Yet another maternal death: a true story from Pakistan.
As a physician who has worked extensively for U.S.-supported programs in Pakistan, I have seen both the difficulties and successes for improving health. Strong support by the U.S. for these programs has contributed to significant health gains for children and women. I believe they are all the more required now in this time of crisis. The story below illustrates the typical issues we all deal with when trying to reduce maternal mortality. It is taken from Haripur, a district located in the North-West Frontier Province of Pakistan. In this primarily rural district of 700,000 people, nearly 30,000 births occur each year. It is estimated that 11 1 mothers die every year due to pregnancy-related complications, and many more suffer from morbidities related to their pregnancy and delivery. The infant mortality rate is 9111,000 live births (UNICEF: The State of the World's Children, 2000) thus, 2,700 children die before seeing their first birthday. (excerpt)
Afghan children facing humanitarian disaster.
The lives of millions of Afghans, and especially Afghan children, are at risk during the coming months. If life-saving humanitarian aid programs providing food, health care, shelter and protective environments are not able to continue operating in Afghanistan, we will undoubtedly be facing the largest humanitarian disaster in the world. Afghan children and their families have been suffering from 23 years of war, which has displaced millions of families and created an estimated 700,000 war widows. An already desperate situation has been made worse by three years of a devastating drought. Not surprisingly, the social indicators of children in Afghanistan are among the worst in the world - for example, United Nations figures show that a quarter of all children born in Afghanistan will die before they reach their fifth birthday. Save the Children has been working with Afghans since 1985, and currently implements large-scale health and education programs for Afghan refugees from offices in Pakistan and health, nutrition, micro-credit, education, landmine awareness and drought response programs from offices inside Afghanistan. Following the tragic events of Sept. 11, Save the Children withdrew its six international staff from Afghanistan, but 8 160 national staff have been continuing to implement most programs from offices in Kabul, as well as centers in northern Afghanistan, under the most difficult circumstances. (excerpt)
As a result of population growth and changing preferences for family size, the number of people needing family planning services in developing countries is likely to increase by an estimated 217 million during 2000-2015. The additional contraceptive commodities required to satisfy this growing demand are considerable and have significant budgetary implications for both governments and households in the developing world. The United Nations Population Fund (UNFPA) estimates the total costs of family planning and related services in developing countries (excluding China) at US$572 million in 2000. To date, more than 50 percent of all contraceptive users in the Central Asian Republics, sub-Saharan Africa, the Middle East and North Africa, and Asia have been served by public sector programs. Governments, in turn, depend heavily on donors and have done so for the past three decades. Nonetheless, donor funding is hardly sufficient to meet current contraceptive needs, and there is no indication that donor commitments will meet rapidly increasing demand. (excerpt)
Twenty years ago the 1st International Congress of Andrology took place in Barcelona. Since then these Congresses have become regular events and the meetings in Tel Aviv (1981), Boston (1985), Firenze (1989), Tokio (1993) and now in Salzburg bear witness to the steady growth of andrology as a scientific and clinical discipline. As Salzburg is the last International Congress of Andrology in this Century, it may be timely to review the situation of andrology at the end of the 20th Century. Andrology can trace its scientific roots back to Antony van Leeuwenhoek (1632-1723), who in 1677 was the first to view and describe the spermatozoon. He was not a scientist, but it was probably not by chance that he was the chief inspector of weights and measures of the city of Delft, reminding us over the centuries that exact methodology is the basis for andrology - as it is of all science. Despite this early start and although spermatozoa have been analysed routinely for the evaluation of fertility since the beginning of this century, it took some 300 years until the first guidelines for standardized semen evaluation were published and, under the aegis of WHO, globally accepted (WHO, 1980, 1987, 1992). Nonetheless, spermatology formed the basis of andrology. (excerpt)
It's time to put words into action Sept. 11 marked a sea-change for how Americans are prepared to view the world. The reality of an interconnected globe in which no country can continue to imagine itself as separate and impregnable is now manifest. And the reality of abject poverty in the shadow of our affluence is far more obvious now that nightly newscasts show the desperate conditions of life experienced by the Afghan people. Where there is no hope there is only danger, and Americans are coming to recognize this fact. They are beginning to understand the way these conditions provide a haven for chaos, violence and terrorism. In homes, offices and supermarkets, people are talking about these issues, asking what we can do to make the world a safer place, a better place. (excerpt)
The WHO/UNICEF Integrated Management Childhood Illness (IMCI) guidelines are being introduced in developing countries worldwide. The standard IMCI training course requires 11 days of lectures and clinical practice, with about six facilitators for 20 first-level health providers. The Quality Assurance (QA) Project developed a computer- based version of the course that reduced the training time to nine days and requires only four facilitators. The Ugandan Ministry of Health and the QA Project collaborated on a randomized comparison study of the two training courses in 1999–2000. The objective of the study was to compare the cost-effectiveness of the two courses on trainees’ knowledge, skill, and performance of IMCI. Three rounds of training were conducted with clinical officers and nurses from primary health facilities in three districts. In all, 114 providers were trained (55 using the standard course and 59 using the computer course). Knowledge and skills between the two groups were compared pre-training, immediately post-training, and three to four months after training. Costs of the two courses were also calculated. (author's)
Malaria vector studies in Eritrea.
Malaria accounts for over 30% of the total outpatient morbidity in Eritrea, and about 28% of all hospital admissions are malaria related. Almost 67% of the resident population of Eritrea lives in malaria endemic areas. The malaria situation is complicated since the country is especially prone to epidemics, which in the past have been a cause of considerable morbidity and mortality. Although malaria remains a major cause of mortality in the country, little is known about the Anopheles mosquito species responsible for transmission of malaria in Eritrea. It also is clear that malaria parasite transmission is driven by the temporal and spatial patterns of vector species of anopheline mosquitoes. Since each mosquito species has a geographical range that is limited according to physiologic levels of tolerance to environmental conditions, understanding how the degree of ecological diversity and biotic interactions would be critical in determining how vector populations are structured. In Eritrea, larval control is implemented as part of an integrated approach to malaria control. However, for larval control to be an integral part of a vector management program, a sound understanding of the factors responsible for larval production of the principal vectors of malaria is crucial. On this basis, the NMCP initiated studies on the spatial patterns of anopheline species and larval ecology in Eritrea with the overall goal of providing insights into the bionomics of malaria parasite vectors. In this report, the results of the first detailed information on the spatial distribution, vector bionomics and larval ecology of the anopheline species in Eritrea is reported. (excerpt)
Kenya: assessment of the health commodity supply chains and the role of KEMSA.
