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NVI Year in review 2018 WHO Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention

Dear colleagues and friends,

I hope the new year has started well for you!

I am pleased to share the “NVI Year in Review 2018”, which features highlights from the work of WHO’s Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention (NVI). This work was conducted in close collaboration with our colleagues in WHO regional and country offices and other HQ departments, as well as with hundreds of other partners.

We are gratified to note significant progress on our topics in many countries over this last year. From strengthening community-based rehabilitation in Mozambique to protecting children from drowning in Viet Nam, managing hypertension in India, and providing urgently needed medicines to treat cancer patients in Yemen, we have helped many people to enjoy better health and well-being.

With input from many of you, we have issued new guidance for the treatment of diabetes and cardiovascular diseases, the latter as part of the Global Hearts Initiative; the prevention of violence against children and the strengthening of emergency and trauma care. We have also provided countries with a toolkit to help them develop, implement and evaluate multi-sectoral action plans for the prevention and control of NCDs and an update of the status of road safety in their countries.

Through the organization of high-profile advocacy events, we have helped to spread knowledge and awareness and garner political support for our issues. Important such events in 2018 include the End Violence Solutions Summit, the Third UN High-Level Meeting on NCDs and the 13th World Conference on Injury Prevention and Safety Promotion.

In addition we are excited with the launch of two new global initiatives: firstly, with support from St. Jude Children’s Research Hospital in the United States, the Global Initiative for Childhood Cancer, and, secondly, with backing from the AO Foundation in Switzerland, the Global Emergency and Trauma Care Initiative. With significant funding for work in countries through these grants, these initiatives will accelerate action and save lives.

A highpoint of the year was the reappointment by the WHO Director-General Dr Tedros of Mr Michael Bloomberg as WHO Global Ambassador for NCDs and Injuries. In this capacity, Mr Bloomberg will continue to engage with WHO to raise awareness and promote investment in NCD and injury prevention and control.

Your ongoing support and collaboration have been integral to what we have been able to achieve together. I warmly thank you, our partners, for working with us and for sharing our vision of enabling people to live healthier, more productive lives.

We look forward to our continued engagement in the year ahead.

Kind regards,

Etienne Krug, Director, NVI, World Health Organization

WHO Department for Management of NCDs, Disability, Violence and Injury Prevention (NVI): Year in review

January Highlights

WHO launched the world's first standardized platform for data collection about burns

In January following extensive pilot testing in 60 health facilities across 30 countries, WHO released the Global Burn Registry - the first ever global platform allowing for standardized data collection about burn victims. This new resource will allow users to view data from their health facility as well as all other participating health facilities, providing a clear picture of the populations in their respective settings at greatest risk of burns and allowing the prioritization of prevention strategies. Data (which are stripped of reference to information which allows identification of individual patients) will be able to be used for further analysis by researchers and policy-makers, among others. Burns account for an estimated 180,000 deaths per year, the majority in homes and workplaces in low- and middle-income countries. High-income countries have made considerable progress in lowering rates of deaths from burns. This has been achieved by promoting safer cook stoves; advocating for the use of smoke detectors, fire sprinklers, and fire-escape systems in homes; and lowering the temperature in hot water taps ─ as well as through improvements in the care and treatment of burn victims. Most of these advances have been unevenly applied in low- and middle-income countries. Since its release more than 1,100 records have been entered into the Global Burn Registry which will be publicly available in early 2019. http://www.who.int/violence_injury_prevention/burns/gbr

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New effort to preventing drowning in children announced in Viet Nam

A new programme to prevent drowning in children in Viet Nam which provides swim skills training and village-based day care was announced during a national consultation on 23 January. The effort is a response to the toll of almost 6,000 deaths from drowning each year in Viet Nam, where drowning is the leading cause of death for children 2-14 years of age. The programme aims to train 10,000 children in swim skills training and provide day care to 40,000 children during the next 5 years. WHO provides technical support to governmental and non-governmental stakeholders, ensuring that the implementation of both interventions is carried out in an effective manner and follows WHO guidance provided in the WHO publications Global report on drowning and Preventing drowning: An implementation guide. WHO has also coordinated basic epidemiologic work with the Hanoi School of Public Health to ensure that the programme is targeting the highest burden provinces and districts. https://www.who.int/violence_injury_prevention/drowning/en/

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February highlights

End Violence Solutions Summit generated political will to prevent violence against children

On 14-15 February, around 400 representatives from 67 countries, including governments, UN agencies, civil society, private sector, and youth and religious groups, highlighted their commitment to ending violence against children by 2030. Hosted by the Government of Sweden in cooperation with the Global Partnership to End Violence against Children and the WePROTECT Global Alliance, the first-ever End Violence Solutions Summit generated political will and increased knowledge about how to prevent violence against children and mitigate its consequences. Globally, it is estimated that up to 1 billion children aged 2–17 years experience physical, sexual, or emotional violence or neglect each year, impacting on lifelong health and well-being. In his speech, WHO Director-General Dr Tedros underlined the importance of adopting an evidence-based approach and encouraged participants to implement INSPIRE: seven strategies to end violence against children. The event culminated with launch of the Stockholm Solutions Summit Proclamation. As follow-up to the Summit, the number of pathfinding countries where the INSPIRE technical package is being implemented rose from 13 to 23, in part with support from new funding from the Governments of Japan and the United Kingdom. The next Summit will take place in 2020. http://www.who.int/violence_injury_prevention/violence/inspire/en/

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Indicators agreed upon to support 12 global road safety targets

