Bulletin of the World Health Organization最新文献

Problem: The Malaita and Western provinces in Solomon Islands had low routine immunization coverage due to disruptions in health services caused by the coronavirus disease 2019 pandemic in early 2022.

Approach: The country introduced the World Health Organization (WHO) Reaching Every District (RED) approach in 2002. Between July and September 2022, we strengthened supportive supervision, monitoring and use of data for decision-making, especially for microplanning and re-establishing outreach to prioritized areas. Health workers were supported to identify key concerns and develop strategies to improve performance. Monthly updates of reported immunization coverage, reporting completeness and fieldwork findings were widely disseminated.

Local setting: Solomon Islands' population is 748 606 people, of whom 165 345 reside in Malaita and 105 367 in Western Province.

Relevant changes: In Malaita Province, reported coverage of third dose of pentavalent vaccine and first dose of measles-rubella vaccine increased from 40% (757/1892) of eligible children to 121% (1144/946) and from 30% (568/1892) to 159% (1504/946), respectively; and in Western Province reported coverage increased from 38% (443/1165) to 191% (1113/583) and from 44% (513/1165) to 149% (868/583), respectively. Reported coverage for the remaining provinces increased from 64% (3380/5282) to 88% (2325/2641) and from 59% (3116/5282) to 137% (3619/2641), respectively. These findings led the programme on immunization to re-expand the WHO RED approach nationwide.

Lessons learnt: Supportive supervision, systematic monitoring and use of data for decision-making helped restoring reported immunization coverage in two low-coverage provinces. However, sustaining these results at a national level is necessary. The WHO RED approach remains relevant, even during a pandemic.

Problem: Violence against women is a global health problem. Effectively preventing such violence requires locally adapted strategies.

Approach: The World Health Organization in Indonesia, in collaboration with United Nations (UN) Population Fund, UN Women, United Nations Children's Fund, United Nations Development Programme and Joint United Nations Programme on HIV/AIDS, launched capacity-building initiatives to introduce RESPECT as an evidence-based framework to address violence against women. The initiatives included stakeholder engagement, module development, sensitization training, a workshop and evaluation sessions. These sessions introduced RESPECT strategies to government officials, UN officers and community representatives, mapped best practices and developed action plans.

Local setting: Indonesia has a substantial burden of violence against women, despite numerous laws and policies to combat it. The 2021 Indonesian violence against women survey showed that 26.1% (3341/12 800) of women aged 15-64 years had experienced violence in their lifetime, with 8.7% (1114/12 800) experiencing violence in the past year.

Relevant changes: The initiatives to introduce RESPECT led to securing government support, and verbal commitment was given by the Director for the Protection of Women's Rights against Domestic Violence and Vulnerability to integrate RESPECT into the 2025-2029 National Development Plan and National Strategy for Reducing Violence Against Women.

Lessons learnt: RESPECT can be adapted to local contexts through customization and capacity-building and by ensuring initial government support, dedicated personnel, resource allocation and use of established relationships with key stakeholders. Improved research, monitoring and evaluation are vital to promote evidence-informed decision-making, together with community engagement and multistakeholder collaboration. The UN can facilitate these efforts.

The normative role of the World Health Organization (WHO) involves creating evidence-based, principled guidelines to guide its Member States in making well-informed public health decisions. While these guidelines often need to be adapted to ensure contextual relevance, foster better implementation and adherence, adapting existing guidelines is more efficient than creating new ones. Here we describe the adaptation of the WHO coronavirus disease 2019 (COVID-19) living guideline on pharmacological interventions for the Caribbean using the grading of recommendations, assessment, development and evaluation (GRADE)-ADOLOPMENT method. The Caribbean Public Health Agency and the Pan American Health Organization led the effort, assembling a diverse panel of 16 experts from seven Caribbean countries and territories. The adaptation process, involving 15 steps, was guided by an experienced methodologist and included selecting relevant clinical questions and prioritizing them based on regional needs. The panel evaluated the latest WHO guidelines and integrated additional local data. They adjusted the direction and strength of several recommendations to better fit the Caribbean context, considering local values and preferences, resources, accessibility, feasibility and impact on health equity. Ultimately, we changed the direction of two recommendations and the strength of five, tailoring them to regional realities. This effort highlights the importance of adapting global guidelines to local settings, improving their applicability and effectiveness. The adaptation process also serves as a valuable opportunity for skill transfer and capacity-building in guideline development. Continued research is needed to assess the impact of these adaptations on health-care outcomes in the Caribbean.

