The need for strengthening of health systems in the Region was abundantly clear in 2012, and remains so today. Inequities in health are widespread, not just among group 2 and 3 countries but also in group 1 countries . Exposure to health risks is rising, particularly to the key causes of noncommunicable diseases – the Region’s leading killers. Health care costs are increasing and health insurance coverage is low, leading to high out-of-pocket health expenditure which drives many families into poverty. Access to quality health care – and sometimes any health care at all – is beyond the reach of a significant portion of the Region’s population. While modern networks of health infrastructure, skilled health care professionals and advanced medical technologies and pharmaceuticals are fully available to citizens in some countries, this is certainly not the case in all countries. Such differences in the strength of health systems contribute to divergent health outcomes, such as in life expectancy, maternal mortality and infant and child mortality.
Health information systems, including civil registration and vital statistics systems, are failing to capture vital information necessary for health system planning, development and monitoring. This includes reliable data on births, deaths and of causes of death, and key health indicators. While there are variations between countries in the quality of the health information system, all countries lack a comprehensive and fully functioning system that can provide the required information in a timely and reliable manner for planning and policy-making.
Capacity and resources for emergency preparedness and response are inadequate and fragmented. The violence, destruction of infrastructure, including health care infrastructure, and displacement of tens of millions of people, has become a severe crisis for health systems that were inadequately prepared. In direct response to these and other severe health challenges, the Regional Office, working with country offices, ministries of health, WHO headquarters and other partners, began the process of strengthening the health systems of Member States.
In October 2012, the Regional Committee endorsed a resolution (EM/RC59/R.3) on health systems strengthening in countries of the Eastern Mediterranean Region. The resolution, which concluded that improving population health of the Region “can only be realized through well performing national health systems which assure universal access to effective and good quality health care”, urged Member States to focus on seven strategic priorities (Box 1). These became the objectives for strengthening health systems.
Box 1. Priorities for health system strengthening
Strengthen leadership and governance in health
Move towards universal health coverage
Strengthen health information systems
Promote a balanced and well-managed health workforce
Improve access to quality health care services
Engage with the private health sector
Ensure access to essential technologies, including medicines
Progress 2012-2016
Leadership and governance: The multi-faceted area of health system strengthening began with an in-depth review of the health systems in the Region and the subsequent development of a brief health system profile for each country. The two-page profiles, which are produced annually, in consultation with Member States, provide critical information on each country and a brief assessment of strengths, weaknesses, opportunities, challenges and priorities. They are aimed at helping policy-makers to focus on the assets and challenges within their countries and provide a useful opportunity and entry point for dialogue, especially during missions to countries. A range of capacity development courses to strengthen government policy-making and decision-making, on health legislation and regulation, health and human rights, and health policy and planning, have been offered in parallel.
A major impediment to progress in public health in many countries has been a lack of capacity to develop and implement evidence-based health policies and programmes. As part of the efforts to strengthen leadership, a leadership for health programme was launched to promote skills among mid-level and senior level public health officials in countries. So far, more than 50 future leaders in public health have graduated. The programme, offered in collaboration with the Harvard School of Public Health, aims to develop future leaders who can address, proactively, local and national health problems that have direct impact on population health. Another leading initiative was the assessment of essential public health functions in the Region. Led by the Regional Director and advised by a global committee of renowned experts, this work established for Member States the specific functions of public health that are essential for the health and wellness of their populations. This was followed by the development of tools and self-assessment guides for countries to identify gaps in their public health capacity. The assessment was implemented in two countries as a pilot experience and will be rolled out to other countries of the Region.
In the area of health governance, an initiative was launched to build capacity in health diplomacy. This concerns the negotiations that Member States engage in at global level, in particular, around health issues that affect all countries and that shape the global policy environment surrounding health. Annual seminars have brought together key players from ministries of health and foreign affairs, diplomats, parliamentarians and experts to discuss the key global health issues of the moment and to learn from each other. Year on year this has proved to be a most useful dialogue from which all participants learn and which is contributing to strengthening the relationship between health and foreign policy in the Region. Several countries are implementing national seminars and workshops.
Universal health coverage: The most important goal for strengthening health systems in countries is the achievement of universal health coverage – and that means for everyone, all countries and both citizens and noncitizens. Universal health coverage must include interventions to tackle the most important causes of morbidity and mortality for the whole population, including the marginalized and vulnerable, as well as protection against catastrophic health costs that can cause financial ruin for families. It is an important target of the health goal of the Sustainable Development Goals and vital for ensuring effective response to the growing impact of noncommunicable diseases. The endorsement, in 2012, by the Regional Committee of universal health coverage as the overarching priority led to the development and subsequent endorsement, in 2014, of the Framework for action on advancing universal health coverage (UHC) in the Eastern Mediterranean Region. This is a strategic policy document that will help to achieve this vitally important initiative for every individual and family in the 22 countries of the Region.
The framework includes a set of strategic actions to achieve universal health coverage that are evidence-based, cost-effective and feasible, and all of which would be supported by corresponding actions by WHO. They include, for example, establishing a multisectoral steering mechanism under the stewardship of each Ministry of Health. They also include actions to enhance financial risk protection, which would ultimately help reduce the share of out-of-pocket spending, and thus of catastrophic health expenditure, and impoverishment. The framework also aims to ensure that each country’s social health insurance coverage scheme contains a package of essential services, including preventive and curative services. Finally, it guides countries to expand coverage to vulnerable groups, particularly the poor and those in the informal sector, and to collect data to allow monitoring of progress toward population coverage.
Following the endorsement of the regional framework for universal health coverage, it is now necessary for each country to implement the recommended actions (Box 2.). To that end, WHO has extended support through health system review missions aimed at identifying challenges and opportunities to create national universal health coverage strategies. By mid-2016 in-depth health system reviews had been conducted and national strategies and plans developed in 10 countries. Almost all countries, including group 3 countries, are actively exploring options for universal health coverage, including the important topic of expanding population coverage through social health insurance, and covering the informal and vulnerable groups.
Box 2. Universal health coverage: key commitments of the framework for action
Developing a vision and strategy
Enhancing financial risk protection
Expanding the coverage of needed health services
Ensuring expansion and monitoring of population coverage
Health information systems: Two interconnected initiatives are being spearheaded by WHO in the Region to address the gaps in, and fragmentation of, health information systems in countries. These initiatives, started in 2012, are vitally important for the future development of evidence-based health policy-making, planning and monitoring.
In the first of these initiatives, WHO has been working intensively with Member States to review and strengthen their health information systems through expert consultations, intercountry meetings and widespread consultation with countries. In 2014, a framework for health information systems was endorsed by the Regional Committee. It provides 68 core indicators to monitor health in three areas: health risks and determinants, health status, including morbidity and mortality, and health system response. For each indicator WHO has provided a detailed analysis of the attributes (meta registry) which covers the source of data, the tool used to generate them and requirements for analysis, use for policy development and dissemination. In the past two years, Member States have started to adopt and report on the core indicators. However, to date, no country is able to report on all of them. Addressing this challenge is essential for all countries. A comprehensive report of the gaps in each country’s data has been shared with ministers of health and a comprehensive assessment is followed to identify the priorities for addressing them. The next step for WHO is to provide technical support to countries, as required, to strengthen their health information systems.