Following establishment of the 12 global performance targets for road safety that were agreed upon by Member States in November 2017, WHO facilitated a process to identify corresponding indicators. On 22-23 February the Informal Consultation of Member States on Road Safety Indicators was attended by representatives of more than 35 Member States as well as several UN agencies including the UN Economic Commission for Europe and UNICEF. Participants deliberated over 33 proposed indicators. At its conclusion a set of indicators covering process and outcomes for each of the 12 global targets was identified by the group. Among them include that all new roads will achieve a three-star rating or better; new and used vehicles will meet recommended priority UN regulations or national equivalents; and the proportion of vehicles travelling over posted speed limits will be reduced by half. These indicators along with the global targets will help to guide action and ensure measurement of progress at the national and global levels. https://www.who.int/violence_injury_prevention/road_traffic/12GlobalRoadSafetyTargets.pdf

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On World Cancer Day, WHO highlighted that cancer no longer needs to be a death sentence

Nearly every family in the world is touched by cancer, which is now responsible for almost 1 in 6 deaths globally. On 4 February, World Cancer Day, WHO highlighted that cancer no longer needs to be a death sentence, as the capacity exists to reduce its burden and improve the survival and quality of life of people living with the disease. A May 2017 World Health Assembly resolution (WHA A70/A/CONF./9) “Cancer prevention and control in the context of an integrated approach" provided a clear road map to realize the potential for prevention, early diagnosis, prompt treatment and palliative care for people with cancer. Since adoption of the resolution, Member States have enacted strategies such as imposing higher taxes on tobacco and alcohol, promoting healthy diets and physical activity, and advocating for access to HPV vaccination. Approximately 30-50% of cancers can be prevented if these risk-reducing policies are maximally implemented. In September Member States reported on progress in achieving implementation of the road map at the Third UN High-level Meeting on NCDs. All in all, this has been an important year for cancer control as steps have been taken to translate political momentum into lives saved. http://www.who.int/cancer/world-cancer-day/2018/en/

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March highlights

WHO called for action to stem the rise in hearing loss

On 3 March, WHO and partners marked the annual World Hearing Day under the theme “Hear the Future”, with national and local events held in more than 40 countries. Among these included hearing checks in clinics, schools and community centres and launches of new campaigns, courses and exhibits. In conjunction with the Day, WHO released a brochure with new estimates indicating that some 900 million people could suffer from disabling hearing loss by 2050, up from 466 million people today. The main reasons are a growing ageing population and the persistence of risks such as ear and vaccine-preventable infections. World Hearing Day is a highlight of WHO’s advocacy work on this topic, through which WHO promotes proven measures such as immunizing children against infectious diseases; screening and treating children who suffer from chronic ear infections; and controlling exposure to loud sounds in occupational and recreational settings. In cases where hearing loss is unavoidable, WHO advocates for access to appropriate and affordable assistive technologies such as hearing aids and communication services like sign language. To review actions undertaken by WHO and partners to implement these and other measures reflected in World Health Assembly resolution (WHA70.13) “Prevention of deafness and hearing loss”, WHO also convened from 3-4 July the 3rd Stakeholders’ Meeting for the WHO Programme on the Prevention of Deafness and Hearing Loss. With 140 representatives of governments, professional societies, NGOs, academia and industry, participants identified ways to further accelerate action. During the meeting WHO announced creation of the World Hearing Forum which is set to drive a global, multi-stakeholder advocacy initiative on ear and hearing care. http://www.who.int/deafness/world-hearing-day/whd-2018/en/ https://www.who.int/deafness/wolrd-hearing-forum/en/

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New set of modules released to help manage cardiovascular diseases (CVDs)

On 6 March WHO released several of the individual modules which comprise the HEARTS technical package for cardiovascular disease management in primary health care. The practical, step-by step modules are supported by an overarching technical document that provides a rationale and framework for this integrated approach. The modules are intended for use by policy-makers and programme managers within Ministries of Health who can influence CVD primary care delivery. More people die from CVDs than from any other cause, with over three-quarters of deaths from heart attacks and strokes occurring in low- and middle-income countries. The HEARTS technical package is part of the broader Global Hearts Initiative, led by WHO and the US Centers for Disease Control and Prevention, which includes four other packages that address the prevention of CVDs, namely MPOWER on tobacco control, SHAKE on salt reduction, ACTIVE on physical activity and REPLACE on industrially produced trans-fat. Through the HEARTS Initiative in the Americas, PAHO/WHO colleagues have provided support to 30 health centres across 8 countries in the region – Argentina, Barbados, Chile, Colombia, Cuba, Ecuador, Panama and Trinidad and Tobago – to implement the HEARTS technical package and scale up control of hypertension. Activities have included conducting baseline assessments, adapting and implementing specific HEARTS modules, building capacities and evaluating programmes, including by use of the PAHO/WHO and World Hypertension League document Monitoring and evaluation framework for hypertension control programs also released in 2018. http://www.who.int/cardiovascular_diseases/hearts/en/ http://iris.paho.org/xmlui/handle/123456789/34877

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Government of Uganda took steps to strengthen school-based violence prevention

According to the Uganda Violence against Children Survey, 6 in 10 females (59%) and 7 in 10 males (68%) reported experiencing physical violence and 1 in 3 girls (35%) and 1 in 6 boys (17%) reported experiencing sexual violence during their childhoods. WHO together with the Ministry of Education and Sports and UNICEF convened from 27-28 March a national policy dialogue to strengthen school-based violence prevention efforts and inform national policies currently under development such as the National Action Plan on Violence against Children in Schools and the National Child Policy. The gathering was attended by 120 participants including the country’s Permanent Secretary of the Ministry of Education and Sports and Director of Basic and Secondary Education. Substantial progress has been made on school-based violence prevention in Uganda in recent years. The “Good School Toolkit” is an example of an evidence-based guidance that has been developed in Uganda, scaled-up in the country and received international recognition. WHO continues to support school-based violence prevention efforts in Uganda and other countries by developing a practical handbook on how to strengthen violence prevention measures at the school level. The handbook, which is being developed by experts from WHO, UNESCO and UNICEF, is expected to be released in May 2019. http://raisingvoices.org/good-school/

