Inexpensive, readily available treatment for fungal keratitis shows promise in Africa

Dr Abel Ebong, one of the registrars at Mbarara University tertiary eye hospital in Uganda administers Chlorhexidine eye drops to a patient with Fungal Keratitis

A new treatment option for a potentially blinding disease has shown promise in a sub-study in Uganda.

Keratitis is an inflammation of the clear tissue at the front of the eye, known as the cornea. When caused by a fungal infection, it can be extremely painful and can even lead to the loss of an eye. Globally, the incidence of fungal keratitis (FK) is estimated to be more than one million cases per year, representing a significant public health concern when potential blindness is taken into account.  It is particularly common in lower-income countries and amongst manual labourers such as farmers who are prone to damaging their eye, leading to infection.

The current standard treatment for FK is the antifungal natamycin, delivered in eyedrops. However, the drug is not effective in all cases, with some on treatment progressing further towards blindness. Additionally, natamycin is not readily available in many countries in sub-Saharan Africa and is relatively expensive.

A research team led by the Mbarara University of Science and Technology in Uganda and the International Centre for Eye Health decided to investigate a different treatment, chlorhexidine gluconate, as part of a wider study on the disease. The sub-study followed pilot trials in South Asia which suggested that chlorhexidine could be equally or more effective than natamycin. It was also known that in Uganda, the majority of keratitis cases are caused by fungi, and the outcomes for fungal infections are more likely to be worse.

Participants in the original keratitis study who were not responding to natamycin (5%) were given an additional treatment with topical chlorhexidine (0.2%). Following up with the patients, 75% of those who had been deteriorating on natamycin alone showed signs of responding after receiving chlorhexidine, with ulcers caused by the infections healing and inflammation subsiding. Whilst a small case series, the results show that chlorhexidine could be a viable further option for patients with these infections who are not responding to treatment. Additionally, the chlorhexidine used in the study was 15 times cheaper than natamycin, making it a practical option which warrants further investigation. With few current available FK treatments, further research following this study has the potential to improve care for FK patients.

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Multisectoral Governance for Reproductive Health: Challenges and Lessons from the Philippines

By Vanessa T. Siy Van (Health Sciences Program, Ateneo de Manila University) and Jhanna Uy (Research Department, Philippine Institute for Development Studies; Health Sciences Program, Ateneo de Manila University)

What is Multisectoral Governance?

Since the twentieth century, governments have recognized that health is as much a product of social, economic, and political conditions as it is of health system performance. Many of these determinants fall outside the purview of health programs, and thus improving health requires multisectoral action. In the case of reproductive health (RH), multisectoral action is instrumental to not only improving indicators such as maternal and child mortality, but also empowering individuals and the sustainable growth of populations, human capital, and economies. However, governing multisectoral action has historically been difficult, especially in low-and-middle-income countries (LMICs) because of weak public administration, chronic underfunding, and limited skilled human resources. While laws are usually deemed the most formal and binding form of policy, many LMICs struggle with obtaining the commitment of non-health sector leaders to commit and operationalize policy implementation in their spheres. Such has been the case for the Philippines, where we found that even with a policy-neutral, rights-based national law, the interest and buy-in of non-health state actors cannot be assumed. The case presents lessons for implementing multisectoral policies, as the presence of policy may not always translate into practice.

Philippines’ Reproductive Health Law

The Philippines is a unitary democratic LMIC where legislation and priority-setting are done at the national level, and social services are decentralized to regional offices and delivered by local government units (LGUs). The Responsible Parenthood and Reproductive Health (RPRH) Law of 2012 was passed in this context after decades of opposition and public debate. Immediately after passage, the RPRH Law’s enactment was delayed twice by the judiciary. Only after concerted efforts by national government agencies (NGAs), civil-society organizations (CSOs), and multilaterals, restrictions were lifted in 2017. Despite these challenges, the law remains one of few national RH policies in Southeast Asia and is celebrated for its explicit call for collaboration among health, education, economic, and social welfare sectors. However, nearly a decade later, the landmark legislation did not translate into significant improvements in RH outcomes: maternal mortality is twice that of the target set by the Sustainable Development Goals; Philippine HIV incidence is one of the fastest-growing in the region; and in 2020, a-third of Filipino children were stunted.

