WHO - WORLD HEALTH ORGANIZATION STATEMENTS TO CICIAMS
WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends. WHO has recognized the importance of water and sanitation from its inception.
THIS PAGE IS FOR WHO - WORLD HEALTH ORGANIZATION INFORMATION , NEWS RELEASES AND STATEMENTS TO CICIAMS .
THE REPORTS BY WHO :THE WORLD HEALTH ORGANIZATION MAY NOT NECESSARILY REFLECT THE VIEWS OF CICIAMS.
WHO BULLETIN ARTICLES ARE ALSO INCLUDED ON THIS PAGE WHICH REFLECT VIEWS OF WRITERS /CONTRIBUTERS TO THE BULLETIN WHICH MAY NOT NOT NECESSARILY REFLECT THE VIEWS OF WHO . BULLETIN ARTICLES ARE HEADED AS SUCH IN BLUE IN THE TOP RIGHT CORNER OF THE ENCLOSURE BOX. OTHER ARTICLES ON THIS PAGE ARE OFFICIAL WHO PRESS RELEASES OR STATEMENTS.
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WORLD HEALTH ORGANIZATION PATIENT SAFETY PROGRAMME THE GLOBAL BURDEN OF UNSAFE MEDICAL CARE
A new study published on 18 September 2013 provides early evidence that adverse events due to medical care represent a major source of morbidity and mortality globally and reinforces the important role quality and safety of care plays in global health. The study, "The Global Burden of Unsafe Medical Care: An Observational Study", published today at the BMJ Quality & Safety, describes the main results of a first-ever study commissioned by the World Health Organization (WHO) and led by Dr Ashish Jha and David Bates, patient safety scientists of the Harvard School of Public Health and the Brigham & Women’s Hospital respectively.
Adapting the methodology developed for the Burden of Disease study series, the researchers estimated disability-adjusted life years (DALYs) lost to measure morbidity and mortality due to specific adverse events. Available data were found for the following set of adverse events: (i) adverse drug events, (ii) catheter-related urinary tract infections, (iii) catheter-related blood stream infections, (iv) nosocomial pneumonia, (v) venous thrombo-embolisms, (vi) falls and (vii) decubitus (pressure) ulcers. The study estimates that there are 421 million hospitalizations in the world annually and approximately 42.7 million adverse events for the seven types described, resulting in 23 million DALYs lost per year. Approximately two-thirds of all adverse events, and the DALYs lost from them, occurred in low and middle income countries. It is clear that this is an early attempt to quantify the burden of unsafe care and more analysis is needed to understand sources of imprecision in these estimates. That said, these data show that the problem of unsafe health care is significantly greater than previously thought globally and that global health policymakers should consider how to make safe patient care an international priority.
“WHO undertook the challenge of estimating the global burden of unsafe care as an essential step to guide global actions in strengthening health systems,” Says Sir Liam Donaldson, WHO Envoy for Patient Safety. “These data are a powerful signal to strengthen the performance of healthcare and to remind policy makers and professionals alike that, to achieve improvements in global health, effective investments to measure and improve the safety of the healthcare are most needed”.
The number of DALYs lost were more than twice as high in low- and middle- income countries (15.5 million) as they were in high income countries (7.2 million). Compared to other conditions, the combination of these seven types of unsafe care alone ranks as the 20th leading cause of morbidity and mortality for the world’s population. It is unlikely that these are “new” previously undiscovered DALYs, but rather that they are captured within the injuries and deaths attributed to other conditions such as cardiovascular disease.
“This study highlights that the standards for safety and quality that patients experience within the healthcare systems across the world, and especially in low-income countries, have a direct impact on their health status and wellbeing,” says Dr Marie-Paule Kieny, WHO Assistant Director General for Health Systems Strengthening and Innovation. “It is therefore essential to set effective mechanisms to reinforce and strengthen the conditions for healthcare delivery to lead to improvements in the safety and quality of care, and therefore to achieve effective universal health coverage”.
Unsafe medical care may even lead patients to opt out of using the formal healthcare system, raising questions of appropriateness and quality of care in the informal sector. In this sense, unsafe care becomes a potentially significant barrier to access for many of the world’s poor.
This study faced significant barriers due to limitations in availability and quality of data sources, hampering the ability to effectively calculate the number of DALYs lost due to unsafe care, particularly within low and middle income countries. While further refinements of the estimates are needed, the data provided in this manuscript represent a significant contribution to the understanding of the burden of unsafe care. They also signal a new direction of scientific enquiry where further methodological developments are necessary to nurture the necessary understanding of this important field.
“This landmark study is also an appeal to the donor and scientific communities to further invest and investigate in this important area of work and to creatively develop methodologies to fill the current gaps in data availability and data quality,” says Dr Edward Kelley, Coordinator of the WHO Patient Safety Programme. “Furthermore, it also calls for policy action to strengthen information systems, of which the medical record and related data sources are essential for the needed understanding about the tall of unsafe care”. The estimates provided are conservative, hindering not only the ability to calculate their consequences, but also limiting the ability of clinical leaders and policymakers to track the potential impact of policies designed to increase the safety of healthcare as well as universal health coverage.
Given the magnitude of the effects shown in this manuscript, it is fair to suggest that to improve the health of the world’s citizens, actions are needed to not only improve access to care but also to invest substantial focus on improving the safety of the healthcare systems that people access worldwide. When patients are sick, they should not be further harmed by unsafe care.
