| Adolescent | For the purposes of this guideline, adolescents are defined as individuals between the ages of 10 and 19 years old. Adolescents are not a homogeneous group; physical and emotional maturation comes with age, but its progress varies among individuals of the same age. Also, different social and cultural factors can affect their health, their ability to make important personal decisions and their ability to access services (1). |
| Adult | A person aged 18 or older (2). |
| Acceptability | All provision of health-care facilities, commodities and services must be acceptable to those who are their intended beneficiaries. They must be provided in a manner respectful of medical ethics and of the culture of individuals, minorities, peoples and communities; sensitive to gender and to life-cycle requirements; must be designed to respect confidentiality and improve the health status of those concerned. Countries should place a gender perspective at the centre of all policies, programmes and services affecting women’s health, and should involve women in the planning, implementation and monitoring of such policies, programmes and services (3). |
| Accessibility | Under international human rights law, countries are required to ensure that health-care facilities, commodities and services are accessible to everyone. This includes physical and economic accessibility, as well as access to information. Human rights bodies have called on countries to eliminate the barriers people face in accessing health services, such as high fees for services, the requirement for authorization by spouse, parent/guardian or hospital authorities, distance from health-care facilities, and the absence of convenient and affordable public transport (3). |
| Accountability | Countries are accountable for bringing their legal, policy and programmatic frameworks and practices in line with international human rights standards. Further, effective accountability mechanisms are key to ensuring that the agency and choices of individuals are respected, protected and fulfilled, including when seeking and receiving health care. Effective accountability requires that individuals, families and groups, including women from marginalized populations, are made aware of their rights, including with regard to sexual and reproductive health, and are empowered to claim their rights (3). |
| Availability | Functioning health and health-care facilities, goods and services, as well as programmes, have to be available in sufficient quantity within the state. The characteristics of the facilities, goods and services will vary depending on numerous factors, including the state’s developmental level. Countries must, however, address the underlying determinants of health, such as provision of safe and potable drinking water, adequate sanitation facilities, health-related education, hospitals, clinics and other health-related buildings, and ensure that trained medical and professional personnel are receiving domestically competitive salaries. As part of this core obligation, countries should ensure that the commodities listed in national formularies are based on the WHO model list of essential medicines, which guides the procurement and supply of medicines in the public sector (3). |
| Autonomy | Autonomy relates to the rights of individuals to self-determination in sexual health; rights that need to be recognized by the state and enabled by everyone – from partners and families to global institutions (4). |
| Children | According to Article 1 of the Convention on the Rights of the Child, “A child means every human being below the age of eighteen years unless, under the law applicable to the child, majority is attained earlier” (2). |
| Comprehensive sexuality education (CSE) | CSE is a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. It aims to equip children and young people with knowledge, skills, attitudes and values that will empower them to: realize their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and understand and ensure the protection of their rights throughout their lives (5). |
| Confirm | To issue a report on the status of a test for an STI (e.g. HIV, HPV), pregnancy or other health condition. Initially reactive test results, including reactive self-test results, need to be confirmed by a health-care provider and/or according to the national validated testing algorithms (6). |
| Digital health | The use of digital technologies for health. An overarching term that comprises both eHealth and mHealth, and emerging areas, such as the use of computing sciences in the fields of artificial intelligence, big data and genomics (7). |
| Digital health intervention | A discrete function of a digital technology to achieve health sector objectives. The classification of digital health interventions follows the different ways in which digital and mobile technologies are being used to support health system needs (7). |
| eHealth | The use of information and communications technology (ICT) in support of health and health-related fields, including health-care services, health surveillance, health literature, and health education, knowledge and research. mHealth is a component of eHealth (7). |
| Enabling environment | Attitudes, actions, policies and practices that stimulate and support the effective and efficient functioning of organizations, individuals and programmes or projects. The enabling environment includes legal, regulatory and policy frameworks, and political, sociocultural, institutional and economic factors (8). |
