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Background Recording and reporting health data in facilities is the backbone of routine health information systems which provide data collected by health facility workers during service provision. Data is firstly collected in a register, to record patient health data and care process, and tallied into nationally designed reporting forms. While there is anecdotal evidence of large numbers of registers and reporting forms for primary health care (PHC) facilities, there are few systematic studies to document this potential burden on health workers. This multi-country study aimed to document the numbers of registers and reporting forms use at the PHC level and to estimate the time it requires for health workers to meet data demands. Methods In Cambodia, Ghana, Mozambique, Nigeria and Tanzania, a desk review was conducted to document registers and reporting forms mandated at the PHC level. In each country, visits to 16 randomly selected public PHC facilities followed to assess the time spent on paper-based recording and reporting. Information was collected through self-reports of estimated time use by health workers, and observation of 1360 provider-patient interactions. Data was primarily collected in outpatient care (OPD), antenatal care (ANC), immunization (EPI), family planning (FP), HIV and Tuberculosis (TB) services. Result Cross-countries, the average number of registers was 34 (ranging between 16 and 48). Of those, 77% were verified in use and each register line had at least 20 cells to be completed per patient. The mean time spent on recording was about one-third the total consultation time for OPD, FP, ANC and EPI services combined. Cross-countries, the average number of monthly reporting forms was 35 (ranging between 19 and 52) of which 78% were verified in use. The estimated time to complete monthly reporting forms was 9 h (ranging between 4 to 15 h) per month per health worker. Conclusions PHC facilities are mandated to use many registers and reporting forms pausing a considerable burden to health workers. Service delivery systems are expected to vary, however an imperative need remains to invest in international standards of facility-based registers and reporting forms, to ensure regular, comparable, quality-driven facility data collection and use.

BackgroundHuman resources information systems (HRIS) are a key tool for collecting and analyzing health workforce data at the country level and the specific focus of milestones 4.1 and 4.2 of the Global Strategy on Human Resources for Health (HRH). Yet documentation on the capabilities of HRIS in low- and middle-income countries (LMICs) is limited. Vital Wave, with IntraHealth International and Cooper/Smith, conducted a targeted scan of the HRIS landscape in 20 countries and “deep-dive” assessments in Burkina Faso, Mozambique, and Uganda. Here we present the case of Uganda’s workforce information ecosystem. Case PresentationSince 2006, Uganda has seen investment in HRIS from different donors, overseen by the Ministry of Health (MOH) and accompanied by the rollout of IntraHealth’s open-source iHRIS software. Despite this history of investment, mapping of the country’s multiple information systems revealed uneven adoption and engagement nationally and sub-nationally, with high levels of data fragmentation due to lack of interoperability and data-sharing practices. We also mapped the administrative processes and data flows for three priority use cases: recruitment and deployment, salary payments, and performance management. What emerges is a complex, decentralized information ecosystem driven by years of donor investment, but one that still sees uneven ownership and data use across the health system. Challenges include:· Limited interoperability between systems, specifically payroll, iHRIS, and the district health information system (DHIS2)· Complex HRH planning and management policy context, with variable implementation of numerous policies and no single reference to guide investments and implementation· Limited visibility into the private and community health workforce. ConclusionsUganda’s progress in developing its HRH information ecosystem underscores the importance of continuously aligning system capabilities, incentives, and motivations to an ever-evolving country context. However, as evidenced in Uganda and our broader assessment findings, robustness of the information ecosystem itself is insufficient to making substantive strides toward the Global Strategy’s milestones 4.1 and 4.2—governance oversight and ownership are critical to success. With a better understanding of what good looks like in terms of HRIS functionality in LMICs and ensuring interventions are addressing the causal issues, there can be many pathways to making systems work.