The first version of the World Health Organization Model list of essential medicines contained 186 medicines in 1977 and has evolved to include 502 medicines in 2023. Over time, different articles criticized the methods and process for decisions; however, the list holds global relevance as a model list to over 150 national lists. Given the global use of the model list, reflecting on its future role is imperative to understand how the list should evolve and respond to the needs of Member States. In 2023, the model list Expert Committee recommended the World Health Organization (WHO) to initiate a process to revise the procedures for updating the model list and the criteria guiding decisions. Here, we offer an agenda outlining priority areas and a vision for an authoritative model list. The main areas include improving transparency and trustworthiness of the recommendations; strengthening connection to national lists; and continuing the debate on the principles that should guide the model list, in particular the role of cost and price of essential medicines. These reflections are intended to support efforts ensuring the continued impact of this policy tool.

Problem: Many national child health guidelines in Malawi, Nigeria and South Africa are outdated and score poorly on rigorous methods and stakeholder participation.

Approach: In line with the World Health Organization's (WHO) emphasis on local guideline contextualization, the Global Evidence-Local Adaptation (GELA) project supported multistakeholder processes to adapt evidence-informed recommendations for child health in Malawi, Nigeria and South Africa. The GELA project team convened national steering groups, which conducted structured, iterative priority-setting exercises to identify priority topics. We identified appropriate source guidelines by systematically searching and screening available guidelines. We then matched recommendations in potential source guidelines to the relevant questions, and assessed the guidelines for timeliness and quality. Drawing on WHO's guideline process, we applied the GRADE-ADOLOPMENT process to develop contextualized recommendations from existing guidelines. If no source guideline or reviews were identified, we conducted new evidence syntheses.

Local setting: Malawi, Nigeria and South Africa are countries with varying health priorities and systems, all transitioning to universal health coverage. Guideline structures differ between countries, with processes largely led from national health ministries.

Relevant changes: National guideline groups, supported by GELA researchers and government-academic partners, developed five contextually-tailored child health recommendations. For most of these recommendations, additional evidence was required to inform contextually appropriate national decision-making. Formal capacity-building and on-the-job learning enhanced the competencies of national contributors and researchers in evidence-informed decision-making.

Lessons learnt: Developing context-relevant recommendations requires considerable resources and time. Further investment in strengthening local capacity is needed for sustainable national guideline development.

Julie Makani talks to Gary Humphreys about the need for guidance and policy to reflect developments in treatment of sickle cell disease.

Objective: To compare uptake of the voluntary Health Star Rating front-of-pack nutrition labelling system with uptake of a mostly mandatory country-of-origin label in Australia over a similar period.

Methods: We used data on numbers and proportions of products carrying health stars and country-of-origin labelling recorded annually between 2015 and 2023 through surveys of four large Australian food retailers. We determined the proportion of products with health stars and country-of-origin labels for each year by dividing the number of products carrying each label by the total number eligible to carry that label.

Findings: The uptake of the voluntary Health Star Rating increased steadily between 2014 and 2018, reaching a maximum of 42% (8587/20 286) of products in 2021 before decreasing to 39% (8572/22 147) in 2023. Mandatory country-of-origin labelling uptake rose rapidly and was found on 93% (17 567/18 923) of products in 2023. In categories where country-of-origin labelling was voluntary, uptake by 2023 was 48% (3313/6925). In our 2023 sample of 22 147 products, 11 055 (50%) carried country-of-origin labelling only, 7466 (35%) carried both health star and country-of-origin labelling, 1106 (5%) carried health star labels only and 2520 (11%) carried neither label.

Conclusion: The experience with country-of-origin labelling shows that widespread and rapid food labelling change can be achieved when required by law. The Australian government should mandate the Health Star Rating without delay. Australia's experience supports other jurisdictions in implementing mandatory front-of-pack nutrition labelling as well as updates to global guidance to recognize mandatory labelling as best-practice in delivering benefits to consumers.