The second initiative, endorsed by the Regional Committee in 2013, focuses on improving civil registration and vital statistics, with specific emphasis on strengthening cause-specific mortality statistics. As a result of the rapid and comprehensive assessments that were conducted in collaboration with the ministries of health and other national stakeholders, there is now a comprehensive picture of the strengths and weaknesses of the civil registration and vital statistics systems in all countries. The gaps are considerable: more than 30% of all births were not registered in this region and just below 20% of deaths were reported with causes specified. The gaps that exist in each country were shared with Member States and technical support has been offered based on the regional strategy endorsed by the Regional Committee. Since the assessments were conducted, the number of countries reporting cause of death statistics from the Region has increased, from 7 in 2012 to 13 in 2016. Still, all countries, irrespective of their current achievement, need to do more to improve the accuracy of cause-specific mortality data, which is essential for monitoring health and also the Sustainable Development Goals.
Health workforce: This initiative involves not only developing the number of health care professionals and other health workers needed in countries but also the quality of the workforce. This is a critical area for health in the Region. Attracting quality health care workers is now very difficult in some countries where there is ongoing instability and conflict and from which many health professionals have been forced to flee with their families. In other countries, pay and working conditions are inadequate to sustain the workforce required. Working in collaboration with ministries of health, several strategies have been pursued to strengthen the health workforce.
A regional framework for health workforce development has been developed in consultation with Member States. The evidence-based framework, which is fully aligned with the global health workforce strategy, provides options for tackling some of the most difficult problems facing countries.
Strengthening medical education is key to health development in the Region. This area of work has been stalled in WHO over the past decade. Intensive work with countries and the International Federation of Medical Education was put into conducting a clear assessment of the situation of medical education in different countries and a regional framework was developed to address existing challenges, based on international experience. The framework is an approach to scaling up the development of quality physicians, beginning with establishing and strengthening the regulatory capacities, providing standards and guidelines for new medical schools, encouraging/strengthening education development centres, building capacity of educational leaders and establishing national independent accreditation programmes. Attracting and retaining competent faculty and developing adequate resources for training are also included. For each priority, short-term and long-term actions by Member States are outlined, matched by specific technical support from WHO.
The development of a regional strategy aimed at strengthening nursing and midwifery has been equally important, since nurses and midwives provide a major proportion of health care services worldwide and in the Region. A significant shortage of nurses and midwives exists in this region, and the strategy recommends strategic actions in five key areas: governance and regulation; workforce management systems; practice and services; access to quality education; and research.
Access to quality health care: Delivery of quality health care services for populations is based on the values and principles of primary health care. Family practice has been promoted as the principal approach for delivering integrated, person-centered primary care in the Region. However, countries have many gaps and challenges in offering full-fledged family practice programmes that are responsive to the changing demographics and disease burden. The major efforts undertaken to strengthen primary health care have included a situation review, strategic guidance to countries, building country capacity and advising on scaling up the production of family physicians. Programmes and tools to improve the quality of care and patient safety have been developed for all levels of patient care. The patient safety assessment manual was updated and a toolkit was developed to support patient safety programmes.
Two new areas of work have been instituted into the strategic priorities of health system strengthening: hospital management and the role of the private health sector.
A situation analysis of public sector hospitals in the Region was conducted and a capacity-building workshop was developed in which senior hospital managers from inside and outside the Region shared best practices on hospital care and management. Subsequently, a network of hospital managers and policy-makers was established to promote collaboration in these areas.
The private health sector is one of the major health providers in most countries. It has expanded rapidly and is often under-regulated. Partnerships with the private sector to deliver publicly financed essential health services can be an important means of population health improvement. For this opportunity to be realized, however, the private health sector needs to be well regulated, based on defined standards and enforcement. Government oversight and stewardship is essential, and a laissez faire approach is not acceptable. The work on the private health sector began with an analysis of the private health sector and was followed by a series of capacity-building workshops and consultations aimed at engaging and regulating private sector health care for universal health coverage.
Essential technologies, including medicines: Access to health technologies, including medicines, vaccines, biologicals and medical devices, can mean the difference between wellness and widespread disease for populations and life and death for individuals. Yet, in many countries, a high percentage of the population lacks regular access to essential technologies, including medicines, while quality assurance is problematic and irrational use is widespread. Government capacity to regulate may be supply-driven, which can result in wasted expenditure and purchase of inappropriate products. There is growing recognition that the weak performance of national health systems in this area is a major constraint to health development.
In response, a robust health technology assessment tool was launched. This assessment is a multidisciplinary decision-making process that uses information about the medical, social, economic, organizational and ethical issues related to use of a health technology. It supports the formulation of safe and effective health policies that are patient-focused and seek to achieve both the best value and best patient outcomes. The tool can provide cost–benefit evaluations to make purchase decisions within a given budget, and can help reduce waste and inefficiencies resulting from inappropriate investments. It also can be valuable to countries working towards universal health coverage.
Pharmaceutical sector profiles were also developed for all countries. The profiles provide a detailed description of the components of the national drug policy, with an indicator score card, as well as the challenges and priorities for action.
Way forward
The framework for universal health coverage and the work with health ministries in collaboration with country offices is very promising and will lead to real progress, if the commitment to this process is maintained and expanded. Special attention will be given to finalizing country-specific roadmaps for universal health coverage, including health financing and service delivery strategies. Experiences and lessons learnt from initiatives both inside and outside the Region will be shared.
Future work in leadership and governance will focus on strengthening of ministries of health, building their capacities for better regulation of the health sector, greater multisectoral involvement, effective decentralization and increased accountability and transparency. Strengthening the capacity of public health in ministries of health is key. The leadership for health programme, which has been successful for two consecutive years, will pay greater dividends as time goes on and as graduates progress in their careers. The programme aims to graduate up to 30 public health leaders from the Region every year. The plan is for the leadership programme to be eventually outsourced to an academic institution in the Region to ensure sustainability.
Accurate data from health information systems is absolutely vital to improve the health of populations. Every country of the Region needs to mobilize high-level political commitment and support from relevant sectors to fulfil the promise of health information system initiatives, especially collection of comprehensive cause-of-death data. Member States have repeatedly expressed concern about the validity of estimates that are used to report on health status in countries. While the methods to generate estimates are improving at the global level, there is no alternative to such estimates unless countries develop reliable data collection and reporting systems. WHO is developing methodologies to assess the validity of the reported indicators so that the results of the assessments will help the countries improve their information systems at a national level. Every country will need to consider the gaps in reporting on the 68 core indicators of the regional health information framework recently provided by WHO and develop a plan. Countries should also consider the areas in their civil registration and vital statistics systems that were identified by the comprehensive assessment and subsequent WHO reports as requiring strengthening.