To assess antibiotic availability and use in health facilities in low- and middle-income countries, using the service provision assessment and service availability and readiness assessment surveys.We obtained data on antibiotic availability at 13 561 health facilities in 13 service provision assessment and 8 service availability and readiness assessment surveys. In 10 service provision assessment surveys, child consultations with health-care providers were observed, giving data on antibiotic use in 22 699 children. Antibiotics were classified as access, watch or reserve, according to the World Health Organization's AWaRe categories. The percentage of health-care facilities across countries with specific antibiotics available and the proportion of children receiving antibiotics for key clinical syndromes were estimated.The surveys assessed the availability of 27 antibiotics (19 access, 7 watch, 1 unclassified). Co-trimoxazole and metronidazole were most widely available, being in stock at 89.5% (interquartile range, IQR: 11.6%) and 87.1% (IQR: 15.9%) of health facilities, respectively. In contrast, 17 other access and watch antibiotics were stocked, by fewer than a median of 50% of facilities. Of the 22 699 children observed, 60.1% (13 638) were prescribed antibiotics (mostly co-trimoxazole or amoxicillin). Children with respiratory conditions were most often prescribed antibiotics (76.1%; 8972/11 796) followed by undifferentiated fever (50.1%; 760/1518), diarrhoea (45.7%; 1293/2832) and malaria (30.3%; 352/1160).Routine health facility surveys provided a valuable data source on the availability and use of antibiotics in low- and middle-income countries. Many access antibiotics were unavailable in a majority of most health-care facilities.Mesurer la disponibilité et l'usage des antibiotiques au sein des établissements médicaux dans les pays à faible et moyen revenu, en recourant à des enquêtes d'évaluation des prestations de service, ainsi que de la disponibilité et de l'état de préparation.Nous avons obtenu des données sur la disponibilité des antibiotiques dans 13 561 établissements médicaux dans le cadre de 13 enquêtes d'évaluation des prestations de service et 8 enquêtes d'évaluation de la disponibilité et de l'état de préparation. Pour 10 de ces 13 enquêtes d'évaluation des prestations de service, ce sont les consultations en pédiatrie impliquant du personnel soignant qui ont été observées, ce qui a permis d'accéder à des données sur l'usage des antibiotiques chez 22 699 enfants. Les antibiotiques ont été répartis en trois groupes, conformément au principe AWaRe mis en place par l'Organisation mondiale de la Santé : antibiotiques dont l'accessibilité est essentielle (Access), antibiotiques à utiliser sélectivement (Watch) et antibiotiques de réserve (Reserve). Le pourcentage d'établissements médicaux possédant des antibiotiques spécifiques ainsi que la proportion d'enfants ayant reçu des antibiotiques pour des syndromes cliniques clés ont été estimés dans différents pays.Les enquêtes ont évalué la disponibilité de 27 antibiotiques (19 de la catégorie Access, 7 de la catégorie Watch, 1 non catégorisé). Le cotrimoxazole et le métronidazole étaient les plus répandus, présents dans 89,5 % des stocks (écart interquartile, EI : 11,6 %) et 87,1 % (EI : 15,9 %) des établissements médicaux. En revanche, 17 autres antibiotiques appartenant aux catégories Access et Watch étaient en stock chez moins de la médiane de 50 % des établissements. Sur les 22 699 enfants observés, 60,1 % (13 638) se sont vu prescrire des antibiotiques (principalement du cotrimoxazole ou de l'amoxicilline). Ce sont les enfants présentant des affections respiratoires qui ont le plus souvent été traités aux antibiotiques (76,1 % ; 8972/11 796), suivis par ceux souffrant d'une fièvre indifférenciée (50,1 % ; 760/1518), d'une diarrhée (45,7 % ; 1293/2832) et de la malaria (30,3 % ; 352/1160).Les enquêtes de routine menées dans