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WHO CONFERENCE REPORT JANUARY 18-23RD 2010 WRITTEN BY ISA WILSON CICIAMS DELEGATE
The address of the Direct-General-Dr Margaret Chan was mainly on the subject of the Haitian earthquake which had happened a few days earlier. She spoke of the massive loss of lives, the horrendous injuries experienced by many survivors and the total destrution of so many homes and buildings including the Medical and Nursing faculties within the University and the response of WHO to this disaster. She also spoke of the need of all member countries to respond to the call for help for this the poorest country in the Western hemisphere. Dr Chan went on to congratulate all those countries who cooperated with information and vaccine sharing during the pandemic outbreak of Swine Flu and the need to continue this preparedness in sharing resources in the event of further pandemic outbreaks. Many other world health issues were also highlighted in Dr Chan's address.I was fortunate to be meeting with Dr Jean Yan , Chief Nurse Scientist about CICIAMS collaboration plans, and I was invited to take part in a brainstorming session to initiate the immediate, medium and longterm nursing needs in Haiti. This included a two way link with the WHO Chief Nurse of the Caribbean Islands who was coordinating the nursing teams in Haiti. She gave an update on the situation and the immediate help needed. She informed us that although the Nursing Faculty in the University had been destroyed, the Nursing College was operational but with little in the way of equipment such as dressings and bandages. She told us that while the staff had set up a receiving centre for the wounded many of the students were out begging for dressings and bandages in the surrounding areas.It was an uplifting and emotional experience to be part of this session and to hear from all the Heads of the Nursing and Midwifery departments at WHO what would be attempted in the immediate, medium and long term to meet the health needs of the people of Haiti. It gave me an insight into the tremendous work of WHO.I was delighted to be informed that our plans for collaboration with WHO for 2010-2012 had been approved so our status as NGO in WHO is assured until 2012 when our next submission will be due. I hope this will encourage all members to inform CICIAMS of all the good work they are involved in so that our status in this organisation will continue for many years.
HIV :TOWARDS UNIVERSAL ACCESS BY 2010
Since 1981 when HIV/AIDS was first described, an estimated 60 million people have been infected with HIV, of whom some 20 million have died. UNAIDS reports that, globally, less than one person in five at risk of HIV has access to basic HIV prevention services. Only 24% of people who needed HIV treatment had access to it by mid-2006. Following the commitment by G8 members and, subsequently, heads of states and governments at the 2005 UN World Summit, the UNAIDS Secretariat along with their partners, have been engaging in consultations to define the concept and a framework for universal access to HIV/AIDS prevention, treatment and care by 2010.
click here for more http://www.who.int/hiv/universalaccess2010/en/index.html
WHO STATEMENTS AND REPORTS
WHO 02 2009
THE HEALTH WORKER SHORTAGE IN AFRICA : ARE ENOUGH PHYSICIANS AND NURSES BEING TRAINED?
Yohannes Kinfu a, Mario R Dal Poz b, Hugo Mercer b & David B Evans
a. School of Population Health, University of Queensland, Brisbane, Qld., Australia.
b. Department of Human Resources for Health, World Health Organization, Geneva, Switzerland.
c. Department of Health Financing, World Health Organization, Geneva, Switzerland.
Correspondence to Yohannes Kinfu (e-mail: email@example.com).
(Submitted: 28 January 2008 – Revised version received: 11 June 2008 – Accepted: 14 July 2008 – Published online: 10 February
Bulletin of the World Health Organization 2009;87:225-230. doi: 10.2471/BLT.08.051599
Recently, considerable attention has been focused on the apparent shortage of health workers in countries with the poorest health
indicators, and the potential impact of the shortage on countries’ ability to fight diseases and provide essential, life-saving interventions.1–3 According to recent WHO estimates, the current workforce in some of the most affected countries in sub-Saharan
Africa would need to be scaled up by as much as 140% to attain international health development targets such as those in the Millennium Declaration.4 The problem is so serious that in many instances there is simply not enough human capacity even to
absorb, deploy and efficiently use the substantial additional funds that are considered necessary to improve health in these countries.
Health worker shortage in sub-Saharan Africa derives from many causes, including past investment shortfalls in pre-service training, international migration, career changes among health workers, premature retirement, morbidity and premature
mortality.5,6 Yet the dynamics of entry into and exit from the health workforce in many of these countries remain poorly understood. This limits the capacity of national governments and their international development partners to design and implement
appropriate intervention programmes. In this paper, we fill some of this information gap by providing the first systematic estimates of health worker inflow and outflow in selected sub-Saharan African countries. For reasons of data availability, our analysis is restricted to two groups of health workers – nurses and midwives combined, and
physicians – and to 12 countries for which the relevant data were available.
The analysis required information on the stock of health workers in each country, as well as annual inflows and outflows. Inflows are associated with the number of new workers hired each year, either graduates of training institutions, migrants or people reentering
the workforce. Outflows are caused by premature deaths among health workers, dismissals, resignations (e.g. to migrate or change career) and retirement. Much of this information is not available in many countries, so this study focuses on 12 African
countries where information was available on the size, age and sex distribution of the health workforce as well as on graduations from training institutions: Central African Republic, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Kenya, Liberia,
Madagascar, Rwanda, Sierra Leone, Uganda, the United Republic of Tanzania and Zambia. Baseline health worker numbers by age and sex were obtained from a WHO survey of health workers conducted in African countries in 20057. This survey is also the source of the data on health worker training institutions, including the number of trainees by type of worker and year of graduation. We use the number of graduates as the maximum possible level of new domestic graduates hired each year. No data on in-migration of health workers or on the number rejoining the workforce annually were
available for any of the countries, though we expect in-migration to be limited to those countries whose health workers are recruited by richer countries. Information on the outflow of health workers is also difficult to obtain. There are patchy data available on the mobility and mortality of health workers as distinct from the rest of the population, but they are limited in scope and rigour.8,9 Thus, we WHO | The health worker shortage in Africa: are enough physicians and nurses being trained? Page 1 of 4 http://www.who.int/bulletin/volumes/87/3/08-051599/en/print.html 2009-03-11
preferred to use age- and sex-specific mortality rates for the population as a whole, as they are usually of good quality,10 and to assume these rates also applied to health workers. These data were also used to estimate the numbers of health workers retiring
each year. In the absence of country-specific information on retirement ages in the public and private sectors, we applied an age of60 years to all settings on the assumption that all health workers who survive to that age then retire.
