of parasites responsible for lymphatic filariasis. We performed generic inverse variance meta-analyses and explored sources of heterogeneity using subgroup analyses. We assessed methodological quality and certainty of evidence. Findings We identified 25 eligible studies, with 172 083 mosquitoes analysed. We observed significantly higher molecular xenomonitoring prevalence with collection methods that target bloodfed mosquitoes compared to methods that target unfed mosquitoes (prevalence ratio: 3.53; 95% confidence interval, CI: 1.52-8.24), but no significant difference compared with gravid collection methods (prevalence ratio: 1.54; 95% CI: 0.46-5.16). Regarding genus, we observed significantly higher molecular xenomonitoring prevalence for anopheline mosquitoes compared to culicine mosquitoes in areas where Anopheles species are the primary vector (prevalence ratio: 6.91; 95% CI: 1.73-27.52). One study provided evidence that reducing the number of sampling sites did not significantly affect molecular xenomonitoring prevalence. Evidence of differences in molecular xenomonitoring prevalence between sampling strategies was considered to be of low certainty, due partly to inherent limitations of observational studies that were not explicitly designed for these comparisons. Conclusion The choice of sampling strategy can significantly affect molecular xenomonitoring results. Further research is needed to inform the optimum strategy in light of logistical constraints and epidemiological contexts. Objectif Explorer llmpact des methodes de collecte de moustiques, de l'intensite de l'echantillonnage et du genre cible sur la detection par xenosurveillance moleculaire des parasites responsables de la filariose lymphatique. Methodes Nous avons recherche systematiquement, dans cinq bases de donnees, des etudes recourant a au moins deux strategies de collecte en vue de l'echantillonnage de moustiques a l'etat sauvage et appliquant des methodes moleculaires pour evaluer la prevalence des parasites responsables de la filariose lymphatique dans le cadre d'une xenosurveillance moleculaire. Nous avons effectue des meta-analyses generiques de variance inverse et explore les sources d'heterogeneite a l'aide d'analyses de sous-groupes. Nous avons evalue la qualite methodologique et la certitude des preuves. Resultats Nous avons identifie 25 etudes admissibles, avec 172 083 moustiques analyses. Nous avons observe une prevalence de xenosurveillance moleculaire significativement plus elevee avec les methodes de collecte ciblant les moustiques hematophages qu'avec les methodes ciblant les moustiques non hematophages (rapport de prevalence: 3,53; intervalle de confiance (IC) a 95%: 1,52-8,24), mais aucune difference significative par rapport aux methodes de collecte de femelles gravides (rapport de prevalence: 1,54; IC a 95%: 0,46-5,16). En ce qui concerne le genre, nous avons observe une prevalence de xenosurveillance moleculaire significativement plus elevee pour les moustiques anopheles que pour les moustiques culicides dans les zones oU les especes d'anopheles sont le vecteur principal (rapport de prevalence: 6,91; IC a 95%: 1,73-27,52). Une etude a mis en evidence que la reduction du nombre de sites d'echantillonnage n'avait pas d'incidence significative sur la prevalence de la xenosurveillance moleculaire. Les preuves de differences dans la prevalence de la xenosurveillance moleculaire entre les strategies d'echantillonnage ont ete considerees comme peu sures, en partie a cause des limites inherentes aux etudes d'observation qui n'ont pas ete explicitement concues pour ces comparaisons. Conclusion Le choix de la strategie d'echantillonnage peut affecter de maniere significative les resultats de la xenosurveillance moleculaire. Des recherches supplementaires sont necessaires pour determiner la strategie optimale en fonction des contraintes logistiques et des contextes epidemiologiques. Objetivo Explorar el impacto de los metodos de recoleccion de mosquitos, la intensidad del muestreo y el genero objetivo en la deteccion mediante xenomonitoreo molecular de los parasitos que causan la filariasis linfatica. Metodos Se realizaron busquedas sistematicas en cinco bases de datos de estudios que utilizaron dos o mas estrategias de recoleccion para el muestreo de mosquitos silvestres y que emplearon metodos moleculares para evaluar la prevalencia de xenomonitoreo molecular de los parasitos responsables de la filariasis linfatica. Se realizaron metanalisis genericos de varianza inversa y