World Health Organization

Health systems today face overlapping pressures-from demographic shifts, workforce shortages, climate change, and geopolitical and economic instability. This strains their ability to deliver effective and equitable care and erodes public trust. Traditional approaches to quality of care, often focused on service volumes or process compliance, are proving insufficient to address these system-wide challenges. In response, this paper proposes a transformational vision for quality of care that moves beyond traditional models. This vision is rooted in two interconnected pillars. First, a focus on outcomes that truly matter to people and populations, prioritizing health and well-being over service volume. The second pillar is a whole-systems perspective that embeds quality across all levels of governance, policy, and financing. This transformation is made possible through three key enablers. First, an empowered workforce and accountable leadership are needed to drive change. Second, data must be used transparently to build trust and guide results-focused work. Finally, innovative solutions and tools must enhance quality and be aligned with equity. Drawing on practical implementation examples, this paper outlines a roadmap for system-wide alignment of health systems-to rebuild trust, improve resource use, and advance health equity. This makes quality a lasting foundation for resilient, sustainable, and equitable healthcare.

BackgroundRabies causes over 60,000 deaths annually, primarily among children, with dog bites responsible for nearly all human cases. Although mass dog vaccination is effective in low-resource settings, structured campaigns have rarely been implemented in refugee camps, where unmanaged dog populations and limited access to post-exposure prophylaxis heighten rabies risk. This study aimed to demonstrate the possibility of delivering systematic mass dog vaccination within a short operational timeframe in a humanitarian setting and to assess community perceptions of rabies risk and prevention.Methodology/principal findingsIn May 2025, a four-day mass dog vaccination campaign was conducted across the Kutupalong-Balukhali refugee settlement in Cox’s Bazar, Bangladesh, with real-time data collection to guide operations. Post-vaccination dog sight surveys assessed operational coverage, while community surveys evaluated knowledge, attitudes and practices (KAP) regarding rabies. Of the 2,275 dogs encountered, 1,781 (78.3%) were vaccinated, with 86.4% classified as unowned community dogs. The overall proportion of marked dogs across all surveyed zones was 71.5% (95% CI: 66.8–75.9%). In the community survey, 34.6% of 1,311 adult respondents (gender-adjusted) had heard of rabies, and 41.2% correctly identified dog bites as the primary route of transmission. Regarding appropriate post-bite care, 25.9% knew to both wash the wound and seek medical care. Approximately 8.7% of households experienced a dog bite in the preceding year, corresponding to a minimum annual incidence of 13.3 bites per 1,000 persons, equating to over 15,000 bites per year.Conclusions/significanceThis study represents the first structured mass dog vaccination campaign in a refugee setting, demonstrating that rabies control can be effectively implemented even in complex humanitarian contexts. The campaign’s success offers a replicable model for integrating zoonotic disease prevention into emergency health responses, underscoring the critical need to safeguard displaced populations from preventable diseases.

Background/Objectives: Sizeable between- and within-country inequalities in childhood immunization impair progress towards the goals set by the global Immunization Agenda 2030 (IA2030) of achieving universal coverage of all persons with essential life-saving vaccines. Monitoring global trends in immunization inequalities helps to identify population subgroups that are less likely to benefit from vaccines and provides evidence for tracking progress on regional and global goals and informing equity-oriented interventions. This paper assesses the state of within-country inequality in childhood immunization across low- and middle-income study countries. Methods: Using data from household health surveys, the analysis quantifies within-country inequality across up to 92 countries, areas and territories, for nine childhood immunization indicators (seven coverage indicators and two indicators of non-receipt of vaccines) by five dimensions of inequality (child sex, mother's age, mother's education, household economic status and place of residence). Absolute and relative summary measures of inequality (difference, ratio, slope index of inequality, relative index of inequality and population attributable risk) were calculated to assess the latest situation of inequality (i.e., using the most recent survey from 2014 to 2023) and change over time (i.e., comparisons with data from 2004 to 2013). Results: The latest situation of inequality revealed overall low or no inequality by child sex, mother's age and place of residence, with more pronounced inequality related to mother's education and household economic status. The median differences between the most and least educated subgroups ranged between 9 and 14 percentage points for immunization coverage indicators, and between 6 and 9 percentage points for non-receipt of vaccines indicators. The extent of inequality in childhood immunization tended to remain about the same as the previous decade, with modest reductions in absolute economic-related and place of residence inequality in DTP3 immunization, as well as place of residence inequality in full immunization (declining by 3.25, 2.42, and 2.16 percentage points over 10 years, respectively). Distinct patterns of economic-related inequality were evident across country income groups, with low-income countries reporting larger inequality than lower- and upper-middle-income countries; there was substantial variation at the country level. Conclusions: Economic- and education-related inequalities in childhood immunization within low- and middle-income countries have persisted over the past decade.