les établissements médicaux constituent une précieuse source d'informations sur la disponibilité et l'usage des antibiotiques dans les pays à faible et moyen revenu. De nombreux antibiotiques dont l'accessibilité est essentielle (Access) étaient absents chez la plupart des établissements médicaux.Evaluar la disponibilidad y el uso de antibióticos en los centros sanitarios de los países de ingresos bajos y medios, mediante la evaluación sobre la prestación de servicios y las encuestas de evaluación sobre la disponibilidad y la preparación de los servicios.Se obtuvieron datos sobre la disponibilidad de antibióticos en 13 561 centros sanitarios en 13 encuestas de evaluación sobre la prestación de servicios y en 8 encuestas de evaluación sobre la disponibilidad y la preparación de los servicios. En 10 encuestas de evaluación sobre la prestación de servicios se observaron consultas de niños con proveedores de atención sanitaria, lo que permitió obtener datos sobre el uso de antibióticos en 22 699 niños. La herramienta AWaRe de la Organización Mundial de la Salud clasificó los antibióticos como de acceso, vigilancia o reserva. Se estimó el porcentaje de centros de atención sanitaria de todos los países que disponían de antibióticos específicos y la proporción de niños que recibían antibióticos para los principales síndromes clínicos.Las encuestas evaluaron la disponibilidad de 27 antibióticos (19 de acceso, 7 de vigilancia, 1 sin clasificar). El cotrimoxazol y el metronidazol fueron los antibióticos con mayor disponibilidad, ya que se encontraban en existencias en el 89,5 % (rango intercuartil, IQR: 11,6 %) y el 87,1 % (IQR: 15,9 %) de los centros de salud, respectivamente. En cambio, otros 17 antibióticos de acceso y vigilancia estaban almacenados en menos de una mediana del 50 % de los centros. De los 22 699 niños observados, al 60,1 % (13 638) se les recetaron antibióticos (principalmente cotrimoxazol o amoxicilina). A los niños con afecciones respiratorias se les recetó con mayor frecuencia antibióticos (76,1 %; 8 972/11 796), seguidos por aquellos con fiebre indiferenciada (50,1 %; 760/1 518), diarrea (45,7 %; 1 293/2 832) y malaria (30,3 %; 352/1 160).Las encuestas de rutina en los centros sanitarios constituyeron una valiosa fuente de datos sobre la disponibilidad y el uso de antibióticos en los países de ingresos bajos y medios. En la mayoría de los centros de atención sanitaria no se disponía de muchos antibióticos de acceso.تقييم مدى توافر المضادات الحيوية واستخدامها في المرافق الصحية في البلدان ذات الدخل المنخفض والمتوسط، وذلك باستخدام مسوح لتقييم كل من الاستعداد، ومدى توافر الخدمات، وتقديم الخدمات.لقد حصلنا على بيانات حول توفر المضادات الحيوية في 13561 مرفقًا صحيًا في 8 مسوح لتقييم الاستعداد ومدى توافر الخدمات و13 دراسة استقصائية لتقديم الخدمات. وفي 10 مسوح لتقييم تقديم الخدمات، لوحظت مشاورات الأطفال مع مقدمي الرعاية الصحية، مما وفر بيانات عن استخدام المضادات الحيوية على 22699 طفلًا. تم تصنيف المضادات الحيوية كمضادات حيوية يجب أن تكون متاحة طوال الوقت بسعر مناسب (ACCESS)، أو مضادات حيوية يوصى بها كاختيار أول أو ثان (WATCH)، أو مضادات حيوية تستخدم كحل أخير (RESERVE)، وفقًا لفئات AWaRe التابعة لمنظمة الصحة العالمية. تم تقدير النسبة المئوية لمرافق الرعاية الصحية في جميع البلدان التي بها مضادات حيوية متاحة بالإضافة إلى نسبة الأطفال الذين يتلقون المضادات الحيوية للمتلازمات السريرية الرئيسية.قيّمت المسوح مدى توافر 27 من المضادات الحيوية (19 مضادًا حيويًا يجب أن يكون متاحًا طوال الوقت بسعر مناسب، و7 مضادات حيوية يوصى بها كاختيار أول أو ثان، وواحد غير مصنف). كان كل من كوتريموكسازول وميترونيدازول متاحين على أوسع نطاق، حيث كانا متوفران بنسبة 89,5% (المدى الربيعي، IQR: 11,6%) و87,1% (IQR: 15,9%) من المرافق الصحية، على التوالي. وفي المقابل، تم تخزين 17 مضاداً حيوياً آخر ليكون متاحًا طوال الوقت بسعر مناسب وللاستخدام كاختيار أول أو ثان، بأقل من متوسط 50% من المرافق. من بين الـ 22699 طفلًا الذين تمت ملاحظتهم، وُصف لـ 60,1% منهم مضادات حيوية (أغلبها من كوتريموكسازول أو الأموكسيسيلين). غالبًا ما يتبع وصف المضادات الحيوية للأطفال المصابين بأمراض في الجهاز التنفسي (76.1%؛ 8972/11796) حمى غير متمايزة (50,1%؛ 760/1518)، وإسهال (45,7%؛ 1293/2832) وملاريا (30,3%؛ 352/1160).