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  • It s finally a year by the end of

    2019-05-09

    It\'s finally 2015: a year by the end of which extreme poverty and hunger are to be eradicated, maternal and child mortality are to be drastically reduced, and the trajectory of the global incidence of HIV, tuberculosis, and malaria are to be reversed. Much has been written about where the Millennium Development Goals succeeded and failed as global targets, and what has changed in the world since 2000. Much work has also been done to establish what happens next. In his synthesis on the post-2015 agenda released last month, UN Secretary-General Ban Ki-Moon summarised and annotated this work, ultimately backing the as the basis for a truly transformative agenda. He also devoted a hefty chunk of the report to the somewhat less exciting subject of how to pay for it. The International Conference on Financing for Development in July marks the first of three key meetings on the post-2015 agenda taking place this year (the others being the special UN summit in September and the 21st Conference of the Parties of the UN Framework Convention on Climate Change [COP21] in December). The conference will take as its starting point the , which lays out policy options for the four main sources of development finance—national public sources (eg, tax income), national private sources (eg, bank credit), international public sources (eg, official development assistance [ODA]), and international private sources (eg, trade and foreign investment). Some of the need for financing reform is explored in this month\'s issue.
    In , Silvina Arrossi and colleagues report a cluster-randomised trial to investigate the effectiveness of using an existing network of trained cyproheptadine hcl health workers to implement self-collection of samples for high-risk human papillomavirus (HPV) detection among women in Jujuy, Argentina—a region with one of the highest cervical cancer mortality rates nationally. In their Article, Arrossi and colleagues highlight two important issues. First, self-collection for HPV detection is an important method to reach women who are rarely or never screened. Second, non-clinicians such as community health workers can have a key role in increasing coverage. Screening based on Papanicolaou (Pap) tests has significantly reduced cervical cancer incidence in high-income countries; however, a small but important proportion of women are still rarely or never screened (eg, 11% in the USA). Screening coverage in low-income and middle-income countries is fairly low, in part because of limited resources and health infrastructure, including a shortage of health professionals to do screening. Self-collection of cervicovaginal samples for detection of HPV could eliminate the need for an initial pelvic examination by a trained health professional and increase screening coverage in countries of low income and middle income and hard-to-reach populations in high-income countries. Self-collection is highly acceptable among women, and self-collected samples are comparable to clinician-collected samples for detection of HPV when analysed with several PCR-based tests. In Europe, self-collection kits delivered to rarely screened women via the postal system increased cervical cancer screening coverage. Since postal systems in low-income and middle-income countries are less reliable, alternative delivery methods need be considered in the implementation of self-collection for HPV detection in these countries. Community health workers, also referred to as lay health workers, are typically members of a community who receive some training to provide health services or health promotion. Organisation and compensation of community health workers ranges from paid employees in a country\'s health-care system—such as in Argentina—to unpaid volunteers in other countries. Community health workers have been successful in significantly increasing childhood immunisation uptake, breastfeeding, and tuberculosis cure rates. In a randomised trial of more than 150 000 women in Mumbai, India, public health workers (similar to community health workers, and defined as women in the community with limited education and experience in working in health programmes) were effective in doing cervical cancer screening by visual inspection with acetic acid. In India, the addition of this screening method by trained public health workers to the routine cervical cancer education led to a significant 31% reduction in cervical cancer mortality over 12 years.