The WHO's 75th anniversary: WHO at a pivotal moment in history.

The World Health Organisation (WHO) was inaugurated in 1948 to bring the world together to ensure the highest attainable standard of health for all. Establishing health governance under the United Nations (UN), WHO was seen as the preeminent leader in public health, promoting a healthier world following the destruction of World War II and ensuring global solidarity to prevent disease and promote health. Its constitutional function would be 'to act as the directing and coordinating authority on international health work'. Yet today, as the world commemorates WHO's 75th anniversary, it faces a historic global health crisis, with governments presenting challenges to its institutional legitimacy and authority amid the ongoing COVID-19 pandemic. WHO governance in the coming years will define the future of the Organisation and, crucially, the health and well-being of billions of people across the globe. At this pivotal moment, WHO must learn critical lessons from its past and make fundamental reforms to become the Organisation it was meant to be. We propose reforms in WHO financing, governance, norms, human rights and equity that will lay a foundation for the next generation of global governance for health.

Human rights and the COVID-19 pandemic: a retrospective and prospective analysis.

When the history of the COVID-19 pandemic is written, the failure of many states to live up to their human rights obligations should be a central narrative. The pandemic began with Wuhan officials in China suppressing information, silencing whistleblowers, and violating the freedom of expression and the right to health. Since then, COVID-19's effects have been profoundly unequal, both nationally and globally. These inequalities have emphatically highlighted how far countries are from meeting the supreme human rights command of non-discrimination, from achieving the highest attainable standard of health that is equally the right of all people everywhere, and from taking the human rights obligation of international assistance and cooperation seriously. We propose embedding human rights and equity within a transformed global health architecture as the necessary response to COVID-19's rights violations. This means vastly more funding from high-income countries to support low-income and middle-income countries in rights-based recoveries, plus implementing measures to ensure equitable distribution of COVID-19 medical technologies. We also emphasise structured approaches to funding and equitable distribution going forward, which includes embedding human rights into a new pandemic treaty. Above all, new legal instruments and mechanisms, from a right to health treaty to a fund for civil society right to health advocacy, are required so that the narratives of future health emergencies-and people's daily lives-are ones of equality and human rights.

Community health workers at the dawn of a new era: 11. CHWs leading the way to "Health for All".

BACKGROUND: This is the concluding paper of our 11-paper supplement, "Community health workers at the dawn of a new era". METHODS: We relied on our collective experience, an extensive body of literature about community health workers (CHWs), and the other papers in this supplement to identify the most pressing challenges facing CHW programmes and approaches for strengthening CHW programmes. RESULTS: CHWs are increasingly being recognized as a critical resource for achieving national and global health goals. These goals include achieving the health-related Sustainable Development Goals of Universal Health Coverage, ending preventable child and maternal deaths, and making a major contribution to the control of HIV, tuberculosis, malaria, and noncommunicable diseases. CHWs can also play a critical role in responding to current and future pandemics. For these reasons, we argue that CHWs are now at the dawn of a new era. While CHW programmes have long been an underfunded afterthought, they are now front and centre as the emerging foundation of health systems. Despite this increased attention, CHW programmes continue to face the same pressing challenges: inadequate financing, lack of supplies and commodities, low compensation of CHWs, and inadequate supervision. We outline approaches for strengthening CHW programmes, arguing that their enormous potential will only be realized when investment and health system support matches rhetoric. Rigorous monitoring, evaluation, and implementation research are also needed to enable CHW programmes to continuously improve their quality and effectiveness. CONCLUSION: A marked increase in sustainable funding for CHW programmes is needed, and this will require increased domestic political support for prioritizing CHW programmes as economies grow and additional health-related funding becomes available. The paradigm shift called for here will be an important step in accelerating progress in achieving current global health goals and in reaching the goal of Health for All.

Institutional and behaviour-change interventions to support COVID-19 public health measures: a review by the Lancet Commission Task Force on public health measures to suppress the pandemic.