قدمت المسوح الروتينية للمرافق الصحية مصدرًا قيمًا للبيانات حول مدى توفر المضادات الحيوية واستخدامها في البلدان ذات الدخل المتوسط والمنخفض. والعديد من المضادات الحيوية التي يجب أن تكون متاحة طوال الوقت بسعر مناسب، لم تكن متوفرة في غالبية مرافق الرعاية الصحية.旨在评估中低收入国家医疗机构中抗生素的可用性和使用情况，采用服务提供评估以及服务可用性和准备情况评估调查。.我们通过 13 项服务提供评估以及 8 项服务可用性和准备情况评估调查，获得了 13 561 个医疗机构的抗生素可用性数据。在 10 项服务提供评估调查中，观察了医疗护理人员参与的儿童会诊，提供了 22 699 名儿童的抗生素使用数据。根据世界卫生组织的知晓 (AWaRe) 类别，抗生素被分为可广泛使用、谨慎使用或保留使用。估算了可获得特定抗生素的国家中的医疗机构所占的百分比以及因主要临床综合征而接受抗生素的儿童比例。.调查评估了 27 种抗生素的可用性（19 种可广泛使用、7 种谨慎使用、1 种未分类）。复方新诺明和甲硝唑的使用最为广泛，医疗机构中库存率分别为 89.5％（四分位距，IQR：11.6％）和 87.1％（IQR：15.9%）。相比之下，其他 17 种可广泛使用、谨慎使用的库存抗生素，在医疗机构中不到中位数的 50％。在观察到的 22 699 名儿童中，有 60.1％ (13 638) 的儿童开了抗生素（主要是复方新诺明或阿莫西林）。患有呼吸道疾病的儿童最常使用抗生素（76.1％；8972/11 796），其次是无特异性发烧（50.1％；760/1518）、腹泻（45.7％；1293/2832）和疟疾（30.3％；352/1160）。.常规医疗机构调查提供了有关中低收入国家抗生素的可用性和使用情况的重要数据来源。在大多数医疗护理机构中，许多可广泛使用的抗生素都不可用。.Оценить доступность антибиотиков и их использование в учреждениях здравоохранения в странах с низким и средним уровнем дохода путем применения опросов для оценки предоставления услуг, их доступности и готовности к их оказанию.Авторы получили данные о доступности антибиотиков в 13 561 учреждении здравоохранения на основании 13 оценок предоставления услуг и 8 опросов для установления доступности услуг и готовности к их оказанию. В 10 опросах с целью оценки предоставления услуг проводилось наблюдение за детскими медицинскими консультациями, что позволило получить данные по применению антибиотиков у 22 699 детей. Антибиотики классифицировались как доступные, применяемые под наблюдением или с ограничениями согласно категориям AWaRe, принятым ВОЗ. Была проведена оценка процентной доли учреждений здравоохранения в разных странах, в которых были доступны конкретные антибиотики, и доли детей, получавших антибиотики по причине основных клинических синдромов.В ходе исследования была оценена доступность 27 антибиотиков (19 доступных, 7 используемых под наблюдением, 1 неклассифицированный). Наиболее доступными были котримоксазол и метронидазол, их запас присутствовал в 89,5% (межквартильный диапазон МКД: 11,6%) и 87,1% (МКД: 15,9%) медицинских учреждений соответственно. Напротив, запасы 17 других доступных и применяемых под наблюдением антибиотиков имелись менее чем в 50% (медианное значение) всех учреждений. Из 22 699 наблюдаемых детей 60,1% (13 638) получали антибиотики по назначению врача (в основном котримоксазол или амоксициллин). Чаще всего антибиотики прописывали детям с респираторными заболеваниями (76,1%; 8972/11 796), а затем при недифференцированной лихорадке (50,1%; 760/1518), диарее (45,7%; 1293/2832) и малярии (30,3%; 352/1160).Регулярные опросы о работе медицинских учреждений позволили получить ценные данные относительно доступности и использования антибиотиков в странах с низким и средним уровнем дохода. В большинстве медицинских учреждений многие доступные антибиотики отсутствовали.

Siyam, Diallo, Lopes and Campbell describe the extreme shortage of health workers worldwide and the importance of information to plan and project workforce needs. The chapter introduces National Health Workforce Accounts proposed by the Global Strategy on Human Resources for Health: Workforce 2030 to standardise the architecture of health workforce information and enhance interoperability between data systems. Set in a Health Labour Market framework, National Health Workforce Accounts use groups of indicators to inform policies to enhance the health workforce development and future planning, and specifically to deliver Universal Health Coverage and the Sustainable Development Goals. The authors describe challenges, progress and future opportunities in strengthening and harmonising national information systems for human resources for health.