Challenges of Putting Policy into Practice

Through semi-structured interviews with national RPRH implementers, we examined national multisectoral governance practices and identified intersectoral coordination challenges. These were supported with document reviews and meeting transcripts of the RPRH National Implementation Team (NIT), composed of government agencies, CSOs, and multilaterals.

Our analysis found three main themes over seven years of RPRH operations:

1.National leaders, particularly the health sector, were unable to rally non-health sector actors around RPRH.

  • Despite a lack of conflicts in sector objectives, there were no concrete strategies and operational plans for integrated RPRH service delivery across sectors.
  • Most NGAs did not make formal changes to their organizational structures for RPRH activities, dedicate funds for RPRH, or develop intra-agency policies to institutionalize RPRH, causing delays in program implementation.
  • The NIT’s Planning, Monitoring, and Evaluation Guide was developed in 2015 after implementation had already begun. The guide does not prescribe concrete targets and meeting mandates are left to the discretion of individual organizations.
  • Multisectoral collaboration was hindered by pressure to preserve each agency’s image and NGAs’ frequent leadership and priority changes.

2.NGAs channel multiple paternalistic directives for RPRH down to smaller subnational units with larger burden for implementation but limited human resources.

  • In the Philippines’ decentralized government, one LGU is expected to implement multiple parallel programs from over a dozen NGAs.
  • Poorer LGUs must forgo some programs and responsibilities or be reliant on NGA resources for RPRH, which themselves are not stable.
  • Due to their legal autonomy, LGUs have only weak accountability to national and regional offices; LGUs are also unrepresented in the NIT.

3.CSOs were important partners in implementation, but failure to manage their expectations and conflicts of interest decreased the effectiveness of the NIT as a platform for multisectoral governance.

  • Given variability of LGU performance, CSOs were invaluable local implementation partners.
  • However, CSOs had private, community-level interests that occasionally put them at odds with national priorities, making NIT unconducive for coordination.

Lessons for the Future

The absence of multi-agency plans, targets, and accountability systems fostered a culture of siloed opportunism. Local resource limitations associated with decentralization were exacerbated by paternalistic financing, coordination, and monitoring. Conflicts in interests and perspectives between state and civil-society actors went unmanaged. Future policy responses built on these system failures, as opposed to first addressing them, will contribute to inconsiderable gains in RH over the next decade. Formal legal policies alone are insufficient to institutionalize whole-of-government action. Advocacy and intersectoral discourse can bridge sectors’ understanding of the scope and depth of the problem, in line with WHO’s recommendations to make health equity a government-wide indicator for national development.


Image credit: Wayne S. Grazio

Universal health coverage policies may fail to ensure the provision of primary care for all without a stronger commitment to community health

By Andres Garchitorena (Institut de Recherche pour le Developpement and NGO PIVOT), Felana A. Ihantamalala (Harvard Medical School and NGO PIVOT), and Matthew H. Bonds (Harvard Medical School and NGO PIVOT).

Background

Nearly half of the world’s population lacks access to essential health services. To address this, most countries have committed to Universal Health Coverage (UHC), with the goal of ensuring the provision of primary health services that are “high quality, safe, comprehensive, integrated, accessible, available, and affordable for everyone everywhere”. Accordingly, UHC policies focus on reducing user fees at health facilities via fee exemptions or national health insurances, and on improving the quality of primary care through health systems strengthening. In practice, ensuring that health systems are capable of reaching everyone is both a design and a data problem. Health systems, after all, lack information on those who do not already access them, and a key determinant of that access is geography: many populations in rural areas of low- and middle-income countries need to walk several hours to consult at a health facility when they need care.

So we ask, how can health policies such as UHC be better designed to achieve universal access to primary health care? How can these information gaps be filled so that health systems are optimized to meet population needs?

To address these issues, the nongovernmental health organization, Pivot, recently partnered with the government of Madagascar to create a model of Universal of Health Coverage in the remote district of Ifanadiana.  This program includes many of the elements encouraged for national UHC policies, such as removal of user fees at health facilities, and improvements to healthcare quality via support to health system readiness and to clinical programs. It also strengthened the local community health program. These programs, which have evolved over time, have been integrated from the beginning with a unique dataset of geocoded patient records encompassing all health center visits in the district over the first four years (nearly 300,000 consultations), along with a vast geographic information system that maps over 20,000km of footpath, 100,000 houses, and every health facility. The result of the analysis of these data are published in our recent study “Geographic barriers to achieving universal health coverage: evidence from rural Madagascar”, which examined the contribution and limitations of policies for UHC and community health towards the realization of universal access to primary health care.

