The WHO Global research agenda on health, migration and displacement identified the health of displaced and migrant populations in the context of climate change as one of the most pressing, yet under-researched, topics. Migration and displacement due to climate change are expected to present new health challenges, for example by worsening long-standing disease burdens, introducing novel health risks and causing health system disruption. Furthermore, it can be anticipated that the health of various migrant groups – including those who did not move because of climate change – will be similarly affected. As examples, internally displaced and migrant populations in urban slums experience food insecurity that is worsened by climate change and threatens their nutritional status; migrant workers are increasingly exposed to severe heat stress at their workplaces; and refugees are affected by weather risks that increase their exposure to waterborne disease outbreaks. Millions of people live in temporary settlements after disasters, with the average stay lasting over a decade.

Background: Human resources are a key determinant for the quality of healthcare and health outcomes. Several human resource management approaches or practices have been proposed and implemented to better understand and address health workers' challenges with mixed results particularly in low- and middle-income countries (LMICs). The aim of this framework synthesis was to review the human resources frameworks commonly available to address human resources for health issues in LMIC. Methods: We searched studies in Medline, Embase, CAB Global Health, CINAHL (EBSCO) and WHO global Index Medicus up to 2021. We included studies that provided frameworks to tackle human resources for health issues, especially for LMICs. We synthesised the findings using a framework and thematic synthesis methods. Results: The search identified 8574 studies, out of which 17 were included in our analysis. The common elements of different frameworks are (in descending order of frequency): (1) functional roles of health workers; (2) health workforce performance outcomes; (3) human resource management practises and levers; (4) health system outcomes; (5) contextual/cross-cutting issues; (6) population health outcomes and (7) the humanness of health workers. All frameworks directly or indirectly considered themes around the functional roles of health workers and on the outcomes of health workforce activities, while themes concerning the humanness of health workers were least represented. We propose a synthesised Human-Centred Health Workforce Framework. Conclusions: Several frameworks exist providing different recurring thematic areas for addressing human resources for health issues in LMIC. Frameworks have predominantly functional or instrumental dimensions and much less consideration of the humanness of health workers. The paradigms used in policy making, development and funding may compromise the effectiveness of strategies to address human resources challenges in LMIC. We propose a comprehensive human resources for health framework to address these pitfalls.

Aim: CPR training for schoolchildren to increase bystander CPR-rates is widely applied. HCPs are regarded as the instructor gold standard, but using non-HCP instructors (e.g., peer-tutors, schoolteachers, medical students) challenges that. This systematic review assesses whether cardiopulmonary resuscitation (CPR) training for children led by peer-tutors, schoolteachers, or medical students results in different learning outcomes to training by health-care professionals (HCPs). Methods: We searched studies that compared CPR training for schoolchildren (population) delivered by peer-tutors, schoolteachers, or medical students (intervention), with training led by HCPs (comparison), assessing student knowledge, skills, willingness and/or confidence to perform CPR (outcome). We included randomized and non-randomized controlled trials (study design). Medline, Embase, Psychinfo, Cinahl, Cochrane, Scopus, Web of Science, and Eric were searched from inception until December 23rd, 2023 (timeframe). Two independent reviewers performed title, abstract, full text screening, bias assessment, and grading of certainty of evidence. We followed the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) guidelines, and registered the review with PROSPERO. Results: Of 9'092 studies identified, 14 were included. Comparison of intervention groups to HCP-led training showed similar overall results (knowledge, skills, self-confidence). Superior results for HCP training were only reported for 'ventilation volume', while schoolteachers and medical students achieved superior knowledge transfer. A meta-analysis was possible for 'compression depth' between peer-tutors and HCPs showing no significant differences. Certainty of evidence was 'low' to 'very low'. Conclusion: This systematic review of CPR training for school children revealed that peer-tutors, schoolteachers and medical students achieve similar educational outcomes compared to those of HCPs. Non-HCPs training schoolchildren is an appropriate cost-efficient alternative and easy to implement in school curricula.

Patient harm due to unsafe care is a leading cause of death and disability worldwide, and most of such harm is avoidable (1). Harm due to medicines and therapeutic options accounted for nearly 50% of the overall preventable harm in medical care (2). The pooled prevalence of preventable medication-related harm was 5% (1 in 20 patients) and one fourth of the harm was severe or potentially life-threatening (3). The prevalence of preventable medication-related harm was nearly double, 7% (1 on 25 patients) in low- and middle-income countries (LMICs) compared to 4% (1 in 14 patients) in high-income countries. This policy brief defines key concepts of medication safety and presents current evidence on the scale of the problem and the urgency of the situation. Medication errors occur throughout the medication use process; however, many recent studies indicate that most errors occur during prescribing and monitoring stages (3, 4). Evidence of medication-related harm in several contexts and environments are discussed. Policy options with benefits, advantages and opportunities to improve medication safety are suggested, including technological solutions. Establishment of medication safety committees within the organizational structure, appointing medication safety or patient safety officers and implementing national action plans on medication safety are recommended. Ensuring a culture of safety and managing changes to the culture in the workplace and in the health care system are important to improve medication safety. Reporting and learning systems for medication errors have been used in countries to identify errors, creating learning opportunities for preventing errors. Methods for addressing the priorities identified in the third WHO Global Patient Safety Challenge: Medication Without Harm are discussed using the strategic framework, focussing on the four domains and the three key action areas. Solutions that could be used in countries are proposed under the four domains of the strategic framework: the patient and the public, health and care workers, medicines as products, and systems and practices of medication and the three action areas: high-risk situations, polypharmacy and transitions of care.