Data on out-migration, resignation before retirement age and dismissals were also not available for most of the countries under study. Migration data, for example, are not collected routinely by occupation in either “supplier” or recipient countries and, even
when pieces of the puzzle are available, they tend to be either incomplete or of indeterminate time scale.11–13 As a result, for the present analysis we adopted rates obtained from two separate case studies in Mozambique and Zambia that provide time-specific data on spatial and career mobility.14–16 Both studies focused on public sector health workers. In Mozambique, 2.3% of the workforce left service each year due to resignation (including for migration) or dismissal, while in Zambia only 1.5% left. Because we cannot say if these rates are typical of other countries, we report two sets of figures based on the two rates.
Finally, taking into account available information on inflows and outflows, we compared the estimated net growth rates of the health workforce to population growth rates estimated for the respective countries by the United Nations Population Division.17
This allowed us to assess two important outcomes given current trends. The first was whether the net growth rate of the health workforce is faster than that of the population, allowing health worker density to increase over time. The second was the extent to
which the workforce would need to grow in each country to attain the minimum density of 2.28 health workers per 1000 population. This was the yardstick developed and reported as being necessary to achieve desired levels of coverage of key health
interventions in the World Health Organization’s The world health report 2006.1
Table 1 presents the estimates of the density of physicians per 1000 population and the annual inflows and outflows per 1000 physicians currently employed. Rates of inflow (also known as workforce regeneration rates) were obtained by dividing the annual number of medical graduates by the total stock of physicians in each country. This is a useful way to understand the proportion of the current workforce that is being regenerated each year. The rate of outflow includes all causes. As explained, premature
mortality and retirement rates are country-specific. Scenario I then adds the rate obtained from the Zambian study to calculate resignations and dismissals, while scenario II uses the higher rates observed in Mozambique. Table 2 reports the same estimates for
nurses and midwives.
Table 1. Density of physicians and estimated annual physician inflows and outflows for 12 African countries a [html 5kb]
Table 2. Density of nurses and midwives and estimated annual nurse/midwife inflows and outflows for 12 African countriesa [html
The results for all 12 countries combined show that, for every 1000 physicians practicing in these countries, 59 medical graduates are produced each year. The rate is slightly higher for nursing and midwifery, at 66 new graduates per 1000 practicing nurses and
midwives. The regional average, however, masks the diverse patterns in the study countries. For instance, in 9 of the 12 (the exceptions are the Democratic Republic of the Congo, Ethiopia and Sierra Leone) the rate at which new graduates enter the system is actually higher for physicians than for nurses and midwives. Moreover, countries that have a relatively high graduation rate for one type of health worker do not necessarily have a relatively high rate for the other. For example, Côte d’Ivoire has the highest graduation rate for physicians (14%) but ranks only 7th in the regeneration rate for nurses and midwives (2.7%).
Generally, in all countries outflows are slightly lower for nurses and midwives than for physicians because age-specific death rates are typically lower for women than men and the proportion of females is higher among nurses and midwives than among physicians. For the 12 countries as a whole, each year the health sector is expected to lose some 2.4% of its physicians and 2.1% of its nurses and midwives to premature mortality, and about 4–6% of both due to all causes combined. Although the 12 countries as a whole are training sufficient physicians to replace outflows when inflows and outflows are
considered together, this is not the case in at least one of the outflow scenarios for 6 countries. The situation is even worse when it comes to nurses and midwives, with only 3 countries (Ethiopia, Liberia and Sierra Leone) unequivocally training sufficient workers to replace those leaving the workforce. However, even in the countries where training is above replacement rates, it is not clear that they will soon be in a position to meet
current unmet needs or the increasing demands of an expanding population. Table 3 shows current density per 1000 population for physicians, nurses and midwives combined, with the net rates of increase (or decrease) under the two scenarios and the rate of population growth. Only 6 countries (Côte d’Ivoire, Ethiopia, Liberia, Madagascar, Sierra Leone and the United Republic of Tanzania) show net rates of increases under both scenarios. In the others, the absolute numbers of physicians, nurses and midwives
seem to be declining. This decline is even more serious when considered alongside the relatively high rates of population growth in most of these countries.
Table 3. Current density of physicians, nurses and midwives and required rate of workforce growth according to population growth rates in 12 African countries
Even among countries with positive net growth rates, only two (Côte d’Ivoire and Ethiopia) stand a chance of meeting some of the current unmet demands in the future by virtue of unequivocally having a faster-growing number of health workers than inhabitants. Nonetheless, the rate of health worker increase is much slower than that required to increase the density to the WHO target of 2.28 health workers per 1000 population in a relatively short time. The column on the right shows the rate of health workforce growth required for each country for the target to be achieved by 2015, the year set for the achievement of the United Nations’ Millennium Development Goals. Not even these 2 countries are expanding health worker supply fast enough to achieve this aim.
Previous work on health workers in sub-Saharan Africa has focused on the numbers available and on the numbers leaving the workforce at a particular point in time.2,5,6 The results have clearly shown that the current number of health workers is insufficient
to meet population health needs at that point in time. This study, which was the first to examine whether current pre-service training can improve the situation, took into account population increases and attrition due to premature death among health
workers, retirement, resignation and dismissal. Although each of these components requires separate and careful analysis, the larger picture of workforce dynamics emerges only when they are considered together.
