With centralisation timely and efficient distribution networ

With centralisation, timely and efficient distribution networks are key. However, mature blood distribution networks are yet to be established in most developing countries. For example, blood donated in Malawi\'s capital Lilongwe is sent to Blantyre (360 km away) for testing at MBTS before it is transported back to Lilongwe for use. This type of centralisation is impractical and unsustainable for the delivery of emergent and elective surgical services, particularly when family members are available and willing to donate blood locally. Health-care systems need a hybrid approach that maintains the establishment of centralised blood banking infrastructure, while simultaneously supporting regional and local hospital transfusion facilities. This will result in blood product use at the site of donation and has several policy advantages. First, this approach acknowledges the importance of centralised regulation and quality assurance, but provides more flexibility for implementation in resource-poor environments. Second, it encourages the concurrent use of replacement and volunteer donors, which should increase supply. Finally, replacement donors are often interested in donating again, providing a potential sustainable source of donation. Evidence suggests that this hybrid model works. In 2010, Bugge and colleagues found a reliable and readily available blood supply at a Malawian district hospital that was using both centralised volunteer blood and local family replacement donations, effectively using a natural hybrid model. A hybrid model must also include strategies for culturally appropriate donor recruitment that target Cilengitide leaders, and provider education programmes aimed at improving transfusion stewardship.
WHO estimates an additional 250 000 mortalities between 2030 and 2050 will be attributable to climate-associated increases in malnutrition, malaria, diarrhoea, respiratory disease, water inaccessibility, and heat stress. Spillover effects on state and regional security are inevitable. The World Economic Forum has identified climate change as the single greatest threat to global stability because of its considerable consequences on the health and stability of developing nations. Analysis of factors contributing to multiple global crises are illustrative of climate change\'s effects on state stability. The ongoing civil war in Syria and the outbreaks of emerging tropical diseases, such as the Ebola and Zika viruses, are two such examples. Although multifaceted in origin, the Syrian conflict was preceded by the nation\'s most severe drought on record, which led to widespread food and water insecurity and deteriorating health outcomes. Pathogens such as the Ebola and Zika viruses are likely to become more frequent as nyctinasty exploit already overburdened health systems struggling to address both existing and emerging care needs. The complex interaction between climate change, health system burdens, and poor health outcomes, and their subsequent impact on politics, security, and society can be captured within the concept of a so-called climate-health-security nexus. Many of the world\'s poorest and most politically fragile nations lie at the centre of this nexus. Within this nexus, poverty, state fragility, poor pre-existing health outcomes, and high susceptibility to climate change converge to amplify the effects of future famines, droughts, and neglected tropical diseases. This amplification subsequently leads to worsened economies, social instability, and reliance on external support. The nations most at risk for climate-triggered health crises are primarily scattered throughout sub-Saharan Africa and south Asia and are already afflicted by the highest rates of disease burden globally (, ). Notably, most of these countries are low-income nations without the resources to adequately contend with climate-related challenges.
Less than a year from now, a new Director-General will be elected to lead WHO. The next Director-General should commit to developing a global agreement on the research and development (R&D) of medicines, vaccines, and diagnostics of public health importance. This is critical in order to address the dual challenges posed by unaffordable medicine prices and a lack of innovation in neglected diseases, antimicrobials, and other public health priorities. Discussions at WHO on how to address failures of the current monopoly-based R&D system have been ongoing for over a decade, but R&D policy change is yet to occur and the will to address the root causes of the access and innovation crisis is still lacking.