se exploraron las fuentes de heterogeneidad mediante analisis de subgrupos. Se evaluo la calidad de la metodologia y la certeza de las evidencias. Resultados Se identificaron 25 estudios elegibles, con 172 083 mosquitos analizados. Se observo una prevalencia significativamente mayor de xenomonitoreo molecular con metodos de recoleccion dirigidos a mosquitos hematofagos en comparacion con metodos dirigidos a mosquitos no hematofagos (razon de prevalencia: 3,53; intervalo de confianza del 95%, IC: 1,52-8,24), pero ninguna diferencia significativa en comparacion con los metodos de recoleccion de hembras gestantes (razon de prevalencia: 1,54; IC del 95%: 0,46-5,16). En cuanto al genero, se observo una prevalencia significativamente mayor de xenomonitoreo molecular para los mosquitos anofelinos en comparacion con los culicidos en zonas donde las especies de Anopheles son el vector principal (razon de prevalencia: 6,91; IC del 95%: 1,73-27,52). Un estudio aporto evidencias de que la reduccion de la cantidad de sitios de muestreo no afecto significativamente la prevalencia del xenomonitoreo molecular. Las evidencias de diferencias en la prevalencia del xenomonitoreo molecular entre las estrategias de muestreo se consideraron de baja certeza, lo que se debio en parte a las limitaciones inherentes de los estudios observacionales que no se disenaron explicitamente para estas comparaciones. Conclusion La eleccion de la estrategia de muestreo puede afectar de manera significativa a los resultados del xenomonitoreo molecular. Se requieren mas investigaciones para determinar la estrategia optima teniendo en cuenta las limitaciones logisticas y los contextos epidemiologicos., Introduction Lymphatic filariasis is a disabling and debilitating disease caused by the filarial worms Wuchereria bancrofti, Brugia malayi or B. timori that are transmitted by mosquitoes of the genera Culex, [...]

Colonialism, which involves the systemic domination of lands, markets, peoples, assets, cultures or political institutions to exploit, misappropriate and extract wealth and resources, affects health in many ways. In recent years, interest has grown in the decolonization of global health with a focus on correcting power imbalances between high-income and low-income countries and on challenging ideas and values of some wealthy countries that shape the practice of global health. We argue that decolonization of global health must also address the relationship between global health actors and contemporary forms of colonialism, in particular the current forms of corporate and financialized colonialism that operate through globalized systems of wealth extraction and profiteering. We present a three-part agenda for action that can be taken to decolonize global health. The first part relates to the power asymmetries that exist between global health actors from high-income and historically privileged countries and their counterparts in low-income and marginalized settings. The second part concerns the colonization of the structures and systems of global health governance itself. The third part addresses how colonialism occurs through the global health system. Addressing all forms of colonialism calls for a political and economic anticolonialism as well as social decolonization aimed at ensuring greater national, racial, cultural and knowledge diversity within the structures of global health. Le colonialisme, qui implique la domination systemique de terres, de marches, de peuples, de ressources, de cultures ou d'institutions politiques dans le but d'exploiter, de detourner et d'extraire des richesses et des ressources, affecte la sante de nombreuses manieres. Ces dernieres annees, la decolonisation de la sante mondiale a suscite un interet croissant, l'accent etant mis sur la correction des desequilibres de pouvoir entre les pays a revenu eleve et les pays a faible revenu, ainsi que sur la remise en question des idees et des valeurs de certains pays riches qui faponnent la pratique de la sante mondiale. Nous soutenons que la decolonisation de la sante mondiale doit egalement aborder la relation entre les acteurs de la sante mondiale et les formes contemporaines de colonialisme, en particulier les formes actuelles de colonialisme d'entreprise et de colonialisme financiarise qui operent par des systemes mondialises detraction de richesses et de profits. Nous presentons un programme d'action en trois parties destine a decoloniser la sante mondiale. La premiere partie porte sur les asymetries de pouvoir