Training capacity insufficient
Our analyses suggest that workforce shortages in the countries under study are even more alarming than suggested by the existing literature. Not only are current numbers insufficient to meet health needs but, in at least 6 of the 12 countries, pre-service training is insufficient to maintain absolute numbers even at their current levels. Current rates of training are sufficient to increase health worker densities in the other 6 countries but, in 4 of them, not enough to keep pace with population growth. This will lead to a drop in health worker availability per person in those countries. Even the 2 countries where current rates of training will increase health worker density will not be able to meet the target level of 2.28 physicians, nurses and midwives per 1000 population until well after 2015.
Boosting pre-service training is clearly important but is a longer-term solution because putting in place the infrastructure (human as well as physical) that is needed in these countries will take a long time. Hence, a variety of complementary, shorter-term responses must be considered. For instance, shifting some tasks from people requiring longer-term training to those requiring less intensive training will enable more services to be made available in a shorter time.18,19 Aggressive retention policies, such as improving the remuneration and working conditions of health workers, addressing unemployment, using telemedicine, and encouraging short term in-migration from surplus to deficit countries, may also be possible, perhaps with donor support.20–22 Preventing AIDS will reduce premature mortality among health workers in the longer-term, while providing antiretroviral treatment for health workers who need it will enable them to work longer. The issue of workers resigning to migrate or to change careers is also vitally important, and several international efforts are under way to address this complex issue.23 While these shorter-term options should be considered, it is important not to ignore the more expensive, longer term issue of preservice training. Only by addressing all of these facets together can solutions be found to the current health worker crisis in Africa.While considering the policy implications, it is also necessary to be aware of the limitations of the study, the most important of which is the difficulty in obtaining accurate figures for the numbers of health workers in a country. Ours come from a questionnaire sent to WHO country offices. The questionnaires were completed with the help of any official records that were available, including professional registers of members, though these might not be totally accurate or up to date. In addition, estimates of the annual number of graduates from training institutions were sometimes obtained by contacting each of the known institutions. The figures on outflows associated with reasons other than death were taken from two in-depth country studies. Data limitations also prevented us from focusing on other workers besides physicians, nurses and midwives. We acknowledge, therefore, that the estimates presented in the study might not be exact and highlight the need for more investment in collecting the basic data necessary for informed decision-making. The fact that outflow estimates for dismissal and resignation were derived from two case studies that may not be representative in themselves also calls for caution. However, to address these data problems, we have tried to make the most conservative assumptions possible. For example, we assumed that all graduates from training institutions would immediately enter the workforce. There will be some immediate loss of potential health workers at
this stage, so our estimates probably overestimate the ability of current training institutions to replenish supply. It is also important to acknowledge that with current attention being focused on health worker shortages, some of the countries under study may already have scaled up training and taken other steps to alleviate them, and this would not be captured by our figures. It is, therefore, necessary for countries to take appropriate action to promote the collection and analysis of data on entry and exit from
the health workforce. ■
Yohanes Kinfu worked at WHO at the time this research was conducted.
Competing interests: None declared.
1. The world health report 2006: working together for health. Geneva: World Health Organization; 2006.
2. Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, et al., et al. Human resources for health: overcoming the
crisis. Lancet 2004; 364: 1984-90 doi: 10.1016/S0140-6736(04)17482-5 pmid: 15567015.
3. Narasimhan V, Brown H, Pablos-Mendez A, Adams O, Dussault G, Elzinga G, et al., et al. Responding to the global human
resources crisis. Lancet 2004; 363: 1469-72 doi: 10.1016/S0140-6736(04)16108-4 pmid: 15121412.
4. United Nations Millennium Development Goals [Home page]. Available from: http://www.un.org/millenniumgoals/
[accessed on 23 January 2009].
5. Zurn P, Dolea C, Stilwell B. Nurse retention and recruitment: developing a motivated workforce [Issue paper 4]. Geneva:
International Council of Nurses; 2005. Available from: http://www.icn.ch/global/Issue4Retention.pdf [accessed on 23
6. Mullan F. The metrics of the physician brain drain. N Engl J Med 2005; 353: 1810-8 doi: 10.1056/NEJMsa050004 pmid:
7. Dal Poz MR, Kinfu Y, Dräger S, Kunjumen T. Counting health workers: definitions, data, methods and global results.
[Background paper for World health report 2006: working together for health]. Geneva: World Health Organization; 2006.
Available from: http://www.who.int/hrh/documents/en/ [accessed on 23 January 2009].
8. Buve A, Foaster SD, Mbwill C, Mungo E, Tollenare N, Zeko M. Mortality among female nurses in the face of the AIDS
epidemic: a pilot study in Zambia. AIDS 1994; 8: 396- doi: 10.1097/00002030-199403000-00023 pmid: 8031526.
9. Cohen D. Human capital and the HIV epidemic in sub-Saharan Africa. Geneva: International Labour Organization; 2002.
10. Life tables for WHO Member States. Geneva: World Health Organization. Available from:
http://www.who.int/whosis/database/life_tables/life_tables.cfm [accessed on 23 January 2009].
11. Connell J, Zurn P, Stilwell B, Awases M, Braichet J-M. Sub-Saharan Africa: beyond the health worker migration crisis? Soc
Sci Med 2007; 64: 1876-91 doi: 10.1016/j.socscimed.2006.12.013 pmid: 17316943.
12. Clemens MA, Pettersson G. A new database of health professional emigration from Africa. Washington, DC: Center for
Global Development; 2006.
