Assessing Mental Health Needs In Northern Haiti: A Multidimensional Approach

This study assessed mental health needs in Northern Haiti, with the socioeconomic and sociocultural factors which predispose to mental disorders. Following the Key Informants approach to needs assessment, two groups were chosen to participate in this study: 27 out of 60 physicians and 30 out of 70 clergymen (n = 57), completed a questionnaire which asked specific questions on certain mental disorders they have either observed or dealt with among the population. The participants were also asked to give the frequency with which those disorders occurred among the population, and to rate the importance of factors contributing to those mental health needs. Descriptive statistics were used to analyze the questionnaire data. The two respondents groups consistently reported the incidence and the prevalence of anxiety disorders and anxiety-based disorders, such as Hypertension and. Shortness of Breath. In addition, the clergymen reported the prevalence of depressive symptoms among the population. Other prevalent disorders reported included: Migraine Headaches, Sleep Disorders, and Paranoid Disorders. The t·110 groups also agreed on three basic mental health needs in Northern Haiti. They .include: 1) Need for mental health services; 2) Need Fer mental health education; and 3) Need for Clinical Psychologists and other mental health practitioners. The contributing factors to those disorders and needs among the population were listed as follows: Inadequate sanitation, beliefs in supernatural causes of illness, childhood malnutrition and chronic undernourishment, and illiteracy. Some general recommendations wen~ made with a view to reduce the incidence and to prevent the occurrence of some of those disorders. These recommendations included: inclusion of mental health in the overall public health programs; development of manpower through existing resources; and mental health education both for the public and for the service providers. The respondents were encouraged to participate more actively in the development 0f mental health programs and to prepare themselves through continuing education, to meet some of the psychological needs of those who seek their help

Tahun Politik, Komunikasi Konfrontatif

Term “Confrontative Communication†popular in Indonesia when the election of Governor ofJakarta at 2012. In that year, one candidate often talk intimidation people and his competitor withusing sarcastic sentence, for example “If you will not choose Betawi man, please out from Jakarta orI will disarm your facilities included your KTP (kartu tanda penduduk, identification card)â€.Confrontative Communication different with Confrontation Communication in medical work which isdone by doctor or nurse. Confrontative Communication is a part of coersive communication which isused in political communication. Every candidate use confrontative communication to defeatcompetitor; among them use it each other.Now, in the politics year for winning the election especially president election, confrontativecommunication without controlled by politics ethics tends to be used in political communication. Thisarticle want to clarify that phenomena.Key words: political communication, coersive communication, confrontative communication

Use and management of protected areas in Ethiopia : multiple stakeholder analysis of sustainable resource management at Awash National Park

In response to recent decentralization in Ethiopia, we investigated the status of and pressure exerted on Awash National Park (ANP), vis-a- vis Park resources, observed land use and land cover changes, causes of park-related conflicts, use and management role of stakeholders at federal, regional and local level and the impact of policy on sustainable resources conservation through a comparative framework of before (pre-1995) and after decentralization (post-1995). We used a combination of two black and white aerial photographs of 1975 and 1986, a satellite image of 2006, field observation, information from local communities and Geographic Information System (GIS) to generate the land use and land cover profile. We selected a total of 210 respondents by stratified random sampling, and group discussion participants and key informants using the purposive sampling technique. Direct observed participation of stakeholders, household questionnaire, and interview with key informants and focus group discussions were used to collect data. Our results showed a declining scattered bushland by a rate of 20.61km2 per year between 1972 and 1986. On the other hand, Shrub encroachment increased by 32.2 % between 1972 and 1986 and by 10.3 % (77.4 km2) during the entire study period. Grassland was the largest cover type in the area between 1986 and 2006 and expanded by 14.2 % (106.4 km2) between 1972 and 1986. The majority of respondents highlighted that the most important drivers of the observed LULC changes pre-1995 were the combined effects of the land reform policy and changes in Park boundary (size of the Park). Population growth was reported to be the main driving factor for LULC change pre-and post-1995. The continuing existence of the area as a national Park receives unreserved support from most pastoral and agro-pastoral communities. From the data we conclude that overall, decentralization in Ethiopia was not effective in terms of improving the status of Awash National Park. We recommend action should be taken in terms of reducing human and livestock pressure and to prevent and solve interest-based conflicts between stakeholderEnvironmental SciencesPh. D. (Environmental Sciences