The health sector in Kenya is a complicated web of vertical health programs with parallel logistics systems that manage health commodities. To improve efficiency within the health sector, the Government of Kenya decided to transform its central and regional medical supply stores into a parastatal organization that would apply private sector management techniques to supply the public health system with the health commodities it requires. Because of the complexity of the logistics systems that serve the health sector, and following the decision to privatize the medical supply stores to streamline these systems, a comprehensive assessment of the health commodity supply chains and the potential role of the new parastatal was conducted during February–March 2001. The assessment reviews all aspects of health commodity management at the time the assessment was carried out for essential drug kits, contraceptives (including condoms for STI/HIV prevention), STI drug kits, HIV test kits, tuberculosis and leprosy drugs, and malaria prophylaxis. This report offers recommendations for the next steps in this process of increasing efficiency, although the results and the recommendations presented here are relevant to the time period of the study. It is important to note that the situation in Kenya is continuously evolving. This report summarizes the results of this study, led by consultants from John Snow, Inc./DELIVER, in collaboration with the Ministry of Health, and with support from the U.S. Agency for International Development. (author's)
This study aims to assess of the quality of child immunization coverage estimates obtained in 101 national population-based surveys in mostly developing countries. The Demographic and Health Surveys (DHS) and UNICEF’s Multiple Indicator Cluster Sample (MICS) surveys provide national immunization coverage estimates for children aged 12-23 months once every three to five years in many developing countries. The data are collected by interview from a nationally representative sample of households. 83 DHS and 18 MICS surveys were included. 85% of mothers reported that they had ever received a health card for their child. 81% still had the card at the time of the interview, and nearly two-thirds of these presented the card to the interviewer. Cards were therefore observed for 55% of children overall. Rural and less educated mothers were less likely to report receiving health cards. Recall of additional immunizations by mothers that presented a card ranged from 1 to 3%. Recall of immunizations by mothers who reported never receiving a card ranged from 9 to 32%. Coverage among those who did not show a card rarely exceeded coverage among those who did, and there was good correlation between DPT and OPV doses received according to health card and recall data. Though maternal recall data are known to be less accurate than health card data, we found no major systematic weaknesses in recall and believe that inclusion of recall data yields more accurate coverage estimates. (author's)
According to UNICEF, diarrhea kills 8,000 children a day and remains one of the major killers of children under five globally. As dehydration is the main complication of diarrhea, treatment focuses upon rehydration through fluid replacement. Intravenous fluids were commonly used until the 1960s when ORS was developed as an alternative treatment. Today, ORS provides an inexpensive way to treat dehydration. The simple combination of sugar and salt effectively enhances fluid absorption in the small intestine. Currently, the World Health Organization (WHO) recommends a standard formulation of glucose-based ORS solution (90 mmol/l of sodium and 11 1 mmol/l of glucose with a total osmolarity of 31 1 mmol/l) for children with diarrhea. However, recent studies suggest that this formula may not be optimal, as increased glucose and sodium concentrations reduce fluid absorption due to higher osmotic loads. Based on these findings, controlled trials were conducted to evaluate the clinical effects of reduced osmolarity ORS (total osmolarity <250 mmol/l with reduced sodium) compared with standard WHO ORS. (excerpt)
PAHO's commitment to child health.
Expansion of the Integrated Management of Childhood Illness (IMCI) strategy, its integration with other elements of the public health system and mobilization of resources to sustain its application are the main challenges facing the countries of the Americas. These were the conclusions of a group of experts who met to evaluate and expand the IMCI strategy, which has proven effective in cutting childhood deaths and illnesses. Specialists from throughout the Americas and representatives of several institutions and international agencies convened No. 19-20 at the headquarters of the Pan American Health Organization (PAHO) in Washington, DC. Every year in the Americas, more than 250,000 children under 5 years of age die from illnesses that can be easily prevented or treated. Acute respiratory infections, diarrheal diseases and malnutrition are the three leading causes of illness and death in this age group. These diseases and others, such as those caused by vaccine-preventable diseases and malaria, are the primary reasons for medical consultation and hospitalization in these countries. It is estimated that these diseases cause 60 to 80 percent of the pediatric consultations in health services, and 40 to 50 percent of hospitalizations of children under 5. (excerpt)
USAID / DCHA / PVC PVO Child Survival Grants Program. Guidelines for mid-term evaluation.
The goal of USAID’s Office of Private and Voluntary Cooperation (PVC) is to build the capability of U.S. PVOs to have a sustainable impact in their work in international development. With USAID’s emphasis on managing for results, program evaluations have become less descriptive and more evidence-based. PVC has assisted PVOs to strengthen their program monitoring and to document program achievements so that PVO’s can provide credible evidence of achievements and results. (excerpt)
Humanitarian workers and displaced people are racing against time to build an estimated 6,000 mud brick shelters in Maslakh camp for the displaced just outside Herat, while across the country others are bracing themselves for the consequences of both the attack on Ahmed Shah Massoud, military leader of the anti-Taliban Alliance, and the tragic events in the United States. They have less than eight weeks before winter takes serious hold bringing snow and freezing winds to rake the valley. Another 4,000 shacks need repairs, and neither of these figures take into account accommodation for new displaced who continue to arrive at a rate of around 300 people a day - more than 8,500 in the month of August. However, all international UN staff are now being evacuated and many NGOs are doing the same. (excerpt)
U.S. Congressional Delegation monitors maternal / child health in Guatemala, Honduras.
