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Economic crisis, health systems and health in Europe. Country experiences
Maresso, Anna; Mladovsky, Philipa; Thomson, Sarah; Sagan, Anna; Karanikolos, Marina; Richardson, Erica; Cylus, Jonathan; Evetovits, Tamás; Jowett, Matthew; Figueras, Josep; Kluge, Hans ( 2015 )
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State of rehabilitation in Tajikistan - Situational Analysis
( 2015 )
Abstract

This publication summarizes the current gap, need and opportunities for intervention in the field rehabilitation for persons with disabilities in Tajikistan. The situational analysis process was conducted by an intersectoral working group consisting of members from different ministries under the leadership of the Ministry of Health and Social Protection, Republic of Tajikistan and with technical support from the WHO Country Office, Tajikistan. It was undertaken in collaboration with different disability and development related stakeholders and adopted a realist synthesis approach, being responsive to the unique social, cultural, economical and political circumstances in the country. The evaluation focuses on rehabilitation policy and governance, service provisions and its impact on persons with disabilities in development of an inclusive, rights-based society with equal opportunity for all in Tajikistan.

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Health systems strengthening in the context of Health 2020: challenges and priorities in the WHO European Region. Expert meeting Barcelona, Spain, 3–4 November 2014
( 2015 )
Abstract

From November 3-4, 2014, the Division of Health Systems and Public Health (DSP), the WHO Regional Office for Europe, brought together senior staff in the Division of Health Systems and Public Health of the WHO Regional Office for Europe and external experts who have worked closely with WHO Europe on health systems strengthening to identify priority areas for health systems strengthening. The meeting was the first step in identifying priorities for health systems strengthening from 2015 to 2020 for a draft resolution to be submitted to the RC65. The meeting was also an opportunity to discuss the content of the upcoming WHO Regional Office’s draft strategic document which will inform the positioning of the Regional Office’s priorities in strengthening people-centered health systems for the next five years, to realize the goals of Health 2020. In identifying priorities, the group discussed key constraints and challenges health systems are likely to face in the next five to ten years, taking into account the diversity of countries in the European Region. The group identified ways in which WHO can best support member states (at country and regional level) to make progress in the priority areas and identified priorities for generating the evidence needed to support member states in health systems strengthening.

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Health systems strengthening in the context of Health 2020: challenges and priorities in the WHO European Region. Expert meeting Barcelona, Spain, 3–4 November 2014
( 2015 )
Abstract

3-4 ноября 2014 г. Отдел систем здравоохранения и общественного здоровья (DSP) Европейского регионального бюро ВОЗ (ЕРБ ВОЗ) организовал совещание с участием ведущих сотрудников DSP и ряда внешних экспертов, тесно сотрудничающих с ЕРБ ВОЗ по вопросам укрепления систем здравоохранения, для обсуждения важнейших задач в этой области. Это совещание стало первым шагом к определению приоритетных направлений укрепления систем здравоохранения в период 2015-2020 гг. Выбранные приоритеты будут включены в проект резолюции по этому вопросу, который будет представлен на рассмотрение 65-й сессии Регионального комитета (РК-65). На Барселонском совещании также были обсуждены содержание и важнейшие положения предстоящего проекта стратегического документа ЕРБ ВОЗ, в котором будет изложена позиция Регионального бюро относительно приоритетов укрепления ориентированных на человека систем здравоохранения в течение следующих пяти лет, что является необходимым условием достижения целей, поставленных в политике Здоровье-2020. В процессе определения приоритетных направлений деятельности участники совещания обсудили основные ограничения, задачи и проблемы, с которыми системам здравоохранения по-видимому, придется иметь дело в ближайшие пять-десять лет, принимая во внимание разнообразие условий в странах Европейского региона ВОЗ. Участники совещания определили, каким образом ВОЗ может наилучшим образом поддерживать эффективную работу государств-членов в решении приоритетных задач на страновом и региональном уровнях, а также выработали приоритеты для формирования фактических данных, необходимых для укрепления систем здравоохранения в государствах-членах.