The introduction of significantly shorter, all-oral regimens has significantly shifted the management of drug-resistant tuberculosis (DR-TB) towards a more tolerable and patient-centred therapeutic approach that aims to enhance treatment adherence, clinical outcomes, and quality of life among patients. Nigeria has gradually adopted this all-oral, shorter regimen, but the impact of this regimen in programmatic settings has not yet been studied. In 2022, a longitudinal, two-armed cohort study was conducted to explore the effectiveness, safety, and feasibility of the all-oral shorter regimen in the programmatic management of RR/MDR-TB in Nigeria. Consenting and eligible RR/MDR-TB patients receiving the all-oral regimen (intervention group) in four states were consecutively enrolled and compared to those receiving the standard of care (SOC). Treatment effectiveness, proportion, and 95% confidence intervals of favourable and unfavourable outcomes were measured at the end of treatment and during follow-up (six and 12 months post-treatment). In total 383 Participants were followed monthly throughout the 9-12-month treatment phase and then reassessed at 6 and 12 months after treatment completion, giving a total possible observation period of up to 24 months (185 received the intervention and 198 the standard of care). At the end of follow-up, there was a higher but non-significant proportion of favourable outcomes among the intervention vs. SOC group (80% vs. 69.7%); a higher proportion of favourable outcomes was also noted at the end of treatment among intervention participants (81.1 vs. 76.8%). Around one third of patients reported at least one serious adverse event (SAE), with no significant differences between arms, and none were deemed related to the use of medication. Intervention participants reported greater improvements in health-related quality of life between baseline and four months compared to those receiving the SOC. These findings support the programmatic use of all-oral shorter treatment for RR/MDR-TB as a regimen that is effective, tolerable, safe, and associated with enhanced health-related quality of life for patients in Nigeria.

Prior qualitative studies have described subjective experiences during Reiki, yet their quantitative relationship to symptom change has not been examined. This study evaluated whether specific subjective Reiki experiences are associated with changes in health-related symptoms using regression and mediation analyses. The study took place at private Reiki practices across the United States. Reiki practitioners (N = 99) invited their clients to complete a survey before and after receiving Reiki. The Reiki sessions were conducted in person, with each session lasting an average of 60 min. Self-report measures based on the Edmonton Symptom Assessment System were used to assess physical and psychological symptoms immediately before (pre) and after (post) the Reiki session. Participants were asked to describe their experience during the Reiki session at post. Linear regression analyses were conducted to explore associations between subjective Reiki experiences and changes in well-being, pain, and anxiety, while controlling for age and gender. Mediation models tested whether pain and anxiety changes mediated the relationship between subjective Reiki experiences and improvements in well-being. A total of N = 1,284 Reiki sessions had both quantitative and qualitative data and were included in the analysis. Experiencing positive emotions was significantly associated with higher well-being and reduced anxiety, and experiencing body sensations was significantly associated with greater pain relief. There was a significant indirect effect of body sensations on well-being via pain relief, a significant indirect effect of positive emotions on well-being via anxiety reduction, and a significant indirect effect of emotional release on well-being via anxiety reduction. The results from this linear regression and mediation analysis suggest that the subjective experience of receiving Reiki is related to changes in different psychological and physical health symptoms. More work is needed to confirm these findings while addressing the limitations of the current study.

Every second matters in postpartum hemorrhage (PPH). Every moment spent working in silos, disjointedly, or competing rather than collaborating is time that could have made the difference between life and death for a woman giving birth. Like maternal health at large, successfully treating and preventing PPH is a test of how well our global health community works together. The joint launch of global guidelines for the prevention and treatment of postpartum hemorrhage by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) is a statement of shared responsibility and a commitment to do better. Developed over 18 months of rigorous collaboration, these guidelines translate research into practical, evidence-based tools designed and ready for real-world use. For too long, fragmented guidance has slowed action at the bedside. The science of preventing and treating PPH is well understood. We have the evidence. We have the tools. We know what needs to be done. The effort to bring key players onto the same page, both literally and figuratively in order to end these preventable deaths was articulated in the global PPH roadmap published in 2023. The joint effort of producing the consolidated guidelines demonstrates that alignment is powerful. By bringing together the collective reach and expertise of WHO, FIGO, and ICM, we show that when institutions work as one we can be more efficient and effective in achieving ambitious goals. Implementation is where lives are saved or lost. Guidelines only fulfill their promise when they are used consistently, promptly and correctly. That responsibility does not rest with one organization or one profession alone. It belongs to governments that must prioritize maternal health, to health professionals who must act decisively, to health systems that must be prepared to respond without delay, and to funders, civil society, industry, women, and advocates who must demand and support change. Postpartum hemorrhage is, above all, a race against time. Time to recognize bleeding. Time to act. Time to escalate care. Delays whether caused by unclear guidance, poor coordination or system failures cost lives. Well-designed, aligned guidelines that bring together global players and professional associations provide clarity and save time. We have a collective responsibility to ensure that our health systems can move fast enough when PPH strikes. Women's lives depend on it. The launch of these joint guidelines is an important step forward. What matters now is that we work together to ensure that every birth is safer and that preventable deaths from postpartum hemorrhage become a thing of the past. The author declares no conflicts of interest. ChatGPT was used to condense the original presentation transcript of the speaker into an initial editorial draft; all content, final edits and approvals were made by the author. Data sharing is not applicable to this article as no new data were created or analyzed in this study.