| Evidence to Decision (EtD) table | A framework to assist people making and using evidence-informed recommendations and decisions. Their main purpose is to help decision-makers use evidence in a systematic and transparent way. When used in a WHO guidelines context, EtD frameworks inform guideline development group (GDG) members about the comparative pros and cons of the interventions being considered, ensure that GDG members consider all the important criteria for making a decision, provide GDG members with a concise summary of the best available evidence about each criterion to inform their judgments, and help GDGs to structure and document their discussions, and to identify any reasons for disagreement, making the process and the basis for their decisions transparent (9). |
| Family planning | Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is achieved through use of contraceptive methods and the treatment of infertility (10). |
| Fertility | The capacity to establish a clinical pregnancy (11). |
| Fertility awareness | The understanding of reproduction, fecundity, fecundability, and related individual risk factors (e.g. advanced age, sexual health factors such as sexually transmitted infections, and life-style factors such as smoking, obesity) and non-individual risk factors (e.g. environmental and work place factors); including the awareness of societal and cultural factors affecting options to meet reproductive family planning, as well as family building needs (11). |
| Fertility care | Interventions that include fertility awareness, support and fertility management with an intention to assist individuals and couples to realize their desires associated with reproduction and/or to build a family (11). |
| Gender equality | Refers to equal chances or opportunities for groups of women and men to access and control social, economic and political resources, including protection under the law (such as health services, education and voting rights). Women and men have equal conditions to realize their full rights and potential to be healthy, contribute to health development and benefit from the results. Achieving gender equality requires specific measures designed to support groups of people with limited access to such goods and resources (12). |
| Harm or social harm | Any intended or unintended cause of physical, economic, emotional or psychosocial injury or hurt from one person to another, a person to themselves, or an institution to a person (6). |
| Health intervention | A health intervention is an act performed for, with or on behalf of a person or population whose purpose is to assess, improve, maintain, promote or modify health, functioning or health conditions. Health interventions can be carried out by a broad range of providers, including lay people,1 across the full scope of health systems; and includes interventions on: diagnostic, medical, surgical, mental health, primary care, allied health, functioning support, rehabilitation, traditional medicine and public health (13). |
| HIV self-testing (HIVST) | A process in which a person collects his or her own specimen (oral fluid or blood) and then performs a test and interprets the result, often in a private setting, either alone or with someone he or she trusts (6). |
| HIV status | Is the final report that is given to the patient; it is the final interpretation of the patient disease state and is based on a collection of testing results generated from one or more assays. HIV status may be reported as HIV-positive, HIV-negative or HIV-inconclusive (6). |
| HPV self-sampling (HPVSS) | A process where a woman who wants to know whether she has HPV infection uses a kit to collect a (cervico-)vaginal sample which is then sent for analysis by a laboratory. Collection methods include lavage, brush, swab and vaginal patch. While HPVSS cannot provide a diagnosis of cervical (pre-)cancer, it identifies those women at higher risk (14). |
| Human rights | Human rights are legal guarantees, equally applicable to everyone everywhere in the world, enshrined in international human rights documents. Human rights protect against actions that interfere with fundamental freedoms and human dignity, and support the agency of individuals and populations. The promotion of human rights requires governments and others to take active steps to put in place institutions and procedures that enable people to enjoy their guaranteed rights (15, 16, 17). |
| Infertility | A disease characterized by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce either as an individual or with his/her partner. Fertility interventions may be initiated in less than 1 year based on medical, sexual and reproductive history, age, physical findings and diagnostic testing. Infertility is a disease that generates disability as an impairment of function (11). |
| Informed decision-making | Respect for individual dignity and for the physical and mental integrity of every person using a health-care facility means also providing each person the opportunity to make reproductive choices autonomously. The principle of autonomy, expressed through free, prior, full and informed decision-making, is a central theme in medical ethics, and is embodied in human rights law. In order to make informed decisions about their sexual and reproductive health, comprehensive information, counselling and support should be made accessible for all people without discrimination, including young people, people living with disabilities, indigenous peoples, ethnic minorities, people living with HIV, and transgender and intersex people. People should be able to exercise their choice from across a range of options but also be free to refuse any and all options (3). |
| Intimate partner violence | Behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship, including acts of physical violence, sexual violence, emotional or psychological abuse and controlling behaviours (6). |