To present the findings of the first round of monitoring of the global implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel ("the Code"), a voluntary code adopted in 2010 by all 193 Member States of the World Health Organization (WHO).WHO requested that its Member States designate a national authority for facilitating information exchange on health personnel migration and the implementation of the Code. Each designated authority was then sent a cross-sectional survey with 15 questions on a range of topics pertaining to the 10 articles included in the Code.A national authority was designated by 85 countries. Only 56 countries reported on the status of Code implementation. Of these, 37 had taken steps towards implementing the Code, primarily by engaging relevant stakeholders. In 90% of countries, migrant health professionals reportedly enjoy the same legal rights and responsibilities as domestically trained health personnel. In the context of the Code, cooperation in the area of health workforce development goes beyond migration-related issues. An international comparative information base on health workforce mobility is needed but can only be developed through a collaborative, multi-partnered approach.Reporting on the implementation of the Code has been suboptimal in all but one WHO region. Greater collaboration among state and non-state actors is needed to raise awareness of the Code and reinforce its relevance as a potent framework for policy dialogue on ways to address the health workforce crisis.Présenter les résultats du premier tour de suivi de la mise en œuvre mondiale du Code de pratique mondial de l'OMS pour le recrutement du personnel de santé («le Code»), un code de conduite volontaire adopté en 2010 par l'ensemble des 193 États membres de l'Organisation mondiale de la Santé (OMS).L'OMS a demandé à ses États membres de désigner une autorité nationale pour faciliter l'échange d'informations sur la migration du personnel de santé et la mise en œuvre du Code. Chaque autorité désignée a ensuite reçu une enquête transversale comportant 15 questions sur une gamme de sujets concernant les 10 articles inclus dans le Code.Une autorité nationale a été désignée par 85 pays. Seuls 56 pays ont signalé l'état de la mise en œuvre du Code. Parmi eux, 37 ont pris des mesures pour appliquer le Code, principalement par le biais des parties concernées. Dans 90% des pays, les professionnels de santé migrants disposeraient des mêmes droits et des mêmes responsabilités que le personnel de santé formé localement. Dans le contexte du Code, la coopération dans le domaine du développement des travailleurs de la santé va au-delà des questions liées à la migration. Une base de données comparative internationale sur la mobilité du personnel de santé est nécessaire, mais elle ne peut être développée que par une approche collaborative et multipartite.Les rapports sur la mise en œuvre du Code de pratique mondial ont été insuffisants en général, sauf dans une région de l'OMS. Une meilleure collaboration entre les acteurs étatiques et non étatiques est nécessaire pour sensibiliser au Code et renforcer sa pertinence en tant que structure efficace pour le dialogue politique sur les moyens de remédier à la crise des effectifs du personnel de santé.Presentar los resultados de la primera ronda de seguimiento de la aplicación global del Código de prácticas mundial de la OMS sobre la contratación internacional de personal sanitario («el Código»), un código voluntario adoptado en 2010 por los 193 Estados miembros de la Organización Mundial de la Salud (OMS).La OMS pidió a los Estados miembros que designaran a una autoridad nacional para facilitar el intercambio de información sobre la migración del personal y la aplicación del Código. Se envió una encuesta transversal con 15 preguntas sobre una variedad de temas relacionados con los 10 artículos incluidos en el Código a las autoridades designadas.Un total de85 países designaron a una autoridad nacional. Solo 56 informaron sobre el estado de aplicación del Código, de los cuales 37 tomaron medidas para la aplicación del mismo, principalmente a través de la participación de las partes interesadas. En el 90 % de los países, los profesionales sanitarios migrantes disfrutan supuestamente de los mismos derechos y responsabilidades legales que el personal sanitario formado en el país. En el marco del Código, la cooperación en el ámbito del desarrollo del personal sanitario transciende las cuestiones sobre migración. Se necesita una base internacional de datos comparativos sobre la movilidad del personal sanitario, la cual solo puede desarrollarse mediante un enfoque de asociación múltiple colaborativo.La elaboración de informes sobre la aplicación del Código ha sido insuficiente en todas las regiones de la OMS, excepto en una. Se requiere una mayor colaboración entre los actores estatales y no estatales a fin de dar a conocer el Código y reforzar su importancia como un marco eficaz para el diálogo político sobre las diversas formas de abordar la crisis del personal sanitario.