Many families in rural Central America used to believe that all sickness could be cured with love and faith. While for some illnesses this may be true, living conditions for many poor Central American families — from unpaved roads to indoor pollution to severe weather — mean that children are prone to repeated debilitating respiratory illnesses like pneumonia. And, in the past, maternal health had been ignored altogether. But times are changing. The Global Health Council, with the support of the Bill & Melinda Gates Foundation, hosted this past August its first Congressional Study Tour (CODEL) to examine programs addressing maternal and child health in Guatemala and Honduras. These two countries were selected for several reasons: They have both survived major crisis situations - a civil war that lasted for 36 years in Guatemala and the devastation of Hurricane Mitch in Honduras in 1998; Both countries have succeeded in preparing and addressing a child and maternal health agenda; Their successes in improving child and maternal health are due, in part, to investments made by the United States; thus the Global Health Council wished to highlight that government funding for child and maternal health issues really can make a difference. (excerpt)
Upgrading the capacity and skills of service providers of the West Bank / Gaza Pilot Health Project.
The insufficient care that mothers and newborns receive during the prenatal period is one of the most pressing health care problems in the West Bank and Gaza. Although a large proportion of mothers receive some antenatal care, only about 17 percent return for postpartum check-ups and few adopt family planning for spacing births during the postpartum period. Fertility rates in the West Bank and Gaza are higher than other countries with similar development status in the region. To address the peri-natal needs of Palestinian women, the United States Agency for International Development Mission for the West Bank and Gaza, in collaboration with the Palestinian Ministry of Health and seven partner organizations, designed and funded a 28-month pilot health project that is expected to have a significant health impact on Palestinian women and their children. The goal of this Pilot Health Project (PHP) is to improve the health status of Palestinian women and their children by upgrading antenatal and postpartum services in three areas in the West Bank and Gaza; specifically in Jenin, Hebron and Gaza. One of the key components of the PHP was the design and implementation of a comprehensive training program aimed at upgrading the capacity and skills of PHP health care providers at 27 clinic sites in the West Bank and Gaza. (excerpt)
Building coalitions, improving lives.
In 1994, the Women's Commission for Refugee Women and Children carried out an assessment of reproductive health services in refugee situations. The study, "Refugee Women and Reproductive Health Care: Reassessing Priorities," found that reproductive health care was not a priority for international relief agencies, despite the fact that poor reproductive health is a significant cause of death and disease in refugee camps once emergency health needs have been met. In response, the Women's Commission and other international organizations convened the Reproductive Health for Refugees Consortium (RHRC) with support from the Mellon Foundation. The RHRC is a group of seven agencies including the American Refugee Committee, CARE International, Columbia University, International Rescue Committee, JSI Research and Training Institute, Marie Stopes International and the Women's Commission dedicated to improving reproductive health care in refugee and internally displaced settings, emphasizing safe motherhood, including emergency obstetrics, family planning, gender-based violence and sexually transmitted infections, including HIV/AIDS. (excerpt)
HIV control in humanitarian settings.
One of the most significant global health developments since the end of the Cold War has been the increase in the number of humanitarian crises. These so-called "complex emergencies" (CEs) are characterized by political instability, armed conflict, population displacements, food shortages, collapse of public health infrastructure, and increased rates of morbidity and mortality. Recent examples include the crises in Afghanistan, Kosovo, the Democratic Republic of Congo and East Timor. Many CEs represent t y e public health catastrophes during which mortality rates may be elevated to 60 times normal, due to a combination of infectious diseases, malnutrition and violent trauma. A major public health challenge facing humanitarian agencies during CEs is controlling the spread of the human immunodeficiency virus (HIV). In fact, there is perhaps no more difficult a setting in which to implement an effective HIV control strategy than during the emergency phase of a CE. Even during the post-conflict or rehabilitation phase, weak public health systems and the lack of human, material and financial resources can severely restrict efforts to limit the spread of the infection. (excerpt)
EngenderHealth makes creative strategies in low-resource settings.
Out of devastation, the unexpected sometimes occurs. In Cambodia, where 30 years of civil conflict left millions dead and an infrastructure shattered, the Reproductive and Child Health Alliance (RACHA) has taken root. In 1996, the U.S. Agency for International Development (USAID) and the Royal Government of Cambodia founded RACHA to improve health care by integrating current medical practices with the traditional structures that survived decades of war.' EngenderHealth has been a partner in RACHA since its inception and now manages implementation of the program in its entirety. RACHA's client-oriented program trains rural health workers and other community members not usually associated with the health sector-Buddhist nuns, monks and village shopkeepers-to deliver quality care to rural areas. What has emerged is a highly effective alliance, where RACHA uses a whole health approach to harness the best of existing community resources in order to develop Cambodia's once devastated health system. (excerpt)
American Indians' contribution to global health.
Annie, a 78-year-old Apache woman, remembers losing seven of her 10 children to dysentery. "There was nothing to do," she says. "My mother-in-law would just massage them and give them strong tea." Through her lifetime, Annie has seen many things, few as remarkable as the decrease in child mortality brought along two decades ago by the introduction of clinical trials to the Apache reservation in Whiteriver, AZ. It was then that a young Apache woman, Carla Baha-Alchesay, approached the tribal leader with a plan that could reverse the death toll on the reservation. She knew some illnesses were stronger than the medicine men, and she wanted to bring a doctor from Johns Hopkins University onto the reservation. (excerpt)
Making the unwanted wanted along the Thai-Burmese border.
Naw Say Wah, a health worker at Mae Tao Clinic, had always planned on having a large family since both she and her husband had come from large families, as is the Karen' tradition. Unfortunately, after having a boy and a girl, she found out that she had become Hepatitis B positive through her work at the clinic. Consequently, Naw Say Wah and her husband decided to limit their family to two children. However, as her daughter Paw Paw (the youngest) grew older, she started to urge her parents to have another child so that she could be an older sister. At about the same, a senior reproductive health worker, Naw Lar Say, had a patient with an unusual history that resulted in ambivalence about her pregnancy. Initially she had a "wanted pregnancy" but this turned into an "unwanted" one after her first trimester when she broke up with her long-term partner and started a new relationship. Since her new partner was not happy about her pregnancy, she started trying to induce abortion by throwing a large stone on her abdomen. After she came to the clinic a few times with symptoms of induced abortion, Naw Lar Say confronted her, begged her to stop, and promised that the clinic would take care of the child after it was born. When it was, Naw Say Wah adopted the baby girl, and her daughter now has the younger sister she has always wanted. (excerpt)
Investing in health for economic development: time for U.S. action.
