Department of Science, Information and Dissemination WHO Regional Office for the Eastern Mediterranean Monazamet El Seha El Alamia St PO Box 7608, Nasr City Cairo 11371, Egypt www.emro.who.int [email protected] Health and well-being profile of the Eastern Mediterranean Region An overview of the health situation in the Region and its countries in 2019 WHO Library Cataloguing in Publication Data World Health Organization. Regional Office for the Eastern Mediterranean Health and well-being profile of the Eastern Mediterranean Region: an overview of the health situation in the Region and its countries in 2019 / World Health Organization. Regional Office for the Eastern Mediterranean p. ISBN: 978-92-9022-339-9 ISBN: 978-92-9022-340-5 (online) 1. Health Status - Eastern Mediterranean Region 2. Sustainable Development 3. Universal Health Insurance 4. Emergency Medical Services 5. Health Promotion I. Title II Regional Office for the Eastern Mediterranean (NLM Classification: WA 300) © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). 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The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Designed by YAT Communication An overview of the health situation in the Region and its countries in 2019 Contents Foreword vii Preface ix Acknowledgements x Acronyms and abbreviations xi Executive summary xiii 1. Health and the Sustainable Development Goals 1 1.1 The 2030 Agenda for Sustainable Development 1 1.2 WHO’s Thirteenth General Programme of Work 2 1.3 The triple billion targets 2 2. The Eastern Mediterranean Region at a glance 4 3. Achieving UHC 8 3.1 UHC service coverage index 8 3.2 Governance 9 3.2.1 Multisectoral approaches and partnerships 9 3.2.2 Health diplomacy 10 3.2.3 Strengthening health legislation, a tool for advancing health 11 3.3 Service delivery and quality 12 3.3.1 Priority benefits packages 12 3.3.2 Primary health care and family practice 13 3.3.3 Hospital care management 15 3.3.4 Health care quality and patient safety 16 3.3.5 Private health sector roles and regulation 17 3.4 Health financing and financial protection 19 3.4.1 Health financing 19 3.4.2 Financial protection 21 3.5 Health data and health information systems 23 3.5.1. Improving civil registration and vital statistics 23 3.5.2. Core health indicators and SDG indicators 25 3.5.3. Improving routine surveillance and facility information systems 26 iii Health and well-being profile of the Eastern Mediterranean Region 3.6 Health workforce 27 3.6.1 Policy and regulatory frameworks on health workforce 29 3.6.2 Health workforce information 30 3.6.3 Quality of health workforce training and the role of academia 31 3.6.4 Protecting health workforce in emergencies 32 3.7 Access to medicines, vaccines and health products 33 3.7.1 Access to essential medicines 33 3.7.2 Assistive technology 34 3.7.3 Selected medical devices 35 3.7.4 Availability of critical or life-saving commodities 37 3.8 Research capacity and use of evidence 37 3.8.1 Research capacity and output 37 3.8.2 Research priorities, governance and support for health research 38 3.8.3 Use of research evidence for policy-making 39 4. Health emergencies 42 4.1 Regional situation 42 4.1.1 Country capacity to respond to emergencies 42 4.1.2 Safe hospitals initiative 43 4.2 Preparedness to respond to outbreaks 43 4.2.1 Epidemic prevention campaigns 44 4.3 Preparedness to respond to humanitarian emergencies 45 4.3.1 Availability of life-saving health services 45 4.3.2 Mental health and psychological support 46 4.3.3 Rehabilitative services 47 4.4 Coordination and collaboration among United Nations agencies and other partners 47 4.5 Rebuilding health systems in countries affected by emergencies 48 5. Promoting health across the life course 49 5.1 Reproductive, maternal, newborn, child and adolescent health, and ageing 49 5.1.1 Reproductive and maternal health 49 5.1.2 Newborn and young child (under 5 years) health 53 5.1.3 Child and adolescent health and development 59 5.1.4 Ageing and health, including dementia 60 5.2 Violence, injuries and disability 62 5.2.1 Violence and injuries, in particular against women, girls and children 62 5.2.2 Road traffic injuries 65 5.2.3 Disability, including prevention of blindness and deafness 66 iv An overview of the health situation in the Region and its countries in 2019 5.3 NCDs 67 5.3.1 The burden of NCDs 67 5.3.2 Main risk factors of NCDs 69 5.3.2.1 Tobacco use 69 5.3.2.2 Physical inactivity 71 5.3.2.3 Harmful use of alcohol 72 5.3.3 Surveillance and evaluation of NCDs and their risk factors 73 5.4 Priority NCDs 74 5.4.1 Diabetes 74 5.4.2 Cardiovascular diseases and hypertension 75 5.4.3 Cancer care and services 76 5.4.4 Asthma and chronic respiratory diseases 79 5.5 Mental health and substance use disorders 79 5.5.1 Burden of mental disorders 79 5.5.2 Addressing the treatment gap 80 5.5.3 Substance use disorders 82 5.6 Double burden of malnutrition 83 5.6.1 Nutrition situation and challenges 83 5.6.2 Strategic approaches 88 5.7 Elimination and eradication of high-impact communicable diseases 89 5.7.1 Enhancing vaccination coverage 89 5.7.2 Polio eradication and the transition agenda 92 5.8 Priority communicable diseases 93 5.8.1 Malaria and other vector-borne diseases 93 5.8.2 Neglected tropical diseases 95 5.8.3 Tuberculosis 96 5.8.4 HIV and AIDS 99 5.8.5 Viral hepatitis 100 5.9 Antimicrobial resistance 101 5.9.1 Development of national action plans on antimicrobial resistance 102 5.9.2 Surveillance of antimicrobial resistance, use and consumption 103 5.9.3 Infection prevention and control programmes 105 5.9.4 Antimicrobial stewardship and awareness programmes 105 5.10 Environment, climate change and health 106 5.10.1 Environment and health 106 5.10.2 Climate change and health 109 6. Other priority areas for action in the Region 111 6.1 Migration and refugees 111 v Health and well-being profile of the Eastern Mediterranean Region 6.1.1 Policy and legislative response to migrant and refugee health 111 6.1.2 Inclusive health information systems 112 6.1.3 UHC and financial protection for migrants and refugees 112 6.1.4 Protecting the health and well-being of women, children and adolescents 113 6.1.5 Addressing NCDs and mental health, with a focus on community-based initiatives 113 6.2 Healthy settings and urban planning 114 6.3 Role of civil society, nongovernmental organizations and networks 115 6.3.1 Civil society organizations 115 6.3.2 Community engagement and community health workers 116 6.4 Social determinants of health and HiAP 117 Conclusion 119 References 122 Country profiles: monitoring progress on health and the SDGs 143 vi An overview of the health situation in the Region and its countries in 2019 Foreword The Millennium Development Goals and subsequent Sustainable Development Goals (SDGs) ushered in new opportunities to significantly improve health status and well-being globally.