13. Ngulube TJ. Impact of HIV/AIDS on human resources for health in Zambia. Lusaka and Brazzaville: Government of
Zambia and World Health Organization Regional Office for Africa; 2005.
14. Ferrinho P, Omar C. The human resources for health situation in Mozambique. Washington, DC: The World Bank; 2006
[Africa region human development working papers series, no. 91].
15. Human resources for health: a synopsis of the current staffing crisis and outline proposals for action. Lusaka: Ministry of
Health (Zambia); 2004.
16. Huddart J, Furth R, Lyons JV. The Zambia HIV/AIDS workforce study: preparing for scale-up. Bethesda, MD: University
Research Co., LLC; 2004.
17. World population prospects: the 2006 revision. New York, NY: United Nations Department of Economic and Social
Affairs; 2006. Available from: http://www.un.org/esa/population/unpop.htm [accessed on 23 January 2009].
18. Allen SM, Ciambrone D. Community care for people with disability: Blurring boundaries between formal and informal
caregivers. Qual Health Res 2003; 13: 207-26 doi: 10.1177/1049732302239599 pmid: 12643029.
19. Gilks CF, Crowley S, Ekpini R, Gove S, Perriens J, Souteyrand Y, et al., et al. The WHO public-health approach to
antiretroviral treatment against HIV in resource-limited settings. Lancet 2006; 368: 505-10 doi: 10.1016/S0140-6736(06)
69158-7 pmid: 16890837.
20. TeleHealth20. national program in support of primary health care, Brazil. 2007. Available from:
http://www.telessaudebrasil.org.br [accessed on 23 January 2009].
21. Vassallo DJ, Swinfen P, Swinfen R, Wootton R. Experience with a low-cost telemedicine system in three developing
countries. J Telemed Telecare 2001; 7: 56-8 doi: 10.1258/1357633011936732 pmid: 11576493.
22. Scheffler RM, Liu J, Kinfu Y, Dal Poz M. Forecasting the global shortage of physicians: an economic- and needs-based
approach. Bull World Health Organ 2008; 86: 516-23 doi: 10.2471/BLT.07.046474 pmid: 18670663.
23. Clark PF, Stewart JB, Clark DA. The globalization of the labour market for health-care professionals. Int Labour Rev 2006;
145: 37-46 doi: 10.1111/j.1564-913X.2006.tb00009.x.
© WHO 2009
WHO 04 08 2008
TARGETED ACTION ON HIV AND TUBERCULOSIS NEEDED TO REACH DRUG USERS
4 August 2008 -- Mexico City -- Health and criminal justice authorities need to provide targeted services to drug users, especially those who inject drugs, to prevent and treat tuberculosis (TB) and HIV. TB is a major cause of death for people living with HIV, but drug users who are HIV positive face stigma, discrimination and barriers to accessing life-saving treatments.
New guidelines issued today aim to reduce these preventable deaths by, for example, improving access to antiretroviral drugs and to isoniazid for drug users living with HIV. Isoniazid preventive therapy (IPT) significantly reduces the risk of TB disease in people living with HIV, but is not widely used.
These are the first recommendations to actively include TB and HIV care within the context of support to drug users. They form part of the Evidence for Action series and build on policy guidance on both TB/HIV and injecting drug use.
Even where IPT is available, health care and outreach workers face major challenges in delivering full care to drug users who are often marginalised by homelessness, poverty, imprisonment, and by public and political hostility. These factors contribute to the transmission of both HIV and TB, and at the same time are barriers to TB, HIV and drug dependence treatment.
To ensure all drug users, including those in prison, can benefit from TB and HIV prevention, treatment support and care, WHO, UNAIDS and the UN Office on Drugs and Crime have developed Policy Guidelines for Collaborative TB and HIV services for Injecting and Other Drug Users - An Integrated Approach. The measures* aim to break down the barriers that stand in the way of better health, outline key interventions, and promote ways to improve coordination and planning across all those who interact with injecting and other drug users.
HIV weakens a person's immune system. Because of this, people living with HIV are up to 50 times more likely to develop TB in their lifetimes than people who are HIV negative. Without proper treatment, the majority of people living with HIV die within two to three months of becoming sick with TB. In 2006, 231,000 people died with HIV and TB. Many of these deaths were preventable.
Unsafe injecting drug use is now a major route of transmission for HIV. Excluding Africa, nearly one in three of all new HIV infections are attributable to unsafe injecting drug use. In areas of eastern Europe and central Asia, that figure rises to two out three new infections. In some areas of eastern Europe a significant association between HIV and multidrug-resistant TB has been observed by researchers.
Addressing TB/HIV is a key theme of the 2008 International AIDS Society conference and comes two months after world leaders issued a call to drastically cut the number of TB/HIV deaths by 2015 at the landmark Global Leaders' Forum on the co-epidemic, held at the UN headquarters in New York.