Health workforce development is critical to every other health initiative. Clear strategies to build the workforce of the future have been developed and will be discussed with Member States at the 63rd session of the Regional Committee. Political and educational leadership at the country level is now necessary to move forward.
The support to medical schools will continue through the implementation of the regional framework for medical education. The framework will be discussed in a ministerial-level meeting for the health and higher education sectors which is planned to take place in the fourth quarter of 2016. Every country is expected to review the nursing and midwifery workforce situation based on the regional framework for action. WHO will provide technical guidance and support through a network of international and regional experts.
Regional programmes for capacity-building and technical support aimed at expanding access to quality health care, including enhancing primary care through expansion of family practice, should be expanded to accelerate progress towards universal health coverage and improve patient safety. Engaging the private health sector is an essential component of the journey to universal health coverage. WHO’s work in 20162017 will continue to provide guidance on strengthening the role of private sector in moving towards universal health coverage and regulating it.
Intercountry meetings on the assessment and regulation of essential technologies have begun with the purpose of establishing guidelines to support Member States. Countries need to finalize, and then implement, action plans to institute health technology assessment and regulation. WHO will continue to provide capacity-building and technical support for every step towards full implementation of the assessment for countries. In addition, international donors are potentially interested in supporting health technology assessment and regulation.
Reliable and timely health information is essential for proper health management, evidence-based decision-making, optimal use of resources, and monitoring and evaluation of public health situations, actions and outcomes. Robust health information systems that generate reliable and timely data to inform the development of appropriate, effective and cost-effective health policies, which is essential to achieve, and monitor progress, towards the Sustainable Development Goals (SDGs) and universal health coverage (UHC). Its importance is emphasized repeatedly in WHO’s Thirteenth General Programme of Work (GPW 13).
The central focus of GPW 13 is impact in countries and the GPW 13 WHO Impact Framework aims to track the joint efforts of WHO, Member States and partners in achieving the GPW’s “triple billion” targets and the measurable impact on people’s health at the country level. The Impact Framework maps SDG targets and indicators to GPW targets and indicators.
To strengthen their health information systems, countries in the WHO Eastern Mediterranean Region are reporting on a list of regional core indicators. The core indicators focus on three main areas:
monitoring health determinants and risks;
assessing health status, including morbidity and cause-specific mortality; and
assessing health system response.
To strengthen national institutional capacity for the use of evidence in health policy-making in the Eastern Mediterranean Region, the WHO Regional Office has developed a framework for health information systems, which provides practical actions that countries can take to build national institutional capacity and outlines the support that WHO can provide to facilitate this process.
WHO supports countries of the Region in strengthening national health information systems. This includes conducting comprehensive health information system assessments, developing national health information system strategies, improving national capacity in death certification and analysis, promoting International Classification of Disease (ICD) coding and (where appropriate) use of DHIS-2 platforms to enhance the reporting of routine data.
Related link
This health and well-being profile for the Eastern Mediterranean Region presents a comprehensive assessment of the health situation at the regional and country levels, using available data up to October 2019. It is guided by the strategic priorities and goals of WHO’s Thirteenth General Programme of Work (GPW 13): achieving universal health coverage; addressing health emergencies; and promoting healthier populations across the life course. Detailed country profiles for each of the 22 countries present the latest available data for a range of health indicators and the health-related SDGs, and highlight country efforts in implementing the 2030 Agenda for Sustainable Development. The health and well-being profile reviews progress made in the Region towards achieving the ambitious goals of Vision 2023 and GPW 13 and provides an opportunity to assess the opportunities and challenges that lie ahead.
The SCORE (Survey, Count, Optimize, Review, Enable) for health data technical package aims to provide support to Member States to strengthen health information systems and capacity to monitor and track progress towards the health-related Sustainable Development Goals (SDGs), including universal health coverage (UHC), and other national and subnational health priorities and targets. Developed by WHO, with the financial support of Bloomberg Philanthropies, SCORE addresses WHO’s commitment to support Member States to effectively collect, analyse, report and use data.
The five essential interventions of the “SCORE for health data package” are:
Survey populations and health risks … to know what makes people sick and their risks
Count births, deaths and causes of death … to know who is born and what people die from
Optimize health service data … to ensure equitable, quality services for all
Review progress and performance … to make informed decisions
Enable data use for policy and action … to accelerate improvement
The technical package includes a framework of essential interventions and their key elements that can assist in prioritizing investments and actions. The SCORE for health technical package also provides recommended standards, guidance and tools to support implementation of the interventions.
is a one-stop solution to address data availability, timeliness, and comparability;
contains all elements that comprise an optimal health information system in a single package;
is a tool to help focus priority investments for data, analytical and statistical capacity;
provides guidance for countries to take targeted policy action to address inequalities and improve population health outcomes;
provides a method to improve data quality to monitor progress towards global goals with the ability to adapt to local contexts;
is a means to develop strong health information systems for emergency preparedness and response, not only for COVID-19 but for any public health threat.
Surveillance is the ongoing systematic collection, analysis, and interpretation of outcome specific data for use in planning, implementing and evaluating public health policies and practices. A communicable disease surveillance system serves two key functions; early warning of potential threats to public health and programme monitoring functions which may be disease-specific or multi-disease in nature.
The early warning functions of surveillance are fundamental for national, regional and global health security. The COVID-19 pandemic and recent outbreaks of severe acute respiratory syndrome (SARS) and avian influenza, and potential threats from biological and chemical agents, demonstrate the importance of effective national surveillance and response systems.
Hospital information systems
The availability of high quality data on health systems is crucial for informing policy development, monitoring performance, allocating resources efficiently, and ensuring proper functioning of the health system within national policy and regulatory frameworks.
Information and communication technology (ICT) within hospitals has clear links with internal management (including procurement, monitoring and reporting) and clinical management (with electronic records supporting quality development and health system cooperation). ICT and decision support systems can improve the appropriateness of clinical decisions, such as antimicrobial prescribing.
The ability to share information between hospitals and other parts of the national health information system is becoming increasingly important for: treating patients (coordinating care, avoiding medication errors and supporting quality improvement); developing proactive population health management (using analytics to identify patients at risk, targeting early intervention or running recall and screening programmes); effectively managing the performance of providers and identifying opportunities for improvement; and ensuring that patients have access to their own records.
Effective national health information system projects have been implemented in many countries, including low- and middle-income countries, under the initiatives of governments and key stakeholders.
District health information systems
Globally, countries use different systems to collect, process, analyse and report data for decision-making. One platform currently in use is DHIS-2 ‒ a flexible, web-based open-source information system with important visualization features, including the Geographic Information System, charts and pivot tables. DHIS-2 enables users to manage aggregate data with a flexible model first implemented more than 15 years ago. DHIS-2 is being used to monitor patient health, improve disease surveillance and locate outbreaks and speed up access to health data.
Several countries in WHO’s Eastern Mediterranean Region are using or piloting DHIS-2 to collect, process, analyse and disseminate health information at national level or within specific programmes.