For the first time in a generation, the rich countries are waking up to the enormity of the health crisis in the poorest parts of the world. For the past 20 years, the AIDS pandemic has run rampant in the developing world with little real effort at control by the richest countries. During the 1990s, as millions were dying in Africa and millions more were becoming infected by the HIV virus, the rich world contributed a pittance — only tens of millions of dollars each year — to control HIV/AIDS in Africa. Twenty-one years into the pandemic, 47 million Africans have been infected, of whom 22 million have already died. And until now, not a single African man or woman has been offered the life-extending antiretroviral therapy through a program supported by official development assistance. (excerpt)
Increasing program impact by ensuring product availability.
In commercial retail, if a store has empty shelves, no customers will shop there, and the business will fail. The same thing is true in public health. Without an adequate supply of essential products-from medicines and HIV test kits to contraceptives-health programs will fail. A strong logistics system is the key to ensuring that health products are available to customers when and where they are needed. The USAID-funded DELIVER project helps policymakers, program managers and key stakeholders, including donors, understand the critical role logistics plays in health programs. DELIVER strengthens logistics management information systems, streamlines distribution, enhances forecasting and procurement capacity, and manages all aspects of actual product pipelines, from warehousing and transportation to inventory and tracking. (excerpt)
USAID's reorganization, Peterson heads new Bureau of Global Health.
Dr. Anne Peterson was sworn in as the head the Bureau of Global Health on Nov. 6, 2001. A trained physician with experience in both domestic and global health, Peterson's long service in public health provides her with the technical background to lead the bureau. Prior to her post at the agency, Peterson served as the Commissioner of Health for the State of Virginia. She has been a consultant to the Centers for Disease Control as well as to the World Health Organization. Additionally, she worked in sub-Saharan Africa for six years. Throughout her career, Peterson has designed disease surveillance and implementation programs, conducted public health training and facilitated community development activities. Although she has been at her post for only a few months, Peterson has developed a reputation as being extremely committed yet down-to-earth and accessible not only to her staff, but also to organizations working in global health. Under Peterson's leadership, USAID's global health programs continue to reflect the agency's commitment to reducing morbidity and mortality rates globally by increasing the quality and access of health services around the world. The bureau's technical work encompasses environmental health, family planning and reproductive health, health policy and systems strengthening, HIV/AIDS, infectious diseases, maternal and child health, nutrition, and the protection of vulnerable children. In addition, the bureau will provide policies and guidance on its program activities. (excerpt)
DOT, DOTS and the need to act now.
More than 127 countries worldwide, including all the high-burden ones, are implementing the WHO tuberculosis (TB) control strategy, known as DOTS, today. This strategy consists of a five-point policy package, one of which is "standardized short-course chemotherapy for all TB cases under proper case-management conditions, including direct observation of treatment". Proper case-management conditions imply technically sound and socially supportive treatment services. In past years, the practical meaning of this element has been clarified in a large number of publications: it is a range of measures, in addition to directly observed therapy (DOT), aimed at promoting treatment adherence. These measures focus on placing patients and their families at the center of TB control activities, providing support and care that is sensitive to their needs, and finding locally appropriate ways of reinforcing their motivation to complete treatment. (excerpt)
By each of these definitions, global health has reached a crisis point. The signs of pain and distress are as acute as they are savage. In Afghanistan, one of every 10 young women is likely to die in pregnancy and childbirth over the course of their reproductive years. Millions more children in sub-Saharan Africa will join the ranks of the 12 million who have already been orphaned as a result of AIDS. And around the world, more than 10 million children will die needlessly during the next year. The vital signs of a healthy world have taken an alarming turn, as one fifth of the children born around the world last year were born in countries where life expectancy is now actually decreasing. A 15- year-old in South Africa is more likely to die of AIDS than she is to live without the disease. And in many of the world's poorest countries, immunizations coverage among children is actually lower than it was a decade ago. (excerpt)
Helping hospice care happen in Africa.
With an estimated 6,000 persons a day dying from HIV-related diseases, the vision of the Foundation for Hospices in Sub-Saharan Africa, Inc. is enormous. Dedicated to the ideal that people with HIV/AIDS in sub-saharan Africa will receive dignified end-of-life care and family support, the foundation's mission is to support organizations in their provision of hospice and palliative care in sub-saharan Africa. More than 20 years ago, grassroots efforts began in America and in some English speaking countries of Africa to re-shape the care for persons with terminal illnesses. In the 1990s, the devastation of AIDS on Africans and Americans brought people together into a "hospice global village." (excerpt)
29th Annual Conference addresses crisis.
From May 28-31, leaders in the field of global health will address four plenary sessions and the annual awards banquet at the Council's annual conference, Global Health in Times $Crisis, in Washington, D.C. In times of crisis, the perpetrators are often condemned, but the heroes are rarely lauded. The names of the men and women who stand on the front lines of war zones rarely, if ever, grace the pages of newspapers. The Global Health Council's annual awards banquet recognizes and celebrates these remarkable individuals- the foot soldiers in the war against poor health and health inequity. They represent the thousands of unsung heroes who, on a daily basis, go into battle against ill health. These individuals are the courageous champions who, one person at a time, look death in the eye and fight it, one person at a time. And, in doing so, put themselves squarely in death’s path. (excerpt)
Hindus and Muslims work together for health.
Muslims and Hindus in the Indian state of Gujarat are navigating through trying times since riots erupted in February over a religious dispute regarding a temple being built on the site of a former mosque. But health centers started by Aga Khan Health Services, India, in 26 villages of Sidhpur have brought a common denominator to the different religious factions, providing the glue that unites the communities despite the civil unrest that killed 700 people during the past two months. Encompassing 54 villages in Sidhpur and Junagadh with a population of 86,500, Aga Khan Health Service's Gujarat Health System Development Project was started in October 1998 with grants from USAID and the Aga Khan Foundation. A week before the recent violence in Gujarat began, Dr. Sidhyartha Mukherjee drove from his office in Ahemadabad 130 km north to the Sidhpur project along two-lane dusty roads filled with trucks and camels close to the Thar Desert. He is the senior manager, responsible for implementing the Aga Khan health programs in India. (excerpt)
Pakistani woman saves lives with clean birth kits.