*Summary of the 13 recommendations in the Policy Guidelines for Collaborative TB and HIV services for Injecting and Other Drug Users:
1. Multisectoral coordination on TB and HIV activities for drug users
2. National plans with roles and responsibilities of service providers
3. Staff training to build effective teams
4. Operational research on TB/HIV services for drug users
5. TB infection control in congregate settings including prisons
6. Case-finding protocol for TB and HIV for services dealing with drug users
7. Access to appropriate treatments for drug users
8. Isoniazid preventive therapy for drug users living with HIV
9. Health workers to assess and provide HIV prevention methods
10. Universal access to TB and HIV prevention, treatment and care as well as drug treatment services to drug users
11. Quality medical services available to prisoners
12. Treatment adherence support measures for drug users
13. Other infections (e.g. hepatitis) and factors should not prevent drug users accessing HIV and TB treatments
For more information, please contact:
Mexico City: Saira Stewart, WHO HIV/AIDS Department, tel +4179 467 2013 firstname.lastname@example.org
Geneva: Glenn Thomas, WHO Stop TB Department, tel +4179 509 0677 email@example.com
WHO 31 07 2008
UNITAID, UNICEF AND WHO ANNOUNCE MASSIVE SCALE-UP IN FIGHT AGAINST HIV IN MOTHERS AND CHILDREN
GENEVA/MEXICO CITY/NEW YORK, 31 July 2008 — As the world's leaders and AIDS community gather in Mexico for the biennial global conference on HIV and AIDS, UNITAID, UNICEF and the World Health Organization (WHO) today announced an infusion of $50 million aimed at halting mother-to-child transmission of HIV.
Over the next two years, UNITAID funding will be used to test some 10 million pregnant women for HIV and treat 285 000 mothers and children in nine target countries: Central African Republic, China, Haiti, Lesotho, Myanmar, Nigeria, Swaziland, Uganda, and Zimbabwe. These countries represent approximately 25% of the world's HIV-infected pregnant women giving birth annually.
"This effort aims to go beyond mere prevention by promoting ongoing treatment for mothers and their babies," said Dr Philippe Douste-Blazy, Chair of UNITAID's Executive Board. "Our aim is to fund the most effective and appropriate medicines and diagnostics on the market for both women and children."
A novel element of the project is that it will allow UNICEF to negotiate reduced drug prices, allowing for a greater scale-up of more effective treatment for HIV-infected women as well as aim to prevent infection in their children. This ramping up means the WHO-recommended treatment protocol – introduced in 2006 and a far superior solution to the single therapy Nevirapine – can be implemented much more quickly and intensively.
Funding will also provide a one-year course of antiretroviral treatment to HIV positive pregnant women in need, in the nine countries.
“Testing pregnant women for HIV gives mothers a better chance to survive this disease,” said Ann M. Veneman, UNICEF Executive Director. ”Women, their children and their entire communities benefit when life-saving treatment is provided to HIV positive mothers as quickly as possible.”
WHO will ensure that expansion of programmes, use of antiretroviral medicines and procurement of commodities are done according to published guidelines and recommendations through close collaboration with Ministries of Health. WHO will also provide support in monitoring and evaluating prevention-of-mother-to-child transmission programmes to meet national targets.
"Women are one of the main target groups for WHO action," said Dr Margaret Chan, WHO Director-General. "Women play an important role in the functioning of communities, in caring for and educating children and make invaluable contributions to societies' development."
The three agencies are already funding and providing commodities to prevent mother to child HIV transmission in eight African countries, representing approximately 342 000 women.
UNITAID is an international financing facility committed to the scale-up of treatment and care for HIV/AIDS, malaria and tuberculosis. It was founded in 2006 by Brazil, Chile, France, Norway and the United Kingdom. Currently, UNITAID is supported by 27 countries - 19 of which are developing or transition countries - and the Gates Foundation. In less than two years of operation, UNITAID has disbursed US$ 280 million and committed US$ 200 more for the purchase of health commodities for the poorest countries.
UNICEF is on the ground in over 150 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from
violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments.
WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.
For further information, please contact:
UNITAID — Daniela Bagozzi, telephone +41 79 475 54 90, email: firstname.lastname@example.org
UNICEF — Kate Donovan, telephone + 52 155 16 12 58 62, email: email@example.com
WHO — Saira Stewart, telephone +41 79 467 21 03, email: firstname.lastname@example.org
All WHO information, fact sheet and news releases are available at www.who.int.
WHO 30 06 2008
RAPID TESTS FOR DRUG RESISTANT TB TO BE AVAILABLE IN DEVELOPING COUNTRIES
Geneva -- People in low-resource countries who are ill with multidrug-resistant TB (MDR-TB) will get a faster diagnosis -- in two days, not the standard two to three months -- and appropriate treatment thanks to two new initiatives unveiled today by the World Health Organization (WHO), the Stop TB Partnership, UNITAID and the Foundation for Innovative New Diagnostics (FIND).
MDR-TB is a form of TB that responds poorly to standard treatment because of resistance to the first-line drugs isoniazid and rifampicin. At present it is estimated that only 2% of MDR-TB cases worldwide are being diagnosed and treated appropriately, mainly because of inadequate laboratory services. The initiatives announced today should increase that proportion at least seven-fold over the next four years, to 15% or more.
"I am delighted that this initiative will improve both the technology needed to diagnose TB quickly, and increase the availability of drugs to treat highly resistant TB," said British Prime Minister Gordon Brown, who helped launch the Stop TB Partnership's Global Plan to Stop TB in 2006 and whose government is a founding member of UNITAID. "The UK is committed to stopping TB around the world, from our funding of TB prevention programmes in poor countries, to our support of cutting edge research to develop new drugs."
In developing countries most TB patients are tested for MDR-TB only after they fail to respond to a standard treatments. Even then, it takes two months or more to confirm the diagnosis. Patients have to wait for the test results before they can receive life-saving second-line drugs. During this period, they can spread the multidrug-resistant disease to others. Often the patients die before results are known, especially if they are HIV-infected in addition to having MDR-TB.
The initiative comes just one week after WHO recommended "line probe assays" for rapid MDR-TB diagnosis worldwide. This policy change was driven by data from recent studies, including a large field trial--conducted by FIND together with South Africa's Medical Research Council and National Health Laboratory Services--which produced evidence for the reliability and feasibility of using line probe assays under routine conditions.