| Key populations | Groups who, due to specific higher-risk behaviours, are at increased risk of HIV irrespective of the epidemic type or local context. These guidelines refer to the following groups as key populations: men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and transgender people (6). |
| Lay health worker | Any person who performs functions related to health-care delivery and has been trained to deliver these services but has no formal professional or para-professional certification, nor a tertiary education degree (6). |
| Medically assisted reproduction (MAR) | Reproduction brought about through various interventions, procedures, surgeries and technologies to treat different forms of fertility impairment and infertility. These include ovulation induction, ovarian stimulation, ovulation triggering, all assisted reproductive technologies (ART) procedures, uterine transplantation, and intra-uterine, intracervical and intravaginal insemination with semen of husband/partner or donor (11). |
| mHealth | The use of mobile and wireless technologies to support health-sector objectives (7). |
| Non-discrimination | The human rights principle of non-discrimination obliges states to guarantee that human rights are exercised without discrimination of any kind based on race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth, or other status such as disability, marital and family status, health status, place of residence, economic status, social situation, sexual orientation and gender identity. This obligation in connection with the right to health means countries are to ensure the availability, accessibility, acceptability and quality of services without discrimination (3). |
| Participation | Meaningful participation requires that individuals are entitled to participate in the decisions that directly affect them, including in the design, implementation and monitoring of health interventions. Under international human rights law, countries have an obligation to ensure active, informed participation of individuals in decision-making that affects them, including on matters related to their health. The International Conference on Population and Development (ICPD) Programme of Action reaffirms this core principle in relation to sexual and reproductive health, stating that “the full and equal participation of women in civil, cultural, economic, political and social life, at the national, regional and international levels, and the eradication of all forms of discrimination on grounds of sex, are priority objectives of the international community”. The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) specifically requires countries to ensure that women have the right to participate fully and be represented in the formulation of public policy in all sectors and at all levels (3). |
| Patient engagement | To promote and support active patient and public involvement in health and health care and to strengthen their influence on health-care decisions, at both the individual and collective levels. Having real patients articulate their experiences and viewpoints helps those taking part in training to appreciate the patient perspective and the importance of preserving trust between clinicians and patients. These core values are essential to care that is compassionate, quality assured and, above all, safe. Exposure to patient stories during training is valuable and helps to motivate practitioners to improve safety. At an organizational level, patients and families can be engaged in the design or development of patient-centred processes and systems, for example as members of advisory committees (18). |
| Patient experience | Patient experience encompasses the range of interactions that patients have with the health-care system, including their care from health plans, and from doctors, nurses and staff in hospitals, physician practices and other health-care facilities. As an integral component of health-care quality, patient experience includes several aspects of health-care delivery that patients value highly when they seek and receive care, such as getting timely appointments, easy access to information, and good communication with health-care providers (19). |
| Patient safety | Patient safety is the absence of preventable harm to a patient during the process of health care and reduction of risk of unnecessary harm associated with health care to an acceptable minimum. An acceptable minimum refers to the collective notions of given current knowledge, resources available and the context in which care was delivered weighed against the risk of non-treatment or other treatment (20). |
| People-centredness | Providing care that is respectful of, and responsive to, individual preferences, needs and values, and ensuring that patient values guide all clinical decisions (21). |
| Point-of-care test (POCT) | Key elements of point-of-care tests are that they allow: (i) testing to be carried out at or near the person being tested, (ii) results to be returned to the person being tested during the same visit, and (iii) results of POCT to be used immediately for patient care and referral (22). |
| Pregnancy | A state of reproduction beginning with implantation of an embryo in a woman and ending with the complete expulsion and/or extraction of all products of implantation (11). |
| Privacy and confidentiality | The right to privacy means that an individual accessing health information and services should not be subject to interference with their privacy, and they should enjoy legal protection in this respect. Sexual and reproductive health involves many sensitive issues that are not widely discussed within families or communities, and health workers are often entrusted with very personal information by their patients. Confidentiality, which implies the duty of providers to not disclose or to keep private the medical information they receive from patients and to protect an individual’s privacy, has an important role to play in sexual and reproductive health (3). |