Roshan lives in Kotlian, a rural suburb of Haripur. She was just 3 when her mother died and was 6 when her father re-married. At the age of 13, while studying in the 8th grade, she was married to her first cousin. She discovered after marriage that he was a drug addict, and after 8 months of her unsuccessful marriage they were divorced. She resumed studies and completed the 8th grade. Later she started teaching in a private school while continuing her studies. There she met with the sisters of her present husband, living in a nearby home. She was married again at the tender age of 16, but without the approval of her family for various reasons. Soon after, she discovered her husband's drinking habit. He assured her that he would soon give it up, but that day never came. He is a barber and owned a shop at the time of their marriage. Soon he had to sell the shop to pay the heavy drinking debt he owed. By that time Roshan was the mother of two children and she had completed her education. The family's situation was worsening day by day, and she was compelled to find ways to supplement their earning. She started stitching clothes for people for meager amounts of money. Meanwhile, she contacted her parents once again and pleaded for help. Her father finally agreed and helped by giving her dowry. Her brother also joined in and continues to help her today. (excerpt)
Leading the way to finding solutions for AIDS.
Last year, President Carter visited our offices in Seattle to discuss global health challenges, including HIV/AIDS, and we came up with the idea of traveling together where the disease is heaviest- Africa-visiting countries at different stages of the epidemic to learn how they are fighting it and where they are succeeding. On this visit, our aim was threefold: To hear from the people on the front lines about where they see the solutions; to encourage more focus on HIV/AIDS prevention-especially more resources and more blunt talk from governments, faith-based groups, businesses and civil society; and to help reduce the stigma of HIV/AIDS by urging leaders to speak openly and reach out in compassion to people living with HIV/AIDS. (excerpt)
Council leads congressional staff delegation to West Africa.
Global Health Council organized a Congressional Study Tour to Côte d'Ivoire and Burkina Faso from Jan. 6-14. The purpose of these study tours is to expose key policy makers to the challenges that people in developing countries face in obtaining adequate health care. Led by Carol Miller, director of Public Policy at the Global Health Council, the group traveled first to Côte d'Ivoire. Arguably the wealthiest country in West Africa, Côte d'Ivoire also has the highest incidence of HIV/AIDS in the region. By far the most vocal and visible AIDS activist in Côte d'Ivoire is First Lady Simone Ehivet Gbagbo, who organized a dinner for the members of our delegation at the official residence. Since her husband took power in 2000, she has launched a nationwide AIDS education campaign aimed at every sector of the population. An eloquent speaker, she recognizes that her unique position provides her an opportunity to open up the dialogue on HIV/AIDS—an essential element in combating the epidemic. (excerpt)
Fighting gender-based violence in refugee camps.
Recently, a serious and pervasive problem was brought to the world's attention through a report by the United Nations High Commissioner for Refugees and Save the Children UK, "Sexual Violence and Exploitation: The Experience of Refugee Children in Liberia, Guinea and Sierra Leone" (UNHCR/Save the Children UK), that describes sexual abuse and exploitation of refugee and displaced children, primarily girls, in those three countries. Increased focus in recent years on issues of gender-based violence perpetrated during conflict has heightened public awareness of the nature and scope of war-related abuses suffered by women and children. For example, press reports during the wars in Bosnia and Rwanda brought wartime rape and sexual assault to the public eye. But war is not the only grounds for violence against women and children, and combatants are not the only perpetrators. Refugee and displaced women and children are highly vulnerable to on-going abuse, exploitation and discrimination by persons in power—when fleeing or fighting, when crossing checkpoints, when seeking asylum, when trying to build a temporary life in a refugee camp, and following repatriation to their home countries. If there can be any good news in all of this, it is that efforts are under way to address and prevent gender-based violence in humanitarian settings. (excerpt)
Tuberculosis (TB) is estimated to have killed more people than any other disease in history. In fact, in the beginning of the 19th century, one out of every three people could expect to perish from the "white plague," much the same way modern society acknowledges heart disease and cancer as our leading causes of death. TB has never discriminated; its victims have included Eleanor Roosevelt, Ludwig van Beethoven, Frederic Chopin and billions of others around the world. Despite its high profile and long history, however, TB is still a rampant killer. Approximately 1.86 billion people are infected with the bacterium that causes TB, and a person dies of TB infection every 15 seconds. No novel drug has been developed to fight this disease in more than 30 years. Many people mistakenly think of TB as a disease of the past. Even though TB often preys on the poor and those with weak immune systems, everyone is at risk. This airborne disease knows no boundaries of race, and it is easily spread through coughing and sneezing. In the last 10 years, both New York and London have had TB outbreaks. Last fall, Seattle Mariners shortstop Carlos Guillen was diagnosed with active TB. Then several Mariners coaches and teammates tested positive for the latent form of TB. (excerpt)
President Bush releases FY 2003 proposed budget.
On Feb. 4, 2002, President George W. Bush released his proposed budget for fiscal year (FY) 2003. This is the first step in the appropriations process that will lead to a final FY 2003 budget for all programs of the federal government. Overall, the proposed budget includes $13.8 billion for international assistance programs through the U.S. Agency for International Development (USAID), a 5.6 percent increase. Unfortunately, this increase is not provided to all programs equally. While the global HIV/AIDS programs received a significant increase, other programs that address child survival, maternal health and infectious diseases were cut by over $100 million. In addition, the proposed budget zeroes out funding for the United Nations Population Fund in FY 2003. This decision to eliminate funding for UNFPA follows the Bush administration's decision to put a hold on the FY 2002 funding for UNFPA (see related article below right). The chart (right) provides specific funding levels for these programs. (excerpt)
Global health in times of crisis.
Times of crisis pose different, although not necessarily unique, challenges to global health. In the face of war, political strife and environmental catastrophes, this community has created innovative ways of providing assistance to victims, provided nourishment to refugees, and engineered new tools for averting disease. Innovation is demanded, and resources to support them are often scarce, but it is during these times of crisis that it becomes critical for the global health community to come together as a whole to find new solutions in the battle against ill health. In May 2002, more than 1,500 global health professionals will join together at the Global Health Council's 29th Annual Conference, "Global Health in Times of Crisis" to explore the critical issues and systems required for responding to health needs during crisis. In plenary sessions, panel sessions and workshops, in conjunction with roundtable and poster presentations, presenters will address the scope of issues in international health. (excerpt)
AIDS in Africa. Issue brief for Congress. Updated August 1, 2002.