What did we find?

We found that the geographic reach of facility-based primary care is quite limited, even after fees are removed at the point of service and quality of services are improved. Half of all consultations in strengthened facilities were from patients who lived within 2 km. Those that lived within 5 km of a strengthened facility experienced substantial increases in utilization – exceeding 1 visit per person-year. But those who lived more than 5km from a strengthened facility accessed care less frequently than those who live near facilities which were never strengthened at all. Importantly for rural Madagascar and many other similar settings, most of the population (75%) lives more than 5km from a health facility. Using results from our statistical models, we predict that scaling up facility-based interventions alone (removing user fees, improving health system readiness), would only achieve modest increases in geographic coverage, with three quarters of the population consulting at facilities less than once per person-year.

However, there are solutions: strengthening community-health can have substantial impacts on the geographic reach of the health system. Community health workers (CHWs) are trained to provide a small subset of clinical services within their community, such as diagnose and treat common illnesses in children under five years. In Madagascar, there are two CHWs for each fokontany (a village or small group of villages), so even remote populations live in close proximity to a CHW. The effect of geography on primary care access in Ifanadiana was greatly reduced when accounting for community health consultations, reaching over 2 consultations per child-year regardless of distance to a health facility. CHWs were the main source of health care delivery for children in remote populations, representing 90% of primary care visits for those living further than 15 km from a health facility. Yet, less than 20% of the district population are part of the target age of CHWs (children under five years), leaving the vast majority of the population in remote areas with virtually no access to care. Further, community health programs are still under-resourced in many countries, where CHWs are considered local volunteers, are poorly compensated, and lack dedicated supervision and adequate training.

What does this mean?

These analyses show how powerful insights arise when comprehensive health reform occurs alongside data systems that are built to shed light on the complexity and heterogeneity of many global health challenges, and are tied to specific policy goals that are actionable. For Madagascar and similar low-income countries, wider support to community health is necessary to achieve universal access to primary care. In response to this evidence, Pivot has piloted a new program with the government of Madagascar to further strengthen the role of community health. In this new program, CHWs proactively visit every household at least once per month, receive biweekly direct supervision and training, and are paid the national minimum wage. This is in line with the recently updated World Health Organization guidelines on community health worker programs, which advise that CHWs should be professionalized – i.e., paid, trained and directly supervised. Yet most countries have not yet adopted policies based on these new guidelines. Our results provide the best evidence to date of the substantial gaps in care that will persist until public health systems adequately integrate professional community health programs. Though there remains debate on how to optimize community health, a greater ability for populations everywhere to access the formal health system is clearly fundamental to any hopes of achieving UHC. And we need the right data to identify who is missing. Professionalized CHWs can contribute to both the clinical and data gaps if they could further expand the scope of primary care services across a greater range of clinical cases and demographic groups.


N.B. Some authors are current or former employees of institutions discussed in this article, including the NGO PIVOT.

Image credit: NGO Pivot

Health Policy and Planning’s Top 10 Articles Contributing to the 2020 Impact Factor

By Natasha Salaria (London School of Hygiene & Tropical Medicine)

The 2020 impact factors are now out as of this month and what a year it has been. We are pleased to announce we have seen an increase in our impact factor which has gone up to 3.344 with our 5-year impact factor coming in at 3.902. This keeps us in Quartile 1 of the Health Policy and Services category (19th out of 88 journals).

As we are all aware, the usage of impact factors is widely contested as a means of assessing journal impact, and we at the London School of Hygiene & Tropical Medicine have signed the Declaration on Research Assessment (DORA) which recognises the need to improve how research is assessed. However it is undeniably still widely recognised by authors, publishers, libraries and academic departments as an indicator of citation rates to journal articles.