The Lancet COVID-19 Commission Task Force for Public Health Measures to Suppress the Pandemic was launched to identify critical points for consideration by governments on public health interventions to control coronavirus disease 2019 (COVID-19). Drawing on our review of published studies of data analytics and modelling, evidence synthesis and contextualisation, and behavioural science evidence and theory on public health interventions from a range of sources, we outline evidence for a range of institutional measures and behaviour-change measures. We cite examples of measures adopted by a range of countries, but especially jurisdictions that have, thus far, achieved low numbers of COVID-19 deaths and limited community transmission of severe acute respiratory syndrome coronavirus 2. Finally, we highlight gaps in knowledge where research should be undertaken. As countries consider long-term measures, there is an opportunity to learn, improve the response and prepare for future pandemics.

Communities, universal health coverage and primary health care.

Universal health coverage (UHC) depends on a strong primary health-care system. To be successful, primary health care must be expanded at community and household levels as much of the world's population still lacks access to health facilities for basic services. Abundant evidence shows that community-based interventions are effective for improving health-care utilization and outcomes when integrated with facility-based services. Community involvement is the cornerstone of local, equitable and integrated primary health care. Policies and actions to improve primary health care must regard community members as more than passive recipients of health care. Instead, they should be leaders with a substantive role in planning, decision-making, implementation and evaluation. Advancing the science of primary health care requires improved conceptual and analytical frameworks and research questions. Metrics used for evaluating primary health care and UHC largely focus on clinical health outcomes and the inputs and activities for achieving them. Little attention is paid to indicators of equitable coverage or measures of overall well-being, ownership, control or priority-setting, or to the extent to which communities have agency. In the future, communities must become more involved in evaluating the success of efforts to expand primary health care. Much of primary health care has taken place, and will continue to take place, outside health facilities. Involving community members in decisions about health priorities and in community-based service delivery is key to improving systems that promote access to care. Neither UHC nor the Health for All movement will be achieved without the substantial contribution of communities.

La couverture maladie universelle (CMU) repose sur un solide système de soins de santé primaires. Pour rendre les soins de santé primaires efficaces, il faut les étendre aux communautés et aux ménages car la majorité de la population mondiale n'a toujours pas accès aux structures médicales offrant des services de base. Nombreux sont les éléments qui prouvent que les interventions communautaires contribuent à améliorer l'utilisation des soins de santé et les résultats cliniques lorsqu'elles font partie intégrante des services proposés au sein des établissements. L'implication des communautés constitue la clé de voûte d'un système de soins de santé primaires local, équitable et intégré. Les politiques et actions visant à le renforcer doivent tenir compte des membres des communautés, et ne pas se limiter à les considérer comme des bénéficiaires passifs de soins de santé. Au contraire, leurs dirigeants devraient jouer un rôle prépondérant dans la planification, la prise de décisions, la mise en œuvre et l'évaluation. Faire progresser la science des soins de santé primaires requiert une optimisation des cadres analytiques et conceptuels, ainsi que des questions de recherche. Les paramètres employés pour évaluer les soins de santé primaires et la CMU se concentrent souvent sur les résultats cliniques, sur les activités et moyens utilisés pour les atteindre. Peu d'attention est accordée aux indicateurs d'une couverture équitable, ou aux mesures de bien-être général, de possession, de contrôle ou de définition des priorités, ou encore à l'étendue du pouvoir d'action des communautés. À l'avenir, les communautés doivent s'engager davantage dans l'évaluation de la réussite des efforts déployés pour développer les soins de santé primaires. La plupart de ces soins ont toujours été et continueront à être prodigués en dehors des structures médicales. Impliquer les membres des communautés dans les décisions destinées à définir les priorités sanitaires et la fourniture de services communautaires est essentiel pour améliorer des systèmes qui permettront de promouvoir l'accès aux soins. Ni la CMU, ni le mouvement «Santé pour tous¼ ne parviendront à leurs fins sans la contribution majeure des communautés.

