The TAP quick guide: a practical handbook for implementing tailoring antimicrobial resistance programmes

The Tailoring Immunization Programmes (TIP) approach was developed by the WHO Regional Office for Europe to support countries in achieving high and equitable vaccination uptake, through understanding the barriers to vaccination among population groups with suboptimal coverage. The TIP inspired the development of a Manual for Tailoring Antimicrobial Programmes (TAP), to be available in 2021. The Manual for TAP then inspired, and served as the foundation for, this user-friendly TAP Quick Guide and TAP Toolbox. This guide was prepared by Felicity Pocklington (Common Thread, London, England), Michael Coleman (Common Thread, London, England) and Sahil Warsi (WHO Regional Office for Europe) under the technical guidance of Ketevan Kandelaki (WHO Regional Office for Europe), Danilo Lo Fo Wong (WHO Regional Office for Europe), Karen Mah (WHO headquarters) and Anand Balachandran (WHO headquarters). Input and review were provided by Siff Malue Nielsen (WHO Regional Office for Europe), Katrine Bach Habersaat (WHO Regional Office for Europe) and Ponnu Padiyara (WHO headquarters). Significant contributions for the technical concept were made by Marie Louise Wright (World Food Programme headquarters), Chantal den Daas (National Institute for Public Health and the Environment Netherlands, RIVM) and Anja Schreijer (Public Health Service, Amsterdam, The Netherlands). This document was produced with the financial assistance of the European Union. The views expressed herein can in no way be taken to reflect the official opinion of the European Union

Operation MECACAR: eradicating polio : final report 1995 - 2000

Operation MECACAR (the coordinated poliomyelitis eradication efforts in Mediterranean, Caucasus and central Asian republics) reaffirms that tremendous public health accomplishments are feasible when national governments, WHO, the United Nations Children\ue2\u20ac\u2122s Fund (UNICEF), and other external partners work together closely--in this case, with the primary goal of reaching every child with oral polio vaccine. Since 1995, 18 countries and areas with diverse political systems have met regularly to exchange information openly, and to plan sound strategies to fight infectious diseases together. The success of Operation MECACAR is clear. Participants synchronized national immunization days (NIDs) against poliomyelitis so that children in mobile population groups could be immunized simultaneously. As a consequence, 15 of the participating countries and areas reported no indigenous poliomyelitis cases in 2000, with steep reductions in the number of cases in the others. In addition to the impact on poliomyelitis incidence, participants benefited from improved dialogue, the sharing of lessons learned, and joint planning. Operation MECACAR has directly influenced the approach to poliomyelitis eradication worldwide. In western and central Africa, 17 countries have already synchronized their NIDs in the autumn of 2000. These countries used the lessons of Operation MECACAR and decided to unite in an effort to rid their children forever of the threat of poliomyelitis. This collaboration will un- doubtedly lead to increased collaboration on other health goals. The mechanism of Operation MECACAR could be adapted for use in other areas of the world, as we seek to certify poliomyelitis eradication in 2005. All countries and areas must work together to exchange information, maintain certification-standard surveillance and contain laboratory poliovirus stocks. In addition, the MECACAR process provides a forum to coordinate policy for stopping poliomyelitis immunization.World Health Organization, Regional Office for Europe with the Regional Office for the Eastern Mediterranean."EUR/00/5018747(F).""The production of this book is funded jointly by the US Centers for Disease Control and Prevention (CDC) and the US Agency for International Development (USAID)." - p. i

Surveillance guidelines for measles, rubella and congenital rubella syndrome in the WHO European Region

