The Public Health Impacts of Gaza's Water Crisis: Analysis and Policy Options.

Gaza has long had water and sanitation challenges, but today it is in a state of emergency. Its dual water crisis combines a shortage of potable water for drinking, cooking, and hygiene with a lack of wastewater sanitation. As a result, over 108,000 cubic meters of untreated sewage flow daily from Gaza into the Mediterranean Sea, creating extreme public health hazards in Gaza, Israel, and Egypt. While these problems are not new, rapidly deteriorating infrastructure, strict limitations on the import of construction materials and water pumps, and a diminished and unreliable energy supply have accelerated the water crisis and exacerbated the water-related health risks. Three wars between Israel and Hamas since 2009 and intra-Palestinian rivalry between Hamas and Fatah have further hindered the rehabilitation of Gaza's water and sanitation sectors. This study describes the relationship between Gaza's water problems and its energy challenges and examines the implications of this water crisis for public health. It reviews the current state of water supply and water sanitation in Gaza, analyzes water-related risks to public health in Gaza, and explains potential regional public health risks for Israel and Egypt. The authors recommend a number of steps to ameliorate the crisis and decrease the potential for a regional public health disaster that take into consideration current political constraints. The audience for this study includes stakeholders involved in Gaza, including the Palestinian, Israeli, and Egyptian governments, various international organizations and nongovernmental organizations working on the ground in Gaza, and the donor community seeking to rehabilitate Gaza.

The UN Commission on Life Saving Commodities 3 years on: global progress update and results of a multicountry assessment.

BACKGROUND: In September, 2012, the UN Commission on Life Saving Commodities (UNCoLSC) outlined a plan to expand availability and access to 13 life saving commodities. We profile global and country progress against these recommendations between 2012 and 2015. METHODS: For 12 countries in sub-Saharan Africa that were off-track to achieve the Millennium Development Goals for maternal and child survival, we reviewed key documents and reference data, and conducted interviews with ministry staff and partners to assess the status of the UNCoLSC recommendations. The RMNCH fund provided short-term catalytic financing to support country plans to advance the commodity agenda, with activities coded by UNCoLSC recommendation. Our network of technical resource teams identified, addressed, and monitored progress against cross-cutting commodity-related challenges that needed coordinated global action. FINDINGS: In 2014 and 2015, child and maternal health commodities had fewer bottlenecks than reproductive and neonatal commodities. Common bottlenecks included regulatory challenges (ten of 12 countries); poor quality assurance (11 of 12 countries); insufficient staff training (more than half of facilities on average); and weak supply chains systems (11 of 12 countries), with stock-outs of priority commodities in about 40% of facilities on average. The RMNCH fund committed US$175·7 million to 19 countries to support strategies addressing crucial gaps. $68·2 million (39·0%) of the funds supported systems-strengthening interventions with the remainder split across reproductive, maternal, newborn, and child health. Health worker training ($88·6 million, 50·4%), supply chain ($53·3 million, 30·0%), and demand generation ($21·1 million, 12·0%) were the major topics of focus. All priority commodities are now listed in the WHO Essential Medicines List; appropriate price reductions were secured; quality manufacturing was improved; a fast-track registration mechanism for prequalified products was established; and methods were developed for advocacy, quantification, demand generation, supply chain, and provider training. Slower progress was evident around regulatory harmonisation and quality assurance. INTERPRETATION: Much work is needed to achieve full implementation of the UNCoLSC recommendations. Coordinated efforts to secure price reductions beyond the 13 commodities and improve regulatory efficiency, quality, and supply chains are still needed alongside broader dissemination of work products. FUNDING: Governments of Norway (NORAD) and the UK (DFID).

A formal representation of the WHO and UNICEF estimates of national immunization coverage: a computational logic approach.