existant entre les acteurs de la sante mondiale des pays a hauts revenus et historiquement privilegies et leurs homologues des pays a faibles revenus et marginalises. La deuxieme partie concerne la colonisation des structures et des systemes de la gouvernance mondiale de la sante elle-meme. La troisieme partie traite de la maniere dont le colonialisme se manifeste a travers le systeme de sante mondial. La lutte contre toutes les formes de colonialisme necessite un anticolonialisme politique et economique ainsi qu'une decolonisation sociale visant a garantir une plus grande diversite nationale, raciale, culturelle et des connaissances au sein des structures de la sante mondiale. El colonialismo, que implica la dominacion sistemica de tierras, mercados, pueblos, bienes, culturas o instituciones politicas para explotar, apropiarse indebidamente y extraer riqueza y recursos, afecta a la salud de muchas maneras. En los ultimos anos ha crecido el interes por descolonizar la salud mundial, en particular para corregir los desequilibrios de poder entre los paises de ingresos altos y los de ingresos bajos, y para cuestionar las ideas y los valores de algunos paises ricos que influyen en la practica de la salud mundial. Sostenemos que la descolonizacion de la salud mundial tambien debe abordar la relacion entre los actores de la salud mundial y las formas contemporaneas de colonialismo, en especial las formas actuales de colonialismo corporativo y financiarizado que operan a traves de sistemas globalizados de extraccion de riqueza y especulacion. Presentamos un programa de accion dividido en tres partes para descolonizar la salud mundial. La primera parte se refiere a las asimetrias de poder que existen entre los actores de la salud mundial procedentes de paises de ingresos altos e historicamente privilegiados y sus homologos de entornos de ingresos bajos y marginados. La segunda parte se refiere a la colonizacion de las estructuras y sistemas de la propia gobernanza de la salud mundial. La tercera parte aborda como se produce el colonialismo a traves del sistema sanitario mundial. Abordar todas las formas de colonialismo exige un anticolonialismo politico y economico, asi como una descolonizacion social destinada a garantizar una mayor diversidad nacional, racial, cultural y de conocimientos dentro de las estructuras de la salud mundial. [phrase omitted], Introduction Medicine and public health have always been shaped by social and political values, (1) as evident in efforts to redress social inequities in health, struggles to realize health as [...]

Global health security is an increasingly complex regime. The failures of global governance and norms of cooperation during the coronavirus disease 2019 (COVID-19) pandemic and the re-entrenchment to nationalist policy-making have created impetus for new governance arrangements, institutions and policy development. These changes include amendments to the International health regulations (IHR), development of a pandemic convention or accord, convening of the High- Level Meeting on Pandemic Preparedness and Response, establishment of the Pandemic Fund, and development of the medical countermeasures platform, among others. These various developments claim to be in synergy with each other, but understanding of regime complexes and forum shifting from international relations reveal the power dyna mics which underlie these processes. I use these concepts to demonstrate how states are transferring negotiations from one institutional location to another in search of more favourable outcomes, or are creating strategic uncertainty within negotiations to avoid future accountability. I further highlight three risks posed by these developments: (i) an increasingly complex landscape for global health security; (ii) erosion of the World Health Organization's authority in global health security; and (iii) dominance of high-income state positions within these negotiations. La securite sanitaire mondiale est un systeme de plus en plus complexe. Les echecs essuyes par la gouvernance mondiale et les normes en matiere de cooperation durant la pandemie de maladie a coronavirus 2019 (COVID-19), ainsi que le retour a une elaboration nationaliste des politiques, ont entraine la creation de mecanismes de gouvernance, destitutions et de programmes politiques inedits. Ces transformations se traduisent notamment par des amendements au Reglement sanitaire international (RSI), la mise au point d'une convention ou d'un accord face aux pandemies, l'organisation