| Psychosocial support | The term “psychosocial” refers to the close relationship between the individual and the collective aspects of any social entity. Psychosocial support can be adapted in particular situations to respond to the psychological and physical needs of the people concerned, by helping them to accept the situation and cope with it (23). |
| Quality | Quality is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge; as well as the totality of characteristics of an entity that bear on its ability to satisfy stated and implied needs. Fulfilment of human rights requires that health-care facilities, commodities and services be of good quality, including scientifically and medically appropriate. This requires, among other things, skilled medical personnel, scientifically approved and unexpired drugs and hospital equipment, safe and potable water, and adequate sanitation (3). |
| Quality assurance | Part of quality management focused on providing confidence among stakeholders that quality requirements will be fulfilled (6). |
| Self-administration | The process of a person administering a pharmacological substance or biomedical intervention to themself. |
| Self-care | WHO’s current working definition of self-care is “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a health-care provider” (24; see Annex 3). The scope of self-care as described in this definition includes health promotion; disease prevention and control; self-medication; providing care to dependent persons; seeking hospital/specialist care if necessary; and rehabilitation, including palliative care (25). Self-care is broad concept which also encompasses hygiene (general and personal); nutrition (type and quality of food eaten); lifestyle (sporting activities, leisure, etc.); environmental factors (living conditions, social habits, etc.); socioeconomic factors (income level, cultural beliefs, etc.); and self-medication (see below) (26). |
| Self-medication | Self-medication is the selection and use of medicines (including herbal and traditional products) by individuals to treat self-recognized illnesses or symptoms. Self-medication is one element of self-care (27). |
| Serodiscordant couple | A couple in which one partner is HIV-positive and one partner is HIV-negative (6). |
| Social accountability | Social accountability is “citizens’ efforts at ongoing meaningful collective engagement with public institutions for accountability in the provision of public goods”. This moves beyond community participatory approaches that impart information and generate demand, to those that empower and educate users to demand state obligated services, and that support health-service actors to recognize and act on these demands (28). |
| Stigma | Originally derived from a Greek word meaning a mark or stain, stigma refers to beliefs, attitudes, practices and social processes that label difference, enable discrimination, reduce opportunities and reproduce social inequalities. Stigma manifests in community norms (felt-normative stigma), mistreatment and acts of discrimination (enacted stigma), and can be internalized (self or internalized stigma) (29). |
| Task sharing | The rational redistribution of tasks and the increased scope of work among different cadres of health-care providers, including trained lay providers (6). |
| Task shifting | Task shifting involves the rational redistribution of tasks among health workforce teams. Specific tasks are moved, where appropriate, from highly qualified health workers to health workers with shorter training and fewer qualifications to make more efficient use of the available human resources for health (30). |
| Transgender | An umbrella term for people whose gender identity and expression does not conform to the norms and expectations traditionally associated with the sex assigned to them at birth; it includes people who are transsexual, transgender or otherwise gender non-conforming. Transgender people may self-identify as transgender, female, male, transwoman or transman, trans-sexual or, in specific cultures, as hijra (India), kathoey (Thailand), waria (Indonesia) or one of many other transgender identities. They may express their genders in a variety of masculine, feminine and/or androgynous ways. Sexual risk practices differ among different subgroups within the transgender community. For example, sexual risk may be higher among transgender women (male to female) or transgender men (female to male) who have receptive anal intercourse with men than among transgender men or transgender women who have sex only with women (31). Transgender people are often highly vulnerable to stigma, discrimination and violence, and have specific health needs that necessitate a distinct public health response. |
| Vulnerable populations | Groups of people who are particularly vulnerable to health conditions in certain situations or contexts, due to socioeconomic factors, disabilities, legal status and unequal power dynamics. WHO defines vulnerability as the degree to which a population, individual or organization is unable to anticipate, cope with, resist and recover from the impacts of disasters. Vulnerable populations can include children, pregnant individuals, elderly people, malnourished people and those who are ill or immunocompromised (32). |
| Waste management | The collection, transportation, disposal or recycling and monitoring of waste. |
| Young people | Those between the ages of 10 and 24 (33). |
| Youth | Individuals between the ages of 15 and 24 (29). |