Information about population health and health risks is a cornerstone of preventing disease and disability. It enables evidence-informed planning and evaluation of health policies and preventive activities. Health and health risks, which predict future health, are key issues for people's welfare, mainatining a fit-for-purpose workforce while minimizing the need for health care for the ageing population. Surveys provide critical information from other sectors such as poverty programmes, education, water and sanitation, living conditions, nutrition, air quality and security.
Population-based surveys are among the main data sources for understanding population health status and health risks and are a prominent source of data for many health-related Sustainable Development Goal (SDG) indicators. Of the 232 SDG indicators, 77 are derived from household surveys; and surveys are often the only source of data for indicators of behaviour and risk factors. They represent the most important instrument to assess inequalities.
A number of countries such as in the Region such as Islamic Republic of Iran, Sudan and Qatar have developed national survey plans as a consolidated approach to guide data collection efforts.
A well-functioning civil registration and vital statistics (CRVS) system registers all births and deaths, issues birth and death certificates, and compiles and disseminates vital statistics, including cause of death information. It may also record marriages and divorces.
As part of the civil registration and vital statistics agenda, a regional strategy was developed and implemented for 2014–2019. Assessments of civil registration and vital statistics systems were conducted in all countries of the Region, and road maps and improvement plans were developed for all countries. These resulted in notable improvements in birth and death registration, and quality of reporting of causes of death.
In 2013, birth registration completeness ranged from 0% to 100% in different countries of the Region, with a regional average of 62%. Death registration also ranged from 0% to 100%, but with a regional average of 23%. By 2018, the timely registration of births and deaths in the Region had reached 70% and 54%, respectively.
One of the key steps towards strengthening health information systems in the Region is improving the capacity of countries in accurate registration of vital statistics, including civil registration and cause-specific mortality. All countries of the Region have birth registration systems, although the level of coverage varies. Coverage of birth registration is above 90% in 14 countries of the Region and under 70% in six low-income countries. All countries of the Region except Somalia have death registration, with different levels of coverage. In half of the countries, the coverage of death registration is 90% or above. In 2018, 14 countries reported mortality data disaggregated by cause of death based on ICD-10, with data completeness above 60% in six countries. The average of data completeness for cause of death in the Region is 32%, which is lower than the global rate (49%) and only higher than the African and South-East Asian regions.
Health and well-being profile of the Eastern Mediterranean Region
This health and well-being profile for the Eastern Mediterranean Region presents a comprehensive assessment of the health situation at the regional and country levels, using available data up to October 2019. It is guided by the strategic priorities and goals of WHO’s Thirteenth General Programme of Work (GPW 13): achieving universal health coverage; addressing health emergencies; and promoting healthier populations across the life course. Detailed country profiles for each of the 22 countries present the latest available data for a range of health indicators and the health-related SDGs, and highlight country efforts in implementing the 2030 Agenda for Sustainable Development. The health and well-being profile reviews progress made in the Region towards achieving the ambitious goals of Vision 2023 and GPW 13 and provides an opportunity to assess the opportunities and challenges that lie ahead.
Progress on the health-related Sustainable Development Goals and targets in the Eastern Mediterranean Region, 2020
The 2030 Agenda for Sustainable Development includes a vision of healthy lives and well-being for all at all ages. This major report is the first comprehensive attempt to chart progress towards the health-related Sustainable Development Goals (SDGs) in WHO's Eastern Mediterranean Region. It presents regional trends between 2015 and 2019 for 50 health-related SDG indicators using available data from WHO and estimates from other United Nations agencies. The report reveals encouraging progress in some areas, but also many gaps and weaknesses in health-related services and outcomes, as well as the data needed to measure them. As such, it will be critical reading for everyone working to plug those gaps and realize the vision of the 2030 Agenda.
Core indicators and indicators on the health-related Sustainable Development Goals
The strengthening of health information systems is a priority for WHO in the Region, as highlighted in Vision 2023, our regional vision for public health. Intensive work with Member States since 2012 has resulted in a clear framework for health information systems. The core indicators focus on three main components: 1) monitoring health determinants and risks; 2) assessing health status, including morbidity and cause-specific mortality; and 3) assessing health system response. The regional core indicators were endorsed by the WHO Regional Committee for the Eastern Mediterranean at its 61st session in 2014, after which Member States started to adopt and report on the indicators. In 2016, the core indicator list was expanded in consultation with Member States to add a set of additional SDG indicators, bringing the total number of core indicators to 75. This year’s report replicates the innovative design that was adopted in 2018, and welcomed by Member States.
All SDG 3 indicators are now included in the core list, and we also report on the coverage of birth and death registration in the Region, a key area of policy interest. These indicators, although they were formally part of the core indicators, were not reported in previous annual reports. Now with improvements and better availability of data in most countries of the Region, they have been added to the report.
Framework for action to improve national institutional capacity for the use of evidence in health policy-making in the Eastern Mediterranean Region (2020-2024)
To strengthen national institutional capacity for the use of evidence in health policy-making in the Eastern Mediterranean Region, the WHO Regional Office has developed a framework for health information systems, which provides practical actions that countries can take to build national institutional capacity and outlines the support that WHO can provide to facilitate this process.
EM/RC66/INF.DOC.3 Regional strategy for the improvement of civil registration and vital statistics systems, 2014–2019 English | Arabic | French
EM/RC60/10 Regional strategy for the improvement of civil registration and vital statistics systems English - Arabic - French
Resolutions
EM/RC66/R.5 Developing national institutional capacity for evidence-informed policy-making for health English | Arabic | French
EM/RC60/R.7 Regional strategy for the improvement of civil registration and vital statistics systems 2014–2019 English - Arabic - French
Progress reports
EM/RC64/INF.DOC.5 Regional strategy for the improvement of civil registration and vital statistics systems 2014–2019 English | Arabic | French
EM/RC62/INF.DOC.8 Regional strategy for the improvement of civil registration and vital statistics systems 2014-2019 English | Arabic | French
WHO Health Emergency Programme
Introduction
As host to some of the world’s biggest emergencies, the Eastern Mediterranean Region carries the largest burden of people in need of aid, with more than 76 million people directly or indirectly affected by conflict, environmental threats and natural disasters.
In 2017, the Syrian Arab Republic entered its seventh year of conflict, with the humanitarian situation of people living in besieged areas becoming increasingly dire. More than two years of conflict in Yemen led to the world’s largest food crisis, the world’s largest cholera epidemic, a rapidly expanding diphtheria outbreak and the near collapse of the health system. In Iraq, a military offensive aiming at liberating Mosul led to the displacement of almost one million people. Somalia faced a triple threat of drought, impending famine and disease outbreaks. Afghanistan, Libya and Palestine struggled to provide health care services in insecure and under-resourced settings.
WHO responded to 10 graded emergencies in the Region during 2017, including four Grade 3 major emergencies in Iraq, Somalia, Syrian Arab Republic and Yemen. Somalia was classified by WHO as a Grade 3 emergency in May 2017, requiring a scaled-up Organization-wide response. As part of WHO’s Whole-of-Syria response, the Gaziantep hub in Turkey was assigned to work within the Grade 3 Syria crisis to expedite the provision of health care cross-border from Turkey to people in northern Syria. The dengue fever outbreak in Pakistan was assigned a Grade 1 emergency from July 2017 to January 2018. Other graded emergency countries included Afghanistan, Libya, Pakistan and Palestine.