Overview The object of this evaluation is the national child care reform initiatives between 2009 to 2021 with a focus on deinstitutionalisation, including in particular for children with disabilities in the selected countries - Armenia, Bulgaria, Montenegro, Georgia, Serbia, Belarus and Tajikistan. The purpose of the evaluation will be to provide a rigorous assessment of national governments’ and UNICEF’s results to date (outcome and impact level) in DI child care reforms supporting children with disabilities and other highly marginalized and vulnerable children in the region – taking into consideration considerable variability across countries and sectors. This will provide objective assessment of strengths and weaknesses in approaches taken by different countries as well as insights on how to address possible system level bottlenecks. The evaluation will be instrumental for further interrogating the progress that has been made in the region in terms of DI with the focus on outcomes and impacts, but also for looking specifically at key common bottlenecks, and exploring where and what types of effective solutions to those bottlenecks have been implemented by national governments including those conducted with support of UNICEF and why they were or were not successful. In particular, there is a need to look at the key accelerators to ensure particularly children with disabilities are appropriately included in deinstitutionalisation efforts. Therefore, the evaluation will be important for harvesting good practices, and sharing experiences on what worked across the region to inform next stages of reforms. Report Details Year Published 2024 Type Project/Programme Joint No Partner/s N/A Consultant name UNICEF CO and the team of For Our Children Foundation Agency Focal Point Stela Grigoras Focal Point Email sgrigoras@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies SwitzerlandArmeniaBulgariaGeorgiaMontenegroSerbiaTajikistanMoldova

Background: Pain, sedation, delirium, and iatrogenic withdrawal syndrome are conditions that often coexist, algorithms can be used to assist healthcare professionals in decision making. However, a comprehensive review is lacking. This systematic review aimed to assess the effectiveness, quality, and implementation of algorithms for the management of pain, sedation, delirium, and iatrogenic withdrawal syndrome in all pediatric intensive care settings. Methods: A literature search was conducted on November 29, 2022, in PubMed, Embase, CINAHL and Cochrane Library, ProQuest Dissertations & Theses, and Google Scholar to identify algorithms implemented in pediatric intensive care and published since 2005. Three reviewers independently screened the records for inclusion, verified and extracted data. Included studies were assessed for risk of bias using the JBI checklists, and algorithm quality was assessed using the PROFILE tool (higher % = higher quality). Meta-analyses were performed to compare algorithms to usual care on various outcomes (length of stay, duration and cumulative dose of analgesics and sedatives, length of mechanical ventilation, and incidence of withdrawal). Results: From 6,779 records, 32 studies, including 28 algorithms, were included. The majority of algorithms (68%) focused on sedation in combination with other conditions. Risk of bias was low in 28 studies. The average overall quality score of the algorithm was 54%, with 11 (39%) scoring as high quality. Four algorithms used clinical practice guidelines during development. The use of algorithms was found to be effective in reducing length of stay (intensive care and hospital), length of mechanical ventilation, duration of analgesic and sedative medications, cumulative dose of analgesics and sedatives, and incidence of withdrawal. Implementation strategies included education and distribution of materials (95%). Supportive determinants of algorithm implementation included leadership support and buy-in, staff training, and integration into electronic health records. The fidelity to algorithm varied from 8.2% to 100%. Conclusions: The review suggests that algorithm-based management of pain, sedation and withdrawal is more effective than usual care in pediatric intensive care settings. There is a need for more rigorous use of evidence in the development of algorithms and the provision of details on the implementation process. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021276053, PROSPERO [CRD42021276053].