La cobertura sanitaria universal (CSU) depende de un sistema de atención primaria de salud sólido. Sin embargo, la atención primaria de salud se debe ampliar a nivel de la comunidad y de los hogares para que logre resultados efectivos, ya que gran parte de la población mundial sigue sin tener acceso a los centros de salud para recibir los servicios básicos. Existen muchas pruebas que demuestran que las intervenciones basadas en la comunidad son efectivas para mejorar el uso y los resultados de la atención de la salud cuando se integran con los servicios que se prestan en los centros de salud. La participación de la comunidad es el elemento fundamental de la atención primaria de salud local, equitativa e integrada. Las políticas y las medidas para mejorar la atención primaria de salud deben tener en cuenta que los miembros de la comunidad son más que receptores pasivos de la atención de salud. Por el contrario, deben ser líderes con una función importante en la planificación, la toma de decisiones, la implementación y la evaluación. El progreso de la ciencia en la atención primaria de salud requiere mejorar los marcos conceptuales y analíticos y los temas de investigación. Los parámetros que se usan para evaluar la atención primaria de salud y la CSU se centran en gran medida en los resultados clínicos de la salud y en los recursos y las actividades que permiten alcanzarlos. Se presta poca atención a los indicadores de cobertura equitativa o a las medidas de bienestar general, propiedad, control o establecimiento de prioridades, o a la medida en que las comunidades participan activamente. Por consiguiente, las comunidades deben participar más en la evaluación del éxito de los esfuerzos por ampliar la atención primaria de salud en el futuro. Gran parte de la atención primaria de salud siempre ha tenido y seguirá teniendo lugar fuera de los centros de salud. La participación de los miembros de la comunidad en las decisiones sobre las prioridades sanitarias y en la prestación de servicios comunitarios es fundamental para mejorar los sistemas que promueven el acceso a la atención, ya que ni la CSU ni el movimiento Salud para Todos se lograrán si las comunidades no contribuyen de manera sustancial.

Community Involvement in Health Systems Strengthening to Improve Global Health Outcomes: A Review of Guidelines and Potential Roles.

Definitions of health systems strengthening (HSS) have been limited in their inclusion of communities, despite evidence that community involvement improves program effectiveness for many health interventions. We review 15 frameworks for HSS, highlighting how communities are represented and find few delineated roles for community members or organizations. This review raises the need for a cohesive definition of community involvement in HSS and well-described activities that communities can play in the process. We discuss how communities can engage with HSS in four different areas-planning and priority-setting; program implementation; monitoring, evaluation, and quality improvement; and advocacy-and how these activities could be better incorporated into key HSS frameworks. We argue for more carefully designed interactions between health systems policies and structures, planned health systems improvements, and local communities. These interactions should consider local community inputs, strengths, cultural and social assets, as well as limitations in and opportunities for increasing capacity for better health outcomes.

Alma-Ata 30 years on: revolutionary, relevant, and time to revitalise.

In this paper, we revisit the revolutionary principles-equity, social justice, and health for all; community participation; health promotion; appropriate use of resources; and intersectoral action-raised by the 1978 Alma-Ata Declaration, a historic event for health and primary health care. Old health challenges remain and new priorities have emerged (eg, HIV/AIDS, chronic diseases, and mental health), ensuring that the tenets of Alma-Ata remain relevant. We examine 30 years of changes in global policy to identify the lessons learned that are of relevance today, particularly for accelerated scale-up of primary health-care services necessary to achieve the Millennium Development Goals, the modern iteration of the "health for all" goals. Health has moved from under-investment, to single disease focus, and now to increased funding and multiple new initiatives. For primary health care, the debate of the past two decades focused on selective (or vertical) versus comprehensive (horizontal) delivery, but is now shifting towards combining the strengths of both approaches in health systems. Debates of community versus facility-based health care are starting to shift towards building integrated health systems. Achievement of high and equitable coverage of integrated primary health-care services requires consistent political and financial commitment, incremental implementation based on local epidemiology, use of data to direct priorities and assess progress, especially at district level, and effective linkages with communities and non-health sectors. Community participation and intersectoral engagement seem to be the weakest strands in primary health care. Burgeoning task lists for primary health-care workers require long-term human resource planning and better training and supportive supervision. Essential drugs policies have made an important contribution to primary health care, but other appropriate technology lags behind. Revitalisng Alma-Ata and learning from three decades of experience is crucial to reach the ambitious goal of health for all in all countries, both rich and poor.