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In this narrative review, we summarise the evidence for and against the glycaemic legacy effect from the long-term follow-up of major diabetes trials and observational cohort studies. We provide a summary of the pathophysiological basis for the legacy effect and discuss some translational research. Results from trials of early diabetes and observational cohort studies suggest that a long-term effect of early glycaemic control exists; however, long-term follow-up from trials in participants with established diabetes is not supportive. Additionally, findings for the legacy effect are more conclusive for microvascular complications than macrovascular events. Overall, these results suggest that the glycaemic legacy effect is a long-term benefit (or risk) conferred to individuals in the early stages of diabetes and which is muted over time as individuals' vasculature changes and they develop complications from diabetes.

In the 10 countries surveyed, the availability of oral contraceptives, injectables, and condoms varied greatly, and the availability of basic items indicating service readiness, such as guidelines, trained staff, equipment, and certain commodities, was low., Background: Access to family planning services and appropriate contraceptive methods is crucial for ensuring good health outcomes for women and adolescent girls. The World Health Organization worked with the U.S. Agency for International Development to develop the Service Availability and Readiness Assessment (SARA) survey to measure health facility capacity to provide end users with appropriate, high-quality health care. In this study, we looked at the service availability and readiness of health facilities to provide contraception in 10 African countries: Benin, Burkina Faso, the Democratic Republic of the Congo, Djibouti, Mauritania, Niger, Sierra Leone, Tanzania, Togo, and Uganda. Methods: This study compared SARA survey data on family planning services from each of the 10 countries. We conducted a descriptive analysis of variations in facility readiness and the availability of services, contraceptive methods, trained staff, family planning guidelines, and basic health care equipment. Results: Overall, many of the countries surveyed had a relatively high availability of at least 1 contraceptive method. Rural facilities tended to have more availability of contraception than urban facilities, and government facilities tended to have higher availability of family planning than other providers. The countries differed in their particular dominant contraceptive method, and stock-outs of contraceptive methods were observed. Countries had overall low levels of all 6 tracer items (availability of family planning guidelines, staff trained in family planning, blood pressure apparatuses, combined oral contraceptive, injectable contraceptives, and male condoms on the day of the assessment), indicating low health system readiness. There were discrepancies between reported and observed availability of blood pressure apparatuses and family planning guides and having at least 1 staff member trained to use these tools. In all countries, unmarried adolescents appeared to have less access to family planning than the general population. Conclusion: Stock-outs and logistics management problems were common among the countries surveyed. Critical gaps between reported and actual availability of products and services often makes it difficult for end users to access appropriate family planning methods. To address many of the issues, additional health worker training is needed and more effort to target and support adolescents should be undertaken. To achieve universal health coverage targets for family planning, gaps in the availability and readiness of health systems to provide contraceptive products and services must be reduced.

Background Community health workers (CHWs) help reduce healthcare disparities and improve access to and quality of care in many countries. Aim To provide an overview to compare and contrast characteristics of CHW programmes in Egypt, Pakistan and Afghanistan and describe the strengths, weaknesses and challenges of the programmes. Methods Scientific databases and grey literature were searched including PubMed, Medline, Cochrane Review Library, WHO databases, and grey literature websites including those of national health ministries. We shortlisted 23 articles to be included in this study. Results The three programmes reviewed vary in their organization, structure, enrolment and payment structure for CHWs. Key challenges identified in the review include: commodity security that compromises quality of services; inadequate and irregular training; unpredictable or inadequate remuneration structure; and lack of standardization among organizations and government ministries. Strengths identified are that the programmes are accepted and integrated into many communities; and have the support of health ministries, which enhances sustainability and regulates standardized training and supervision. These also increase participation and empowerment of women, evident in the fact that CHWs have organized among themselves to demand better treatment and more respect for the work that they do. Conclusion Our findings should alert policy-makers to the need to review CHWs' scope of practice, update education curricula, and prioritize in-service training modules and improved working conditions. The effectiveness and impact of CHW programmes has been shown countless times, demonstrating that task sharing in healthcare is a successful strategy with which to approach global health goals.