"Five months ago, WHO renewed its call to make MDR-TB an urgent public health priority," said WHO Director-General Dr Margaret Chan, "and today we have evidence to guide our response. Based on that evidence, we are launching these promising initiatives."
The new initiative consists of two projects. The first, made possible through $26.1 million in funding from UNITAID*, will introduce a molecular method to diagnose MDR-TB that until now was used exclusively in research settings. These rapid, new molecular tests, known as line probe assays, produce an answer in less than two days.
Over the next four years -- as lab staff are trained, lab facilities enhanced and new equipment delivered -- 16 countries** will begin using rapid methods to diagnose MDR-TB, including the molecular tests. The countries will receive the tests through the Stop TB Partnership's Global Drug Facility, which provides countries with both drugs and diagnostic supplies.
As part of the project, WHO's Global Laboratory Initiative and FIND will help countries prepare for installation and use of the new rapid diagnostic tests, ensuring necessary technical standards for biosafety and the capacity to accurately perform DNA-based tests. One country, Lesotho, is already equipped to start using these tests; Ethiopia is expected to be ready by the end of 2008. The tests will be phased in from 2009-2011 in the remaining 14 countries.
Under a second, complementary agreement with UNITAID for US$ 33.7 million, the Global Drug Facility will boost the supply of drugs needed to treat MDR-TB in 54 countries, including those receiving the new diagnostic tests. This project is also expected to achieve price reductions of up to 20% for second-line anti-TB drugs by 2010. All the countries receiving this assistance have met WHO's technical standards for managing MDR-TB and already have treatment programmes in place. Some will use grants from the Global Fund against AIDS, Tuberculosis and Malaria to purchase the drugs.
"Through the US$ 60 million support provided by UNITAID, these projects are expected to produce significant results in diagnosing and treating patients as well as reducing drug prices and the costs of diagnosis. These efforts illustrate the way in which innovative financing can be deployed for health and development," said Philippe Douste-Blazy, Chairman of UNITAID's Executive Board.
For more information, please contact:
Glenn Thomas, WHO Stop TB Department. Tel: +41 795090677. E-mail: email@example.com Tel: +41 792546835. E-mail: firstname.lastname@example.org
Judith Mandelbaum-Schmid, Stop TB Partnership.
Audrey Quehen, UNITAID Tel: +41 792012127. E-mail: email@example.com
Jewel Thomas, FIND Tel: +41 798306364, E-mail: Jewel.firstname.lastname@example.org
Note to Editors:
*UNITAID is an international drug purchase facility, established to provide long-term, sustainable and predictable funding to increase access and reduce prices of quality drugs and diagnostics for the treatment of HIV/AIDS, malaria and tuberculosis in developing countries.
** Negotiations are being carried out with the following countries for MDR-TB diagnostics:
Azerbaijan, Bangladesh, Côte d’Ivoire, the Democratic Republic of Congo, Ethiopia, Georgia, Indonesia, Kazakhstan, Kyrgyzstan, Lesotho, Republic of Moldova, Myanmar, Tajikistan, Ukraine, Uzbekistan, Viet Nam
WHO - WHO/UNAIDS/World Bank/Global Fund/ 09 06 2008
WORLD LEADERS AT UN MEETING CALL FOR JOINT ACTION TO REDUCE TUBERCULOSIS DEATHS AMONG PEOPLE LIVING WITH HIV
9 June 2008, New York City - For the first time ever, heads of government, public health and business leaders, heads of UN agencies and activists came together at UN Headquarters today to confront a threat to global health that could undermine investments in life-saving drug treatment for people living with HIV.
Tuberculosis (TB) is taking the lives of nearly a quarter of million people living with HIV each year. TB is the number one cause of death among people living with HIV in Africa. Worldwide it is a leading cause of death in this population.
The World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Children’s Fund (UNICEF) recently announced that some three million people are now receiving life-saving anti-retroviral treatment, but TB, especially drug-resistant forms of the disease, threatens to hinder this progress. Because HIV weakens the immune system people living with HIV are up to 50 times more likely to develop TB disease over their lifetimes than people who are HIV negative. Without proper treatment with anti-TB drugs, the majority of people living with HIV die within two to three months of becoming sick with TB.
The leaders spelt out specific measures, recommended by WHO*, needed to avert deaths from HIV/TB. People living with HIV must be screened regularly for TB. Those who are sick with TB need effective TB treatment, and those without TB disease should receive preventive therapy with the drug isoniazid. These treatments are not expensive. A six-month course of TB treatment costs US$ 20, and a course of preventive drug therapy costs US$ 2. Simple measures to prevent the spread of TB among HIV-infected people, especially in health care settings, also need to be put in place.
In 2006, WHO reported that only 1% of the total estimated number of people infected with HIV worldwide were screened for TB. But some countries are making gains on detecting HIV among TB patients and providing life-saving treatments for both diseases.
Kenya, Malawi and Rwanda, for example, more than doubled the proportion of TB patients tested for HIV infection and treated appropriately between 2004 and 2007, according to national government data. In Kenya, the percentage of TB patients tested for HIV rose from 19% to 70%, and in Malawi the increase was from 25% to 83%. In Rwanda, in 2004, TB services were not testing any patients for HIV; in 2007, they tested 89%.
Today's HIV/TB Global Leaders' Forum was convened by the UN Secretary-General's Special Envoy to Stop TB, Dr Jorge Sampaio, and endorsed by the UN Secretary-General Ban Ki-moon. The Forum was opened by the Secretary-General and Mr Srgjan Kerim, President of the UN General Assembly.