Health security threats in the Region continued to place populations at increased risk. In 2017, outbreaks of cholera were reported from Somalia and Yemen, while dengue and other epidemic arboviruses such as chikungunya were reported from Pakistan, Somalia and Sudan. Oman, Qatar and the United Arab Emirates continued to report transmission of Middle East respiratory syndrome (MERS) coronavirus sporadically, while Lebanon reported one imported MERS case and Saudi Arabia reported eight small hospital outbreaks of MERS. Avian influenza among humans was reported in Egypt, although the numbers were low compared to numbers reported in 2014–2015. Crimean–Congo haemorrhagic fever was reported in Afghanistan and Pakistan, and the United Arab Emirates reported travel-associated Legionnaire’s disease during the first quarter of 2017. A number of countries, notably Afghanistan, Pakistan, Palestine and Tunisia, also reported a high number of seasonal influenza cases. At least eight countries in the Region (Djibouti, Egypt, Oman, Pakistan, Saudi Arabia, Somalia, Sudan and Yemen) fall within Category 4 of WHO’s new country classification for Zika virus, meaning that these countries have established competent vectors without any documented past or current transmission.
WHO’s response
The constraints on the health sector response in major emergencies in the Region included insecurity and limited humanitarian access to people in need, limited capacities of national health systems and partners, shortages of health personnel, bureaucratic constraints and insufficient funding. In a number of countries, the operating environment remained volatile with frequent attacks on health care. Out of a total of 212 attacks on health care recorded by WHO globally in the first three quarters of 2017, 170 (80%) occurred in the Eastern Mediterranean Region, with a significant majority of all attacks occurring in the Syrian Arab Republic. Despite the neutrality of health, political developments in a number of countries resulted in restrictions on access and increasing violence, impeding WHO’s ability to reach people in need. An escalation of clashes in Yemen in December 2017 forced WHO and many partners to scale back their operations in the country. The operational challenges faced by WHO in emergency countries included limited availability of skilled public health expertise for surge deployment. This highlighted gaps in the existing emergency rosters and the need for improved systems to identify, train and retain a larger pool of more skilled public health experts who are ready for immediate deployment when needed.
Despite these challenges, within 72 hours of both the deadly blasts in Somalia in October and the earthquake at the border between the Islamic Republic of Iran and Iraq in December, supplies were delivered from WHO’s hub in Dubai to national health authorities using regional funds. In 2017, WHO’s logistics hub in Dubai delivered a total of 85 shipments of medicines and medical supplies (weighing 791 tonnes) to 20 counties in the Region and beyond. In Iraq, Somalia, Syrian Arab Republic and Yemen, these supplies successfully reached more than 23.5 million beneficiaries. As needs for life-saving medicines and medical supplies in emergency countries increased, international suppliers were unable to keep up with growing demands by WHO. This highlighted the need to increase the number of regional wholesale suppliers. In line with this, WHO is expanding the role of its logistics hub in Dubai to an operational role that is better equipped to fill ongoing and increasing needs through a more streamlined and expedited process. A strategic assessment of estimated health supplies by all priority emergency countries will be conducted, and the supplies procured and pre-positioned in the hub for dispatching as needed. This will ensure that urgently needed health supplies reach their destination in a period of weeks rather than months.
In accordance with the principles of the revised Emergency Response Framework (ERF), WHO activated the Incident Management System in all Grade 3 countries in the Region to fulfil its six critical functions. This involved the deployment of an Incident Manager, a public health officer and an information management officer to support ongoing response activities on the ground and scale up WHO’s operational and technical support to address the immediate health needs and risks facing populations. Also in line with the implementation of the ERF, in November 2017 WHO began development of a regional roadmap, a strategic handbook and emergency operation plans for the activation of a regional emergency operations centre (EOC). In November and December 2017, the EOC was activated to coordinate the response to acute watery diarrhoea/cholera outbreaks in Somalia, Sudan and Yemen, and the earthquake at the Iranian/Iraqi border.
WHO led or jointly led health sector coordination in eight countries in the Region where the health cluster has been activated. Health cluster achievements in 2017 included preventing the collapse of the health system and closure of 14 public hospitals and 18 nongovernmental organization hospitals in Gaza by providing essential fuel to run back-up generators during the 20-hour power cuts. In Iraq, the cluster operationalized the trauma referral pathway and was instrumental in saving the lives of 24 000 severely injured people, and health cluster partners immunized 99% of target children in newly accessible areas. In Yemen, health partners were able to reach 6 million people with life-saving health services and supported the collapsing health system through the provision of essential medicines, incentives to health workers, operational costs and rehabilitation to keep more than 2500 health facilities running. In Pakistan, health partners conducted a vulnerability assessment for the Federally Administered Tribal Areas (FATA), and the findings were used to develop a transition plan for 2018–2020 which serves as the basis for FATA transition from emergency to development. In the Syrian Arab Republic, health cluster partners supported 14.4 million medical procedures and provided 8.6 million treatment courses.
The Emergency Medical Team (EMT) initiative was launched in the Region in September 2017 with the goal of establishing a cadre of skilled national multidisciplinary medical teams to act as first responders when emergency strikes. The regional EMT strategy was created with a three-pronged approach: scaling up national EMT capacity in country; deploying national EMTs from one country in the Region to another as needed; and establishing a dedicated EMT coordination cell in national emergency operations centres. Each country decides how many teams and what types of teams they want. Countries also decide what teams to establish for deployment to other countries. Once these international teams comply with WHO standards they become part of the regional EMT system. From September to December 2017, trauma experts from the Regional Office worked with 15 countries to initiate the process, and conducted meetings with the ministries of health of Egypt, Islamic Republic of Iran, Jordan, Oman, Palestine and Qatar to provide an overview of the initiative. In the Islamic Republic of Iran, a two-day workshop on the EMT initiative was conducted with all stakeholders to create a national EMT taskforce to oversee the creation of a national multidisciplinary EMT.
In 2017, WHO’s work in the area of emergencies was 80% funded on average, through support from a number of key donors. These included the United States Agency for International Development (USAID), United States Department of State, European Commission’s Humanitarian Aid and Civil Protection Department (ECHO), Germany, United Nations Office for the Coordination of Humanitarian Affairs (OCHA), Japan, Republic of Korea, United Nations Central Emergency Response Fund (CERF), United Kingdom, Norway, Qatar, Kuwait, World Bank, Saudi Arabia, United Arab Emirates, Oman, China, Italy, France, Canada, Algeria and Lithuania. However, while some countries received substantial support from donors in 2017, other countries facing forgotten emergencies, where health needs are just as critical, remained significantly underfunded, including Somalia, Sudan and refugee-hosting countries. The emergency in the Syrian Arab Republic was also underfunded in 2017. Since the activation of the Regional Solidarity Fund in January 2016, country donations to the Fund have been limited, and WHO still depends on internal funding for its immediate emergency response needs. In 2017, WHO allocated US$ 1.6 million of internal funding to support emergency response activities in Iraq, Somalia, Syrian Arab Republic and Yemen. Activities supported included cholera response, health services for internally displaced persons and immunization campaigns.