Sub-Saharan Africa has been far more severely affected by AIDS than any other part of the world. The United Nations reports that 28.5 million adults and children are infected with the HIV virus in the region, which has about 10% of the world’s population but more than 70% of the worldwide total of infected people. The overall rate of infection among adults in sub-Saharan Africa is about 9%; it is 1.2% worldwide. Twelve countries, mostly in east and southern Africa, have HIV infection rates of more than 10%, and the rate has reached 38.8% in Botswana. An estimated 21.5 million Africans have died of AIDS, including 2.2 million who died in 2001. AIDS has surpassed malaria as the leading cause of death in Africa, and it kills many times more Africans than war. In Africa, HIV is spread primarily by heterosexual contact, and sub- Saharan Africa is the only region where women are infected at a higher rate than men. Experts relate the severity of the African AIDS epidemic to the region’s poverty. Health systems are ill-equipped for prevention, diagnosis, and treatment. Poverty forces many men to become migrant workers in urban areas, where they may have multiple sex partners. Poverty leads many women to become commercial sex workers, vastly increasing their risk of infection. (excerpt)
What does a half billion dollars mean? [letter]
President Bush stepped into the Rose Garden in mid-June to announce that his Administration proposes to spend $500 million over the next three years on the prevention of mother-to-child-transmission (MTCT) of HIV/AIDS. His announcement was received by many as a positive step, but by others as a serious disappointment. Among those applauding the President were U.S. Sen. Jesse Helms, R-NC, hardly known as a longtime supporter of international development or HIV/AIDS efforts, and Sen. Ted Kennedy, D-MA, who does not often find himself on the same side of issues as Sen. Helms. U.S. Sen. Bill Frist, R-TN, — who had earlier proposed and then withdrawn support for $500 million for HIV/AIDS in the emergency funding bill now moving through Congress — lauded the President for taking a critical step in the global fight against AIDS. (excerpt)
Eradicating HIV / AIDS amid civil war in southern Sudan.
It was a meeting that would give rise to many firsts. In mid-January, international and local organizations sat down with southern Sudanese government representatives in a first joint discussion to slow the transmission of HIV/AIDS in a conflict setting. "It was the first time that so many organizations pulled all of their humanitarian and development expertise together to detail a plan to control the spread of AIDS in a complex emergency setting," said Sandra Krause, director of the Reproductive Health Project for the Women's Commission for Refugee Women and Children, one of many participating agencies. Over the last 30 years, Sudan's civil war has destroyed much of the country's social and economic infrastructure, displacing an estimated 4.4 million people—the highest number of internally displaced persons in the world. The ongoing conflict has made southern Sudan particularly vulnerable to HIV, a virus that has infected more than 40 million people in more than 90 countries—including about 25 million people in Africa. (excerpt)
You say you want a resolution [letter]
It's always nice to begin the new year with good news, but 2003 begins with enormous uncertainties. Due to pre-election jockeying, Congress failed to pass its international assistance appropriations for the government's fiscal year that began on Oct. 1, 2002, and programs have been temporarily funded at prior levels until the new Congress convenes in early January to finally pass a budget. While sizeable increases for global health were part of the Senate- passed bill, the House chose a more frugal approach, and its point of view may have the upper hand in the final negotiations when the new Republican-controlled Senate sits down at the table. With estimates of total costs ranging between $100 billion and $100 trillion, the looming war with Iraq (combined with gathering momentum for further tax cuts) promises an extended period of enormous budget deficits. The first thing to suffer in that scenario is spending on items not considered important for national security and economic recovery. (excerpt)
The academy for educational development: providing knowledge to improve lives.
Since its founding in 1961, the Academy for Educational Development, an independent nonprofit organization based in Washington, D.C., has become one of the world's foremost human and social development organizations. With its worldwide staff of more than 1,000, AED pursues its commitment to solving critical social problems in health, education, youth development and the environment. AED's focus on education centers on the belief that providing people with the appropriate information and knowledge, gives them the tools to improve their own lives. Today, AED implements more than 250 projects serving people in Africa, Asia, Europe, Latin America, the Middle East, and throughout the United States. These projects are carried out by 23 Centers of Excellence. AED'S cutting-edge health programs are helping to combat malaria through innovative public/private partnerships, conducting new research to prevent mother-to-child transmission of HIV, reducing transmission of HIV/AIDS through workplace education, and encouraging breastfeeding to improve infant survival rates. (excerpt)
Improving nutrition in Burundi.