عرض نتائج الجولة الأولى لرصد التنفيذ العالمي لمدونة منظمة الصحة العالمية لقواعد الممارسة بشأن توظيف العاملين الصحيين على المستوى الدولي ("مدونة القواعد")، وهي مدونة قواعد طوعية تم إقرارها في عام 2010 بواسطة جميع الدول الأعضاء في منظمة الصحة العالمية (WHO) البالغ عددها 193 دولة.طلبت منظمة الصحة العالمية أن تعين الدول الأعضاء فيها هيئة وطنية لتيسير تبادل المعلومات حول هجرة العاملين الصحيين وتنفيذ مدونة القواعد. وتم فيما بعد إرسال استقصاء مقطعي يتضمن 15 سؤالاً حول عدد من المواضيع المتعلقة بالمواد العشرة الواردة في مدونة القواعد إلى كل هيئة معينة.قام 85 بلداً بتعيين هيئة وطنية. وقام 56 بلداً فقط بالإبلاغ عن حالة تنفيذ مدونة القواعد. وقام 37 منها باتخاذ خطوات نحو تنفيذ مدونة القواعد، وتم ذلك بشكل أساسي من خلال إشراك الجهات المعنية ذات الصلة. وفي 90 % من البلدان، أظهرت التقارير أن العاملين الصحيين المهاجرين يتمتعون بنفس الحقوق القانونية والمسئوليات مثلهم مثل العاملين الصحيين المدربين محلياً. وفي سياق مدونة القواعد، يتجاوز التعاون في مجال تطوير قوة العمل الصحية المسائل المرتبطة بالهجرة. وتوجد حاجة إلى قاعدة معلومات مقارنة دولية حول تنقل قوة العمل الصحية ولكن لا يمكن تطويرها إلا عبر نهج تعاوني متعدد الأطراف.كان الإبلاغ عن تنفيذ مدونة القواعد دون المستوى الأمثل في جميع أقاليم منظمة الصحة العالمية باستثناء إقليم واحد. وتوجد حاجة إلى تعاون أكبر بين الجهات الفاعلة للدول وغير الدول لزيادة الوعي بمدونة القواعد وتدعيم ملاءمتها كإطار عمل فعال من أجل حوار سياسي حول سبل التعامل مع أزمة قوة العمل الصحية.描述对世界卫生组织（WHO）在全球实施卫生人员国际招聘全球行为守则（“守则”）进行第一轮监控的调查结果，守则是2010 年由世卫组织所有193 个成员国采纳的自律守则。WHO要求其成员国指定一个促进卫生人员移民信息交流和守则实施的全国性主管机关。然后，向每个指定的主管机关发出一份包含15 个问题的横断面调查，这些问题与守则中10 项条款的一系列主题相关。有85 个国家指定了全国性主管机关。仅有56 个国家报告了守则实施的状态。在这些国家中，有37 个采取措施实施守则，其主要手段是让有关的利益相关者参与进来。在90%的国家中，移民卫生专业人士据报告与在本国培养的卫生专业人士享有同样的法律权利和责任。在守则的背景下，卫生劳动力发展领域的合作超越了移民相关问题。需要建立一个有关卫生劳动力流动性的国际比较信息库，而这只能通过协作、多方参与的方法实现。除了一个WHO区域外，其他所有地区中报告的守则实施都未达到最为理想的状态。国家和非国家参与者之间需要加强协作，唤起对守则的意识，强化其在解决卫生劳动力危机过程中作为政策对话有效框架的相关性。Представить выводы, сделанные в результате первого этапа мониторинга процесса внедрения на глобальном уровне Глобального кодекса ВОЗ по практике международного найма персонала здравоохранения (далее в тексте «Кодекс»). Данный Кодекс является добровольным и был принят в 2010 году всеми 193 государствами-членами Всемирной организации здравоохранения (ВОЗ).В соответствии c рекомендациями ВОЗ, государства-члены должны были назначить национальный орган, ответственный за соблюдение Кодекса и содействие обмену информацией по вопросам миграции персонала здравоохранения. Всем назначенным органам была направлена анкета, включающая в себя 15 вопросов по различным темам, относящимся к 10 включенным в Кодекс статьям.Национальные органы были назначены в 85 странах. Отчет о текущем состоянии процесса внедрения Кодекса предоставили только 56 стран, из которых 37 предприняли определенные шаги по внедрению Кодекса, заключающиеся в основном в определении обязательств для вовлеченных сторон. По имеющимся данным, в 90% стран мигрировавшие работники здравоохранения обладают теми же законными правами и несут такую же ответственность, что и персонал здравоохранения, подготовленный внутри страны. Согласно Кодексу, сотрудничество в области подготовки трудовых ресурсов здравоохранения выходит за рамки вопросов, относящихся к миграции. Требуется создание международной сравнительной информационной базы данных по мобильности трудовых ресурсов здравоохранения, чего можно достигнуть только в результате совместной работы множества партнеров.Предоставленные отчеты по внедрению Кодекса не содержали достаточных данных для всех регионов ВОЗ, кроме одного. Чтобы повысить информированность о Кодексе и его значимость как потенциальной основы для проведения диалога по вопросам поиска путей для выхода из кризиса в сфере трудовых ресурсов здравоохранения требуется более высокий уровень взаимодействия между государственными и негосударственными учреждениями.