de la Reunion de haut niveau inedite sur la prevention, la preparation et la riposte face aux pandemies, l'etablissement du Fonds de lutte contre les pandemies, mais aussi l'instauration de la plateforme de contre-mesures medicales. Ces differents changements affirment reuvrer en synergie, mais la comprehension des complexites du systeme et revolution des debats, qui se detachent des relations internationales, revelent les dynamiques de pouvoir qui sous-tendent ces processus. J'utilise ces concepts pour montrer comment les Etats transferent les negociations d'un siege institutionnel a l'autre en quete de resultats plus favorables, ou creent une incertitude strategique dans le cadre des negociations pour se soustraire a de futures responsabilites. Je souligne egalement trois risques que comportent ces changements: (i) un paysage sans cesse plus complexe pour la securite sanitaire mondiale; (ii) l'erosion de l'autorite exercee par l'Organisation mondiale de la Sante en la matiere; et enfin, (iii) la position dominante des Etats a revenu eleve dans les negociations. La seguridad sanitaria mundial es un sistema cada vez mas complejo. Los fracasos de la gobernanza mundial y de las normas de cooperacion durante la pandemia de la enfermedad por coronavirus de 2019 (COVID-19) y el repliegue hacia la formulacion de politicas nacionalistas han impulsado nuevos acuerdos de gobernanza, instituciones y desarrollo de politicas. Estos cambios incluyen enmiendas al Reglamento Sanitario Internacional (RSI), el desarrollo de una convencion o acuerdo sobre pandemias, la convocatoria de la Reunion de Alto Nivel sobre Preparacion y Respuesta ante Pandemias, el establecimiento del Fondo para Pandemias y el desarrollo de la plataforma de contramedidas medicas, entre otros. Estos diversos desarrollos pretenden funcionar en sinergia, pero la comprension de las complejidades del sistema y la evolucion de los debates, al margen de las relaciones internacionales, revelan la dinamica de poder que subyace a estos procesos. Utilizo estos conceptos para demostrar como los Estados trasladan las negociaciones de un lugar institucional a otro en busca de resultados mas favorables o crean incertidumbre estrategica dentro de las negociaciones para evadir futuras responsabilidades. Ademas, destaco tres riesgos que plantean estos acontecimientos: (i) un panorama cada vez mas complejo para la seguridad sanitaria mundial; (ii) la perdida de autoridad de la Organizacion Mundial de la Salud en materia de seguridad sanitaria mundial; y (iii) el predominio de las posiciones de los Estados de ingresos altos en estas negociaciones., Introduction Global health security, defined by the World Health Organization (WHO) as 'the activities required, both proactive and reactive, to minimize the danger and impact of acute public health events [...]

Objective To analyse and classify inclusions of corporate social responsibility in international investment agreements, especially inclusions with reference to public health. Method We extracted the text of international investment agreements containing corporate social responsibility inclusions from the electronic database of investment treaties. We conducted a documentary analysis of the corporate social responsibility inclusions, and we developed a typology categorizing inclusions based on level of detail and reference to international commitments. Findings Of the 3816 agreements signed as of October 2023, 127 agreements contain corporate social responsibility inclusions. Since the first inclusion of corporate social responsibility in 2008, the percentage of agreements containing such inclusion signed each year has steadily increased from 4.6% (4/86) in 2008 to 42.8% (21/49) in 2018 and 33.3% (3/9) in 2023. Using the typology we developed, we categorized the level of detail as follows: nine were minimal, 27 were low, 35 were low- medium, 107 were medium, 11 were medium-high and seven were high. Health is mentioned in 36 of these inclusions. Conclusion This analysis indicates that international investment agreements increasingly incorporate a high level of detail on expectations regarding investors' corporate social responsibility. Such provisions offer a potential tool to increase government guidance and accountability of global corporations, including with respect to governments' public health objectives. Objectif Analyser et classer les dispositions relatives a la responsabilite sociale des entreprises dans les accords internationaux d'investissement, en