The WHO Regional Committee for Europe adopted the goal of eliminating indigenous measles transmission in 1998. In 2005, the Regional Committee expanded this commitment to include rubella and set a date for the elimination of both diseases by 2010. Although Member States did make progress, through the implementation of a strategic plan, the goal was not achieved. The WHO Regional Committee for Europe acknowledged at its sixtieth session (2010) that the regional goal of eliminating measles and rubella is achievable, and set a new target date of 2015. In the document Eliminating measles and rubella and preventing congenital rubella infection, WHO European Region strategic plan 2005-2010, key strategies are identified to meet the targets for interrupting transmission of indigenous measles and rubella and preventing congenital rubella infection. Strengthening surveillance systems by vigorous case investigation, including laboratory confirmation, is one of these key strategies. In line with the elimination goal, Surveillance guidelines for measles, rubella and congenitalrubella syndrome in the WHO European Region are intended to provide technical advice on the design and implementation of surveillance programmes. Surveillance indicators defined in these guidelines will be critical for assessing whether Member States have achieved the level of disease surveillance necessary for documenting elimination of indigenous measles and rubella transmission, and verifying that the Region's elimination objectives have been reached.Acronyms -- 1. Introduction -- 1.1. Objectives of surveillance and programme monitoring -- 2. Measles, rubella and CRS: disease description, epidemiology and diagnosis -- 2.1. Measles -- 2.2. Rubella -- 2.3. Congenital rubella syndrome -- 2.4. Rationale for disease elimination and an integrated approach to measles and rubella surveillance in the European Region -- 3. Case definitions for surveillance and reporting of measles and rubella -- 3.1. Measles -- 3.2. Rubella -- 3.3. Classification of cases by origin of infection -- 3.4. Measles and rubella outbreaks -- 4. Measles and rubella surveillance -- 4.1. Laboratory assessment algorithms for measles and rubella infection -- 4.2. Data collection and reporting -- 4.3. Reporting to WHO -- 5. Monitoring and evaluation -- 5.1. Surveillance performance indicators. -- 5.2. Indicators for monitoring progress towards elimination -- 6. Surveillance of CRS -- 6.1. Rationale -- 6.2. CRS -- clinical features, case classification and laboratory criteria for confirmation -- 6.3. CRS surveillance -- 6.4. Other approaches to identifying CRS cases -- References -- Annex I. Integrated measles and rubella case investigation form -- Annex II. Measles and rubella database for case-based reporting -- CISID -- Annex 3. Collection, storage and shipment of specimens for laboratory diagnosis and interpretation of results."E93035."The Vaccine Preventable Diseases and Immunization Programme (VPI) of the Division of Communicable Diseases, Health Security and Environment of the WHO Regional Office for Europe expresses its gratitude to those who have contributed their time and experience, and provided input and suggestions in the development of these guidelines. A special thanks to the US Centers for Disease Control and Prevention (CDC) and the European Centre for Disease Prevention and Control (ECDC) for their technical input.Mode of access: World Wide Web as an Acrobat .pdf file (1.2 MB, 71 p.).Includes bibliographical references (p. 41-44)

Evaluating implementation of the WHO set of recommendations on the marketing of foods and non-alcoholic beverages to children: Progress, challenges and guidance for next steps in the WHO European Region

This paper describes the status of the implementation of the WHO Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages to Children (2010). The Set of Recommendations, adopted by the World Health Assembly, urges Member States to reduce the impact on children of the marketing of energy-dense, highly processed foods and beverages that are high in saturated fats, trans fats, free sugars and/or salt (HFSS). A growing body of independent monitoring and research indicates that existing policies and regulations are markedly insufficient to address the continuing challenges in this field. This report identifies loopholes, ongoing challenges, and factors that Member States need to consider to effectively limit the harmful impact that HFSS food marketing has on children, their health and their rights. Policies and regulations tend to use narrow definitions and criteria (they frequently apply to pre-digital media only, to younger children and not to adolescents, and to “child-directed” media, rather than those with the greatest child audiences), and they almost never address the complex challenges of crossborder marketing. This situation can be explained, in part, by the strong scrutiny and opposition that countries have faced from parts of the private sector, and by weak self-regulatory schemes. As a result, and in order to ensure that States uphold their legal obligations to protect the child’s right to health and related rights, the World Health Assembly requested that WHO provides additional technical support to Member States in implementing the Set of Recommendations. This report identifies challenges States need to address

Report From the technical meeting on developing the evaluation culture and the methodology for the end-term evaluation of the Portuguese National Health Plan 2020 held on 14 and 15 December 2017, Lisbon, Portugal