In complex humanitarian emergencies, such as the present situation in Burundi, acute malnutrition becomes an inevitable consequence of armed conflict. The displacement of people and the inability of the local population to work their land compounds the heavy dependence of the predominantly rural population on changes in weather patterns, creating very unstable situation that can easily result in outbreaks of malnutrition epidemics, as was seen in Burundi in early 2001. Burundi has been affected by low-intensity but vicious and unpredictable civil strife for nearly a decade. Almost one-fifth of the Burundian population of 7 million live displaced from their homes and fields. Another quarter of a million Burundians live as refugees in camps in neighboring Tanzania. These refugees are only now making the slow return to their country, often to find out that their property has been destroyed while they were gone. Occasionally, armed bands of rebels loot villages, destroy property and kill civilians, further complicating the already difficult economies of most households. This situation led not only to continual degradation of health-care structures in the country and consequent public health emergency characterized by high child and adult mortality, but also to high rates of severe and moderate acute malnutrition among children under 5 years of age. (excerpt)
In December 1999, Project HOPE initiated its child survival and maternal care project in the oblast of Navoi, Uzbekistan. HOPE is using a comprehensive approach of building the capacity of its partners and the community to reach the project goal of reducing maternal and child mortality and morbidity. At project start-up, Uzbekistan had infant and child mortality rates of 50, per 1,000 and 62 per 1,000 live births, respectively, and the maternal mortality rate was estimated at 55 per 100,000 live births. The primary causes of deaths in children were ARIs, particularly pneumonias, perinatal causes, and diarrheal diseases. Immunization coverage rates were relatively high, but immunizable/infectious diseases, particularly hepatitis B (7% of children are chronic carriers) and measles were on the increase due to lack of funding for vaccines and supplies. Similarly to common childhood diseases (e.g., diarrheas and pneumonias), pregnancies and deliveries were not managed, using appropriate protocols. Mothers and babies were separated at births, often for 1-2 days, and while most women eventually breastfed, exclusive breastfeeding was virtually non-existent, increasing infants' risk for disease. Malnutrition in women and children was high: nearly one third of children were stunted in their growth and close to two-thirds of women and children suffered from anemia, with a potential long-term impact on their productivity and scholastic achievement. Women still had more children than they desired, and relied predominantly on the IUD. HOPE is implementing this project in the oblast of Navoi, one of the three oblasts where the government is implementing the Health One program with support from the World Bank. Navoi has an ethnically diverse population of 769,000, living mainly on 10% of the land that is not desert. The oblast has the highest overall maternal mortality rate and the highest infant mortality rate due to diarrhea in the Republic. (excerpt)
In the midst of enormous public health challenges - the AIDS pandemic, the continued rates of maternal and child morbidity and mortality - Dr. E. Anne Peterson leads the U.S. Agency for International Development's Bureau for Global Health. She sat down with the Global Health Council's Annmarie Christensen and Tina Flores to share her thoughts on USAID, its future and its priorities, private-public partnerships, the media and superstars. Q: How do you think USAID has affected the lives of people across the globe? A: The U.S. Agency for International Development has been at the forefront of efforts to help people across the globe. I am very pleased with what USAID accomplishes. Government bureaucracies don't always have the greatest reputation. But when I go to the field, it's great to see the AID folks who live and work there — the partners that they work with, the women, the children, and the families that are affected. It's on-the-ground, and at the in-country level where I can see our programs and our funding making a difference. It is also taking that experience and bringing it to the national level — to guide policy, and bring the lessons learned both to the NGOs in the country and the government — so that they can do their own work better. It's so much harder to measure, but you can actually see that you have really transformed a policy that seems beyond what your own little program does, trickles out, and makes a huge difference to the same thing at the international level. (excerpt)
Young people use cameras to speak out for change in South Africa.
Finding ways to maintain hope amid the realities of township life in Mdantsane, South Africa's second largest township, is daunting, but young leaders there have taken a bold step towards progress and change. Built as a homeland township by the apartheid government, Mdantsane now houses 600,000 black South Africans who grapple daily with the challenges of unemployment, poverty, crime and rampant diseases like tuberculosis and AIDS. Its rows of modest homes line street after street in the rolling hills outside a small industrial port city in the Eastern Cape Province. In November 2001; Management Sciences for Health (MSH), through the South African EQUITY project, worked with young leaders in Mdantsane to implement Photovoice, a community assessment methodology that puts cameras into the hands of community residents. Photovoice helps communities identify their problems and resources and communicate with policy-makers in a way that is powerful and motivating. Since 1991, Photovoice projects in China, the United States, and elsewhere have created awareness of local conditions and empowered disenfranchised people to act as catalysts for community change. (excerpt)
Iron and vitamin A deficiencies are the most widespread nutrition deficiencies in the world today, affecting as many as 3.5 billion people (International Food Policy Research Institute 2001). Vitamin A plays a vital role in the growth and repair of body tissues, and is particularly important in maintaining good eyesight and healthy skin, as well as aiding in teeth and bone formation. Early vitamin A deficiency symptoms are excessive skin dryness, lack of mucous membrane secretion, and dryness of the eyes due to a malfunctioning of the tear glands. These symptoms cause susceptibility to bacterial invasion. Persistent deficiency impairs growth, development, vision and immune systems, and in severe cases can lead to xerophthalmia, a blinding eye disease which results in permanent blindness if adequate vitamin A levels are not restored. Vitamin A deficiency is one of the most common causes of maternal and infant health problems in developing countries. Pregnant and lactating women are particularly susceptible to vitamin A deficiencies. Frequent, closely spaced pregnancies compound the problem by depleting the vitamin A stored in the liver. (excerpt)
This paper presents a concise overview of the status of current HIV/AIDS policies among the 14 member countries of the Southern Africa Development Community (SADC). Not all countries in the region have national HIV/AIDS policies. Therefore, this review also considers policy statements contained in national strategic plans, short-term plans, and sector-specific policy and strategy statements. The review includes analysis of those existing HIV/AIDS-specific policies and programmes available from specific government line ministries. The sector-specific analysis is provided as a starting point for building an expanded multi-sectoral response to HIV/AIDS across the region. The purpose of this review is to provide SADC with a summary of the region’s progress and best practices to date and recommendations for future activities that can contribute the most to improving the policy environment for an effective response to the epidemic. (excerpt)
Promoting local ownership to reach indigenous communities in Bolivia.
In rural areas of Bolivia, only 30 percent of deliveries take place in health centers. Many poor and indigenous pregnant women opt not to seek care or lack easy access to services. Because of the low levels of attended delivery, a shockingly high number of women die in childbirth. Problems of access to health care are most pronounced among the indigenous populations in the Lowlands region of the Amazon, one of the poorest and most under-served areas of Bolivia. Heavy rains and poorly maintained roads make transport difficult, the health infrastructure is poor, and few women's health agencies work here. According to the 1994 Indigenous Census, the majority of indigenous women in this area deliver their children in their own home attended by family members or traditional birth attendants. The Census reports that women in the Amazonian Lowlands have limited knowledge of sexual and reproductive health, and are generally unaware that free services are available under the National Health Insurance. Groups working in the Amazonian Lowlands of Bolivia report an urgent need for culturally relevant information and education on sexual and reproductive health, with a specific focus on STI/AIDS transmission, family planning and obstetric complications. (excerpt)
In September 1997, USAID/G-CAP signed a Cooperative Agreement with Project Concern International –PCI- to develop the “Better Health for Rural Women and Children” project. The purpose of the agreement was to provide assistance to PCI to join USAID’s other partners in achieving the SO, “Better Health for Women and Children”. The PCI Agreement was amended on various occasions, five of these (No. 1, 2, 4, 9 and 10) to provide incremental funding. Amendment No.5 changed the requirements for financial reports and corrected the base for cost sharing percentage. Amendment No.6 followed the Mid-term Evaluation and included a) a decrease to the total estimated cost by $1,511,023; b) budget modification; c) amendment for the Key Personnel Section; d) amendment to the Indirect Cost Section; e) amendment to the Program Description; f) updated the Standard Provisions, and g) incorporated Annex A, entitled “Program Approach and Proposed Activities”, Annex B, entitled “Management Plan”, Annex C entitled “USAID/Guatemala-CAP Strategic Objective “Better Health for Rural Women and Children”, and Annex D, entitled “Performance Monitoring Plan” into the agreement. Amendments 7, 8 and 11 changed the period for submission of SF-272 financial reports, deleted a key position (Regional Operation Manager solicited by PCI) and replaced the Required as Applicable Standard Provision No.6 entitled “Voluntary Population Planning” with CIB-01-08. The last amendment extended the completion date of the Agreement to November 4, 2001 without increasing the TEC. (excerpt)
A review of control methods for African malaria vectors.