Background Globally 214 million women of reproductive age in developing regions have unmet needs in modern contraceptives. Intrauterine contraception (IUC) is highly effective, has few medical contraindications, low discontinuation, and is a low cost modern contraceptive method. However, there is relatively low use of IUDs in LMICs. One reason for this may be policies that restrict IUD availability and use. This study assess national policies pertaining to IUD from a diverse set of countries. Methods Between December 2015 and February 2016, a 12-question survey pertaining to IUD policy was sent to WHO regional and country representatives. Results Sixty-nine surveys were used from countries through WHO regional offices. Among those surveyed, 87% (n = 60) had policies pertaining to IUD use. Among them, 84% (n = 58) reported that hormonal IUDs were available, but only 42% (n = 29) had them in the public sector. Free IUDs in the public sector were available in 75% (n = 52) of countries. For IUD promotion, 75% (n = 52) of countries reported cooperation with NGOs, and 48% (n = 33) received free devices from donors. Policy restrictions beyond the WHO guidelines existed in 15 countries and included restrictions to use for women who were nulliparous, adolescent, unmarried, or had multiple partners. Conclusions National policy is important in facilitating modern contraceptive uptake. While many countries who responded in the survey, have policies about IUD use in place, 16% still had none on IUD. Another gap identified was low availability of hormonal IUDs, especially in the public sector. Private sector remains untapped potential in expanding method choice by making IUDs available and accessible in developing countries. Most countries do have policy in place to facilitate IUD use, though there are still gaps in the accessibility of IUDs in many countries. Lastly there is a need to revisit restrictive policies that prevent IUD use for specific populations of women for whom IUDs can be beneficial in realizing their reproductive needs.

Backgrund Marginalized groups, such as nomadic populations across the world, have perhaps the least access to modern reproductive health (RH) services. This scoping review aims to identify barriers to access to RH services faced by nomadic populations from the existing literature and to highlight possible opportunities to address them. Methods Key databases, including PubMed, Popline, Google Scholar, and Google Advanced were searched for relevant articles published between 2002 and 2019. A total 344 articles were identified through database online searches, and 31 were included in the review. Results Nomadic people face complex barriers to healthcare access that can be broadly categorized as external (geographic isolation, socio-cultural dynamics, logistical and political factors) and internal (lifestyle, norms and practices, perceptions) factors. To effectively address the needs of nomadic populations, RH services must be available, accessible and acceptable through tailored and culturally sensitive approaches. A combination of fixed and mobile services has proven effective among mobile populations. Low awareness of modern RH services and their benefits is a major barrier to utilization. Partnership with communities through leveraging existing structures, networks and decision-making patterns can ensure that the programmes are effectively implemented. Conclusion Further research is needed to better understand and address the RH needs of nomadic populations. Though existing evidence is limited, opportunities do exist and should be explored. Raising awareness and sensitization training among health providers about the specific needs of nomads is important. Improved education and access to information about the benefits of modern RH care among nomadic communities is needed. Ensuring community participation through involvement of nomadic women and girls, community leaders, male partners, and trained traditional birth attendants are key facilitators in reaching nomads. However, participatory programmes also need to be recognized and supported by governments and existing health systems.