particulier celles relatives a la sante publique. Methodes Nous avons extrait de la Base de donnees electronique des traites d'investissement (EDIT) le texte d'accords internationaux d'investissement contenant des dispositions relatives a la responsabilite sociale des entreprises. Nous avons effectue une analyse documentaire des dispositions relatives a la responsabilite sociale des entreprises et avons elabore une typologie classant ces dispositions selon leur niveau de detail et leur reference a des engagements internationaux. Resultats Sur les 3816 accords signes en date d'octobre 2023, 127 contiennent des dispositions relatives a la responsabilite sociale des entreprises. Depuis l'inclusion de la premiere disposition de responsabilite sociale des entreprises en 2008, le pourcentage d'accords signes chaque annee et contenant ce type de disposition a augmente regulierement, passant de 4,6 % (4/86) en 2008 a 42,8% (21/49) en 2018 et 33,3% (3/9) en 2023. A l'aide de la typologie que nous avons elaboree, nous avons classe le niveau de detail comme suit : neuf niveaux de detail etaient minimes, 27 etaient faibles, 35 etaient faibles a moyens, 107 etaient moyens, 11 etaient moyens a eleves et sept etaient eleves. La sante est mentionnee dans 36 de ces dispositions. Conclusion Cette analyse indique que les accords internationaux d'investissement integrent de plus en plus souvent un niveau eleve de details sur les attentes en matiere de responsabilite sociale des entreprises. Ces dispositions constituent un outil potentiel pour renforcer les orientations gouvernementales et la responsabilite des entreprises internationales, notamment en ce qui concerne les objectifs de sante publique des gouvernements. Objetivo Analizar y clasificar las inclusiones de la responsabilidad social empresarial en los acuerdos internacionales de inversion, en especial las inclusiones con referencia a la salud publica. Metodo Se extrajo de la Base de Datos Electronica de Tratados de Inversion el texto de los acuerdos internacionales de inversion que incluian la responsabilidad social empresarial. Se realizo un analisis documental de las inclusiones de la responsabilidad social empresarial y se elaboro una tipologia que clasifica las inclusiones en funcion del nivel de detalle y la referencia a los compromisos internacionales. Resultados De los 3816 acuerdos firmados hasta octubre de 2023, 127 acuerdos contienen inclusiones de responsabilidad social empresarial. Desde la primera inclusion de la responsabilidad social empresarial en 2008, el porcentaje de acuerdos firmados cada ano que contienen esta inclusion ha aumentado de manera constante, pasando del 4,6% (4/86) en 2008 al 42,8% (21/49) en 2018 y al 33,3% (3/9) en 2023. Mediante la tipologia que se desarrollo, se categorizo el nivel de detalle de la siguiente manera: nueve fueron minimos, 27 fueron bajos, 35 fueron bajos-medios, 107 fueron medios, 11 fueron medios-altos y siete fueron altos. La salud se menciona en 36 de estas inclusiones. Conclusion Este analisis indica que los acuerdos internacionales de inversion incorporan cada vez mas un alto nivel de detalle sobre las expectativas en materia de responsabilidad social empresarial de los inversores. Estas disposiciones ofrecen una herramienta potencial para aumentar la orientacion de los gobiernos y la rendicion de cuentas de las empresas mundiales, incluso con respecto a los objetivos de salud publica de los gobiernos. [phrase omitted], Introduction The term corporate social responsibility reflects a shift in the norms and expectations of the public and governments regarding corporate behaviour and its impact on objectives including public health. [...]

Over 281 million people around the world are counted as international migrants. (1) Many migrants are forcibly displaced - with 36.4 million refugees and 6.1 million asylum-seekers by mid-2023. Furthermore, [...]

Improving health system performance is a priority for policy-makers. As the population ages and the burden of chronic disease grows, governments are spending more on health-care provision. (1) Unpredictable and [...]

Q: How did you to come focus on audiology so early? A: Here in South Africa, training in audiology begins at the undergraduate degree level, so you're essentially required to [...]

Health inequity is the presence of unfair, avoidable or remediable differences in achieving optimal health and well-being among people. However, despite global commitment to reduce health inequities, progress has been [...]