PROCESSO DE TOMADA DE DECISÃO - DECISÕES DE ROTINA E NÃO ROTINA NUMA EMPRESA DE CONSULTORIA

The main objective of this study is to identify routine and non-routine decision-making in a company that provides consulting services in the areas of tax accounting, auditing and advisory services in agricultural, environmental, financial, legal and technological activities, located in Nampula city, Mozambique. As for the methodology, it was an exploratory research, based on the published bibliography that facilitated the fitting of theories and concepts to add knowledge through the literature regarding decision-making processes. As for the approach to the problem, it is classified as inductive and as for the technique used, it is classified as bibliographic and in the collection of information a questionnaire addressed to the General Director of the company was used. Data were collected from April to May 2021 given the availability of the interlocutor. The results were satisfactory in responding to the general objective that was intended with the theme, it allowed us to realize that decisions are taken by alternatives that better solve the company's problems.El objetivo principal de este estudio es identificar la toma de decisiones rutinarias y no rutinarias en una empresa que brinda servicios de consultoría en las áreas de contabilidad tributaria, auditoría y servicios de asesoría en actividades agrícolas, ambientales, financieras, legales y tecnológicas, ubicada en el ciudad. de Nampula, Mozambique. En cuanto a la metodología, se trató de una investigación exploratoria, basada en la bibliografía publicada que facilitó la adecuación de teorías y conceptos para agregar conocimiento a través de la literatura sobre los procesos de toma de decisiones. En cuanto al abordaje del problema, se clasifica como inductivo y en cuanto a la técnica utilizada, se clasifica como bibliográfico y en la recogida de información se utilizó un cuestionario dirigido al Director General de la empresa. Los datos fueron recolectados de abril a mayo de 2021 dada la disponibilidad del interlocutor. Los resultados fueron satisfactorios al responder al objetivo general que se pretendía con la temática, nos permitió darnos cuenta que las decisiones se toman por alternativas que resuelvan mejor los problemas de la empresa.O presente estudo tem como objectivo principal, identificar a tomada de de cisões de rotina e de não rotina numa empresa que presta serviços de consultoria nas áreas de contabilidade fiscal, auditoria e assessoria em actividades agrárias, ambientais, financeiras, jurídicas e tecnológicas, localizada na cidade de Nampula, em Moçambique. Quanto à metodologia trata-se de uma pesquisa exploratória, baseada na bibliografia publicada que facilitou o encaixe de teorias e conceitos para acrescentar o conhecimento através da literatura referente a processos de tomada de decisão. Quanto à abordagem do problema classifica-se como indutivo e quanto à técnica utilizada classifica-se como bibliográfica e na recolha de informação foi utilizado um questionário dirigido ao Director Geral da empresa. Os dados foram recolhidos nos meses de Abril e Maio de 2021 dada a disponibilidade do interlocutor. Os resultados foram satisfatórios ao responderem ao objectivo geral que se pretendia com o tema, permitiu perceber que as decisões são tomadas por alternativas que melhor resolvem os problemas da empresa

The accession of Ethiopia to the WTO in the context of its policy on "developmental state"

Unlike many other international instruments, accession to the WTO does not simply require the commitment of the government to sign and ratify the multilateral agreements. A country needs to make considerable legislative and administrative changes to comply with the standards of the WTO and its members to finalize the negotiation for accession. For governments with impure free market economy policy the challenges amplify. The government of Ethiopia publicly pronounces its adherence to the ideology of the developmental state. On the other hand the nucleus of WTO principles is progressive trade liberalization. Therefore, this dissertation tries to provide some reflection on the paradox created as a result of the divergence in priority between WTO principles and developmental state in the context of Ethiopian desire to join the organization. The research is an interdisciplinary work. The issues that will be discussed are not purely legal in their nature. They have legal, political and economic dimensions. And the main focus of the paper is on trade in services and foreign investment negotiation aspect of the accession. Furthermore the objective of the dissertation is to give some insight for policy makers about the challenges and opportunities that „Developmental State‟ ideology will pose in the accession process of Ethiopia to the WTO. The research is divided into five chapters. Chapter one gives introductory remarks about the concept of the developmental state and accession to the WTO. The limitations of the WTO accession process and an overview of the features of developmental state in the world and particularly in Ethiopia are also briefly discussed in the chapter. The origin and concept of developmental state in the world, in Africa and Ethiopia is discussed in some detail under chapter two. The chapter also tries to show the impact of developmental state policies in the laws of the country that are going to be deliberated in the process of accession. Chapter three is about accession to the WTO. In this chapter the requirements, benefits, challenges and procedures of accession are dealt in depth. The writer debates and tries to show the fact that the system is slowly shifting from rule based negotiation to power and precedent based negotiation. By analyzing the laws of Ethiopia that are inspired by the principles of developmental state against the legal and precedent requirements to join the WTO, I tried to correlate the findings of chapter two and three in chapter four. Specific strategies and advises on how to move the negotiation forward on certain areas are also outlined in this chapter. Finally, conclusion and my summarized recommendations are placed under chapter five.EconomicsLL. M. (with specialization in International Economic Law