Community health workers (CHWs) help reduce healthcare disparities and improve access to and quality of care in many countries.To provide an overview to compare and contrast characteristics of CHW programmes in Egypt, Pakistan and Afghanistan and describe the strengths, weaknesses and challenges of the programmes.Scientific databases and grey literature were searched including PubMed, Medline, Cochrane Review Library, WHO databases, and grey literature websites including those of national health ministries. We shortlisted 23 articles to be included in this study.The three programmes reviewed vary in their organization, structure, enrolment and payment structure for CHWs. Key challenges identified in the review include: commodity security that compromises quality of services; inadequate and irregular training; unpredictable or inadequate remuneration structure; and lack of standardization among organizations and government ministries. Strengths identified are that the programmes are accepted and integrated into many communities; and have the support of health ministries, which enhances sustainability and regulates standardized training and supervision. These also increase participation and empowerment of women, evident in the fact that CHWs have organized among themselves to demand better treatment and more respect for the work that they do.Our findings should alert policy-makers to the need to review CHWs' scope of practice, update education curricula, and prioritize in-service training modules and improved working conditions. The effectiveness and impact of CHW programmes has been shown countless times, demonstrating that task sharing in healthcare is a successful strategy with which to approach global health goals.تقاسم المهام في القوى العاملة الصحية: لمحة عامة عن برامج العاملين الصحيين المجتمعيين في أفغانستان، باكستان، مصر.معظم علي، ريجل فولز.يساعد العاملون الصحيون المجتمعيون في تخفيف مواطن التفاوت في الرعاية الصحية وتحسين الحصول على الرعاية الجيدة في العديد من البلدان.الغرض من هذا البحث تقديم نظرة عامة لمقارنة ومقابلة خصائص برامج العاملين الصحيين المجتمعيين في أفغانستان وباكستان ومصر ووصف مواطن القوة ومكامن الضعف والتحديات في تلك البرامج.بحثنا في قواعد البيانات العلمية وفي المنشورات الرمادية، بما في ذلك PubMed و Medline ومكتبة مراجعة كوكرين، وفي قواعد البيانات لمنظمة الصحة العالمية، وفي مواقع المنشورات الرمادية بما فيها مواقع وزارات الصحة الوطنية على الإنترنت. وقد أعددنا قائمة قصيرة تتضمن 23 مقالً لإدراجها ضمن الدراسة.تختلف البرامج الثلاثة التي استعرضناها من حيث التنظيم والبنية الهيكلية، والانخراط في العمل، وبنية دفع الأجور للعاملين الصحيين المجتمعيين. وتتضمن التحديات الرئيسية التي تعرفنا عليها في هذه الدراسة: ضمان تقديم الخدمات دون التقليل من جودتها؛ والتدريب غير الكافي وغير المنتظم؛ والبنية الهيكلية غير المتوقعة أو غير الكافية للتعويضات والأجور؛ وغياب المعايير القياسية الموحَّدة لدى المنظمات والوزارات الحكومية. بينما تتضمن مواطن القوة التي تعرفنا عليها أن البرامج مقبولة ومندمجة في كثير من المجتمعات، وتتلقى الدعم من وزارات الصحة مما يعزِّز استدامة تلك البرامج، وأن تنظيم التدريب والإشراف يتم وفق أسس قياسية موحَّدة. وقد أدت تلك البرامج أيضًا إلى زيادة مشاركة المرأة وتمكينها، وقد تجلى ذلك في حقيقة أن العاملين الصحيين المجتمعيين قد نظموا مطالبهم بمعاملة أفضل وبمزيد من الاحترام للعمل الذي يقومون به.ينبغي أن تثير النتائج التي توصلنا إليها انتباه أصحاب القرار إلى ضرورة استعراض نطاق الممارسة للعاملين الصحيين المجتمعيين، وتحديث مناهج تعليمهم، وإعطاء الأولوية للوحدات التدريبية أثناء الخدمة، وتحسين ظروف العمل. أثبت الباحثون في العديد من البحوث مدى فعالية وتأثير برامج العاملين الصحيين المجتمعيين، مما يدل على أن تقاسم المهام في مجال الرعاية الصحية استراتيجية ناجحة تصلح لتحقيق الأهداف الصحية العالمية.Partage des tâches chez les personnels de santé : vue d’ensemble des programmes des agents de santé communautaires en Afghanistan, en Égypte et au Pakistan.Dans de nombreux pays, les agents de santé communautaire contribuent à réduire les disparités en matière de soins de santé et à améliorer l’accès à des services de qualité.Fournir une vue d’ensemble permettant de comparer et de mettre en lumière les similitudes et les différences entre les programmes destinés aux agents de santé communautaires en Afghanistan, en Égypte et au Pakistan, et décrire les atouts, les faiblesses et les difficultés de ces programmes.Des recherches ont été effectuées dans des bases de données scientifiques et dans la littérature grise, notamment PubMed, Medline et la Cochrane Review Library, dans les bases de données de l’OMS et sur des sites Web de littérature grise, notamment ceux de ministères de la santé nationaux. ; 23 articles ont été sélectionnés et inclus à la présente étude.Les trois programmes examinés diffèrent sur le plan de leur organisation, de leur structure, de leur inclusion et au niveau du système de paiement des agents de santé communautaires. Les difficultés essentielles relevées lors de notre analyse comprenaient les points suivants : la sécurité au niveau de l’approvisionnement des produits qui compromet la qualité des services ; le caractère inadéquat et irrégulier des formations ; un système de rémunération imprévisible ou inadéquat ; et un manque d’harmonisation parmi les organisations et les ministères gouvernementaux. Les atouts identifiés sont l’acceptation et la bonne intégration de ces programmes au sein de nombreuses communautés, ainsi que l’existence de soutiens de la part des ministères de la santé, ce qui renforce la pérennité et permet de réglementer les formations et le contrôle de façon harmonisée. Ces atouts ont également favorisé la participation et l’autonomisation des femmes, comme le montre l’organisation, parmi les agents de santé communautaires eux-mêmes, de requêtes visant à obtenir de meilleurs traitements et un plus grand respect pour le travail qu’ils accomplissent.Nos conclusions devraient alerter les responsables politiques quant au besoin de revoir le champ d’activité des agents de santé communautaires, de mettre à jour les programmes de formation et de donner la priorité aux modules de formation en cours d’emploi ainsi qu’à l’amélioration des conditions de travail. L’efficacité et l’impact des programmes destinés aux agents de santé communautaires ont été mis en évidence à d’innombrables reprises, ce qui démontre que le partage des tâches chez les personnels de santé représente une bonne stratégie pour aborder les objectifs de santé mondiaux.