The leaders pointed to HIV/TB as a major constraint to economic development, since most TB deaths are among adults of working age. Because it most often strikes society's most disadvantaged people, they said, the dual epidemic is a barrier to social justice and human rights. They also warned that HIV/TB could evolve as a threat to global health security, particularly in the light of emergence of virtually untreatable TB strains.
Dr Sampaio will report on the outcome of the forum to the UN High-Level Meeting on AIDS, which begins tomorrow. Today's forum was supported by UNAIDS, the World Bank, WHO, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Stop TB Partnership.
For further information, please contact:
Judith Mandelbaum-Schmid, Stop TB Partnership, mobile +41 79 254 6835, email email@example.com.
Glenn Thomas, WHO Stop TB Department, mobile +41 79 509 0677, email firstname.lastname@example.org
Patricia Leidl, WHO HIV Department, mobile +41 79 619 8525, email email@example.com
Jon Liden, Global Fund against AIDS, Tuberculosis and Malaria, mobile +41 22 79 11723,
Mahesh Mahalingham, UNAIDS, mobile +41 79 892 3814, email firstname.lastname@example.org
Phil Hay, World Bank, mobile +1 202 409 2909, email email@example.com
*For information about WHO's policies on HIV/TB, including the 3Is (Intensified TB Case Finding, Isoniazid Preventive Therapy and Infection Control) please visit http://www.who.int/tb/publications/tbhiv_interim_policy/en/ and http://www.who.int/hiv/pub/meetingreports/art_hivtb_meeting_april2008/en/index.html.
WHO 25 03 2008
10,000 HEALTH WORKERS STOP POLIO IN ONE OF THE MOST DANGEROUS PLACES ON EARTH
Somalia passes polio-free landmark
25 March 2008, Geneva, Switzerland – Somalia is again polio-free, the Global Polio Eradication Initiative (GPEI) announced today, calling it a 'historic achievement' in public health. Somalia has not reported a case since 25 March 2007, a major landmark in the intensified eradication effort launched last year to wipe out the disease in the remaining few strongholds.
Against a backdrop of widespread conflict, large population movements and a dearth of functioning government infrastructure, transmission of poliovirus in the country has been successfully stopped. This landmark victory is a result of the efforts of more than 10,000 Somali volunteers and health workers who repeatedly vaccinated more than 1.8 million children under the age of five by visiting every household in every settlement multiple times, across a country ranked one of the most dangerous places on earth.
The use of innovative approaches tailored to conflict areas was pivotal in stopping polio in the country. These included increased community involvement and the effective use of monovalent vaccines to immunize children in insecure areas with several doses, within a short period of time.
"This truly historic achievement shows that polio can be eradicated everywhere, even in the most challenging and difficult settings," said Dr Hussein A Gezairy, Regional Director for the World Health Organization's Office for the Eastern Mediterranean.
Polio, which can cause lifelong paralysis, has been stopped nearly everywhere in the world following a 20-year concerted international effort. Only four polio-endemic countries remain – Afghanistan, India, Nigeria and Pakistan – and the eradication of polio globally now depends primarily on stopping the disease in these countries.
Poliovirus travels easily and, in the world of modern travel, can cover long distances. Until transmission of the virus has been interrupted in the four remaining endemic countries, the risk to the rest of the world remains high. Somalia, which had already eradicated the disease in 2002, became re-infected in 2005 by poliovirus originating in Nigeria. This repeated success in Somalia indicates the disease can be stopped even in areas with no functioning central government.
“Somalia beat polio in the midst of more widespread conflict and poverty than that affecting Afghanistan and Pakistan,” according to Dr Maritel Costales, Senior Health Advisor, UNICEF New York, citing insecurity and large population movements in those countries as challenges to reaching all children with vaccine. “But Somalia shows that when communities are engaged, children everywhere can be reached.” Afghanistan and Pakistan could be the first of the remaining endemic countries to stop polio; between them they account for 5% of all cases of polio in 2007.
Consistent financial commitment continues to be crucial to completing polio eradication. The global effort currently faces a shortage of US$525 million for 2008-2009, funding urgently needed to fight the disease in the remaining endemic areas and protect children in high-risk polio-free areas. Rotary International, the top private sector contributor and volunteer arm of the GPEI, has contributed US$9.2 million for polio eradication in Somalia, and US$700 million worldwide since 1985. “Somalia clearly shows that the tailored tools and tactics of the intensified eradication effort are working,” commented Mohamed Benmejdoub, Chair of Rotary's Eastern Mediterranean PolioPlus Committee. “A polio-free world is a feasible public health goal and a global public good. I urge governments across the world – and in particular the G8 countries – to rapidly make available the necessary resources. Together, we can ensure that no child need ever again suffer the terrible pain of lifelong polio-paralysis.”
Notes to editors:
The Global Polio Eradication Initiative is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF. Since 1988, the incidence of polio has been reduced by more than 99 percent. At the time, more than 350,000 children were paralysed every year, in more than 125 endemic countries. Today, four countries remain which have never stopped endemic transmission of polio: Afghanistan, India, Nigeria and Pakistan. In 2007, 1,308 cases have been reported worldwide (data as at 18 March 2008).
One of the 10,000 Somali volunteers and health workers is Ali Mao Moallim, who – more than 30 years ago on 26 October 1977 – became the last person on earth to contract smallpox. Over the past few years, working with WHO, he has travelled extensively throughout Somalia to immunize children against polio and foster community engagement during immunization campaigns. "Somalia was the last country with smallpox. I wanted to help ensure that we would not be the last place with polio, too," he stated.
Somalia's last case of indigenous polio was in 2002. On 12 July 2005, the country was re-infected by poliovirus originating in Nigeria, resulting in an outbreak of 228 cases in total. Systematic and wide-scale