Production of official statistics frequently requires expert judgement to evaluate and reconcile data of unknown and varying quality from multiple and potentially conflicting sources. Moreover, exceptional events may be difficult to incorporate in modelled estimates. Computational logic provides a methodology and tools for incorporating analyst's judgement, integrating multiple data sources and modelling methods, ensuring transparency and replicability, and making documentation computationally accessible. Representations using computational logic can be implemented in a variety of computer-based languages for automated production. Computational logic complements standard mathematical and statistical techniques and extends the flexibility of mathematical and statistical modelling. A basic overview of computational logic is presented and its application to official statistics is illustrated with the WHO & UNICEF estimates of national immunization coverage.

A mid-term assessment of progress towards the immunization coverage goal of the Global Immunization Vision and Strategy (GIVS).

BACKGROUND: The Global Immunization Vision and Strategy (GIVS) (2006-2015) aims to reach and sustain high levels of vaccine coverage, provide immunization services to age groups beyond infancy and to those currently not reached, and to ensure that immunization activities are linked with other health interventions and contribute to the overall development of the health sector. OBJECTIVE: To examine mid-term progress (through 2010) of the immunization coverage goal of the GIVS for 194 countries or territories with special attention to data from 68 countries which account for more than 95% of all maternal and child deaths. METHODS: We present national immunization coverage estimates for the third dose of diphtheria and tetanus toxoid with pertussis (DTP3) vaccine and the first dose of measles containing vaccine (MCV) during 2000, 2005 and 2010 and report the average annual relative percent change during 2000-2005 and 2005-2010. Data are taken from the WHO and UNICEF estimates of national immunization coverage, which refer to immunizations given during routine immunization services to children less than 12 months of age where immunization services are recorded. RESULTS: Globally DTP3 coverage increased from 74% during 2000 to 85% during 2010, and MCV coverage increased from 72% during 2000 to 85% during 2010. A total of 149 countries attained or were on track to achieve the 90% coverage goal for DTP3 (147 countries for MCV coverage). DTP3 coverage ≥ 90% was sustained between 2005 and 2010 by 99 countries (98 countries for MCV). Among 68 priority countries, 28 countries were identified as having made either insufficient or no progress towards reaching the GIVS goal of 90% coverage by 2015 for DTP3 or MCV. DTP3 and MCV coverage remained < 70% during 2010 for 16 and 21 priority countries, respectively. CONCLUSION: Progress towards GIVS goals highlights improvements in routine immunization coverage, yet it is troubling to observe priority countries with little or no progress during the past five years. These results highlight that further efforts are needed to achieve and maintain the global immunization coverage goals.

Avoiding complacency and maintaining progress in routine immunization.

A review of estimated coverage with three doses of diphtheria, tetanus, pertussis vaccine (DTP3) suggests many countries will not meet the Global Immunization Vision and Strategy (GIVS) goal to increase national immunization coverage levels to at least 90% by 2010 and to sustain these levels through at least 2015. In fact, 42% of low-income countries have made insufficient or no progress towards the goal, compared to 8% of high-income countries. Despite enormous and increasingly successful efforts to address the global burden of vaccine-preventable diseases and extraordinary improvements in universal childhood immunization, opportunities remain to improve routine immunization coverage globally.

WHO and UNICEF estimates of national infant immunization coverage: methods and processes.

WHO and the United Nations Children's Fund (UNICEF) annually review data on immunization coverage to estimate national coverage with routine service delivery of the following vaccines: bacille Calmette-Guérin; diphtheria-tetanus-pertussis, first and third doses; either oral polio vaccine or inactivated polio vaccine, third dose of either; hepatitis B, third dose; Haemophilus influenzae type b, third dose; and a measles virus-containing vaccine, either for measles alone or in the form of a combination vaccine, one dose. The estimates are based on government reports submitted to WHO and UNICEF and are supplemented by survey results from the published and grey literature. Local experts, primarily national immunization system managers and WHO/UNICEF regional and national staff, are consulted for additional information on the performance of specific immunization systems. Estimates are derived through a country-by-country review of available data informed and constrained by a set of heuristics; no statistical or mathematical models are used. Draft estimates are made, sent to national authorities for review and comment and modified in light of their feedback. While the final estimates may not differ from reported data, they constitute an independent technical assessment by WHO and UNICEF of the performance of national immunization systems. These country-specific estimates, available from 1980 onward, are updated annually.