To strengthen the funding base for its activities, WHO will enhance engagement and dialogue with existing partners and new partners in order to mobilize resources for emergency response, aiming to increase by half the total contributions for health emergencies, including for under-resourced countries. To that end, it will strengthen institutional dialogue and presence across the Region and establish regional partnerships promoting multi-year funding, so that it is able to serve the longer-term needs for investment in under-funded countries and complex emergencies. This includes developing new partnerships and new models of funding.
Efforts will also continue to scale up response and early recovery by setting up incident management systems and emergency operating centres, promoting the use of country business models, expanding the Dubai logistics hub and strengthening coordination through health clusters.
Emerging infectious diseases
The likelihood of the emergence and rapid transmission of high-threat pathogen diseases has increased in the Region due to the acute, protracted humanitarian emergencies affecting many countries directly or indirectly, which have led to high numbers of internally displaced persons and refugees living in overcrowded, overburdened spaces, with little or no access to basic health care services and environmental infrastructure. Other risk factors include rapid urbanization, climate change, weak surveillance, limited laboratory diagnostic capacity and increased human–animal interaction. Meanwhile, challenges persist for efforts to prevent and control emerging and epidemic-prone diseases in the Region, including knowledge gaps regarding the risk factors for transmission and disease epidemiology for a number of emerging and epidemic-prone infections that are commonly prevalent in the Region, weakened or fragmented disease surveillance systems for early detection of health threats, and limited laboratory diagnostic capacities owing to fragile health systems in crisis-affected countries. These challenges arise as a result of insufficient investment in disease surveillance and response activities, and the absence of a cohesive and inclusive country-focused strategy for the prevention, containment and control of emerging and epidemic-prone diseases.
In 2017, a number of outbreaks of emerging infectious disease were successfully contained, including cases of dengue fever in Pakistan, cholera in Somalia, travel-associated Legionnaire’s disease in the United Arab Emirates, acute watery diarrhoea in Sudan, and a small number of hospital outbreaks of MERS in Saudi Arabia. This was possible due to rapid field investigation and deployment of surge staff from the Regional Office, the involvement of Global Outbreak Alert and Response network (GOARN) partners to provide support to the operational response, and by guiding and advising the affected countries in implementing rapid public health containment measures.
The WHO Emerging and Dangerous Pathogens Laboratory Network was established in 2017 to develop high-security laboratories for the timely detection, management and containment of outbreaks from novel, emerging and dangerous pathogens. The Network has already conducted laboratory training in the detection and diagnosis of emerging diseases. Also in 2017, surveillance systems in the Islamic Republic of Iran, Palestine, Saudi Arabia, Somalia, Sudan, the Syrian Arab Republic and the United Arab Emirates were enhanced for emerging diseases, and early warning systems set up for detection of health threats. Additionally, in line with resolution EM/RC62/R.1,a sentinel surveillance system for severe acute respiratory infections (SARI) was established and operationalized in 19 out of 22 countries, enhancing their capacity for detection and mitigation of threats from MERS coronavirus, avian influenza A (H5N1) and other similar novel respiratory viruses. The Eastern Mediterranean Flu Network, a regional database for influenza data sharing, was expanded to receive SARI surveillance data from 13 of 19 countries in the Region with functioning influenza surveillance. In addition, a technical advisory group was established to identify priority research initiatives on MERS in the Region to address critical knowledge gaps and contribute to improving public health response to MERS. WHO also organized the first-ever scientific conference on acute respiratory infections to review progress in influenza surveillance and showcase new knowledge gained in surveillance for detection of influenza and other emerging respiratory viruses in the Region. During 2017, WHO also oversaw the implementation of public health preparedness, readiness and mitigation measures in Saudi Arabia during the hajj 2017 (1438 H), as required by the IHR. Risk-mapping for current and future distribution of Aedes mosquito vectors was completed as part of the regional plan to identify potential Zika hotspots, and to enhance preparedness and readiness measures for prevention, detection and early response to Zika virus infections. Operational strategies for strengthening cholera preparedness and other control measures were harmonized for rapid implementation in affected countries and at-risk countries, following a consultative meeting held in mid-2017 in Beirut, Lebanon. Currently, evidence on burden and risk factors for emerging disease health threats, and on best practices for control interventions, is being accumulated through a systematic review.
Going forward, WHO will strengthen the prevention and control of emerging and epidemic-prone diseases by helping countries forecast, detect and assess the risk of health events and mount rapid responses to outbreaks, mapping hotspots and building effective surveillance systems, and conducting risk assessments in high-risk countries as a basis for plans for preparedness and response.
Preparedness
In 2017, support was provided to Egypt, Iraq, Jordan and Pakistan to conduct risk assessments and develop their all-hazards preparedness and response plans. The regional roster of experts was augmented in conducting a regional public health emergency pre-deployment course for national counterparts and WHO country office staff. In addition, supporting the International Committee of the Red Cross to conduct a regional course on health emergencies for large populations provided an additional opportunity to effectively train more staff from the Region. A hospital emergency course was conducted in Bahrain, Libya and Sudan as part of series to be repeated across the Region. In addition, the Regional Office participated in the first global face-to-face meeting of the WHO operational readiness task force.
An expert two-day consultation was held with the purpose of bringing international and national stakeholders together to discuss the health of migrants and displaced populations. An analysis of health impacts on internally displaced persons, refugees, migrants and returnees in the Region was presented, and a proposed regional plan of action was discussed.
As part of implementation of Regional Committee resolutions EM/RC62/R.3 of 2015 and EM/RC63/R.1 of 2016, the Regional Office continued to support additional voluntary JEEs. In 2017, support was given to Kuwait, Oman, Saudi Arabia and United Arab Emirates. WHO has consistently liaised with the remaining countries and provided training for several of them to commence self-assessment in order to undergo JEE. Regional guidance on conducting JEEs in crisis countries was developed and training workshops were additionally provided for Libya, Iraq, Syrian Arab Republic and Yemen. The training was a unique opportunity for participants to share experiences and return to their countries as advocates for the process.
As JEE completion is only the first step, the focus has shifted towards assisting countries in developing and costing their national action plans for health security post-JEE. Utilizing JEE results, as well as other assessments and results from the IHR monitoring and evaluation framework, the plans incorporate a multisectoral approach to strengthening national health security under IHR. In 2017, national workshops were convened in Jordan and Saudi Arabia involving all relevant IHR-bound sectors. The workshops identified priority actions across the 19 technical areas of the JEE. WHO also provided technical support to Afghanistan and Sudan to develop their national action plans for health security.
