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      Strengthening global health security by embedding the International Health Regulations requirements into national health systems


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          The International Health Regulations (IHR) 2005, as the overarching instrument for global health security, are designed to prevent and cope with major international public health threats. But poor implementation in countries hampers their effectiveness. In the wake of a number of major international health crises, such as the 2014 Ebola and 2016 Zika outbreaks, and the findings of a number of high-level assessments of the global response to these crises, it has become clear that there is a need for more joined-up thinking between health system strengthening activities and health security efforts for prevention, alert and response. WHO is working directly with its Member States to promote this approach, more specifically around how to better embed the IHR (2005) core capacities into the main health system functions. This paper looks at how and where the intersections between the IHR and the health system can be best leveraged towards developing greater health system resilience. This merging of approaches is a key component in pursuit of Universal Health Coverage and strengthened global health security as two mutually reinforcing agendas.

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          Governance challenges in global health.

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            The link between the West African Ebola outbreak and health systems in Guinea, Liberia and Sierra Leone: a systematic review

            Background An Ebola outbreak started in December 2013 in Guinea and spread to Liberia and Sierra Leone in 2014. The health systems in place in the three countries lacked the infrastructure and the preparation to respond to the outbreak quickly and the World Health Organisation (WHO) declared a public health emergency of international concern on August 8 2014. Objective The aim of this study was to determine the effects of health systems’ organisation and performance on the West African Ebola outbreak in Guinea, Liberia and Sierra Leone and lessons learned. The WHO health system building blocks were used to evaluate the performance of the health systems in these countries. Methods A systematic review of articles published from inception until July 2015 was conducted following the PRISMA guidelines. Electronic databases including Medline, Embase, Global Health, and the Cochrane library were searched for relevant literature. Grey literature was also searched through Google Scholar and Scopus. Articles were exported and selected based on a set of inclusion and exclusion criteria. Data was then extracted into a spreadsheet and a descriptive analysis was performed. Each study was critically appraised using the Crowe Critical Appraisal Tool. The review was supplemented with expert interviews where participants were identified from reference lists and using the snowball method. Findings Thirteen articles were included in the study and six experts from different organisations were interviewed. Findings were analysed based on the WHO health system building blocks. Shortage of health workforce had an important effect on the control of Ebola but also suffered the most from the outbreak. This was followed by information and research, medical products and technologies, health financing and leadership and governance. Poor surveillance and lack of proper communication also contributed to the outbreak. Lack of available funds jeopardised payments and purchase of essential resources and medicines. Leadership and governance had least findings but an overarching consensus that they would have helped prompt response, adequate coordination and management of resources. Conclusion Ensuring an adequate and efficient health workforce is of the utmost importance to ensure a strong health system and a quick response to new outbreaks. Adequate service delivery results from a collective success of the other blocks. Health financing and its management is crucial to ensure availability of medical products, fund payments to staff and purchase necessary equipment. However, leadership and governance needs to be rigorously explored on their main defects to control the outbreak.
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              All roads lead to universal health coverage


                Author and article information

                BMJ Glob Health
                BMJ Glob Health
                BMJ Global Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                20 January 2018
                : 3
                : Suppl 1
                : e000656
                [1 ] departmentHealth Systems and Public Health , World Health Organization Regional Office for Europe , Copenhagen, Denmark
                [2 ] Preventive Medicine and Public Health and University Clinical Hospital INCLIVA, University of Valencia , Valencia, Spain
                [3 ] departmentCommunicable Diseases and Health Security , World Health Organization Regional Office for Europe , Copenhagen, Denmark
                [4 ] departmentCountry Health Emergency Preparedness and IHR , World Health Organization , Geneva, Switzerland
                [5 ] departmentService Delivery and Safety , World Health Organization , Geneva, Switzerland
                [6 ] World Health Organisation Representative , Moscow, Russian Federation
                [7 ] departmentHealth Systems and Public Health , World Health Organization Regional Office for Europe , Copenhagen, Denmark
                Author notes
                [Correspondence to ] Dr Govin Permanand; permanandg@ 123456who.int
                ©World Health Organization [2018]. Licensee BMJ.

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial IGO License (CC BY-NC 3.0 IGO), which permits use, distribution, and reproduction for non-commercial purposes in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL. See: https://creativecommons.org/licenses/by-nc/3.0/igo

                : 23 November 2017
                : 18 December 2017
                : 19 December 2017
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                health policies and all other topics,public health,health systems


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