The international migration of health personnel is on the rise. Recent data demonstrate increasing reliance on foreign-born and foreign-trained health professionals in OECD countries with a 60 % increase in the total number of migrant nurses and physicians over the last decade and a higher proportionate increase from countries experiencing ‘critical’ health workforce shortages [1]. These trends are projected to worsen [2]. OECD countries are not the only destination. Emerging economies in Asia, the Middle East, and sub-Saharan Africa are increasingly the destinations for migrating health professionals [3].

Background Evidence-based health workforce policies are essential to ensure the provision of high-quality health services and to support the attainment of universal health coverage (UHC). This paper describes the main characteristics of available health workforce data for 74 of the 75 countries identified under the ‘Countdown to 2015’ initiative as accounting for more than 95% of the world’s maternal, newborn and child deaths. It also discusses best practices in the development of health workforce metrics post-2015. Methods Using available health workforce data from the Global Health Workforce Statistics database from the Global Health Observatory, we generated descriptive statistics to explore the current status, recent trends in the number of skilled health professionals (SHPs: physicians, nurses, midwives) per 10 000 population, and future requirements to achieve adequate levels of health care in the 74 countries. A rapid literature review was conducted to obtain an overview of the types of methods and the types of data sources used in human resources for health (HRH) studies. Results There are large intercountry and interregional differences in the density of SHPs to progress towards UHC in Countdown countries: a median of 10.2 per 10 000 population with range 1.6 to 142 per 10 000. Substantial efforts have been made in some countries to increase the availability of SHPs as shown by a positive average exponential growth rate (AEGR) in SHPs in 51% of Countdown countries for which there are data. Many of these countries will require large investments to achieve levels of workforce availability commensurate with UHC and the health-related sustainable development goals (SDGs). The availability, quality and comparability of global health workforce metrics remain limited. Most published workforce studies are descriptive, but more sophisticated needs-based workforce planning methods are being developed. Conclusions There is a need for high-quality, comprehensive, interoperable sources of HRH data to support all policies towards UHC and the health-related SDGs. The recent WHO-led initiative of supporting countries in the development of National Health Workforce Accounts is a very promising move towards purposive health workforce metrics post-2015. Such data will allow more countries to apply the latest methods for health workforce planning. Electronic supplementary material The online version of this article (doi:10.1186/s12960-017-0190-7) contains supplementary material, which is available to authorized users.

ObjectiveTo describe the worldwide implementation of the WHO Child Growth Standards (‘WHO standards’).DesignA questionnaire on the adoption of the WHO standards was sent to health authorities. The questions concerned anthropometric indicators adopted, newly introduced indicators, age range, use of sex-specific charts, previously used references, classification system, activities undertaken to roll out the standards and reasons for non-adoption.SettingWorldwide.SubjectsTwo hundred and nineteen countries and territories.ResultsBy April 2011, 125 countries had adopted the WHO standards, another twenty-five were considering their adoption and thirty had not adopted them. Preference for local references was the main reason for non-adoption. Weight-for-age was adopted almost universally, followed by length/height-for-age (104 countries) and weight-for-length/height (eighty-eight countries). Several countries (thirty-six) reported newly introducing BMI-for-age. Most countries opted for sex-specific charts and the Z-score classification. Many redesigned their child health records and updated recommendations on infant feeding, immunization and other health messages. About two-thirds reported incorporating the standards into pre-service training. Other activities ranged from incorporating the standards into computerized information systems, to providing supplies of anthropometric equipment and mobilizing resources for the standards’ roll-out.ConclusionsFive years after their release, the WHO standards have been widely scrutinized and implemented. Countries have adopted and harmonized best practices in child growth assessment and established the breast-fed infant as the norm against which to assess compliance with children's right to achieve their full genetic growth potential.