Under the IHR monitoring and evaluation framework, WHO has provided technical support to countries in implementing their IHR capacities. Egypt, Iraq and Pakistan held diverse exercises from “table-top” to full-scale simulations in order to test and improve implementation of their national capacities. An after-action review to critically review outbreak response for systematic gaps was held in Morocco (brucellosis), with additional reviews planned for outbreaks in Pakistan (dengue) and Sudan (acute watery diarrhoea). The Region convened its sixth stakeholder meeting to review IHR implementation in December 2017, bringing together diverse national sectors and technical partners. This year the scope was expanded to global participation in light of the IHR’s tenth anniversary. Two national bridging workshops, effectively bringing together the JEE process and World Organisation for Animal Health (OIE) tool for evaluating the performance of veterinary services, were held in Jordan and Morocco to improve collaboration between the human and animal health sectors and identify and plan joint activities for inclusion within national action plans for health security.
WHO will continue to support countries to meet the requirements of the IHR by building and sustaining their capacities in all-hazards surveillance and response and providing support in monitoring their compliance with IHR, developing national action plans for health security, building capacity of their IHR focal points, mobilizing resources, fostering coordination and dialogue with partners, and getting support from other countries.
WHO Health Emergency Programme
Introduction
The Eastern Mediterranean Region is witnessing an unprecedented magnitude and scale of crises. Almost two thirds of countries in the Region are directly or indirectly affected by emergencies, including four countries (out of a total of six globally) experiencing major emergencies designated by WHO and the United Nations as Level 3: Iraq, Somalia, Syrian Arab Republic and Yemen. The Region also hosts countries witnessing protracted emergencies, including Afghanistan, Lebanon, Libya, Pakistan, Palestine and Sudan. Many of the remaining countries in the Region are affected by the crises in neighbouring countries.
WHO’s response
Increasing numbers of people in need of health services continue to challenge the capacity of WHO and health partners to respond. By the end of 2016, out of a total of 140 million people in need of health services globally, more than 76 million (54%) lived in the Region in countries directly or indirectly affected by emergencies. Ongoing insecurity and limited access by humanitarian workers to people in need continued to challenge WHO’s response. In Iraq, Syrian Arab Republic and Yemen, almost 30% of all people in need are living in hard-to-reach, inaccessible or opposition-controlled areas.
Attacks on health care in the Region continued relentlessly. In 2016, more than 252 attacks were reported from eight countries, accounting for 83% of all reported attacks globally. The Syrian Arab Republic remained the most dangerous country in the world for health workers, with almost 70% of all reported attacks globally.
Thousands of civilians sustain trauma injuries every month in the Region as a result of escalating conflict. In the Syrian Arab Republic alone, more than 25 000 people are injured every month and require trauma care. In Iraq, more than 3000 people were injured in the first 10 weeks following the launch of military operations in Mosul in October 2016.
The Region also bears the greatest burden of displaced populations, with more than 30 million displaced people across the Region. More than half of all refugees globally come from the Syrian Arab Republic, Somalia and Afghanistan. The Syrian Arab Republic accounts for the largest number of refugees and internally displaced persons, with more than 65% of the population displaced both inside the country and in neighbouring states.
Demand for health services by displaced populations continues to place a large burden on national health systems across the Region. The high cost of services, human resource shortages, insufficient medicines and equipment and economic deterioration are some of the many barriers facing refugees seeking health care.
The year 2016 marked the first time in several years that WHO was able to reach all 18 besieged areas in the Syrian Arab Republic. During the military operations in East Aleppo, WHO played a key role in negotiations with all parties to the conflict, and developed a comprehensive medical evacuation plan designed to save the lives of hundreds of wounded and critically ill patients trapped inside the city. 811 patients were successfully transported to hospitals in western Aleppo, Idleb and across-the border to Turkey.
WHO and partners supported a landmark national multi-antigen immunization campaign in the Syrian Arab Republic, taking place over three rounds in April, July and November 2016. The accelerated immunization campaign was the first opportunity for thousands of children living in many besieged and hard-to-reach areas to be immunized since the beginning of the conflict.
In Iraq, WHO supported the provision of trauma care for people affected by the Mosul crisis by establishing four trauma stabilization points and a field hospital near the front lines. As military operations continued, WHO-supported mobile medical clinics and mobile medical teams were sometimes the first to reach newly accessible areas to deliver health care services to thousands of people who had been cut off from aid since June 2014.
An attack on a Médecins Sans Frontières hospital in October 2015 in Kunduz, Afghanistan, required WHO and partners work to fill critical gaps to save lives in the conflict-affected province. In July 2016, WHO established a trauma care unit at Kunduz Regional Hospital to manage mass casualties and also supported the establishment of a physical and psychological rehabilitation centre at the hospital. From its opening in July until December 2016, more than 2400 patients were treated at the trauma care unit and surgeons conducted 1045 major and minor operations.
Two field hospitals procured with the support of WHO were established in priority locations in Libya where existing health facilities were no longer functioning. A field hospital in Benghazi helped fill critical gaps in a context where 10 out of the city’s 14 hospitals were non-functional. A second field hospital was established in the green mountain area, with a catchment population of more than half a million. Even in the most difficult circumstances in Libya, in 2016 WHO was able to conduct a national health assessment for the first time in four years. The assessment identified some significant needs, most significantly in Benghazi where more than 50% of all hospitals were non-functional.
In April, WHO initiated a comprehensive assessment in Somalia focusing on approximately 1074 public health facilities across the country. This health facility assessment was the first of its kind to be conducted in Somalia by health authorities and partners. In December, a cholera outbreak in the Middle Shebelle region of Somalia was contained and the number of cases declined as a result of strong coordination between health partners, a successful public information and prevention campaign and training conducted for health workers. The surveillance data helped the country to monitor transmission, as well as take appropriate control measures in the hotspots. Samples were sent to Somalia’s first-ever national laboratory, established in 2016 with support from WHO, and which significantly reduced waiting times for results.
Emerging infectious diseases
Emerging infectious diseases, including the outbreaks in recent years, occurred in security-compromised countries with complex and protracted humanitarian emergencies where large populations are internally displaced and there is inadequate access to clean water, sanitation and basic health services. Surveillance systems in fragile health systems may not be able to detect all health threats in a timely manner. This compromises the effectiveness of public health response measures and makes populations more vulnerable to infectious diseases. The potential for Zika spreading into the Region remains a real concern. Additionally, as the population has no immunity to this new virus, preparedness measures need to be continued to prevent any introduction.
Cholera outbreaks in Yemen and Somalia were effectively responded to through appropriate public health interventions which helped to avert major international spread. The Early Warning Alert and Response Network in Iraq demonstrated its flexibility by rapidly expanding to address a large number of displaced populations from Mosul, following escalation of military activities in September 2016.
Surveillance systems for influenza-like illness and severe acute respiratory infections in 16 countries aided detection and response to epidemic influenza and other acute respiratory infections in the Region. Technical missions were conducted to enhance preparedness and response capacities in Saudi Arabia for MERS-CoV, and in Egypt, Pakistan and Sudan for Zika virus infection.
