Your Place, Your Space

  The International Health Regulations (IHR) provide a framework and predictable structure for countries. Implementation of core components is measured, preferably annually, and the response rate in 2018 was a successful 96%. In October 2021, WHO referenced IHR when formulating 7 recommendations for resilience in health [1] With IHR, global health sets unspoken expectations. However, we cannot anticipate IHR to be consistently interpreted, let alone adopted and accepted as necessary, without respect for individualism in countries.  Completing a survey as a side thought versus completing a survey with full investment in healthcare improvement are two very different activities. Let’s do better to ensure full investment of IHR with every country, by being welcomed into countries. In their space:   * Create focused leadership groups with the SPAR and survey responders, grouped by country and region. https://extranet.who.int/e-spar/#submission-details * Create focuse...

Water, sanitation and hygiene (WASH), while recognized as a necessity, requires acceptance by the healthcare team. As we work toward universal WASH, and as we work toward standards in attention health delivery process measures and outcome measures, we should work toward culturally appropriate design.   WASH monitoring reveals that 25% of health care facilities have no basic water services, 10% of health care facilities globally have no sanitation services and one in three do not have adequate facilities to clean hands at the point of care. One in three health care facilities do not segregate waste safely [1]. Advancing WASH in healthcare across the world is an urgent necessity, and global strategic plans are forming.  Care is affected for the 712 million people who have no access to water when they use health care facilities, yet we have not fully invested in understanding the effects. The reality of WASH inaccess also affects how current care is perceived and how current...

To assure adequate energy and electricity for healthcare worldwide, those assisting first need to be welcomed in.  To assure energy reduction and efficiency in healthcare, those involved must feel welcomed at the table. Here are a few ways we can ask for a welcome, as well as welcome others in:  *Structure international and national authorities to healthcare energy assurance. Assess for gaps at the table, including when partnerships develop for global assessments. [1} *Structure the assessments of energy in healthcare. How is adequacy measured? How does a community define if they have enough energy and how are the definitions of quality of care mismatched?  *Assess current response. How are philanthropic and nonprofit partnerships defining, assessing and responding to lack of energy in healthcare [2,3,4,5]? Where are the disconnects and mismatches? *Assess for understanding of medical equipment and use within evidence-based guidelines. Where are these facilities in adopt...

We have an opportunity to improve the short term and long term approach to Personal Protective Equipment (PPE) worldwide. We can best meet this opportunity by respecting one another’s place and space. We should: Initiate international, regional and local discussions around PPE needs. Ask countries what the want and need, and set intentions for standardization with genuine partnership. Catalog the regulatory agencies involved with PPE by country. Detail the manufacturing supply chain by country. Detail the current processes, time and transport logistics. List and compare product safety processes involved, including failures and breaches noted. If 60% of the PPE manufacturing is based in two countries, what is the being asked of the rest of the world? What are populations awaiting, what are the logistics issues, what are the regulatory and product safety differences between countries and how are these populations affected? Are comparisons even offered before procurement?  Develop s...

Keeping it simple for oxygen coordination is best accomplished when we're welcomed in.  It’s good to support global leadership in medical oxygen supply management for underserved communities and countries in need.  It’s great to support efforts that strengthen individual country leadership toward national strategies on medical oxygen supply management.   Both require some tread into a country’s vulnerabilities on medical needs.  Let’s tread meaningfully and in a way that assures a welcome back.  Detail the coordinating agencies or government departments responsible for medical oxygen supply receipt. Meet with health administrators.  Detail a country’s current policies, compare with a global review and detail opportunities for policies on oxygen management. Is medical oxygen supply and/or maintenance an ongoing regulatory component within a country? What would it take to sharpen regulatory efforts? Is medical oxygen supply a component to ongoing emergen...

Mortality data accuracy is a cornerstone of pandemic management, and it is a cornerstone of any health issue. COVID data inaccuracy offers tremendous opportunity to improve healthcare epidemiology sustainably. And we can improve only when welcomed into one another's national space and place.   Mortality accuracy is challenging due to statistical logistics and geopolitics; it is also challenging due to sociocultural considerations.  We don't really know how each affects accuracy of the mortality data . We don't know the weight of each consideration because we haven't properly assessed them.   We have addressed some solutions for statistical logistics with COVID, such as improving real time data, use of EHR, use of cemetery and cremation data, use of excess death or other metrics, consistency to death definitions and strengthened regional epidemiology.  We have addressed few solutions for geopolitics related to COVID. Most solutions rely on normalizing the ex...

  Building better for current and future pandemics seems reasonable, and doable.  Yet managing pandemics also seemed reasonable and doable during the decades of funded planning in the United States. Funding supported to thwart bioterrorism, by the way.  So the main lesson learned from these first years of a fresh pandemic should incorporate a way to circumvent false assurances and reliance on planners.  And how do we move on from planning? Doing.  If the World Health Organization recommends building better and getting sustainable development back on track , do so. Don’t continue to plan, just do. And do it with LMIC partnership in their place and space.  Let’s energize this doable move with COVID vaccine and therapeutics. When the vaccines, therapeutics and supplies are delivered to countries, particularly low and middle income (LMIC) countries, are they delivered to credentialed labor supply? How is the labor credentialing assured across borders? How is la...