The interplay of factors that affect post-partum loss or retention of weight gained during pregnancy is not fully understood. The objective of this paper is to describe patterns of weight change in the six sites of the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) and explore variables that explain variation in weight change within and between sites. Mothers of 1743 breastfed children enrolled in the MGRS had weights measured at days 7, 14, 28 and 42 post-partum, monthly from 2 to 12 months and bimonthly thereafter until 24 months post-partum. Height, maternal age, parity and employment status were recorded and breastfeeding was monitored throughout the follow-up. Weight change patterns varied significantly among sites. Ghanaian and Omani mothers lost little or gained weight post-partum. In Brazil, India, Norway and USA, mothers on average lost weight during the first year followed by stabilization in the second year. Lactation intensity and duration explained little of the variation in weight change patterns. In most sites, obese mothers tended to lose less weight than normal-weight mothers. In Brazil and Oman, primiparous mothers lost about 1 kg more than multiparous mothers in the first 6 months. In India and Ghana, multiparous mothers lost about 0.6 kg more than primiparas in the second 6 months. Culturally defined mother-care practices probably play a role in weight change patterns among lactating women. This hypothesis should stimulate investigation into gestational weight gain and post-partum losses in different ethnocultural contexts.

Objective To construct growth curves for school-aged children and adolescents that accord with the WHO Child Growth Standards for preschool children and the body mass index (BMI) cut-offs for adults. Methods Data from the 1977 National Center for Health Statistics (NCHS)/WHO growth reference (1–24 years) were merged with data from the under-fives growth standards’ cross-sectional sample (18–71 months) to smooth the transition between the two samples. State-of-the-art statistical methods used to construct the WHO Child Growth Standards (0–5 years), i.e. the Box-Cox power exponential (BCPE) method with appropriate diagnostic tools for the selection of best models, were applied to this combined sample. Findings The merged data sets resulted in a smooth transition at 5 years for height-for-age, weight-for-age and BMI-for-age. For BMI-for-age across all centiles the magnitude of the difference between the two curves at age 5 years is mostly 0.0 kg/m² to 0.1 kg/m². At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m² for boys and 25.0 kg/m² for girls. These values are equivalent to the overweight cut-off for adults (> 25.0 kg/m²). Similarly, the +2 SD value (29.7 kg/m² for both sexes) compares closely with the cut-off for obesity (> 30.0 kg/m²). Conclusion The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5 to 19 years age group. Bulletin of the World Health Organization 2007;85:660–667.

Health workforce indicators?1 Those should be easy. We just need to count the numbers entering from training institutions or through re-entry, the numbers working, and the numbers exiting. If we know where these people work, we have the distribution of health workers within a country, and if we also have information on their competencies, responsiveness and productivity, we can know about their performance.

OBJECTIVE: The goal of this study was to compare World Health Organization (WHO) growth velocity standards with reference data based on US children. METHODS: Comparisons were made between reference values for weight and length gains based on serial data from US children and the WHO child growth standards. We compared weight velocities for boys and girls for selected percentiles (5th, 25th, 50th, 75th, and 95th) for 1-month intervals from birth to 6 months, 2-month intervals up to 12 months, and 3-month intervals up to 24 months. For length, we compared 2-month intervals from birth to 6 months and 3-month intervals up to 24 months. RESULTS: WHO and US monthly weight increments were similar at the 5th percentile up to 3 months of age; values for other US percentiles were below the WHO percentiles ∼150 g on average. From 3 months onward, the US values converged to a narrow range of CONCLUSIONS: There are important differences between the WHO standards and the reference values for growth velocity based on US data. The WHO values are a better tool for assessing growth velocity and making clinical decisions.