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Review of the national tuberculosis programme in Romania
de Colombani, Pierpaolo; Hollo, Vahur; Jansen, Niesje; Kremer, Kristin; Labelle, Soleil; Makhmudova, Mavluda; Ramis, Oriol; Sandgren, Andreas; Stillo, Jonathan; Tukvadze, Nestan; Yedilbayev, Askar ( 2015 )
Abstract

Romania has the highest incidence of TB in the European Union (EU)/European Economic Area (EEA), representing one quarter of the EU/EEA TB burden. A review of the national TB programme in Romania was jointly organized by the WHO Regional Office for Europe and the European Centre for Disease Prevention and Control, with WHO leading all operations, from 10 to 21 March 2014. The review acknowledged the high rates of detection and treatment success achieved among patients with drugsusceptible forms of TB; it also pointed to the large proportion of patients with multidrug-resistant TB who are not detected or are poorly treated. The review identified major challenges to be addressed at programme level as well as at health system level and gave the Ministry of Health and the national TB programme 14 main recommendations for improvement.

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HIV Programme Review in Albania: Antiretrovial therapy and procurement and supply management
Lazarus, Jeffrey V.; Gottfredsson, Magnus; Tavagnutti, Nicolas ( 2015 )
Abstract

This WHO country mission, conducted in March 2015, aimed to review the antiretroviral therapy and procurement and supply management components of the HIV/AIDS programme in Albania in order to address current deficiencies and inform the development of a Concept Note for the Global Fund to Fight AIDS, Tuberculosis and Malaria. Albania has a low HIV prevalence overall with 699 individuals diagnosed with HIV in the country at the end of 2013. It is a concentrated epidemic and data on mode of transmission is incomplete. While most of the reported cases are heterosexual transmission there may be a number of unreported or undiagnosed cases among men who have sex with men, people who inject drugs, and sex workers. As of February 2015, 21 children and 339 adult patients with HIV (total of 360) were receiving antiretroviral therapy (ART) in Albania. The number of HIV tests in the country is very low and thus the number of HIV-related deaths in the country is likely to be underestimated. The majority of people living with HIV in Albania are unaware of their infection and thus likely to be actively transmitting the virus. This report provides main and specific recommendations for optimizing HIV testing, ART and developing efficient procurement and supply chain management for HIV in Albania.

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Building primary care in a changing Europe
Kringos, Dionne S.; Boerma, Wienke G.W.; Hutchinson, Allen; Saltman, Richard B. ( 2015 )
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Health Systems in Transition; Ukraine; Health system review
Lekhan, Valery; Rudiy, Volodymyr; Shevchenko, Maryna; Nitzan Kaluski, Dorit; Richardson, Erica ( 2015 )
Abstract

This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population’s health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3% in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conflict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system

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Germany. Health system review.
Busse, Reinhard; Blümel, Miriam ( 2014 )
Abstract

This analysis of the German health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In the German health care system, decision-making powers are traditionally shared between national (federal) and state (Land) levels, with much power delegated to self-governing bodies. It provides universal coverage for a wide range of benefits. Since 2009, health insurance has been mandatory for all citizens and permanent residents, through either statutory or private health insurance. A total of 70 million people or 85% of the population are covered by statutory health insurance in one of 132 sickness funds in early 2014. Another 11% are covered by substitutive private health insurance. Characteristics of the system are free choice of providers and unrestricted access to all care levels. A key feature of the health care delivery system in Germany is the clear institutional separation between public health services, ambulatory care and hospital (inpatient) care. This has increasingly been perceived as a barrier to change and so provisions for integrated care are being introduced with the aim of improving cooperation between ambulatory physicians and hospitals. Germany invests a substantial amount of its resources on health care: 11.4% of gross domestic product in 2012, which is one of the highest levels in the European Union. In international terms, the German health care system has a generous benefit basket, one of the highest levels of capacity as well as relatively low cost-sharing. However, the German health care system still needs improvement in some areas, such as the quality of care. In addition, the division into statutory and private health insurance remains one of the largest challenges for the German health care system, as it leads to inequalities.

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Report of the joint WHO and ECDC programme review of the national TB control programme in the Netherlands
( 2014 )
Abstract

At the request of the Centre for Infectious Disease Control of the National Institute of Public Health and the Environment and the KNCV Tuberculosis Foundation, the WHO Regional Office for Europe and the European Centre for Disease Prevention and Control conducted a review of the national TB prevention and control strategies and activities of the Netherlands. The particular focus was on reviewing the progress made in implementing the recommendations of the previous international review in 2008, advising on the scale and quality of laboratory TB services, reviewing and advising on the human resource component of the TB public health services and on screening and contact investigation policies and practices, including those for migrants. The review produced specific recommendations that will enable relevant country stakeholders to further improve current TB prevention and control strategies and interventions.