After delving into some of the citation data, we would like to share our top 10 most highly cited articles that contributed to the 2020 impact factor in Health Policy and Planning:

  1. Original article: Disrespectful and abusive treatment during facility delivery in Tanzania: a facility and community survey
  2. Original article: The cost of not breastfeeding: global results from a new tool
  3. JOINT 3RD
    – Review: The impact of cash transfers on social determinants of health and health inequalities in sub-Saharan Africa: a systematic review
    – Review: Integrated mental health services in China: challenges and planning for the future
  4. Original article: How do external donors influence national health policy processes? Experiences of domestic policy actors in Cambodia and Pakistan
  5. JOINT 5TH:
    – Original article: Towards an understanding of resilience: responding to health systems shocks
    – 10 best resources: 10 best resources on power in health policy and systems in low- and middle-income countries
    – Review: The silencing of political context in health research in Ethiopia: why it should be a concern
  6. Original article: Mental health system costs, resources and constraints in South Africa: a national survey
  7. Original article: Jeopardizing quality at the frontline of healthcare: prevalence and risk factors for disrespect and abuse during facility-based childbirth in Ethiopia
  8. JOINT 8th:
    – Review: Community health volunteers could help improve access to and use of essential health services by communities in LMICs: an umbrella review
    – Original article: Priority setting for health in the context of devolution in Kenya: implications for health equity and community-based primary care
    – Original article: The investment case for hepatitis B and C in South Africa: adaptation and innovation in policy analysis for disease program scale-up
  9. Original article: Dissatisfaction with current integration reforms of health insurance schemes in China: are they a success and what matters?
  10. Original article: Strengthening mental health system governance in six low-and middle-income countries in Africa and south Asia: challenges, needs and potential strategies
Contributions by country/region Count Contributions by organizations Count
UNIVERSITY OF LONDON 50 USA 104
LONDON SCHOOL OF HYGIENE TROPICAL MEDICINE 44 ENGLAND 73
HARVARD UNIVERSITY 27 SOUTH AFRICA 26
JOHNS HOPKINS UNIVERSITY 15 CANADA 23
UNIVERSITY OF CALIFORNIA 13 AUSTRALIA 22
UNIVERSITY OF CAPE TOWN 11 SWITZERLAND 18
WORLD HEALTH ORGANIZATION 11 KENYA 14
MAKERERE UNIVERSITY 9 INDIA 13
RUPRECHT KARLS UNIVERSITY HEIDELBERG 8 TANZANIA 11
UNIVERSITY OF SYDNEY 8 GERMANY 10

*These data summarize the top 10 countries/institutions for papers published in 2018 and 2019 i.e. the impact factor window. The ‘record count’ values mean that at least one author listed on any paper is affiliated with the named institution or is from the listed country. It is meant to be descriptive rather than comparative.

Our top 10 contributions by organizations include high performing higher education institutions such as Johns Hopkins, Harvard University, University of Cape Town, University of Makerere and the World Health Organization.

The journal has wide reach and publishes papers from authors in over 75 countries, many from low- and middle-income countries who are able to utilise our reduced rate or free access countries list.

In 2020, our blog audience included readers from Kenya, India, UK, USA, South Africa, Nigeria, Myanmar, Ghana, Australia and Brazil.

Altmetric

Altmetric is an alternative metric to the impact factor, used to demonstrate engagement with journals on an individual article level. Altmetric collects data on universal popularity and uptake, including within policy documents to show how research has influenced health policy as well as media outlets and social media platform discussions.

There have been 61 policy documents including out content by 12 unique policy sources in 8 countries including policy documents in the World Bank, the National Institute for Health and Care Excellence, Food and Agriculture Organization of the United Nations and the World Health Organization.

Here are the Top 10 articles from 2020 with the highest Altmetric score published in Health Policy and Planning:

  1. Commentary: Tuberculosis control and care in the era of COVID-19
  2. Commentary: What role can health policy and systems research play in supporting responses to COVID-19 that strengthen socially just health systems?
  3. Original article: Providers’ perceptions of disrespect and abuse during childbirth: a mixed-methods study in Kenya
  4. Original article: The state of diet-related NCD policies in Afghanistan, Bangladesh, Nepal, Pakistan, Tunisia and Vietnam: a comparative assessment that introduces a ‘policy cube’ approach
  5. Review: Social values and health systems in health policy and systems research: a mixed-method systematic review and evidence map
  6. Commentary: Climate change: an urgent priority for health policy and systems research
  7. Original article: Intersectoral (in)activity: towards an understanding of public sector department links between water, sanitation and hygiene (WASH) and childhood undernutrition in South Africa
  8. Methodological Musing: Document analysis in health policy research: the READ approach
  9. Review: Health system resilience: a literature review of empirical research
  10. Original article: Applying a complex adaptive systems approach to the evaluation of a school-based intervention for intimate partner violence prevention in Mexico