Main competencies for policy evaluation in Portugal - National Institute of Health (INSA): Evaluate the implementation and results of policies, NHP and the MoH programs. Legal documents: Decreto-Lei n.º 124/2011, de 29 de dezembro + Regulamento n.º 329/2013, 29 de agosto.Participantes: WHO - Neda Milevska, Dominique Danau, Snezhana Chichevalieva; INSA - Teresa Caldas de Almeida (DPS), Carlos Dias (DEP), Alexandra Costa (DPS), Ricardo Mexia (DEP), Ana Cristina Garcia (DEP). O INSA colaborou na redação do documento e validação da versão final.This report serves to inform on the meeting discussions and conclusions in developing the evaluation culture and the methodology for the end-term evaluation of the Portuguese National Health Plan 2020 (PNS 2020). The meeting was technically supported by the WHO Regional Office for Europe to Portugal (BCA 2016-2017).Portugal has endorsed its National Health Plan (PNS) 2012-2016 in 2012 and in 2015 has extended its duration until 2020, scoping the commitments to Health 2020 at national and local levels. Portuguese national authorities planned for end-term evaluation of the PNS 2020 in their strategic and operational documents, to ensure meeting of the PNS objectives, goals and targets. WHO, Regional Office for Europe has supported policy development in Portugal in the last decade and especially the PNS 2020 as an implementing tool of the WHO European policy framework for health and well-being Health 2020. Following this line of cooperation for policy development, the Ministry of Health of Portugal requested technical support from the WHO Europe for developing a methodology of the PNS 2020 end-term evaluation as part of the signed Biennial Collaborative Agreement 2016-2017. The policy evaluation planning phase was initiated in July 2017 at a technical level to discuss evaluation structures, questions, criteria and methodological approach, as a prerequisite for further developing the work plan and terms of reference of the PNS 2020 end-term evaluation. Based on the conclusions of the meeting of WHO National Health Policies’ Program and the Portuguese National Health Institute (INSA) held in July 2017, INSA started several activities, and especially: (1) mapping of implementation evidence for PNS 2020, based on a methodology developed with technical support of WHO that included PNS 2020, Health 2020, NCD-GMF and SDG targets and indicators, (2) conceptualizing the governance structure and different scenarios for the end-term evaluation of PNS 2020, and (3) preparing high-level technical dialogue to bring together national institutions mandated with specific aspects for health policy development, implementation, monitoring, and evaluation at different levels, as well as expert community. High-level technical dialogue was held on 14 and 15 December 2017. It widened the scope of discussions beyond the end-term evaluation of the PNS 2020 towards developing a culture for policy evaluation in the country, using the PNS 2020 evaluation for a more focused approach and discussions. This report presents a condensed overview of the rich and open meeting discussions, conclusions, and recommendations to serve further developing of the policy evaluation culture and the PNS 2020 end-term evaluation.N/

Tackling food marketing to children in a digital world: trans-disciplinary perspectives. Children’s rights, evidence of impact, methodological challenges, regulatory options and policy implications for the WHO European Region

There is unequivocal evidence that childhood obesity is influenced by marketing of foods and non-alcoholic beverages high in saturated fat, salt and/or free sugars (HFSS), and a core recommendation of the WHO Commission on Ending Childhood Obesity is to reduce children’s exposure to all such marketing. As a result, WHO has called on Member States to introduce restrictions on marketing of HFSS foods to children, covering all media, including digital, and to close any regulatory loopholes. This publication provides up-to-date information on the marketing of foods and non-alcoholic beverages to children and the changes that have occurred in recent years, focusing in particular on the major shift to digital marketing. It examines trends in media use among children, marketing methods in the new digital media landscape and children’s engagement with such marketing. It also considers the impact on children and their ability to counter marketing as well as the implications for children’s rights and digital privacy. Finally the report discusses the policy implications and some of the recent policy action by WHO European Member States

Trends in drinking habits among adolescents in the Baltic countries over the period of transition: HBSC survey results, 1993–2002