Background The Zika virus epidemic in Latin America has elicited official recommendations for women to delay or avoid pregnancy in affected countries, which has increased demand for family planning services. It is likely, however, that health facilities in areas where the population is most vulnerable to the disease lack the capacity to respond to the increased demand for family planning services. Our objectives are to perform facilities assessment and understand client perceptions in areas affected by Zika virus, and to track changes in these parameters over time. Methods/design We will collaborate with local health authorities to map facilities that have the capacity to provide services in contraception and safe abortion, including induced abortion to the full extent of the law and post-abortion care for treatment of complications from unsafe abortion and post-abortion contraception. We then will carry out a survey of facilities to assess the availability of services and their readiness to provide contraception and safe abortion care. All facilities will be assessed for baseline readiness and availability of services, and a random subsample of surveyed facilities will be reassessed in second and third rounds of surveys. Focus group interviews with clients will be conducted as part of the facilities surveys in order to gain an understanding of the community’s knowledge, needs and perceived barriers to healthcare in the context of the Zika virus epidemic. Discussion The findings of this study will aid the response to Zika virus ranging from the identification of healthcare facilities that can be potentially strengthened, to the formulation of interventions to reduce barriers and improve readiness of facilities to provide contraception and safe abortion services. Lessons learned from this study will help to build and strengthen health systems that are more prepared to consistently providing reproductive healthcare services in the context of health emergencies.

Published online: 22 July 2011 This article compares the foreign policies of France and Germany in the 1990s towards the European Union (EU)'s special relationships with the countries of Africa, the Caribbean and the Pacific (ACP) on the one hand and the Central and Eastern European countries (CEEC) on the other. Whereas France advocated support for ACP interests, Germany supported those of the CEEC. We argue that French and German prioritisations cannot sufficiently be explained by rationalist, interest-based approaches (i.e. neorealism, economic liberalism and institutionalism) and offer a constructivist supplement to fill in the gaps. This approach is based on the concept of solidarity. First, we develop our theoretical concept and identify three principles of solidarity action (i.e. ties, need and effort). We then apply our concept of solidarity to show how French and German policies towards the Cotonou Agreement, concluded in 2000 with the ACP, and the EU's Eastern enlargement process were shaped by different social constructions of solidarity, resulting in strong preferential support for either the ACP (France) or the CEEC (Germany).

Background ZIKV(Zika Virus) during pregnancy can result in many adverse events such as fetal deaths or newborns with congenital abnormalities including microcephaly and other neural irregularities. Due to these harmful outcomes of pregnancy associated with the Zika virus, we can expect to see a change in the type and scale of demand for family planning and safe abortion services in areas affected by the Zika virus. The monitoring and reporting capacities of the local health clinics in these areas could benefit from the introduction of infrastructural improvements necessary to establish a sentinel site network. Through these sites, the WHO will collect data on the situation from local health professionals to get real time information from the population group and act accordingly to mitigate the consequences of the Zika virus outbreak in a localized and culturally appropriate way. The objectives are to establish a sentinel sites surveillance network for reporting on uptake and utilization of contraception and safe abortion care services; to strengthen monitoring, and data quality assurance in the selected sentinel surveillance sites; and finally to assess the contraception and safe abortion care service utilization trends in the affected sites on a regular basis. Methods The proposal includes a set of objectives and actions that enable the creation of a set of criteria for the selection of the sentinel sites, as well the implementation of monitoring and reporting systems that will be used in data collection. Discussion The data collected will be used to better understand the changing demand for family planning and safe abortion needs. This will ultimately be used to inform local health workers and policy makers as to how best to track the continued Zika virus outbreak and mitigate the consequences. The learning from establishment of surveillance sentinel sites will help to strengthen health systems at regional and subregional levels that are more adaptable and capable of providing reproductive healthcare services and of responding to future emergencies.