Don’t forget to check out our latest outputs including:

  • [RESEARCH COLLECTION] Evidence to inform the COVID-19 Response
  • [PODCASTS]
    – To Bend without Breaking: A Qualitative Study on Leadership by Doctors in Sierra Leone
    – Effectiveness of containment and closure policies across income levels during the COVID-19 pandemic
    – Impact of campaign-style delivery of routine vaccines using routine health services data in India
  • [SUPPLEMENTS] Watch this space for a 2021 supplement publishing in November in collaboration with Health Systems Global
  • [EDITOR’S CHOICE ARTICLES]
  • [NEW INNOVATION & PRACTICE REPORTS GUIDELINES]
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Current approaches to COVID-19 emergency response planning: scope to promote health systems resilience and reduce avoidable death and illness

By Saqif Mustafa (World Health Organization), Yu Zhang (World Health Organization), Zandile Zibwowa (World Health Organization), Redda Seifeldin (World Health Organization), Louis Ako-Egbe (World Health Organization Country Office, Monrovia, Liberia), Geraldine McDarby (World Health Organization), Edward Kelley (World Health Organization), Sohel Saikat (World Health Organization)

COVID-19 has been with us for over a year and a half now and despite some evidence of service restoration, profound disruptions to essential health services persist globally. Health systems resilience – the ability to effectively respond to shocks while maintaining routine and core functions, and adapting to evolving threats – is critical to maintaining progress and ensuring sustained universal health coverage and health security. Building resilient health systems requires an integrated approach to health sector planning and utilising lessons learned from past and ongoing events.

During and after the 2014-16 Ebola Virus Disease outbreaks in West Africa, health systems resilience became ubiquitous. There was widespread acknowledgement that the indirect effects of Ebola on health and health systems were greater than the devastating direct impact of Ebola on morbidity and mortality (e.g. an additional 11,000 malaria, HIV/AIDS and tuberculosis deaths alone). The indirect impact of COVID-19 on excess morbidity and mortality is still being counted and emerging evidence suggests the total exact toll could be huge.

Despite numerous calls to build health systems resilience to major crises such as infectious disease outbreaks and pandemics, an integrated approach to strengthening health systems globally and nationally has been limited. By an integrated approach, we mean the coming together, participation and joint working of those actors responsible for health security, humanitarian, and disease- and life-course-specific programmes as well as those working on strengthening the building blocks of the health system (e.g. governance, health financing, health workforce, essential health products, health information systems and service delivery). Past emergencies have revealed a cycle of ‘panic and neglect’ and limited ability to deploy a whole-of-government and whole-of-society approach with health in all policies. COVID-19 has again exposed these gaps and prevailing fragmentations in efforts to strengthen health systems. It is within this context that we reviewed COVID-19 preparedness and response plans from 106 countries in our recent Health Policy and Planning article.

There are a few critical considerations that should be highlighted from this study that can inform ongoing and future policy and operational planning:

  1. There is scope to better embed considerations for maintaining routine health systems functionality in emergency planning

We found that 47% of COVID-19 preparedness and response plans (CPRPs) considered the maintenance of non-COVID-19 essential health services. During an emergency, the predominant focus of decision makers is invariably on the crisis itself. Therefore, prior to the occurrence of an emergency, health sector and health emergency planning should establish the structures and platforms needed for joint working and active involvement of those responsible for health security, humanitarian, disease- and life-course-specific programmes, health systems strengthening, and universal health coverage; and crucially maintain inter- and multi-sectoral working in all contexts.

  1. Better integration can provide added value

By integrating efforts across health security, humanitarian and disease- and life-course-specific programmes and investing in health systems so they are able to tackle multiple and diverse threats, this can save costs, provide greater efficiency, enable accountability and build trust. This is especially important given the impact of COVID-19 on the economy globally and dwindling development assistance and external funding for health.

