Paediatric formulations and essential drugs lists are available in about one in three countries (35% and 31% respectively). CIS countries are more likely to have these lists, compared to EU countries. The WHO model lists of essential medicines (26), launched in 1977 and updated every two years, were developed to meet the priority health-care needs of populations. This was complemented in 2007 by an essential medicines list for children, the most recent version of which was published in 2017 (27).
While efforts have been made to better acknowledge the needs of children in essential drugs lists and to improve the availability of paediatric formulations, lack of access to appropriate medicines for children in cases where they would make a potential difference to survival continues to be a problem globally (28). Additionally, fewer than half of countries reported having information about the number of drug prescriptions issued to children and adolescents under 18. Without monitoring, over- and underuse of prescription medications cannot be identified and addressed. Closing the gap will be essential for achievement of the SDGs, which means not only that the availability of age-appropriate formulations improves, but also that they are delivered in optimal doses (28).
Conclusion
Health systems for children and adolescents are diverse. Some have paediatricians as the primary providers, while others have GPs. These systems, have their strengths and weaknesses, but all depend on sufficient numbers of providers who are accessible and have the skills to work with children and adolescents and to understand their health conditions. There is a need to collect and analyse disaggregated data to support health systems to make the right choices for children and adolescents (see also Chapters 3 and 8). An essential drugs list for children and paediatric formulations of all essential drugs are important tools for countries throughout the Region to adopt. Developing and implementing national quality standards, monitoring systems and processes for quality improvement in line with WHO standards are needed everywhere.
Table 4.1 includes all indicators used in this chapter, and data from the country profiles and the survey displayed by country with summary statistics.
Table 4.1. Heath systems and quality of care: summary table
Country
Transition from paediatric to adult services for continuing care Mechanism for assuring the quality of care Mechanism for continuous education for professsionals for adolescent health Obligation to perform regular perinatal death audits Paediatric essential drugs list is public Paediatric formulations of all essential drugs Information about the number of drug prescriptions Collecting data about gaps between staffing levels Care models Country code
Albania – – – – – – – – GP-led ALB
aMKD: the former Yugoslav Republic of Macedonia (MKD is an abbreviation of the ISO).
Table 4.1 contd
GPs per 100 000 population General paediatricians per 100 000 population Nurses per 100 000 population Hospitalization rate under 5 per 1 000 Hospitalization rate aged 5–9 per 1 000 Hospitalization rate aged 10–14 per 1 000 Hospitalization rate aged 15–18 per 1 000 Hospitalization rate aged 0–14 per 1 000 Country code
Country
References
1. Weber MW, Backhaus S, Chukwujama O, Fenski F, Henking C, Schatte L et al. Pädiatrische versorgungskonzepte in Europa. Monatsschrift Kinderheilkunde 2018;166(2): doi:0.1007/s00112-017-0426-6 (in German).
2. Blair M, Rigby M, Alexander D. Final report on current models of primary care for children, including sections on context, operation and effects, and related business models (Commission Deliverable D6 (D1.2)). London: Models of Child Health Appraised; 2017
(http://www.childhealthservicemodels.eu/wp-content/uploads/2015/09/20170228_Deliverable-D6-1.2_Final-Report-on-Current-Models-of-Primary-Care-for-Children.pdf).
3. Minicuci N, Corso B, Rocco I. Identification of models of children’s primary care: systematic review and meta-analysis of the literature (Commission Deliverable: report on systematic review and meta-analysis for MOCHA WP1 (edition 1)). London: Models of Child Health Appraised;
2016 (http://www.childhealthservicemodels.eu/wp-content/uploads/2015/09/Deliverable-2-D1.1_MOCHA-Systematic-review-1.pdf).
4. Bali D, Kuli-Lito G, Ceka N, Godo A. Maternal and child health care services in Albania.
J Pediatr. 2016;177:S11–20.
5. Baranov A, Namazova-Baranova L, Albitskiy V, Ustinova N, Terletskaya R, Komarova O. The Russian child health care system. J Pediatr. 2016;177:S148–55.
6. Bogdanović R, Lozanović D, Pejović Milovančević M, Sokal Jovanović L. The child health care system of Serbia. J Pediatr. 2016;177:S156–72.
7. Cullu F, Vural M. An overview on child health care in Turkey. J Pediatr. 2016;177:S213–6.
8. Jenni OG, Sennhauser FH. Child health care in Switzerland. J Pediatr. 2016;177:S203–12.
9. Margvelashvili L, Karseladze R, Abesadze G, Kvlividze O. Child health care in Georgia. J Pediatr.
2016;177:S68–70.
10. Sargsyan S, Movsesyan Y, Melkumova M, Babloyan A. Child and adolescent health in Armenia:
experiences and learned lessons. J Pediatr. 2016;177:S21–34.
11. Tasher D, Rubin L, Grossman Z, Grotto I, Dahan D, Berlowitz Y et al. Child health care in Israel.
J Pediatr. 2016;177:S107–15.
12. Tasic V, Danilovski D, Gucev Z. The child health care system of Macedonia. J Pediatr.
2016;177:S127–37.
13. Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation. Geneva: World Health Organization; 2017
(http://apps.who.int/iris/bitstream/handle/10665/255415/9789241512343-eng.pdf;jsessionid=13A7A25F99326D5B5DC9F69CFC5F7E92?sequence=1).
14. Core competencies in adolescent health and development for primary care providers, including a tool to assess the adolescent health and development component in pre-service education. Geneva:
World Health Organization; 2015 (http://www.who.int/maternal_child_adolescent/documents/
core_competencies/en/).
15. Making every baby count: audit and review of stillbirths and neonatal deaths. Geneva: World Health Organization; 2016 (http://www.who.int/maternal_child_adolescent/documents/stillbirth-neonatal-death-review/en/).
16. Child Healthcare Problem Identification Programme. South Africa: Child PIP; 2012
(http://www.childpip.org.za/index.php?option=com_content&task=view&id=12&Itemid=35).
17. Meeting on child health redesign in the WHO European Region: Copenhagen, Denmark, 31 October–2 November 2017. Copenhagen: WHO Regional Office for Europe; 2018
(http://www.euro.who.int/__data/assets/pdf_file/0003/364530/child-health-redesign-meeting-eng.pdf?ua=1).
18. Health 2020: a European policy framework and strategy for the 21st century. Copenhagen: WHO Regional Office for Europe; 2013 (http://www.euro.who.int/__data/assets/pdf_file/0011/
199532/Health2020-Long.pdf?ua=1).
19. Costello AM, Dalglish SL on behalf of the Strategic Review Study Team. Towards a grand convergence for child survival and health: a strategic review of options for the future building on lessons learnt from IMNCI. Geneva: World Health Organization; 2016 (http://www.who.int/
maternal_child_adolescent/documents/strategic-review-child-health-imnci/en/).
20. Improving the quality of care for reproductive, maternal, neonatal, child and adolescent health in the WHO European Region. A regional framework to support the implementation of Health 2020.
Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/__data/
assets/pdf_file/0009/330957/RMNCAH-QI-Framework.pdf?ua=1).
21. Department of Maternal, Newborn, Child and Adolescent Health (MCA): progress report 2014–
15. Geneva: World Health Organization; 2016
(http://apps.who.int/iris/bitstream/handle/10665/205631/9789241510356_eng.pdf?sequence=1).
22. Maternal and perinatal death reviews in the UK. In: World Health Organization [website].
Geneva: World Health Organization; 2018 (http://www.who.int/maternal_child_adolescent/
epidemiology/maternal-death-surveillance/case-studies/united-kingdom/en/).
23. Maternal death reviews in Moldova. In: World Health Organization [website]. Geneva: World Health Organization; 2018 (http://www.who.int/maternal_child_adolescent/epidemiology/
maternal-death-surveillance/case-studies/moldova/en/).
24. Lazzerini M, Shukurova V, Davletbaeva M, Monolbaev K, Kulichenko T, Akoev Y et al.
Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan. Bull World Health Organ. 2017;95:397–407. doi:http://dx.doi.org/10.2471/
BLT.16.176982 (http://www.who.int/bulletin/volumes/95/6/16-176982/en/).
25. Global standards for quality health care services for adolescents. Geneva: World Health
Organization; 2015 (http://www.who.int/maternal_child_adolescent/documents/global-standards-adolescent-care/en/).
26. WHO model list of essential medicines. 20th list (March 2017) (amended August 2017). Geneva:
World Health Organization; 2017 (http://www.who.int/medicines/publications/essentialmedicines/
6th_EMLc2017_FINAL_amendedAug2017.pdf?ua=1).
27. WHO model list of essential medicines for children. 6th list (March 2017) (amended August 2017).
Geneva: World Health Organization; 2017 (http://www.who.int/medicines/publications/
essentialmedicines/6th_EMLc2017_FINAL_amendedAug2017.pdf?ua=1).
28. Hoppu K, Sri Ranganathan S. Essential medicines for children. Arch Dis Child.
2015;100(Suppl. 1):s38–42. doi:10.1136/archdischild-2013-305705.
70
Introduction
This chapter summarizes the indicators included in the country profiles and baseline survey related to young people’s rights and participation in national strategy efforts. The content relates to the European child and adolescent health strategy’s overall priority of “Making children’s lives visible” and its second priority of transforming the governance of child and adolescent health – supporting growth during adolescence.
The chapter describes the ways in which children’s and adolescents’ rights to health are implemented and acknowledged, and highlights their opportunities to participate in the process of creation and implementation of these policies. Findings are put in perspective in accordance with the UNCRC (1).
Key findings
● Thirty-five countries have an ombudsman with a mandate for children’s and adolescents’ right to health and nearly all said that health has been a consistent part of UNCRC reporting.
● Children and adolescents are not consulted in 15 countries in the review, development, or implementation of their child and adolescent health strategy.
● Access to contraception or abortion without parental consent was reported by 32 and 23 countries, respectively.
● Less than half of the countries report that they systematically collect information on children’s and adolescents’ knowledge on sexuality.
● Policies for assent, confidentiality and consent, as well as those for adolescents’ access to care without parental consent, exist in three quarters of the countries.