and maternal mortality makes US foreign assistance effective.COVID-19 has revealed shortcomings in WHO's powers and funding, warranting substantial reforms. WHO has limited authority to ensure state compliance with the IHR, including constrained ability to independently verify official state reports. But after leaving WHO, the USA would be on the outside looking in, without global influence to promote crucial reforms. Stand-alone US programmes, moreover, could never substitute for a truly global agency. Absent treaty obligations, in a multipolar world, mean there are no guarantees that countries will cooperate with the USA.Health and security in the USA and globally require robust collaboration with WHO-a cornerstone of US funding and policy since 1948. The USA cannot cut ties with WHO without incurring major disruption and damage, making Americans far less safe. That is the last thing the global community needs as the world faces a historic health emergency.LOG is director of the WHO Collaborating Center on National and Global Health Law. MAH is co-chair of the WHO Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing and receives no compensation for this work apart from travel-related expenses. The other authors declare no competing interests.
Our results should be viewed as an initial step in a multi-stakeholder dialogue on HTA implementation. Each MENA country should develop its context-specific HTA roadmap, as such roadmaps are not transferable without taking into account country size, economic status, public health priorities and adopted systems of health care financing.
Different approaches are used for integration of sexual and reproductive health (SRH) services at the primary health care (PHC) level, aiming at providing comprehensive services leaving no one behind. This paper aims to assess gaps in the delivery of SRH in PHC services, identifying challenges and proposing action towards universal health coverage in Arab countries. The United Nations Population Fund, Arab States Regional Office (UNFPA/ASRO), in partnership with Middle East and North Africa Health Policy Forum (HPF), launched an assessment of integration of SRH into PHC in 11 Arab countries in 2017-2018. Desk reviews were conducted, using published program reports and national statistics. Data from country reports were compiled to present a regional assessment, challenges and recommendations. SRH services are partially integrated in PHC. Family planning is part of PHC in all countries except Libya, where only counselling is provided. Only Morocco, Tunisia and Oman provide comprehensive HIV services at PHC level. Jordan, Libya and Saudi Arabia rely mainly on referral to other facilities, while most of the integrated family planning or HIV services in Sudan, Morocco and Oman are provided within the same facilities. Action is required at the policy, organisational and operational levels. Prioritisation of services can guide the development of essential packages of SRH care. Developing the skills of the PHC workforce in SRH services and the adoption of the family medicine/general practice model can ensure proper allocation of resources. A presented regional integration framework needs further efforts for addressing the actions entailed.
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