BACKGROUND: The Baltic countries – Estonia, Latvia, and Lithuania – are considered to be an example of regional homogeneity over the period of transition. The World Health Organization cross-national study on Health Behavior in School-aged Children (HBSC) allows a comparison and time trends analysis of behavioral patterns among adolescents in this region. The aim of this study was to estimate the prevalence and trends of alcohol consumption and drunkenness among adolescents of Estonia, Latvia, and Lithuania in 1993/94, 1997/98, and 2001/02. METHODS: Representative samples of 5286 boys and 6485 girls aged 15 from Estonia, Latvia, and Lithuania were surveyed in 1993/94, 1997/98, and 2001/02 school-year within the framework of HBSC study. The standardized survey methods were applied. The research focused on the following outcome variables: i) frequency of drinking beer, wine, and spirits; and ii) frequency of drunkenness. The same wording of questions on the consumption of alcohol was retained in each survey. RESULTS: Beer was the most frequently used alcoholic beverage across the Baltic countries among adolescents. The rate of weekly drinking of any alcoholic beverage increased considerably during the eight years of observation, especially among Estonian and Lithuanian students. In 2001/02, 25% of boys and 12.5% of girls have reported drinking alcohol at least weekly. The rate of regular alcohol drinking was two times higher in boys, while irregular drinking was more prevalent in girls. Two or more episodes of drunkenness in the lifespan were reported by 30% of boys and 15% of girls in 1993/94 and by 52% of boys and 36% of girls in 2001/02. The use of alcoholic beverages was related to the perceived family wealth: the students from the families perceived by them as wealthy were more likely to drink weekly as compared to the students from the families perceived by them as not wealthy. CONCLUSION: Over the period between 1993 and 2002 the prevalence of alcohol consumption among adolescents increased considerably across the Baltic countries. The efforts of dealing with this problem should employ a combination of measures, including the strategies relevant for the period of transition

Human health effects of benzene, arsenic, cadmium, nickel, lead and mercury: Report of an expert consultation

Ana Isabel Cañas Portilla y Argelia Castaño Calvo del Centro Nacional de Sanidad Ambiental (ISCIII) han participado en este informe como expertos proporcionando comentarios técnicos.Benzene, arsenic, cadmium, lead, mercury and nickel are ubiquitous pollutants in ambient air. The main sources are industrial processes, electricity generation and fuel combustion. The main routes of exposure are inhalation for benzene, and diet for arsenic, cadmium, lead, nickel and mercury. Inhalation of benzene, arsenic and cadmium is relevant for exposure in active tobacco smokers and people exposed to second-hand tobacco smoke. Epidemiological studies show that exposure to these pollutants is associated with adverse effects on the cardiovascular (cadmium, lead, mercury); haematological (benzene, lead); immunological, neurological and reproductive (benzene, lead, mercury); respiratory (cadmium, nickel); renal (cadmium, lead); and skeletal (cadmium) systems. Limited epidemiological evidence on ambient air pollution suggests adverse effects on the cardiovascular system (arsenic and nickel). Since benzene, arsenic, cadmium and nickel are classified as carcinogenic, the lowest possible exposure level is suggested to minimize the risk for cancer development in view of the no-effect threshold paradigm. Lead and methylmercury compounds are classified as possibly carcinogenic to humans. However, the available evidence is insufficient to warrant updating the air quality guidelines for these air pollutants. Evidence gaps are identified and these should guide future research efforts.S

A comparison of trends in caesarean section rates in former communist (transition) countries and other European countries

Caesarean section rates are rising across Europe, and concerns exist that increases are not clinically indicated. Societal, cultural and health system factors have been identified as influential. Former communist (transition) countries have experienced radical changes in these potential determinants, and we, therefore, hypothesized they may exhibit differing trends to non-transition countries. By analysing data from the WHO Europe Health for All Database, we find transition countries had a relatively low caesarean section rate in 2000 but have since experienced more rapid increases than other countries (average annual percentage change 7.9 vs. 2.4)

Common Goods for Health : Economic Rationale and Tools for Prioritization

This paper presents the economic rationale for treating Common Goods for Health (CGH) as priorities for public intervention. We use the concept of market failure as a central argument for identifying CGH and apply cost-effectiveness analysis (CEA) as a normative tool to prioritize CGH interventions in public finance decisions. We show that CGH are consistent with traditional lists of public health core functions but cannot be identified separately from non-CGH activities in such lists. We propose a public finance decision tree, adapted from existing health economics tools, to identify CGH activities within the set of cost-effective interventions for the health sector. We test the framework by applying it to the 2018 Disease Control Priority (DCP) list of interventions recommended for public funding and find that less than 10% of cost-effective interventions unconditionally qualify as CGH, while another two-thirds may or may not qualify depending on context and form. We conclude that while CEA can be used as a tool to prioritize CGH, the scarcity of such analyses for CGH interventions may be partly responsible for the lack of priority given to them. We encourage further research to address methodological and resource challenges to assessing the cost-effectiveness of CGH intervention packages, in particular those involving large investments and long-term benefits