Engagement of private health sector in communicable disease and immunization programmes in Pakistan.

Background: In Pakistan, where the burden of communicable diseases remains high, the private sector accounts for 62% of health care provision. Aim: To describe the role of the private sector in communicable disease management in Pakistan and inform a more effective engagement towards achieving Universal Health Coverage. Methods: We searched the literature and available documents on policies, regulations and experiences in private health sector engagement in Pakistan. We interviewed policy level experts regarding the formulation of national health policies and plans and a sample of private providers using a structured questionnaire to assess their awareness of and engagement in communicable disease programmes. Results: Published reports described initiatives to engage the private sector in improving coverage for a package of care and programme-specific initiatives. Pakistan did not have a national policy for structural engagement, and regulations were limited. Policy level experts interviewed perceived the private sector as market-driven and poorly regulated. Thirty-nine percent of private sector providers interviewed were aware or had been trained in procedures or guidelines, and 23% of them had had their performance monitored by government. Conclusion: We recommend that the Ministry of Health provide overall vision for the operations of the public and private health sectors so that both sectors can complement each other towards the achievement of Universal Health Coverage, including for communicable diseases.

Achieving integrated disease surveillance in the Eastern Mediterranean Region.

Access to reliable and timely information is key for healthcare decision-making at the regional, national and sub-national levels. However, lack of access to such information hampers to progress towards achievement of the Sustainable Development Goals (SDGs) in the Eastern Mediterranean Region (EMR), as indicated in the Regional Progress Report on Health-Related Sustainable Development Goals.

Preparations for sustainability and transition from Global Fund support in the Eastern Mediterranean Region.

Background: HIV, tuberculosis and malaria (HTM) services receive financial support from the Global Fund and need to plan for sustainability and transition from external funding. Aim: To recommend actions for addressing key sustainability and transition issues in 15 countries receiving Global Fund grants in the WHO Eastern Mediterranean (EMR) Region. Methods: We reviewed documents, interviewed key informants, and conducted case studies in Sudan and Tunisia to highlight key considerations for sustainability and transition from Global Fund that is tailored to the EMR and the health system building blocks. Sustainability considerations should align with the health system building blocks, including governance, financing, service delivery, workforce and health product management, with the addition of considerations for key and vulnerable populations because of their particular importance for HIV and tuberculosis services. Conclusion: While hoping for economic growth and reduction of the burden of HTM, EMR countries need to prepare for transition from Global Fund support. Proactive steps that are tailored to the health system building blocks and address the needs of key and vulnerable populations should progressively increase national capabilities as well as resources dedicated to HTM.

Cutaneous leishmaniasis in Syria: A review of available data during the war years: 2011-2018.

BACKGROUND: Cutaneous leishmaniasis (CL) has historically been reported from Syria. Since 2011, the country has been affected by a war, which has impacted health and health services. Over the same period, an increase in the number of cases of CL has been reported from several areas across the country and by a number of authors. This study aims to provide the first quantitative evidence of the epidemiological evolution of CL in Syria during the war. MATERIALS AND METHODS: Data on number of CL cases for the period 2011-2018 were extracted from three different surveillance systems: the Ministry of Health (MoH) routine surveillance system, the MoH/WHO sentinel-syndromic Early Warning Alert and Response System (EWARS), and surveillance data collected by the international nongovernmental organization (NGO) the MENTOR Initiative. Data were cleaned and merged to generate the best possible estimates on number of CL cases; incidence of CL was also calculated based on data on resident population. Data reported from the years preceding the conflict (2007-2010) were also added to the analysis for comparative purposes. RESULTS: The analysis of data from the three available sources over the period considered indicates that number of reported cases progressively grew from prewar levels to reach a peak in 2015, decreased in 2016, remained stable in 2017, and increased again in 2018. Such a trend was mirrored by changes in incidence of infection. Some governorates, which used to report low numbers of CL cases, started recording higher number of cases after the onset of the war. CONCLUSION: The war coincided with a major rise in reported number of CL cases and incidence of infection, although an increasing trend was already appreciable before its onset.

Caries prevalence in 11- to 14-year old migrant children in Germany.

OBJECTIVES: To assess whether immigration stage is associated with higher prevalence of dental caries among schoolchildren in Heidelberg, Germany. METHODS: A cross-sectional dental examination on 570 schoolchildren, aged 11 to 14 years, in schools with high proportions of immigrant pupils (49.5%) was performed. Carious, missing and filled permanent teeth were recorded for each child, so that mean DMFT values could be calculated. The pupils were classified into three groups: M0 (children and their parents were born in Germany), M1 (children who were born in Germany but whose parents were born outside of Germany), and M2 (children and their parents were born outside of Germany). RESULTS: The mean DMFT values in M1 and M2 were close, and both were significantly higher than the corresponding values in M0. The proportions of caries-free children in M0, M1 and M2 were 63.7%, 40.3% and 42.3%, respectively. CONCLUSION: In Germany, migrant children have a poorer dental health status than native children coming from the same low socio-economic classes. Risk-oriented public health policies with appropriate prevention programs must be developed for these children.