1.1.3 Countries enabled to strengthen their health systems to address population-specific health needs and barriers to equity across the life course

Scorecard

The scorecard showed that, despite a challenging year, provision of technical support at country level was satisfactory. Many corrective measures were scaled up to mitigate the indirect impacts of COVID-19. In relation to global public health goods, better regional planning in their development and better use at country level are necessary. Many of the challenges posed by COVID-19 in institutional capacity-building, especially at country level, were compensated by virtual meetings. Funding was delayed or difficult to mobilize in the early months of 2020. Although many innovations were made available on virtual platforms, equity was a concern.

The scope of the outputs and of their assessment was interpreted differently by the major WHO offices. The output delivery team noted that gender, equity and human rights should be integrated into the areas of work of this output, and greater clarity and coherence in planning are required to define what is expected from all WHO offices.

Achievements and challenges

Equity, quality and affordable care are essential to ensure comprehensive access to services throughout the life-course, comprising fertility decisions, preconception care, including family planning, pregnancy, childbirth, newborns, children, adolescents, women, men and older people, and to achieve this output.

The COVID-19 pandemic has affected access to and use of services during the life course considerably, with drops in the use of services, especially for reproductive and child health and immunization. The continuity of essential health services was generally maintained, with countries modifying programmes and taking measures to mitigate the impacts of COVID-19. As many resources were reallocated to the COVID-19 response, including WHO staff, planned activities were reorganized, postponed or moved to digital platforms. For example, WHO convened webinars in several languages to provide guidance on maintaining family planning programmes, which were attended by over 5000 participants in more than 100 countries.

Interim guidance on clinical management of COVID-19 in pregnant women, developed early in the pandemic, was widely disseminated through a module in the WHO Academy mobile App, and webinars were organized by the regional offices for Africa, the Eastern Mediterranean and South-East Asia.

COVID-19 presented major challenges to immunization services. For example, in the South-East Asia Region, an estimated 3.5 million children missed routine third doses of diphtheria, tetanus and polio vaccine as programmes were delayed, cancelled or reduced when staff were repurposed. With partners, WHO has supported countries in resuscitating and restoring immunization programmes. Guidance was provided on re-shaping services and on catch-up campaigns for millions of missed vaccinations and on safety. Despite the challenges, there were some successes. Seven countries in Europe were verified as having eliminated endemic transmission of rubella, and disease surveillance laboratory networks for measles, rubella and polio maintained full accreditation. The Immunization, Vaccine and Biologicals department, which is also leading the COVID-19 vaccine response, played a strong leadership role in global policy and among partners.

The pandemic resulted in greater awareness of the problems faced by older people and particularly those in long-term care facilities, who are the most affected by COVID-19. The programme on ageing was thus at the forefront of advocacy in all the regional offices and WHO headquarters, including for the development of integrated care. In the Americas and European regions, for example, interim guidance was provided on barriers and on long-term care facilities and also increased use of digital platforms for older people. In other developments, the United Nations Decade of Healthy Ageing was endorsed in 2020 and a baseline report issued, which includes an analysis of data from 52 countries, national case studies and evidence reviews.

The pandemic also resulted in cross-fertilization among different programmes and areas of work. For example, in the African Region, the link between quality of care and infection control and prevention was strengthened. Surveillance of maternal and perinatal deaths improved in the Americas, with monitoring of the potential impact of COVID-19 on pregnant women and newborns.

Improving the quality of care for maternal, newborn and child health continued to be a priority in 2020. WHO organized four series of 34 webinars in which countries shared experiences and lessons learnt in delivering high-quality care during the pandemic. Over 8000 practitioners of quality care in 93 countries attended the series, and over 1300 practitioners of maternal, newborn and child health participated in communities of practice, discussing practical solutions to challenges.

In the African Region, 15 country teams participated in a workshop to improve the quality of paediatric care. In the Americas, an evidence-informed guide for the follow-up of premature and seriously ill newborns was published, to strengthen the quality of care. In the Western Pacific Region, a health system approach to quality and safety was used to improve newborn health, and nine countries were supported in scaling up high-quality, early, essential newborn care.

To address the increase in violence against women during the pandemic, WHO guidance on care for violence survivors was provided in several documents. Estimates of the global, regional and country prevalence of violence against women were generated, guidance on clinical management of rape was updated, and protocols were developed for the care of rape survivors in humanitarian settings. WHO with UN Women issued the “ RESPECT women” package for preventing violence against women for policy-makers, with 26 programme briefs on promising interventions.

The Adolescent well-being framework, developed with partners, is part of a broad programme of work for the 2022 Global Summit on Adolescents. To ensure that district health systems are more responsive to adolescents, four African countries were supported in district implementation of national adolescent health strategies in the context of COVID-19. Strengthening of the provision of comprehensive sexuality education in West and Central Africa included a regional report on local youth and an accountability framework as part of the Muskoka initiative covering eight countries. WHO also contributed to drafting a bill for the East Africa community to increase adolescents’ access to sexual and reproductive health-care services.

Experiences in scaling up use of the WHO guideline on management of possibly serious bacterial infections in young infants were documented in seven countries and published in a peer-reviewed journal.

To mitigate harmful effects on children experiencing stress at home and deprived of regular learning opportunities due to pandemic restrictions, WHO and partners hosted a series of webinars to facilitate dialogue among stakeholders on responsive caregiving, early learning and prevention of child maltreatment. A draft handbook on nurturing care was made available to strengthen such services.