Background: Pain, sedation, delirium, and iatrogenic withdrawal syndrome are conditions that often coexist, algorithms can be used to assist healthcare professionals in decision making. However, a comprehensive review is lacking. This systematic review aimed to assess the effectiveness, quality, and implementation of algorithms for the management of pain, sedation, delirium, and iatrogenic withdrawal syndrome in all pediatric intensive care settings. Methods: A literature search was conducted on November 29, 2022, in PubMed, Embase, CINAHL and Cochrane Library, ProQuest Dissertations & Theses, and Google Scholar to identify algorithms implemented in pediatric intensive care and published since 2005. Three reviewers independently screened the records for inclusion, verified and extracted data. Included studies were assessed for risk of bias using the JBI checklists, and algorithm quality was assessed using the PROFILE tool (higher % = higher quality). Meta-analyses were performed to compare algorithms to usual care on various outcomes (length of stay, duration and cumulative dose of analgesics and sedatives, length of mechanical ventilation, and incidence of withdrawal). Results: From 6,779 records, 32 studies, including 28 algorithms, were included. The majority of algorithms (68%) focused on sedation in combination with other conditions. Risk of bias was low in 28 studies. The average overall quality score of the algorithm was 54%, with 11 (39%) scoring as high quality. Four algorithms used clinical practice guidelines during development. The use of algorithms was found to be effective in reducing length of stay (intensive care and hospital), length of mechanical ventilation, duration of analgesic and sedative medications, cumulative dose of analgesics and sedatives, and incidence of withdrawal. Implementation strategies included education and distribution of materials (95%). Supportive determinants of algorithm implementation included leadership support and buy-in, staff training, and integration into electronic health records. The fidelity to algorithm varied from 8.2% to 100%. Conclusions: The review suggests that algorithm-based management of pain, sedation and withdrawal is more effective than usual care in pediatric intensive care settings. There is a need for more rigorous use of evidence in the development of algorithms and the provision of details on the implementation process. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021276053, PROSPERO [CRD42021276053].

Objectives: The aim of this scoping review was to map out the existing evidence of the impact of the COVID-19 lockdown on parents of children and adolescents. We sought to: 1) identify parenting domains that were particularly affected by lockdown measures, 2) describe the challenges and opportunities of lockdown measures in these domains, and 3) define protective and exacerbating factors modulating the effect of lockdown measures on parents. Methods: We identified five main domains investigated in the context of parenting during the early COVID-19 lockdown derived from 84 studies: health and wellbeing, parental role, couple functioning, family and social relationships, and paid and unpaid work. For each domain, we listed challenges and opportunities, as well as discriminant factors. Results: The lockdown impacted all five different but interconnected domains, introduced new roles in parents' lives, and particularly affected women and vulnerable populations. Conclusion: This scoping review highlights the importance of approaching public health policymaking from a social justice perspective. Such an approach argues for social and public health policies to promote health accounting for its social, economic, political, and commercial determinants.

Overview This evaluation purpose is to provide information to decision makers regarding the implementation of the Preparatory Stage of the Child Guarantee, as part of the agreement between UNICEF with the European Commission. As the European Child Guarantee is in process of establishing mechanisms at different levels for planning, implementation and monitoring, the evaluation process intends to inform the ongoing specific political processes that can lead to decisions concerning actions to be taken, monitoring of progress and results, and implementation. It is therefore expected that the evaluation adopts a developmental character, allowing to feed into key decision-making moments. In addition to UNICEF, primary audience and users of evaluation findings, conclusions, and recommendations include European Commission, national governments, civil society organizations, academics, and other practitioners and decision makers in the area of child poverty and social exclusion of children in the European Context, and other contexts dealing with similar child-related matters. The evaluation will add transparency to the implementation of Phase III. It shall be managed by the independent Evaluation Section at UNICEF ECARO and conducted by an external institution to ensure that evaluation principles are safeguarded. An Evaluation Reference Group will be established to ensure technical soundness as well as guide the process in the integration of the findings, conclusions, and recommendations in the implementation of the preparatory stage of the Child Guarantee. Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A Consultant name Policy Research Institute Agency Focal Point Stela Grigoras Focal Point Email sgrigoras@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies Switzerland

Overview The Evaluation of UNICEF's response to the outflow of children and women affected by the emergency in Ukraine is expected to have a strong learning purpose on several fronts: Providing relevant and integrated data, both operationally and programmatically into UNICEF's response to the evolving crisis; Informing the planning and direction of ongoing efforts in the establishment and implementation of the response in the short and medium-term; and Producing lessons that will be useful and applicable outside of the countries directly involved, as needed. The Evaluation will strengthen UNICEF's accountability to the affected populations, particularly children and women, as well as partners and stakeholders supporting the overall response. The Evaluation is expected to produce actionable recommendations on how to strengthen ongoing efforts in providing support to refugee children and women through the UNICEF response in coordination with host governments and other key stakeholders, as well as provide lessons on how to improve future preparedness, response, and planning in dealing with the influx of people seeking assistance during an armed conflict. Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A Consultant name Julia Betts, RowSquared Agency Focal Point Octavian Bivol Focal Point Email obivol@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies Switzerland