The Global Outbreak Alert and Response Network (GOARN) was expanded in the Region to include new international partners together with a pool of regional experts for responding to infectious disease outbreaks and other health emergencies. National rapid response teams were trained in Saudi Arabia and Somalia for deployment across the country to manage outbreak detection, response and containment. In order to enhance readiness for international outbreak response a pool of public health experts received training on field investigation and response to public health emergencies as part GOARN activities in the Region. The Regional Office supported Saudi Arabia with public health preparedness measures by deploying a team of experts who provided necessary advice for preventing any major health emergency during the hajj.
Five countries (Jordan, Somalia, Sudan, Syrian Arab Republic and Yemen) received technical support in developing comprehensive cholera preparedness and response plans that promote integrated prevention and control interventions. As part of such cholera elimination plan, an oral cholera vaccination campaign was conducted in the White Nile State in Sudan targeting refugees and host communities in order to prevent the spread of cholera among refugees fleeing South Sudan.
Under the Pandemic Influenza Preparedness Framework and as part of Regional Office’s work in pandemic influenza preparedness, epidemiological and virological surveillance for influenza-like illness and severe acute respiratory infections were enhanced in 16 countries. A web-based interactive platform, Eastern Mediterranean Flu Network, was deployed for countries to share epidemiological and virological data on influenza regularly.
Since the declaration on 1 February 2016 that the clusters of microcephaly thought to be associated with Zika virus constituted a public health emergency of international concern, WHO rapidly scaled up preparedness and readiness measures to prevent introduction of the Zika virus into the Region. The Regional Office developed a regional preparedness plan for Zika virus in collaboration with countries. As part of the plan, systematic risk assessments were conducted in the Region, entomological surveillance for competent vectors was strengthened in all high-risk countries, appropriate risk communication materials were developed and disseminated and a group of health managers was trained on roles and responsibilities in an incident command system, an important response mechanism during health emergencies.
Preparedness
Additional challenges remain related to building and enhancing national preparedness and disaster risk reduction. National public health plans for preparedness and response to all hazards and national assessment of potential hazards in countries of the Region are mostly lacking. Several activities were conducted to enhance national capacities for disaster risk reduction based on the Sendai Framework; yet, more needs to be done. Major mass gatherings in the Region require enhanced action by WHO and health partners in the areas of evidence-based planning for all public health emergencies and scaling up national capacities to respond to acute health needs during these events.
Developing and costing national plans of action for health security based on the outcomes of the joint external evaluation of IHR capacities requires the involvement of all relevant national stakeholders, including civil society and the private sector, and the positioning of responsibility for health security at the highest levels of authority to ensure implementation of the plans. Aligning national plans for health security with other existing plans and mobilizing domestic and external resources to fund and implement these plans remain key challenges.
Donor support for the regional health emergency programme continues to be weak. In 2016, WHO appeals for the Region were 39% funded, with US$ 164 million received out of US$ 425 million requested. Restricted access to affected populations because of high levels of ongoing conflict and violence remains a significant impediment to increased donor support.
Between April and December 2016, WHO and partners supported 10 countries in the Region to conduct joint external evaluations of IHR capacities: Afghanistan, Bahrain, Jordan, Lebanon, Morocco, Pakistan, Qatar, Somalia, Sudan and Tunisia. Plans to support the remaining countries to conduct the evaluations are ongoing. Support was given to Pakistan and Jordan to develop and cost their national action plan for health security based on the outcomes of the joint external evaluation. Discussion with partners is ongoing to coordinate the support to the rest of the countries that conducted the evaluations to develop and cost their plans of action.
The new IHR monitoring and evaluation framework was introduced to countries through a regional meeting with focus on the joint external evaluations and on ways to improve how they are conducted in countries. The Regional Office led the global efforts to develop guidance on conducting the joint external evaluation in crisis countries. The guidance will be pilot tested in Iraq and Libya as a first step for conducting the evaluations in these countries.
The first phase of an all-hazard risk assessment was successfully carried out in priority provinces in Afghanistan in 2016 to support operational planning for emergency response. The second phase is expected to take place in 2017. The Regional Office hosted the first workshop on the Capacity for Disaster Reduction Initiative, aimed to enhance the capacity of partners to support the implementation of the Sendai Framework for Disaster Risk Reduction. The workshop was attended by representatives of the Food and Agriculture Organization of the United Nations, the World Food Programme, the United Nations Office for the Coordination of Humanitarian Affairs, the United Nations Development Programme and by WHO regional and country office staff.
To scale up emergency preparedness, training was organized for emergency focal points in countries of the Region, in partnership with the Asian Disaster Preparedness Center, Johns Hopkins University and the Centers for Disease Control and Prevention (CDC), Atlanta, to enhance multisectoral leadership and coordination in responding to all-hazard public health emergencies. WHO worked closely with the Inter-Agency Standing Committee to assess readiness capacity of country offices to respond to priority hazards. Assessments were conducted in Sudan and Somalia in 2016, and action plans were developed aligning the outcomes of the joint external evaluation missions and country capacity assessments for emergency preparedness.
To enhance the capacity of countries to cope with the additional demand on health services resulting from hosting refugees and migrants, a working group from all concerned international and regional organizations and academic institutions is currently under development. WHO and the International Organization for Migration will be the secretariat for this working group. The working group will aim at supporting countries in the Middle East and North Africa to operationalize and implement the strategic, global and regional priorities and framework on migrant health.
Overview
Girls and boys for change: Tobacco control now
WHO has selected “Women and tobacco use” as the theme for World No Tobacco Day 2010 to:
highlight this serious, growing problem throughout the world
emphasize the increasing use of non-cigarette forms of tobacco, such as shisha and smokeless tobacco among women
stress how women are being increasingly targeted by tobacco companies
draw attention to the alarm expressed in the WHO Framework Convention on Tobacco Control (FCTC) at "the increase in smoking and other forms of tobacco consumption by women and young girls worldwide".
Tobacco is the only legal consumer product that kills when used exactly as intended by the manufacturer. World No Tobacco Day will help to save more lives and to limit the damage caused by tobacco use.
The key messages of this year’s World No Tobacco Day are:
All of us have a responsibility to prevent the tobacco epidemic from becoming as bad among women as among men.
Women have a right to be protected from the harms of tobacco use through measures called for in the WHO FCTC.
All countries have a moral obligation to ratify and fully implement the WHO FCTC to save lives.
Surveillance is the ongoing systematic collection, analysis, and interpretation of outcome specific data for use in planning, implementing and evaluating public health policies and practices. A communicable disease surveillance system serves two key functions; early warning of potential threats to public health and programme monitoring functions which may be disease-specific or multi-disease in nature.
The availability of high quality data on health systems is crucial for informing policy development, monitoring performance, allocating resources efficiently, and ensuring proper functioning of the health system within national policy and regulatory frameworks.
Information about population health and health risks is a cornerstone of preventing disease and disability. It enables evidence-informed planning and evaluation of health policies and preventive activities. Health and health risks, which predict future health, are key issues for people's welfare, mainatining a fit-for-purpose workforce while minimizing the need for health care for the ageing population. Surveys provide critical information from other sectors such as poverty programmes, education, water and sanitation, living conditions, nutrition, air quality and security.