Factors associated with women’s autonomy regarding maternal and child health care utilization in Bale Zone: a community based cross-sectional study

Background Women's autonomy in health-care decision is a prerequisite for improvements in maternal and child health. Little is known about women’s autonomy and its influencing factors on maternal and child health care in Ethiopia. Therefore, this study was conducted to assess women’s autonomy and identify associated factors in Southeast Ethiopia. Method A community based cross-sectional study was conducted from March 19th until March 28th, 2011. A total of 706 women were selected using stratified sampling technique from rural and urban kebeles. The quantitative data were collected by interviewer administered questionnaire and analyzed using SPSS for window version 16.0. Descriptive statistics, bivariate and multiple logistic regression analyses were carried out to identify factors associated with women’s autonomy for health care utilization. Result Out of 706 women less than half (41.4%) had higher autonomy regarding their own and their children’s health. In the multiple logistic regression model monthly household income >1000 ETB [adjusted odds ratio(AOR):3.32(95% C.I: 1.62-6.78)], having employed husband [AOR: 3.75 (95% C.I:1.24-11.32)], being in a nuclear family structure [AOR: 0.53(95% C.I: 0.33-0.87)], being in monogamous marriage [AOR: 3.18(95% C.I: 1.35-7.50)], being knowledgeable and having favorable attitude toward maternal and child health care services were independently associated with an increased odds of women’s autonomy. Conclusion Socio-demographic and maternal factors (knowledge and attitude) were found to influence women’s autonomy. Interventions targeting women’s autonomy with regards to maternal and child health care should focus on addressing increasing awareness and priority should be given to women with a lower socioeconomic status