  1. Guidance from the WHO and UN is well adopted in country level policy and planning

The WHO and broader UN system developed and continues to develop and update guidance as the evidence base evolves at an unprecedented rate. Overall, our findings indicate good alignment of national plans with the global planning guidance. This consistency observed during the course of COVID-19 response can be harnessed and extended during the health systems recovery process as well as in routine health systems planning for achieving universal health coverage and health security as interdependent objectives.

  1. Countries across all income groups had disruption in maintaining essential health services

There is no clear trend between specific country income groups and planning considerations for the maintenance of essential health services. This aligns with the widespread service disruptions observed including in high-income countries that were ranked top for health systems performance in terms of universal health coverage and health security scores. The political and governance context, ability to rapidly deploy whole-of-government and whole-of-society resources, extent of investment (or disinvestment) in essential public health functions, and establishing linkages between public health activities and clinical care are likely factors that contribute to better health systems resilience.

  1. COVID-19 is a once-in-a-generation opportunity for integrated health system strengthening

Our study provides evidence on the current state of integration in planning between emergency preparedness and response activities and broader, routine health systems functions which can inform the building of more integrated, resilient health systems for ongoing and future threats. As COVID-19 vaccines are deployed, health systems are now transitioning from a predominant focus on acute response to a combination of tackling smaller outbreaks, variants of concern and recovery of routine and essential health services. The pandemic has brought about unprecedented global media, political and investment attention on health systems strengthening for both health security and universal health coverage objectives. Health sector decision makers should continually appraise their health systems performance from policy and planning to operational levels, and leverage the attention and investments brought about by COVID-19 to build back better, more integrated and resilient health systems.


Article: COVID-19 Preparedness and Response Plans from 106 countries: a review from a health systems resilience perspective

Photo credit: WHO / Andre Rugema

Barnard 3.0 – Updating the library collection: a look at the pamphlets

With the update to the Barnard Classification Scheme completed, thousands of physical items in the library collection have had classmarks changed. Updating items on the records management system and the physical items in the main collection, the basement and the pamphlet collection in the gallery. Rather the large and daunting endeavour!

Up in the Gallery : The Library’s pamphlet collection

The pamphlet collection, located upstairs in the gallery, is perhaps an often-overlooked part of the library collection, covering a wide range of the school’s research and teaching areas, some of the items can only be found in the LSHTM Library. There are thousands of items, and when searching for physical items on Discover, if the item listed has the location ‘Gallery’, it is a part of the Library’s pamphlet collection. Many students perhaps don’t realize this when looking for items and don’t even thing to look upstairs!

An example of a record on Discover of an item found in the pamphlet collection: Gallery is listed as the location.

The pamphlet collection includes a large number of items which provide a snapshot of public health at the time, historical items on a variety of topics, including government documents, newspaper and magazine articles, academic papers and awareness pamphlets for campaigns, and so much more. Many items have been bound together providing collective works on a particular area. So if you were looking at an area such as water hygiene, you can find a huge amount of more material you have easily overlooked.

A sample of the historical bounded items held on Water Hygiene in the pamphlet collection.

For years many of the items were not on the library management system, so after helping to catalogue the items, the idea of going through a long list of pamphlets and updating classmarks was perhaps not the most joyous!

The pamphlets cover a wide range of subject areas, from whooping cough to women in Norway.

For me anyway, perhaps because I helped catalogue many of the items, one of the more interesting things about the pamphlet collection is the variety of cover art, fonts used and graphic design. The more interesting items tend to be the ones for public consumption. Items used as advertising booklets or awareness campaigns for a particular illness or disease, which tend to use more bold images and can be rather artful and eye catching.

Materials provide a snapshot of the thinking and research of the time.  The covers also provide examples of popular graphic design from the periods.

2021 Broadsheet now available to read

We had to wait a year, but the 2021 broadsheet is now available and as always packed with stories from around the world about John Snow and the society. Enjoy the read

https://johnsnowsociety.org/files/2021/08/Broad-Sheet-2021-final.pdf

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2021 Tony Fauci – COVID-19: Lessons Learned and Remaining Challenges

The John Snow Society Annual Pumphandle Lecture was given by Dr Anthony Fauci, Director of the U.S. National Institute of Allergy and Infectious Diseases (NIAID).

