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  • br The influx of refugees has placed tremendous strains on

    2019-05-17


    The influx of refugees has placed tremendous strains on existing health-care facilities in Syria neighbouring countries like Jordan. Jordan\'s FK506 has swelled by 20% since the inception of the Syrian civil war. The response from the WHO has been splintered and timid, even in comparison with the Ebola crisis. It is trivialising the reality on the ground. I was at the WHO\'s headquarters during the outbreak of the Ebola virus disease in West Africa. The WHO was then castigated for its tragic failure to lead the global fight, respond quickly enough, and instigate the mobilisation of expertise and resources to stop its spread. Others accused it of being “too politicised, too bureaucratic, too overstretched and too slow to adapt to change”. Provisions were put in place to deal with future emergencies of such global dimensions. Regrettably, lessons have not been learnt. Health is an inalienable human right enshrined in the Universal Declaration of Human rights. Health is a political choice, a mirror of how power constellations, interests, ideological positions, state and non-state actors, development banks, academic institutions, hybrid organisations, civil society, and philanthropies intermingle with each other. And while the WHO stands incapable of stopping civil wars, it lies within her realm to maintain and promote global health security, coordinate and support member states in their response and preparedness, and build equitable and effective health systems especially in low-income and middle-income countries; systems that can withstand shocks and mega-disasters. A large number of doctors, nurses, and health-care workers have been killed or injured. Health infrastructural capacities in Jordan are overstretched to their absolute maximum limits. Refugees live in cramped, unsanitary camps in harsh winter conditions. Communicable and non-communicable diseases could circulate widely in such circumstances, compounded by shortages of medical instruments, clean running water, electricity, vaccines, protective equipments like gloves, sterilisation tools, drugs, and advanced diagnostic services. Minor surgical procedures such as tooth extraction could be fatal with the lack of antibiotics, compliance, professionals, and basic infection control measures. Also, it is not surprising that those who endured persecution, injuries, stress, and brutality, have psychological traumas, with impacts on their general and oral health, eating habits, and behaviours. We must look beyond medical interventions, to include the economic, social, psychological, spiritual, and cultural determinants of health. This is the kernel of global public health and health promotion. This is a unique opportunity for the WHO to become a leader of political acumen, to build resilient health-care systems, enhance preparedness and coordination efforts, integrate oral health with general health strategies in cost-effective manners under the tutelage of the WHO. In a nutshell, this is an extraordinary challenge that requires an extraordinary response.
    Universal health coverage (UHC) as a target in the health Sustainable Development Goals (SDGs) empowers countries to seize the exceptional chance to reach a great convergence in global health. In recent years, many countries have adopted UHC as an aspiration for national policy and WHO pointed out that all countries could take actions to move more rapidly towards it. To achieve UHC in Iran, the Government of President Hassan Rouhani designed and adopted the Health Transformation Plan (HTP) in 2014. Apparently inspired by the experience of Thailand and Turkey, the plan called the biggest revolution in the health system. According to the World Bank statistics from 2013, out-of-pocket expenditures (OOPs) in Iran constituted about 52·1% of total expenditure on health, for which Iran was ranked 13th among WHO Regional Office for the Eastern Mediterranean (EMRO) countries. According to WHO brief report, OOPs were one of the main flaws of Iran\'s health system. The main goal of HTP was to promote the financial protection to improve efficiency, equity, and effectiveness, through eight service packages.