DESCARTE INCORRECTO DE MÁSCARAS EM TEMPO DE PANDEMIA DE COVID-19

Face protection masks have become mandatory for the general population, at this time of the Covid-19 pandemic, but the lack of awareness of the damage that comes from incorrect disposal leads to environmental damage. It was proposed as an objective of this study to contribute to the effects of disposable masks in terms of environmental pollution, encouraging their correct disposal. The narrative review method stands out and is accommodated as a study of a qualitative nature and had the observation at the place of the events and a search was also carried out in the information base of MEDLINE, SciELO and Google Scholar and it was not left out the official recommendations, mostly from the World Health Organization. The collection of information was based on a questionnaire. The results of this research are considered satisfactory because they respond to the objectives outlined for the present study. It was concluded that it is necessary to continue with actions to raise awareness of the population in matters of environmental education so that people understand what environmental problem that need solutions so that the environmental future is not harmed and have an awareness of the environmental impacts. Also continue to fight the spread of the disease and at least reduce the use of disposable masks by opting for recyclable material such as homemade masks that can be reused. It is recommended that masks be disposed of correctly and that more research be carried out to educate and sensitize populations on solid waste management.Las máscaras de protección facial se han vuelto obligatorias para la población en general, en este momento de la pandemia de Covid-19, pero la falta de conciencia sobre los daños que se derivan de la eliminación incorrecta conduce al daño ambiental. Se propuso como objetivo de este estudio contribuir a los efectos de las mascarillas desechables en términos de contaminación ambiental, incentivando su correcta eliminación. Se destaca el método de revisión narrativa y se acomoda como un estudio de carácter cualitativo y tuvo la observación en el lugar de los hechos y también se realizó una búsqueda en la base de información de MEDLINE, SciELO y Google Scholar y no quedó fuera. Recomendaciones oficiales, en su mayoría de la Organización Mundial de la Salud La recolección de información se basó en un cuestionario. Los resultados de esta investigación se consideran satisfactorios porque responden a los objetivos trazados para el presente estudio. Se concluyó que es necesario continuar con acciones de concientización de la población en materia de educación ambiental para que las personas entiendan cuáles son los problemas ambientales que necesitan solución para que no se perjudique el futuro ambiental y tengan conciencia de los impactos ambientales. También seguir luchando contra la propagación de la enfermedad y al menos reducir el uso de mascarillas desechables optando por material reciclable como mascarillas caseras que se puedan reutilizar. Se recomienda desechar correctamente las mascarillas y realizar más investigaciones para educar y sensibilizar a la población sobre el manejo de los residuos sólidos.As máscaras de protecção facial tornaram de uso obrigatório pela população em geral, nesta época da pandemia de Covid-19 mas a falta de consciência dos danos que advém do descarte incorrecto leva a danos ambientais. Foi proposto como objectivo deste estudo em contribuir os efeitos das máscaras descartáveis quanto a poluição do meio ambiente incentivando o descarte correcto das mesmas. Destaca-se o método de revisão narrativa e acomoda-se como um estudo de natureza qualitativa e teve a observação no local dos acontecimentos e também realizou-se uma busca na base de informações da MEDLINE, SciELO e Google Scholar e não se deixou de fora as recomendações oficiais maioritariamente da Organização Mundial da Saúde. A recolha de informação foi feita com base num questionário. Os resultados desta pesquisa são considerados satisfatório porque respondem aos objectivos traçados para o presente estudo. Concluiu-se que é necessário continuar com as acções de sensibilização da população em matérias de educação ambiental de modo que as pessoas percebam quais são os problemas ambientais que precisam de soluções para que o futuro ambiental não seja prejudicado e ter uma consciência quanto aos impactos ambientais. Continuar também a combater o alastramento da doença e no mínimo reduzir o uso das máscaras descartáveis optando pelo material reciclável como as máscaras caseiras que podem ser reutilizadas. Recomenda-se o descarte das máscaras de forma correcta e que se façam mais pesquisas capazes de educar e sensibilizar as populações sobre a gestão de residuos sólidos.As máscaras de protecção facial tornaram de uso obrigatório pela população em geral, nesta época da pandemia de Covid-19 mas a falta de consciência dos danos que advém do descarte incorrecto leva a danos ambientais. Foi proposto como objectivo deste estudo em contribuir os efeitos das máscaras descartáveis quanto a poluição do meio ambiente incentivando o descarte correcto das mesmas. Destaca-se o método de revisão narrativa e acomoda-se como um estudo de natureza qualitativa e teve a observação no local dos acontecimentos e também realizou-se uma busca na base de informações da MEDLINE, SciELO e Google Scholar e não se deixou de fora as recomendações oficiais maioritariamente da Organização Mundial da Saúde. A recolha de informação foi feita com base num questionário. Os resultados desta pesquisa são considerados satisfatório porque respondem aos objectivos traçados para o presente estudo. Concluiu-se que é necessário continuar com as acções de sensibilização da população em matérias de educação ambiental de modo que as pessoas percebam quais são os problemas ambientais que precisam de soluções para que o futuro ambiental não seja prejudicado e ter uma consciência quanto aos impactos ambientais. Continuar também a combater o alastramento da doença e no mínimo reduzir o uso das máscaras descartáveis optando pelo material reciclável como as máscaras caseiras que podem ser reutilizadas. Recomenda-se o descarte das máscaras de forma correcta e que se façam mais pesquisas capazes de educar e sensibilizar as populações sobre a gestão de residuos sólidos