The recording can be found here

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United Nations Resolution Passes First Resolution to Tackle Preventable Sight Loss

The International Centre for Eye Health (ICEH) at the London School of Hygiene & Tropical Medicine joins the eye health community in celebrating the passing of the first United Nations resolution on preventable sight loss. All 193 countries of the United Nations General Assembly (UNGA) unanimously adopted the resolution today, which sets eye health goals for members to achieve by 2030.

The resolution follows the publication of the Lancet Global Health Commission on Global Eye Health in February 2021, which highlighted that there are 1.1 billion people living with preventable sight loss worldwide. It also showed that improving eye health is essential to the United Nations’ Sustainable Development goals (SDGs). This latest resolution recognises the effect of reduced eye health on many of the major SDGs, including those pertaining to poverty, employment and sustainability, and also calls on targets for eye care to be included within the SDGs themselves.

Professor Matthew Burton, Director of ICEH and co-chair of the Commission said: “Evidence has shown that vision impairment leads to detrimental effects for health, wellbeing, and economic development. This is despite the fact that 90% of vision loss could be prevented or treated with existing, highly cost-effective interventions. This resolution takes an important step by acknowledging that improved eye health can accelerate the achievement of the Sustainable Development Goals. Today’s agreement is essential for the hundreds of millions needlessly living with treatable vision loss, paving the way for real action on eye health for the future.”

Research from the Commission showed that vision loss costs the global economy $411 billion, which this new resolution seeks to address, creating expectations for international financial institutions and donors to provide targeted finances, especially to support low- and middle-income countries in tackling preventable sight loss.

The resolution further acknowledges key areas related to eye health, including healthy ageing, disability and gender equity, with the agreement calling for the United Nations to incorporate eye health into all its projects, including through Unicef and UN-Women.

“It has been estimated that without urgent action 1.8 billion people will be living with untreated vision impairment by 2050,” continued Professor Burton. “This new resolution provides a framework for improvement globally, but continued commitment by governments and international institutions is needed to ensure access to care for all.”

The resolution can be accessed here: https://www.undocs.org/en/A/75/L.108

For more information on the Lancet Global Health Commission on Global Health, visit https://globaleyehealthcommission.org/

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DEPTH Researchers nominated for RCPCH ‘Voice Champion Award’

In uncertain times, it was a real morale boost to receive some good news from the Royal College of Paediatrics and Child Health (RCPCH). The RCPCH ‘& Us’ team, who advocate for and involve children, young people and families in health services, recently told us that DEPTH researchers Dr Alicia Renedo and Dr Sam Miles from LSHTM were nominated for the RCPCH & Us Voice Champion Award. 

The Voice Champion Award is a youth-led award recognising adults that go over and above their job role to work with RCPCH &Us to improve services with children, young people and families. The nominations were all anonymised and reviewed by young people from RCPCH &Us, who created criteria and a scoring system, then worked virtually together to review and discuss the fantastic nominations.

Alicia and Sam were not only thrilled to be nominated but also impressed by the youth-led nature of the nomination and award process. Putting young people at the heart of health services participation is key to how we work in DEPTH, so the RCPCH & Us Voice Champion Award feels like a real reflection of the values that we prioritise in DEPTH, too.

This Sickle Cell Life is an NIHR-funded research project that explores the voices and experiences of young people with sickle cell as they transition from paediatric to adulthood, and adult healthcare services.

Project Research Lead, Dr Renedo, says of the nomination:

“This was excellent news for the DEPTH team. We admire the work done by RCPCH &US, and they are a role model for participation, so coming from them, this nomination felt very special.”

Project Principal Investigator and DEPTH Group Director Prof Cicely Marston said:

“I’m so delighted to see Alicia and Sam recognised in this way. They work really hard to make sure our participatory work is inclusive and their work with young people on this project has been brilliant.” 

We feel very honoured to be nominated, and thank all of our collaborators and colleagues for their role in making This Sickle Cell Life happen. You can read an ‘Evidence’ brief of This Sickle Cell Life by NIHR here.

Some of the This Sickle Cell Life collaborators (Top row L-R: Patrick Ojeer, Ganesh Sathyamoorthy, Sam Miles, Nordia Willis, Alicia Renedo, Andrea Leigh. Bottom row L-R: Cicely Marston, John James, Siann Millanaise. Photo: Anne Koerber)