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Myanmar endeavored to strengthen its health system to provide rehabilitation

In March, WHO supported a consensus workshop in Nay Pyi Taw, Myanmar, to support development of Myanmar’s National Rehabilitation Strategy. The workshop was opened by the country’s Minister for Health and Sports and brought together over 70 representatives from the Ministry, other government agencies, international and civil society organizations, and rehabilitation professionals. The workshop was part of a broader collaborative process between Myanmar and WHO. Myanmar has committed to utilizing the WHO Rehabilitation in health systems and Rehabilitation 2030: A Call for Action as a basis for strengthening the health system in order to provide quality rehabilitation services. Throughout 2018 WHO has supported the Ministry of Health and Sports to use various tools to undertake a detailed situation assessment and develop a strategic plan for rehabilitation. Plans are in place in early 2019 to develop a rehabilitation monitoring framework and establish evaluation and review processes. Similar efforts are also currently underway in Botswana, Guyana, Jordan, Nepal, Solomon Islands and Sri Lanka. https://www.who.int/rehabilitation

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April highlights

WHO issued new guidance on managing diabetes

In April WHO released the Guidelines on second-and third-line medicines and type of insulin for the control of blood glucose levels in non-pregnant adults with diabetes mellitus. These guidelines update the recommendations for managing hyperglycaemia in the WHO Package of essential NCD interventions (WHO PEN) for primary care in low-resources settings, reviewing several newer oral agents as second- and third-line treatment. The guidelines also present recommendations on the selection of type of insulin (analogue versus human) for adults with type 1 and type 2 diabetes. The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014, with 8.5% of adults over 18 years of age affected by the disease. In 2012 alone diabetes caused 1.5 million deaths. Its complications can lead to heart attack, stroke, blindness, kidney failure and lower limb amputation. Diabetes can be treated, and its consequences avoided or delayed with a healthy diet, physical activity, medication and regular screening and treatment for complications. A synopsis of the WHO guidelines was published in the Annals of the Internal Medicine in September. https://www.who.int/diabetes/publications/guidelines-diabetes-medicines/en/; https://annals.org/aim/fullarticle/2698900/medicines-treatment-intensification-type-2-diabetes-type-insulin-type-1

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Protocol based treatment of hypertension and diabetes initiated in Kerala, India

As part of the “Resolve to Save Lives” initiative to reduce deaths from CVDs, WHO promotes the treatment of hypertension using standardized protocols, unique identifiers for patients and simple indicators in primary health care. These interventions are deemed critical to reducing CVD deaths. In 2018 WHO and partners supported the implementation of these in several countries. On 4 April Kerala State of India launched its programme on NCDs incorporating these interventions and others reflected in the WHO HEARTS technical package for CVD management in primary health care. The Honourable Minister of Health of the State of Kerala; President of Resolve; and other dignitaries participated in the launch event. Next steps include expansion and scale up of the initiative in the four districts of Kerala. Four other states in India are already currently implementing these interventions to save lives. https://www.resolvetosavelives.org/

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WHO guidance on indicators for community-based rehabilitation (CBR) used in Mozambique

“Inclusive Sofala”, an initiative of Light for the World’s Mozambique Country Strategy 2016-2020, aims to promote an inclusive society in the Province of Sofala, in which people with disabilities can participate equally in social, economic and cultural life. The core approach to promote inclusion is CBR. With a view to evaluating the initiative, baseline data were gathered in line with WHO’s Community-based rehabilitation indicators manual. In this regard from 10-13 April WHO supported Light for the World with a training in Beira of 12 interviewers and field supervisors. Following the training, data collection took place, with 400 interviews carried out of 200 of people with disability and 200 of other members of the community. The findings were analyzed and described in a final report in May. In addition to providing baseline data for evaluation, the data collected will assist in defining priorities for the CBR programme. The same measurement will be repeated at the end of the 4-year project. http://www.who.int/disabilities/cbr/cbr_indicators_manual/en/

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may highlights

WHO Director-General called for global elimination of cervical cancer

Cervical cancer is the fourth most common cancer among women globally, with an estimated 570,000 cases and 311,000 deaths annually despite the availability of effective strategies for vaccination, screening, early diagnosis, treatment and palliative care. Without urgent scale-up of services, the projected burden of cervical cancer is set to increase to almost 460,0000 deaths by 2040, a close to 50% increase from 2018. In May WHO Director-General Dr Tedros announced a global call to action towards the elimination of cervical cancer, highlighting the impact that cervical cancer has on women and the moral imperative to address the inequitable burden of the disease on women in poor countries. Proven strategies to address cervical cancer include vaccination to prevent human papillomavirus (HPV) infection, screening and treatment of pre-cancerous lesions. Acceleration in implementing those strategies with adequate coverage offers the potential to eliminate cervical cancer as a public health problem globally. In 2018 many countries including Mongolia and Uzbekistan have taken action. In late 2018 the respective Ministries of Health hosted trainings of health professionals with support from colleagues from WHO and WHO’s International Agency for Research on Cancer. As follow up to these trainings, efforts are now underway in Mongolia to update national guidelines on cervical cancer screening and in Mongolia and Uzbekistan to support pilot projects making use of new HPV-based screening algorithms. https://www.who.int/reproductivehealth/call-to-action-elimination-cervical-cancer/en/; https://www.who.int/reproductivehealth/cervical-cancer-public-health-concern/en/

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71st World Health Assembly adopted resolution calling for greater action on rheumatic heart disease

On 25 May the 71st World Health Assembly adopted a resolution on rheumatic heart disease with the support of 26 Member States and 6 NGOs. In their statements, delegates recognized that rheumatic heart disease remains a significant public health concern in many countries, affecting around 30 million people and causing 305,000 deaths annually. A comprehensive approach to prevention and control in endemic countries is needed. Priority activities outlined in the resolution include accelerating multisectoral efforts to reduce poverty; improving access to primary health care; building the capacity to detect and manage group A streptococcal pharyngitis, rheumatic fever and rheumatic heart disease; and ensuring the timely and reliable access to technologies and medicines for diagnosis and treatment. Among other actions, international stakeholders, including private sector entities, are supporting research and development on new technologies and medicines. http://apps.who.int/gb/ebwha/pdf_files/WHA71/A71_25-en.pdf

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New WHO tools highlighted that investing in noncommunicable disease (NCD) control generates major financial and health gains

In May WHO released a new document, Saving lives, spending less: a strategic response to noncommunicable diseases, and in September a related online tool. Developed with the support of Bloomberg Philanthropies, the document reveals for the first time the financing needs and returns on investment of the WHO cost-effective and feasible “Best Buy” policies to protect people from NCDs, the world’s leading causes of death and ill health. It shows that for every US$ 1 invested in expanding interventions to address NCDs in low- and lower-middle-income countries, there will be a return to society of at least US$ 7 in increased employment, productivity and longer life. If all countries use these interventions, the world would move significantly closer to achieving Sustainable Development Goal (SDG) target 3.4 to reduce premature death from NCDs by one third by 2030. The document indicates that taking effective measures to prevent and control NCDs costs just an additional US$ 1.27 per person per year in low- and lower-middle-income countries. The health gains from this investment will save 8.2 million lives through 2030 and generate US$ 350 billion through averted health costs and increased productivity during the same period. The related online tool, developed based on country-specific data from the report, allows for calculations to be made on such factors as lives that can be saved; additional per person, per year investment needed to implement the “Best Buys”; return on investment for each “Best Buy” intervention; and economic gains generated by increased productivity and reduced health care costs between now and 2030. https://www.who.int/ncds/management/ncds-strategic-response/en/; http://apps.who.int/global-business-plan-ncds

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WHO delivered life-saving cancer medicines to Yemen

For countries in crisis, one of the greatest threats to health comes not from bullets and bombs, but from a lack of medicines to treat NCDs, including cancer. On 7 May WHO delivered more than 7 tons of various life-saving medicines to treat cancer to Yemen, where the world’s worst humanitarian crisis will soon be entering its fifth year. The supplies, provided through the generous support of the World Bank and the Government of Germany, were delivered to the country’s National Oncology Centre in Sana’a. Since 2005 more than 60,000 cancer patients from across Yemen − 12% of whom are children − have received treatment at the Centre, while an estimated 30,000 are still in dire need of interventions like chemotherapy and radiotherapy. The challenges facing the Centre are not only shortages of medicines, but also the lack of professional oncologists and other medical staff. “The health challenges are tremendous. We have managed to bring in this shipment despite logistical constraints and the ongoing conflict that threaten our supplies on a regular basis.” said Dr N. Zagaria, WHO Representative to Yemen. “The crisis prolongs the suffering of the Yemeni people, who are sick and dying from preventable diseases. This is unacceptable. We need to do more to ensure that everyone has access to essential health care.” Less than 30% of low-income countries like Yemen report that treatment services for cancer patients are generally available. As a response similar such efforts are underway, often with support from the International Atomic Energy Agency and WHO's International Agency for Research on Cancer, in Afghanistan, Democratic People’s Republic of Korea, Liberia and Syria.

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june highlights

WHO Independent High-level Commission on NCDs called for urgent action against chronic diseases

On 1 June the report of the WHO Independent High-level Commission on NCDs called for urgent action to address chronic diseases and mental disorders. The Commission, which comprises health and development leaders from governments, civil society and business, is co-chaired by the presidents of Finland, Sri Lanka and Uruguay, Minister of Healthcare of the Russian Federation and Former Federal Minister of Pakistan. Entitled Time to deliver, the report demanded high-level political commitment and the immediate scaling up of actions to address the epidemic of NCDs. During the launch, the President of Uruguay, Dr T. Vázquez, called on world leaders to "redouble efforts" to meet SDG target 3.4 and to promote mental health and well-being. "Preserving and improving people's quality of life is a way of enhancing human dignity in order to make progress in terms of economic growth, social justice and human coexistence," he said. The Commission makes six recommendations in its report:

  1. Heads of state and government should take responsibility for the NCD agenda;
  2. Governments should identify and implement a specific set of priorities;
  3. Governments should reorient health systems to include NCD prevention and control and mental health services in their universal health coverage policies and plans;
  4. Governments should increase effective regulation, appropriate engagement with the private sector, academia, civil society, and communities;
  5. Governments and the international community should develop a new economic paradigm for funding actions on NCDs and mental health;
  6. Governments need to strengthen accountability to their citizens for action on NCDs and simplify existing international accountability mechanisms.

Delivering the report to the WHO Director-General Dr Tedros was the first activity of the Commission, which will continue to provide high-level support to the NCD community by catalyzing action and financing, especially for low- and middle-income countries. The Commission's report helped inform the outcome document of the Third UN High-level Meeting on NCDs held in September in New York. https://www.who.int/ncds/management/time-to-deliver/en/

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july highlights

WHO and partners released tools for implementing INSPIRE technical package

On 12 July, WHO and partners launched the INSPIRE handbook: action for implementing the seven strategies. Targeted towards policy-makers, practitioners and advocates, the handbook gives guidance on how to put in place a select group of measures to prevent violence against children which are based on the best available evidence of what works. The strategies will advance efforts to achieve SDG target 16.2 to end all forms of violence against children. To coincide, UNICEF and partners launched the INSPIRE indicator guidance and results framework, a companion document designed to help monitor progress and track changes over time as the INSPIRE strategies are implemented. The INSPIRE Working Group, an informal network of some 100 agencies committed to implementing INSPIRE-related programmes, also announced a call for proposals to support INSPIRE awareness-raising and engagement activities in low- and middle-income countries. Funding was made possible by the New Venture Fund and Ignite Philanthropy: Inspiring the End to Violence Against Girls and Boys. Since its launch the handbook has been used as the basis for trainings in Cambodia, Malawi, Namibia, Philippines, Tanzania and Uganda, as well as in global and regional fora such as the congresses hosted by the International Society for the Prevention of Child Abuse and Neglect. http://www.who.int/violence_injury_prevention/violence/inspire-package/en/; http://www.cpcnetwork.org/inspirefund/

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WHO supported Tajikistan and other countries to implement the Model Disability Survey (MDS)

In many countries, reliable data about disability are generally not available. In 2018 WHO continued to support countries to improve their data using the MDS, a general population household survey that measures the levels of disability and the needs, barriers, and inequalities faced by people with disability in a particular setting. Through a project funded by the US Agency for International Development, WHO integrated the Brief MDS into the existing Gallup World Poll in India, Laos and Tajikistan. In Tajikistan from 3-6 July, in consultation with the WHO Country Office, the country's Agency of Statistics integrated the Brief MDS into the existing health module of the Household Budget Survey. To do so WHO provided technical support to train approximately 30 trainers and field supervisors in the capital Dushanbe. The health module was then piloted in 750 households from August to November 2018. The data collected are being used to estimate the distribution of disability for the whole population, calculate disability rates and monitor progress towards the SDGs. Eventually, these data will help to advocate for policies which would ensure a more inclusive society. Similar efforts were undertaken to expand use of the MDS through WHO-supported trainings in Costa Rica; Philippines; and Dubai, United Arab Emirates. WHO also supported the Governments of the Philippines and Qatar to finalize the reports from their nationally representative surveys, highlighting policy recommendations in areas such education and labour. https://www.who.int/disabilities/data/mds/en/

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Government of Ethiopia sought to address hypertension

From 25-29 June WHO colleagues participated in a planning meeting and protocol consensus workshop on hypertension prevention and control in Addis Ababa, Ethiopia, in partnership with the Government of Ethiopia and Resolve to Save Lives. In addition to meetings with focal points at the Ministry of Health, which included a briefing by the State Minister and a workshop on protocol selection and drug procurement for hypertension, field visits were conducted in Addis Ababa and Oromia to assess the current mechanisms for service delivery for hypertension control at the primary care level. Following the meeting, a protocol was endorsed by the national authorities to be rolled out in early 2019 as part of the Resolve to Save Lives project in the country. Resolve to Save Lives, with US$ 225 million from Bloomberg Philanthropies, the Chan Zuckerberg Initiative, and the Bill & Melinda Gates Foundation, uses proven strategies such as those being promoted to address hypertension to improve health in low- and middle-income countries. https://www.resolvetosavelives.org/

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august highlights

WHO and partners considered next steps for eye care

On 20-21 August WHO convened an informal meeting of stakeholders from the eye care sector to chart next steps for the field. The meeting involved more than 50 officials from WHO Collaborating Centres, other research institutes and NGOs as well as colleagues from across WHO. Participants identified key areas of future work including development of specific tools linked to eye care which are needed to further universal health coverage, expand the eye care workforce and integrate eye care into overall health systems. Advice received during the meeting will inform the scoping phase for these new areas of work. Participants also had a discussion on ways they might systematically support countries to implement the recommendations of the forthcoming World report on vision. The report, whose Editorial Committee convened several times in 2018, will provide authoritative evidence on the magnitude of vision impairment globally, as well as its prevention, treatment and rehabilitation. By helping to shape the global agenda on vision, the report will assist Member States in their efforts to reduce the impact of eye diseases and vision impairment, improve the lives of people with vision impairment, and achieve the SDGs, particularly SDG target 3.8 on universal health coverage. Also this year WHO and partners marked the annual World Sight Day on 11 October with the theme “Eye Care Everywhere”, by advocating that everyone, everywhere has access to good eye health. To coincide with the day, WHO released a photo essay on comprehensive eye care and, with the Ministry of Health of Peru, a feature story highlighting how the Government of Peru has expanded access to eye care services through maternal and child health facilities, as one of many initiatives in the country to address avoidable vision impairment. https://www.who.int/blindness/vision-report/wrv-info/en/; https://www.who.int/blindness/world_sight_day/2018/en/

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Finland hosted 12th General Meeting of the Global Alliance against Chronic Respiratory Diseases (GARD)

From 30 August to 1 September, Finland’s National Institute for Health and Welfare hosted some 120 GARD members for their 12th General Meeting, under the title “The Natural Step to Respiratory Health”. Participants addressed such issues as the global burden of chronic respiratory diseases, the tobacco end game, air pollution and mHealth, and integrating respiratory health into primary health care, among others, through plenary sessions, working groups and poster presentations. Officially launched in March 2006, GARD is an informal alliance of agencies committed to reducing the global burden of respiratory diseases by improving the diagnosis and medical care for people who suffer from these often underdiagnosed and untreated diseases. During the General Meeting, GARD members, with their vision of a world where all people breathe freely, committed to expanding support to countries to strengthen the management of chronic respiratory diseases and enhance advocacy for reducing air pollution as a major risk factor. In 2018 countries such as Eswatini and Timor-Leste were supported to strengthen the management of respiratory diseases. https://www.who.int/gard/en/

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september highlights

Heads of State and Government and ministers to the Third UN High-Level Meeting on NCDs adopted new political declaration

Heads of state and government or their representatives from 84 Member States approved for adoption a new political declaration on NCDs, namely Time to deliver: accelerating our response to address NCDs for the health and well-being of present and future generations during the opening segment of the Third UN High-level Meeting on NCDs on 27 September. The declaration reflects 13 new commitments, among them scaling up efforts to reduce tobacco consumption, harmful alcohol use, unhealthy diets and physical inactivity, notably through cost effective, evidence based interventions to halt obesity, as well as strengthening and reorienting health systems towards the achievement of universal health coverage. The WHO Director-General Dr Tedros noted in his remarks that governments are “dangerously off course” in efforts to reduce premature deaths from NCDs by one third by 2030, as reflected in SDG target 3.4. He pressed leaders to commit to the WHO “Best Buy” policies to protect people from NCDs. The UN General Assembly formally adopted the political declaration on 10 October. http://www.un.org/ga/search/view_doc.asp?symbol=A%2F73%2FL.2&Submit=Search&Lang=E

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WHO launched Global Initiative for Childhood Cancer

On 28 September WHO announced a new effort - the WHO Global Initiative for Childhood Cancer - with the aim of reaching at least a 60% survival rate for children with cancer by 2030, thereby saving an additional 1 million lives. This new target represents a doubling of the global cure rate for children with cancer. The aims of the initiative are two-fold: to increase prioritization of childhood cancer through awareness raising at global and national levels and to expand the capacity of countries to deliver best practice in childhood cancer care. Concretely, WHO supports governments to assess current capacities in cancer diagnosis and treatment including the availability of medicines and technologies; set and cost priority cancer diagnosis and treatment programmes; and integrate childhood cancer into national strategies, health benefits packages and social insurance schemes. Cancer is a leading cause of death for children, with 300,000 new cases diagnosed each year among children aged 0-19 years. Children with cancer in low- and middle-income countries are four times more likely to die of the disease than children in high-income countries. This is because their illnesses are not diagnosed, they are often forced to abandon treatment due to high costs, and the health professionals entrusted with their care lack specialized training. The WHO Global Initiative for Childhood Cancer, which involves development of a WHO technical package to help scale-up capacities within national health systems, will be achieved with support from a host of partners. Among them is St. Jude Children's Research Hospital in the United States, the first WHO Collaborating Centre on childhood cancer, which has committed US$ 15,000,000 to supporting implementation of the initiative. https://www.who.int/cancer/childhood-cancer/en/

WHO Director-General reappoints Michael Bloomberg as WHO Global Ambassador for NCDs and Injuries

On 27 September WHO Director-General, Dr Tedros, renewed the appointment of Mr Michael Bloomberg as WHO Global Ambassador for NCDs and Injuries. The announcement coincided with the Third UN High-Level Meeting on NCDs, during which world leaders agreed steps to better address NCDs. "I am delighted that Mike Bloomberg has agreed to continue in his role as WHO Global Ambassador," said Dr Tedros. "He has had tremendous impact in that role over the past two years. I want to particularly thank him for launching the Partnership for Healthy Cities - so far 50 cities have signed up to the network, committing to protecting their populations from NCDs and injuries." Many of the activities from the first appointment will continue during the second term, including building the Partnership for Healthy Cities and promoting investment in NCD and injury prevention. "NCDs are an urgent problem affecting more and more people, but we have the power to change that," said Mr Bloomberg. "Cities and countries are starting to make encouraging progress, and the faster we act, the more lives will be saved. I'm looking forward to working with Dr Tedros and WHO for another two years." http://www.who.int/ncds/management/ncd-ambassador/en/; https://partnershipforhealthycities.bloomberg.org/

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october highlights

WHO released toolkit to assist countries to accelerate NCD prevention and control

In October WHO released the Toolkit for developing, implementing and evaluating national multisectoral action plans (MAPs) for NCD prevention and control. The toolkit, which includes two key components: Part I “Tools for developing a national NCD MAP” and Part II “Framework for NCD MAP evaluation”, is targeted at policy-makers and programme managers in charge of national MAPs for NCD prevention and control. It covers the main steps from situation assessment, stakeholder engagement, and setting national NCD targets to implementation, monitoring and evaluation, including practical templates and examples. Since its release several countries have adapted components of the tool in accordance with their national context, with Sri Lanka and Turkmenistan focusing on prioritization and costing; Cameroon, Egypt and Nigeria on the development of NCD plans; and South Africa on evaluation. https://www.who.int/ncds/governance/policies/en/; http://apps.who.int/nmh/ncd-map-toolkit/

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Timor-Leste strengthened services for the prevention and treatment of chronic respiratory diseases

Nearly 1 of every 20 deaths in Timor-Leste is attributed to chronic respiratory diseases like chronic obstructive pulmonary disease and asthma. These diseases are linked to smoking and indoor air pollution, the latter caused by the use of biomass fuels in homes across the country. In 2017 the country’s Prime Minister launched a project to improve the early detection and management of chronic respiratory diseases through implementation of the WHO Package of essential NCD interventions (WHO PEN) for primary care in low-resources settings at primary health care centres in Dili and Ermera and at the Dili National Hospital. Through this project services for chronic respiratory diseases are integrated into those to prevent and treat NCDs. In addition, medicines and medical devices such as peak flow metres have been procured and primary health care professionals have been trained. Regarding the latter, with facilitators from the National Health Training Institute and WHO Timor-Leste, 31 primary health care providers were trained in October in the clinical management of chronic respiratory diseases and patient and family education about these causes of ill health, bringing the total number during the year to 90. Through the latest evaluation, nearly one quarter of all of the estimated cases of chronic respiratory diseases in the country are diagnosed and under treatment.

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november highlights

Safety 2018 addressed ways to achieve targets linked to violence and injuries

Violence and injuries take the lives of more than 13,000 people around the world each day, and account for 9% of the world’s deaths. In an effort to prevent them, nearly 1,000 experts from more than 90 countries gathered for Safety 2018, the 13th World Conference on Injury Prevention and Safety Promotion, to share the latest evidence and experiences from successful programmes. Preventing violence and injuries will further attainment of the SDGs and WHO’s 13th GPW 2019-2023. During the opening ceremony, presided over by Her Royal Highness Princess Maha Chakri Sirindhorn of Thailand, Dr E. Krug, WHO Director, noted “Urgent action is needed to avoid this unnecessary suffering of millions of families every year. We know what needs to be done. Safety 2018 provides an opportunity for the world’s leading violence and injury prevention researchers, practitioners and advocates to consider ways to scale up strategies to save lives.” In addition the conference served as an opportunity to train a number of journalists on violence and injury prevention, with a view to their being able to report on these topics with a focus on solutions; host a number of site visits to drowning prevention programmes in Thailand; and hold several side meetings, including of Ministry of Health focal points who work on these topics. The conference concluded with adoption of the Bangkok Declaration. http://www.worldsafety2018.org/

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Ministry of Health Focal Points for Violence and Injury Prevention convened in Bangkok

From 3-4 November the 5th Global Ministry of Health (MoH) Focal Points for Violence and Injury Prevention convened some 100 delegates from 70 primarily low- and middle-income countries, including MoH focal points, heads of WHO Collaborating Centres and NGOs in Official Relations, and WHO colleagues from across the organization. The meeting was opened by H.E. Dr P. Sakolsatayadorn, Minister of Public Health of Thailand, who welcomed delegates, highlighting the significant progress that has been made in the country to address violence and injuries. He was joined by Dr D. Kertesz, Representative of WHO Thailand, who indicated WHO’s willingness to support MoH focal points in their various roles, from data collection to prevention and services. In an effort to catalyze national and regional action, participants developed an agenda for achieving targets in violence prevention and road safety reflected in the SDGs and WHO’s 13th GPW 2019-2023 and also determined how to strengthen efforts to prevent drowning and provide emergency trauma care. They also familiarized themselves with the latest WHO technical guidance, including WHO technical packages. At the close of the meeting, updates were given on projects towards which the MoH focal points could make important contributions in the coming year or so, among them the Fifth UN Global Road Safety Week on “Leadership for Road Safety” (May 2019), the Third Global Ministerial Conference on Road Safety (February 2020) and the Global Burn Registry. https://www.who.int/violence_injury_prevention/5th_MOH_FP_meeting/en/

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Two new tools released to enhance emergency and trauma care

In early November WHO released two new tools to support efforts to provide timely, life-saving emergency and trauma care. These include:

  • WHO International Registry for Trauma and Emergency Care (WHO IRTEC): WHO IRTEC is a web-based platform for aggregation and analysis of case-based data from emergency care visits. The platform is free to users and provides a range of automated reports to facilitate quality improvement, system planning and scholarly publication. Standardized audit filters allow rapid identification of cases where simple process changes can save lives. The registry is currently available for use with acute injury cases presenting to facilities and will expand to include general emergency conditions in 2019. The WHO Standardized Clinical Forms for Emergency Care Visits provide a simple mechanism for collecting the IRTEC data points, and directly improve clinical care by ensuring a systematic approach to every acutely ill and injured person. Since the launch of WHO IRTEC, initial trainings for users of the registry have been conducted in Burundi, Ethiopia, Kenya, Malawi, Mozambique, Namibia, Rwanda, South Sudan, Tanzania, Uganda, Zambia and Zimbabwe.
  • Basic Emergency Care (BEC) course: Developed by WHO and the International Committee of the Red Cross, in collaboration with the International Federation for Emergency Medicine, BEC is an open-access training course for frontline healthcare providers who manage acute illness and injury with limited resources. Produced in response to requests from multiple countries and international partners, the BEC package includes a participant workbook and electronic slide decks for each module. An annotated Facilitator Guide will be available shortly. Integrating the guidance from WHO Emergency Triage, Assessment and Treatment (ETAT) for children and the Integrated Management of Adult/Adolescent Illness (IMAI), BEC teaches a systematic approach to the initial assessment and management of time-sensitive conditions where early intervention saves lives. The BEC course has been offered with WHO support in countries including Ethiopia, Kenya, Malawi, Solomon Islands, Sudan, Tanzania, Uganda and Zambia. It has been translated into Portuguese and Spanish, with translations underway in Arabic and French. https://www.who.int/emergencycare/irtec/en/; https://www.who.int/emergencycare/publications/Basic-Emergency-Care/en/

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Philippines promoted mandatory use of child restraints

As part of the Bloomberg Initiative for Global Road Safety (BIGRS) 2014-2019 WHO offered technical support through the WHO Legal Development Programme to the Government of the Philippines by providing the evidence base, data and best practices in the development of a child restraint law and related standards. WHO also supported a further study on child restraint access and availability in the country. Engagement with Members of Parliament was ensured through the involvement of Representative C. Sarmiento, a member of the Global Network for Road Safety Legislators. Numerous in-depth articles in national newspapers, produced by journalists trained through the WHO Media Fellowship Programme, created a sense of urgency around the issue and kept it high on the agenda of policy-makers and other influencers. These efforts contributed to the introduction of stronger bills in both the House of Representatives and the Senate, with a final version adopted by both in November. The Child Safety in Motor Vehicles Act mandates the use of child restraints for children up to 150 cm or 59 inches in height - equivalent to approximately 12 years of age - and prohibits children below that age to sit in the front seat. The Act adopts the current UN child restraint standard and periodic updates to the standard, and prohibits manufacture, sale or import of non-standard child restraints. Finally, the Act imposes financial penalties and license suspension for road users as well as financial penalties for industry violators. The Act is presently awaiting signature of the President. https://www.who.int/violence_injury_prevention/road_traffic/countrywork/en/

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december highlights

New WHO report highlighted insufficient progress to tackle lack of safety on the world's roads

The Global status report on road safety 2018 indicates that road traffic deaths continue to rise, with an annual 1.35 million fatalities. Road traffic injuries are now the leading killer of children and young people aged 5-29 years. The report, which was funded by Bloomberg Philanthropies, was launched by the WHO Director-General Dr Tedros on 7 December. In his remarks he commented that road traffic deaths are “an unacceptable price to pay for mobility”. The event featured powerful testimonials from road traffic victims and statements from many partners including the Ambassadors from Brazil, France and India; Mr M. Bloomberg, WHO Global Ambassador for NCDs and Injuries; Mr J. Todt, UN Secretary-General’s Special Envoy for Road Safety; and Dr S. Akselrod, WHO Assistant Director-General. The report documents that despite an increase in the overall number of deaths, the rates of death relative to the size of the world population have stabilized in recent years, suggesting that existing road safety efforts in some countries have mitigated the situation. In the settings where progress has been made, it is largely attributed to better legislation around key risks such as speeding, drinking and driving, and failing to use seat-belts, motorcycle helmets and child restraints; safer infrastructure like sidewalks and dedicated lanes for cyclists; improved vehicle standards such as those that mandate electronic stability control; and enhanced post-crash care. The global status reports are used as a tool to monitor progress towards achieving the road safety targets reflected in the SDGs, the Decade of Action for Road Safety 2011-2020, and WHO’s 13th GPW 2019-2023. In addition to the main report, WHO produced several spin-off products, including a summary, infographics and videos. Additionally, for the first time, WHO released a mobile app based on data from the report (WHO GRS Info) with interactive features that will facilitate use of the data presented. The app is available at Google Play and on iTunes. The media coverage of the report has been extensive. https://www.who.int/violence_injury_prevention/road_safety_status/2018/en/

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WHO launched the Global Emergency and Trauma Care Initiative

On 8 December in Davos, Switzerland, WHO announced the Global Emergency and Trauma Care Initiative, with the generous support of a CHF 10,000,000 grant from the AO Foundation. Around the world acutely ill and injured people die every day due to a lack of timely emergency care. Many countries have no emergency access telephone number to call for an ambulance or no trained ambulance staff. Many hospitals lack dedicated emergency units and have few providers trained in the recognition and management of emergency conditions. These gaps result in millions of avoidable deaths every year. The goal of the WHO Global Emergency and Trauma Care Initiative is to save millions of lives over the next five years through improvements to emergency care systems. Its aims are two-fold: to rapidly increase capacities to provide quality emergency care in countries around the world, and to foster awareness through a global advocacy campaign about its potential to save lives. In an initial phase WHO and partners will support 10 low- and middle-income countries to assess their national emergency care systems, identify any shortcomings and implement proven interventions to address these gaps. https://www.who.int/emergencycare/en/

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Members of Parliament stepped up role as advocates for safe roads

On 14-15 December WHO hosted the annual meeting of the Leadership Council of the Global Network for Road Safety Legislators. The 35 participants included Members of Parliament representing 12 countries (Armenia, Benin, Brazil, Egypt, Kyrgyzstan, Nepal, Nigeria, Philippines, Tanzania, Thailand, Ukraine and United Kingdom) as well as ministers and other high-ranking officials from Luxembourg, Philippines, Thailand and the European Commission and partner organizations including FIA Foundation, Towards Zero Foundation and World Bank. The Global Network, as indicated in its Manifesto #4RoadSafety, highlights the decisive role that Members of Parliament have in legislating for safe roads. During the meeting participants reflected on the findings of the Global status report on road safety 2018 and prioritized strategies for achieving the SDG target 3.6 to cut road traffic deaths and injuries by 50% by 2020. Since its establishment in 2016, the Global Network has gained momentum, with two regional chapters established in 2018, one in the WHO African Region launched in July in Nigeria and another in the WHO Eastern Mediterranean Region launched in September in Jordan. Members of Parliament committed to continuing to push for stronger legislation for road safety, looking ahead in particular to highlighting their legislative achievements during the 3rd Global Ministerial Conference on Road Safety to be held in February 2020 in Stockholm, Sweden. The newly elected 12-member Leadership Council will continue to be chaired by Mr B. Sheerman, Member of Parliament from the United Kingdom, with support from two vice-chairs, Dr H. Abou-Ali, Member of Parliament from Egypt, and Mr R. Adadi, Member of Parliament from Tanzania. http://www.4roadsafety.org/about/; http://www.4roadsafety.org/wp-content/uploads/2017/05/4roadsafety-Manifesto.pdf

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