Preventing hospitalizations due to ambulatory care sensitive conditions (ACSCs) is traditionally the responsibility of primary care. The determinants of ACSC hospitalizations, however, are not purely medical, but also influenced by other factors like patients’ social and personal circumstances. Interventions that include or consist entirely of community health services and social care could potentially reduce the ACSC hospitalization rate. Comparisons of the features of successful interventions of this nature, however, are still lacking. We therefore conducted a systematic review of the literature to identify out-of-hospital interventions that (a) included aspects or consisted entirely of community health services and social care and (b) analyzed the ACSC hospitalization rate as an outcome measure. We identified papers reporting the results of 32 interventions and extracted structural and behavioral features to determine which of these were shared by most or all of the successful interventions. We found that all of the successful interventions included a primary care physician and provided care management. Moreover, most of the successful interventions were characterized by a high degree of interconnectedness between professional groups and provided care within so-called health care homes. We also identified a set of care coordination activities that were implemented in most of the successful interventions. Policy makers may wish to consider adopting these features when designing interventions that aim to reduce the ACSC hospitalization rate.

Introduction: Coordination of healthcare professionals seems to be particularly important for patients with complex chronic disease, as they present a challenging interplay of conditions and symptoms. As one solution, to counteract or prevent this, improving collaboration between general practitioners (GPs) and specialists has been the aim of studies by linking or coordinating their services along the continuum of care. This scoping review summarises role distributions and components of this collaboration that have potential for improvement for the care of patients with complex chronic conditions. Methods: Scoping review as a knowledge synthesis for components of collaboration and role distributions between medical specialists and GPs in intervention studies. The PubMed database was searched for literature from 2010-2020. Results: Literature search and reference screening generated 2,174 articles. 30 articles originating from 22 unique projects were included in our synthesis. In the interventions to improve collaboration, the GP is most commonly in charge of patient management and extends the scope of practice. The specialist provides support when needed. Clear definition of roles, resources for knowledge transfer and education from specialists are commonly utilised interventions. Typically, combinations of process and system changes addressing communication and coordination issues are applied. Most interventions improve provider and patient satisfaction, health outcomes, and reduce care fragmentation. Conclusion: This review showed that interventions to improve collaboration between GPs and medical specialists seem promising. Further efforts should be made to test and apply the findings systematically in broad clinical practice.

There is a lack of knowledge about the successful implementation of family nursing practices. This scoping review maps current knowledge about the implementation of evidence-informed family nursing practices across settings and populations. A systematic search (CINAHL, PubMed, Medline) identified 24 publications, published between 2010 and 2020. We found nurses' implementation experience to be one of disruption, learning, and moving to new ways of practicing. The implementation resulted in benefits to families and self but was marked by fluctuation and partial integration of evidence-informed family nursing practices into care delivery. Uptake was shaped by various contextual determinants, with barriers mainly at the team and organizational levels. We identified low-quality, tentative evidence that capacity-building strategies coupled with dissemination-educational strategies may enable family nursing practice skills and increase the quality of family care. More rigorous research is needed to build further knowledge about effective implementation. Future implementation endeavors should utilize the evolving knowledge base in family nursing and tailor implementation strategies to contextual barriers.

Overview In 2020, the UNICEF evaluation function launched and rolled out Round 1 of the RTA of UNICEF’s response to COVID-19. The Round 1 RTA was conceived as a forward-looking reflection, rooted in the ways in which UNICEF Country Offices (COs) were responding to the pandemic, as it was unfolding, gauging issues related to adaptation, implementation and quality of the response. Round 1 of the RTA looked at all areas of COs’ response to the COVID-19 pandemic and focused on six ECARO countries: Croatia, Georgia, Kyrgyzstan, Moldova, Tajikistan, and Ukraine. Following the extension of UNICEF’s corporate emergency level until the end of 2021 and the evaluation function’s support for an extension of the assessment, UNICEF ECARO has extended the RTA for a second round to conduct more detailed analysis of UNICEF response to COVID-19 in education and social protection in nine ECAR countries Report Details Year Published 2022 Type Project/Programme Joint No Partner/s N/A Consultant name Natasha Robinson et al Agency Focal Point Talha Zakria Focal Point Email tzakria@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies Switzerland

Overview Co-funded by the EU, UNICEF Europe and Central Asia Regional Office (ECARO) is implementing a Project to support refugee and migrant children in front line and transition countries. One of the deliverables of the 4.5 million Euro Project is an end-of-project, external and independent evaluation that is intended to assess the outcomes envisioned under the RMChild-Health Project. The summative evaluation will be used to demonstrate UNICEF’s accountability to delivering on the Project objectives and results, as well as for learning purposes to inform future programming related to the health of refugee and migrant children in southern and south-eastern Europe. Report Details Year Published 2022 Type Project/Programme Joint No Partner/s N/A Consultant name IOD Parc Agency Focal Point Sandra Gorini Focal Point Email sgorini@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies Switzerland