DESCARTE INCORRECTO DE MÁSCARAS EM TEMPO DE PANDEMIA DE COVID-19

Face protection masks have become mandatory for the general population, at this time of the Covid-19 pandemic, but the lack of awareness of the damage that comes from incorrect disposal leads to environmental damage. It was proposed as an objective of this study to contribute to the effects of disposable masks in terms of environmental pollution, encouraging their correct disposal. The narrative review method stands out and is accommodated as a study of a qualitative nature and had the observation at the place of the events and a search was also carried out in the information base of MEDLINE, SciELO and Google Scholar and it was not left out the official recommendations, mostly from the World Health Organization. The collection of information was based on a questionnaire. The results of this research are considered satisfactory because they respond to the objectives outlined for the present study. It was concluded that it is necessary to continue with actions to raise awareness of the population in matters of environmental education so that people understand what environmental problem that need solutions so that the environmental future is not harmed and have an awareness of the environmental impacts. Also continue to fight the spread of the disease and at least reduce the use of disposable masks by opting for recyclable material such as homemade masks that can be reused. It is recommended that masks be disposed of correctly and that more research be carried out to educate and sensitize populations on solid waste management.Las máscaras de protección facial se han vuelto obligatorias para la población en general, en este momento de la pandemia de Covid-19, pero la falta de conciencia sobre los daños que se derivan de la eliminación incorrecta conduce al daño ambiental. Se propuso como objetivo de este estudio contribuir a los efectos de las mascarillas desechables en términos de contaminación ambiental, incentivando su correcta eliminación. Se destaca el método de revisión narrativa y se acomoda como un estudio de carácter cualitativo y tuvo la observación en el lugar de los hechos y también se realizó una búsqueda en la base de información de MEDLINE, SciELO y Google Scholar y no quedó fuera. Recomendaciones oficiales, en su mayoría de la Organización Mundial de la Salud La recolección de información se basó en un cuestionario. Los resultados de esta investigación se consideran satisfactorios porque responden a los objetivos trazados para el presente estudio. Se concluyó que es necesario continuar con acciones de concientización de la población en materia de educación ambiental para que las personas entiendan cuáles son los problemas ambientales que necesitan solución para que no se perjudique el futuro ambiental y tengan conciencia de los impactos ambientales. También seguir luchando contra la propagación de la enfermedad y al menos reducir el uso de mascarillas desechables optando por material reciclable como mascarillas caseras que se puedan reutilizar. Se recomienda desechar correctamente las mascarillas y realizar más investigaciones para educar y sensibilizar a la población sobre el manejo de los residuos sólidos.As máscaras de protecção facial tornaram de uso obrigatório pela população em geral, nesta época da pandemia de Covid-19 mas a falta de consciência dos danos que advém do descarte incorrecto leva a danos ambientais. Foi proposto como objectivo deste estudo em contribuir os efeitos das máscaras descartáveis quanto a poluição do meio ambiente incentivando o descarte correcto das mesmas. Destaca-se o método de revisão narrativa e acomoda-se como um estudo de natureza qualitativa e teve a observação no local dos acontecimentos e também realizou-se uma busca na base de informações da MEDLINE, SciELO e Google Scholar e não se deixou de fora as recomendações oficiais maioritariamente da Organização Mundial da Saúde. A recolha de informação foi feita com base num questionário. Os resultados desta pesquisa são considerados satisfatório porque respondem aos objectivos traçados para o presente estudo. Concluiu-se que é necessário continuar com as acções de sensibilização da população em matérias de educação ambiental de modo que as pessoas percebam quais são os problemas ambientais que precisam de soluções para que o futuro ambiental não seja prejudicado e ter uma consciência quanto aos impactos ambientais. Continuar também a combater o alastramento da doença e no mínimo reduzir o uso das máscaras descartáveis optando pelo material reciclável como as máscaras caseiras que podem ser reutilizadas. Recomenda-se o descarte das máscaras de forma correcta e que se façam mais pesquisas capazes de educar e sensibilizar as populações sobre a gestão de residuos sólidos.As máscaras de protecção facial tornaram de uso obrigatório pela população em geral, nesta época da pandemia de Covid-19 mas a falta de consciência dos danos que advém do descarte incorrecto leva a danos ambientais. Foi proposto como objectivo deste estudo em contribuir os efeitos das máscaras descartáveis quanto a poluição do meio ambiente incentivando o descarte correcto das mesmas. Destaca-se o método de revisão narrativa e acomoda-se como um estudo de natureza qualitativa e teve a observação no local dos acontecimentos e também realizou-se uma busca na base de informações da MEDLINE, SciELO e Google Scholar e não se deixou de fora as recomendações oficiais maioritariamente da Organização Mundial da Saúde. A recolha de informação foi feita com base num questionário. Os resultados desta pesquisa são considerados satisfatório porque respondem aos objectivos traçados para o presente estudo. Concluiu-se que é necessário continuar com as acções de sensibilização da população em matérias de educação ambiental de modo que as pessoas percebam quais são os problemas ambientais que precisam de soluções para que o futuro ambiental não seja prejudicado e ter uma consciência quanto aos impactos ambientais. Continuar também a combater o alastramento da doença e no mínimo reduzir o uso das máscaras descartáveis optando pelo material reciclável como as máscaras caseiras que podem ser reutilizadas. Recomenda-se o descarte das máscaras de forma correcta e que se façam mais pesquisas capazes de educar e sensibilizar as populações sobre a gestão de residuos sólidos

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods: Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings: In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation: GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations