Explore the vast range of titles available.

During the COVID-19 pandemic, Nepal rapidly expanded its PCR testing capacity, essential for effective outbreak response. However, many laboratories faced overwhelming test volumes, resulting in delays that may have hindered containment efforts. This study aims to determine whether these challenges stemmed from capacity limitations and/or imbalanced sample distribution due to inadequate coordination. In this retro-perspective simulation of SARS-CoV-2 testing in Nepal during 2021, we evaluate the impact of coordinated sample transfers on reducing laboratory stress and wait times during demand peaks. Our findings reveal that centralized coordination and strategic partnerships for sample transfers significantly enhance diagnostic network performance, even under high demand. These insights offer valuable guidance for policymakers on implementing effective coordination strategies to strengthen diagnostic networks for future pandemics.

Background The COVID-19 pandemic has underscored limitations in current methods for assessing country-level health emergency preparedness, which often overlook essential factors like ongoing epidemics, natural disasters, conflicts, or community trust. Addressing this, the World Health Organization (WHO) developed the Dynamic Preparedness Metric (DPM), a composite measure that assesses epidemic risk by accounting for hazards, vulnerabilities, and capacity, offering insights for improving country-level health emergency preparedness. Methods Our analysis tested the DPM’s effectiveness in supporting preparedness at global and WHO-regional levels, focusing on five acute syndromes. The DPM regional average is calculated from individual country scores, and a one-year trend analysis (from the 1st to 4th quarters of 2023) was conducted globally for all syndromes, as well as regionally for diarrhoeal syndrome. Additionally, we back-calculated DPM scores from 2018 to 2021 to explore the metric’s responsiveness to the COVID-19 pandemic. Underlying standardized indicators were also analysed to pinpoint primary risk factors. Results Initial findings highlight substantial variation across WHO regions. Short-term analyses revealed temporal trends in regional risk, while medium-term analyses showed decreased scores and expanded capacity gaps during COVID-19. Primary risk factors identified include health system deficiencies, urbanization, and the prevalence of epidemic-prone diseases, with considerable regional differences. Conclusions These results emphasize the importance of a dynamic, risk-informed approach to health emergency preparedness assessment. Tracking shifts in hazards, vulnerabilities, and capacities enables refinement of health emergency preparedness and readiness planning, fostering more responsive and effective health security strategies.

BackgroundThe Himalayan nation of Nepal lies in the seismic fault line with greater risks of earthquakes and other recurrent hazards like landslide, fire, drought, epidemic, storm, hailstorm, avalanches and Glacial Lake Outburst Floods. Nepal with the help of national and international partners had taken several disaster preparedness measures prior to the earthquake in 2015 which alone killed nearly nine thousand people, more than 22 000 injured, and caused economic loss equivalent to seven billion dollars. This article summarizes the efforts taken by the injury rehabilitation sub cluster (IRSC) to effectively manage the available internal capacity and coordinate the efforts of multilateral humanitarian aid agencies including foreign medical teams.MethodData from the Ministry of Health, situation reports, IRSC meeting minutes and partner reports were reviewed for analysis.ResultsThe main purpose of the IRSC was to map current needs and capabilities, coordinate response activities and referrals, and to share information amongst multiple stakeholders. It enabled timely and adequate response resulting in preventing and minimizing disability. Implication for Injury prevention, trauma care and disability rehabilitation: 1) Develop and implement standardized disaster preparedness planning and response protocols including step-down rehabilitation facilities and stockpiling of assistive devices 2) Stakeholder mapping at different levels – region, province and local communities 3) Injury-related and disability-disaggregated data included in data collection and reporting 4) Establish trauma care systems, accessible environment and services, integrated disability management and advocate ‘Rehabilitation in Health Systems’ WHO (2017) 5) Community Based Rehabilitation (CBR) should be a necessary component in emergency rehabilitation. 6) Policy and programme advocacy for disability inclusion in disability risk reduction (DRR).ConclusionHealth systems strengthening (Build-Back-Better) in injury prevention, trauma care and rehabilitation can impact both large-scale disasters and routine injuries. Integrated disability management can cover other disabilities due to neglected tropical diseases, non-communicable diseases, pediatric and geriatric care.

With the advances in digital information sharing channels, democratization of content, and access, as well as social shifts in information exchange, we live in increasingly complex information environments. How people process and manage this is layered with multiple determinants that can impact information seeking, health behaviors, and public health. Understanding the dynamics of the information environment in priority populations and its impact on communities and individuals is critical for those working in public health and health emergencies. This study aimed to provide an overview of the approaches to and implementation of information environment assessments as they relate to public health and health emergencies. We conducted a rapid scoping review of the approaches to, and implementation of information environment assessments. The search followed guidance from the Joanna Briggs Institute on conducting systematic scoping reviews, and our reporting is in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. We included both academic and gray literature in the English language. As this is an emerging field, an additional step involved input from an informal expert group to identify any further tools or approaches. Studies that assessed, described, or discussed approaches to assessing the information environment were included. We excluded papers where the information environment was not the primary focus, or the focus was on individual components only. Two authors (BKW and SVM) independently screened results for inclusion. A total of 17 publications were identified through the structured literature and internet searches, with an additional 5 sourced from the informal expert group. The review highlighted a significant variety in the breadth and number of domains covered in an assessment, including information needs, seeking, access, production, engagement, information quality, and reach. Some assessments adopted a comprehensive, systems-oriented approach, examining factors influencing information beyond the individual level to encompass broader systemic dynamics, while others were significantly narrower in scope. The COVID-19 pandemic has intensified interest in understanding how the information environment shapes people's access to, engagement with, and ability to act on health information. Assessing the information environment is a critical step in identifying and understanding barriers and facilitators that impact different populations and identifying opportunities for strengthening systems. However, a universally accepted approach for such assessments in public health and health emergencies is currently lacking. This paper contributes to the literature by synthesizing current knowledge on assessment tools and frameworks, providing a foundation for future research and development in this area.

This case study describes the health response provided by the Ministry of Health of Nepal with support from UN agencies and several other organisations, to the 1.4 million women and adolescent girls affected by the major earthquake that struck Nepal in April 2015. After a post-disaster needs assessment, the response was provided to cater for the identified sexual and reproductive health (RH) needs, following the guidance of the Minimum Initial Service Package for RH developed by the global Inter-Agency Working Group. We describe the initiatives implemented to resume RH services: the distribution of medical camp kits, the deployment of nurses with birth attendance skills, the organisation of outreach RH camps, the provision of emergency RH kits and midwifery kits to health facilities and the psychosocial counselling support provided to maternity health workers. We also describe how shelter and transition homes were established for pregnant and post-partum mothers and their newborns, the distribution of dignity kits, of motivational kits for affected women and girls and female community health volunteers. We report on the establishment of female-friendly spaces near health facilities to offer a multisectoral response to gender-based violence, the setting up of adolescent-friendly service corners in outreach RH camps, the development of a menstrual health and hygiene management programme and the linkages established between adolescent-friendly information corners of schools and adolescent-friendly service centres in health facilities. Finally, we outline the gaps, challenges and lessons learned and suggest recommendations for preparedness and response interventions for future disasters. Cette étude de cas décrit la réponse donnée par le Ministère népalais de la santé, avec le soutien d’institutions des Nations Unies et de plusieurs autres organisations, aux 1,4 million de femmes et d’adolescentes touchées par le séisme majeur qui a frappé le Népal en avril 2015. Après une évaluation des besoins postérieure à la catastrophe, l’intervention a été mise en œuvre pour répondre aux besoins de santé sexuelle et génésique identifiés, en suivant les recommandations du dispositif minimum d’urgence pour la santé génésique, établi par le Groupe de travail interorganisations. Nous décrivons les initiatives appliquées pour rétablir les services de santé génésique : distribution de trousses médicales dans les camps, déploiement d’infirmières compétentes pour assister les accouchements, organisation de camps de santé génésique de proximité, fourniture de trousses de santé génésique d’urgence et de nécessaires pour sages-femmes aux centres de santé, et soutien psychosocial prodigué aux agents de santé travaillant dans les maternités. Nous décrivons également comment des abris et des foyers relais ont été créés pour les femmes enceintes, les jeunes mères et leurs nouveau-nés, la distribution de trousses hygiéniques [pour redonner un sentiment de dignité à leurs bénéficiaires], de kits de motivation pour les femmes et les adolescentes touchées, et les femmes enrôlées comme agents de santé bénévoles. Nous décrivons l’aménagement d’espaces adaptés aux femmes près des centres de santé pour offrir une réponse multisectorielle à la violence sexiste, la création de points de services destinés aux adolescents dans des camps de santé génésique de proximité, la mise au point d’un programme de prise en charge de la santé et l’hygiène menstruelle, et les liens instaurés entre les points d’information pour adolescents dans les écoles et les centres de services s’adressant aux jeunes dans les établissements de santé. Enfin, nous soulignons les lacunes, les difficultés et les leçons retirées ; et nous proposons des recommandations pour la préparation et la réponse à de futures catastrophes. Este estudio de caso describe la respuesta de salud proporcionada por el Ministerio de Salud de Nepal con el apoyo de organismos de las Naciones Unidas y varias otras organizaciones, a 1.4 millones de mujeres y adolescentes afectadas por el gran terremoto que azotó a Nepal en abril de 2015. Después de una evaluación de necesidades post-desastre, la respuesta fue proporcionada para atender las necesidades de salud sexual y reproductiva identificadas, siguiendo la orientación del Paquete de Servicios Iniciales Mínimos de salud reproductiva creado por el Grupo de Trabajo Interinstitucional. Describimos las iniciativas aplicadas para reanudar la prestación de servicios de salud reproductiva: la distribución de kits para campamentos médicos, el despliegue de enfermeras con habilidades de asistencia de partos, la organización de campamentos de extensión en salud reproductiva, el suministro de kits de salud reproductiva para emergencias y kits de partería a unidades de salud, y el apoyo de consejería psicosocial brindado a trabajadores de salud materna. Además, describimos cómo se establecieron refugios y hogares de transición para madres embarazadas y posparto y sus recién nacidos, la distribución de kits de dignidad, de kits de motivación para mujeres y niñas afectadas y voluntarias sanitarias comunitarias. Informamos sobre el establecimiento de espacios amigables a mujeres cerca de las unidades de salud, con el fin de ofrecer una respuesta multisectorial a la violencia de género, el establecimiento de puestos de servicios amigables a adolescentes en campamentos de extensión en salud reproductiva, la creación de un programa de gestión de salud e higiene menstrual, y los vínculos establecidos entre puestos escolares informativos amigables a adolescentes y centros de servicios amigables a adolescentes en establecimientos de salud. Por último, señalamos las brechas, retos y lecciones aprendidas; y sugerimos recomendaciones de intervenciones de preparación y respuesta a futuros desastres.

The need to address antimicrobial resistance (AMR) through a One Health (OH) approach is now well recognized. There is, however, limited guidance on how AMR surveillance should be implemented across sectors to generate meaningful AMR and AMU data for decision‐making. Using a sympatric approach to cross‐sector sample collection, Nepal adopted the WHO extended‐spectrum beta‐lactamase (ESBL)–producing Escherichia coli ( E. coli ) Tricycle Project as a step toward OH surveillance for assessing the prevalence of ESBL‐producing E. coli across human, veterinary, and environment sectors. This involved a three‐stage approach: identification of human hotspots (Stage 1) and sample collection sites for poultry (Stage 2) and wastewater (Stage 3). A total of 53 blood cultures from patients with bloodstream infections (BSIs), 100 stool samples from healthy pregnant women, 220 poultry ceca from slaughterhouses and live markets, and 48 wastewater samples were processed for bacterial culture and analyzed for the presence of ESBL‐producing E. coli . The prevalence of ESBL‐producing E. coli among isolated E. coli was the highest in wastewater samples (91%) followed by human BSIs (49%), poultry (38.6%), and fecal carriage isolates from healthy pregnant females (15%). A statistically significant association was seen in the prevalence of multidrug resistance among ESBL producers (52%) and nonproducers (26%). ESBL‐producing E. coli was detected in all wastewater samples tested except for the upstream river. The findings of the study showed a high prevalence of ESBL‐producing E. coli in samples from all three sectors and provided baseline data based upon which strategies for the safe disposal of communal and hospital waste, integrated AMR surveillance, and control strategies could be planned and implemented.

Seven months after the April 2015 Nepal earthquake, and as relief efforts were scaling down, health authorities faced ongoing challenges in health-service provision and disease surveillance reporting. In January 2016, the World Health Organization recruited and trained 12 Nepalese medical doctors to provide technical assistance to the health authorities in the most affected districts by the earthquake. These emergency support officers monitored the recovery of health services and reconstruction of health facilities, monitored stocks of essential medicines, facilitated disease surveillance reporting to the health ministry and assisted in outbreak investigations. In December 2015 the people most affected by the earthquake were still living in temporary shelters, provision of health services was limited and only five out of 14 earthquake-affected districts were reporting surveillance data to the health ministry. From mid-2016, health facilities were gradually able to provide the same level of services as in unaffected areas, including paediatric and adolescent services, follow-up of tuberculosis patients, management of respiratory infections and first aid. The number of districts reporting surveillance data to the health ministry increased to 13 out of 14. The proportion of health facilities reporting medicine stock-outs decreased over 2016. Verifying rumours of disease outbreaks with field-level evidence, and early detection and containment of outbreaks, allowed district health authorities to focus on recovery and reconstruction. Local medical doctors with suitable experience and training can augment the disaster recovery efforts of health authorities and alleviate their burden of work in managing public health challenges during the recovery phase.

The International Health Regulations Monitoring and Evaluation Framework (IHRMEF) includes four components regularly conducted by States Parties to measure the current status of International Health Regulations (IHR) 2005 core capacities and provide recommendations for strengthening these capacities. However, the four components are conducted independently of one another and have no systematic referral to each other before, during or after each process, despite being largely conducted by the same team, country and support organisations. This analysis sets out to identify ways in which IHRMEF components could work more synergistically to effectively measure the status of IHR core capacities, taking into account the country’s priority risks. We developed a methodology to allow these independent components to communicate with each other, including expert consultation, a qualitative crosswalk analysis and a country-level quantitative analysis. The demonstrated results act as a proof of concept and illustrate a methodology to provide benefits across all four components before, during and after implementation.

Using publicly available SPAR data, we retrospectively reviewed scores from 2018 to 2020 among 73 WHO SPs who met World Bank classification as LIC or LMIC.4 SPAR data after 2020 were excluded due to indicator changes in the second edition being incomparable to previous years.5 SPAR scores were available for 13 core capacity areas composed of 1–3 individually scored indicators. Health service provision The health service provision capacity area consists of three indicators: case management, infection prevention and control (IPC)/water, sanitation and hygiene (WASH) standards and access to essential health services. Points of entry PoE capacity indicators showed improvement with fewer SPs at lower level 1 (PoEs identified for public risk assessment and PoE public health emergency contingency plan in development) and level 2 (some designated PoEs implementing routine core capacities with competent authorities and developed public health emergency contingency plans for biological hazards) in 2020 (47 to 36 SPs). Similar to the health service provision case management indicator, PoE capacity level 4 requires expansion of capacities and contingency plans to all-hazards events, of which only nine SPs had achieved by 2020.

Background The World Health Organization’s ‘building back better’ approach advocates capitalizing on the resources and political will elicited by disasters to strengthen national mental health systems. This study explores the contributions of the response to the 2015 earthquake in Nepal to sustainable mental health system reform. Methods We systematically reviewed grey literature on the mental health and psychosocial response to the earthquake obtained through online information-sharing platforms and response coordinators (168 documents) to extract data on response stakeholders and activities. More detailed data on activity outcomes were solicited from organizations identified as most active in the response. To triangulate and extend findings, we held a focus group discussion with key governmental and non-governmental stakeholders in mental health system development in Nepal (n = 10). Discussion content was recorded, transcribed, and subjected to thematic analysis. Results While detailed documentation of response activities was limited, available data combined with stakeholders’ accounts suggest that the post-earthquake response accelerated progress towards national mental health system building in the areas of governance, financing, human resources, information and research, service delivery, and medications. Key achievements in the post-earthquake context include training of primary health care service providers in affected districts using mhGAP and training of new psychosocial workers; appointment of mental health focal points in the government and World Health Organization Country Office; the addition of new psychotropic drugs to the government’s free drugs list; development of a community mental health care package and training curricula for different cadres of health workers; and the revision of mental health plans, policy, and financing mechanisms. Concerns remain that government ownership and financing will be insufficient to sustain services in affected districts and scale them up to non-affected districts. Conclusions Building back better has been achieved to varying extents in different districts and at different levels of the mental health system. Non-governmental organizations and the World Health Organization Country Office must continue to support the government to ensure that recent advances maximally contribute to realising the vision of a national mental health care system in Nepal.