This report reviews published information on selected control methods for anopheline mosquitoes and provides readers with a relatively brief introduction to options for malaria vector control. The review describes most of the physical, chemical, and biological methods that have been used in malaria vector control programs and summarizes information on factors that influence the efficacy of each method. Because of the programmatic focus of the Environmental Health Project (EHP) on community-based actions to prevent disease transmission, the review pays greatest attention to environmental management and other vector control methods that may be implemented by community-based organizations. The report is organized in accordance with the suggested groupings of the World Health Organization (WHO) Manual on Environmental Management for Mosquito Control with Special Emphasis on Malaria Vectors. (excerpt)
The standard days method: an innovative approach to family planning.
The Standard Days Method, developed by Georgetown University's Institute for Reproductive Health with support from USAID, is an innovative and cost-effective approach to addressing the growing need for family planning around the world. The widening gap between the cost of meeting the increasing demand for family planning and the funding available for needed contraceptive commodities is a concerning reality. Estimated at approximately $24 million in 2000, the "donor gap" could reach as much as $240 million by 2015 (Ross and Bulatao, 2001, Contraceptive Projections and the Donor Gap). Underlying this ten-fold increase are two facts: 1) contraceptive prevalence is increasing, and 2) the size of the population of reproductive age in developing countries is growing. One way to redress the situation is to develop and introduce new, low- cost family planning methods. The availability of simple, effective methods like the Standard Days Method can meet the family planning needs of many couples around the world, without placing undue burden on programs and donors. (excerpt)
Spreading a future with bed nets.
In Nigeria, malaria has long been recognized as a major health hazard. Spread by the Anopheles mosquito, pregnant women and young children are particularly vulnerable to the disease. The use of insecticide-treated bed nets dramatically reduces the risk of infection as it kills or repels the disease- carrying mosquitoes, which feed during the night. While bed nets that are not treated do help prevent malaria, they are significantly less effective than those dipped in insecticide. Because insecticide repels mosquitoes before they can land on or near the net, they are less likely to crawl through torn or un- tucked netting, or bite skin that comes into contact with the bed nets. In February 2002, Futures Group Europe implemented the Nigeria Insecticide-Treated Malaria Nets Program (ITN) to address this problem using social marketing. Futures Group manages and implements health projects throughout the developing world, specializing in sexual and reproductive health and social marketing. The company comprises two principal support offices — Futures Group Europe, based in Bath, U.K., and The Futures Group International, based in Washington, DC. Together the sister organizations work with donors, governments and the corporate sector to design and implement health policies and programs through out network of developing country projects. (excerpt)
Adapting to change learning program on population, reproductive health and health sector reform.
Important changes have occurred over the past decade in the policy and program environment for the population and reproductive health fields. These changes embody renewed commitments to human rights and gender equity in international affairs as well as recognition of changing economic, demographic and epidemiological conditions in countries. The commitments were agreed upon during the series of international conferences and summits that took place during the I990s, including the International Conference on Population and Development in Cairo (ICPD), the Fourth World Conference on Women (FWCW) and the Social Summit. A key accomplishment of these conferences was to establish measurable goals toward which governments and development agencies could focus their efforts to improve the health and welfare of poor people around the world. The "plus-five" follow- up to these conferences further sharpened global attention on outcomes and on actions that need to be undertaken to achieve International Development Goals (IDGs), later expressed as the Millennium Development Goals (MDGs). They also identified key challenges that governments and agencies face in their efforts to implement commitments made at the conferences. Chief among these challenges are shortfalls in financial support for needed action, lack of implementation capacity in countries, and the rapidly changing policy and program environments in which the work must be done. (excerpt)
Training in Reproductive Health, 2001. Annual report, 1 October 2000 - 30 September 2001.
As the flagship project in reproductive health training for the United States Agency for International Development (USAID), the Training in Reproductive Health (TRH) Project works to increase the availability of high quality reproductive healthcare in low-resource settings. Central to the work carried out by TRH is the strategic development of clinical education and training systems using the performance improvement approach, and the development of innovative learning tools and interventions. TRH staff working in our field offices throughout the world (Bolivia, Burkina Faso, Georgia, Ghana, Haiti, Kenya, Malawi, Nepal, Peru, Turkey, Uganda, Ukraine and Zambia), in collaboration with Baltimore-based staff and counterparts from many international and national agencies, produced a number of important results. These are summarized below. (excerpt)
Protecting the health of the Americas.
Dr. Mirta Roses Periago was named director of the Pan American Health Organization (PAHO) in January of this year, becoming the first woman and the first Argentine to lead the 100-year-old organization. Her appointment culminated an 18-year career at PAHO and is a testament to her dedication to the health of the Americas. She recently sat down with Sr. Editor Tina Flores to share her views on collaboration among the countries of the Americas, partnerships between PAHO and NGOs, women as leaders, and information sharing. Q How has PAHO benefited the citizens of the Americas? A: I wouldn't say that PAHO has been responsible for, but certainly it has been a major contributor to, improving the health status of the people of the Americas. It has contributed to making them aware of the importance of working together. It is a very important step in public health, you know, to have all the countries understand the international dimensions of public health and, therefore, that they have something to share, that they have a common destiny, and that they can share resources, share experiences. It is very important because in health it is easier for people to understand the linkages - the interdependence. So, by focusing on issues of public health, PAHO has been able to move the countries to understand this common destiny and strength that they have. (excerpt)
Using entertainment-education to reach youth in Mexico.
Poverty and overpopulation are two of Mexico's biggest challenges. The Population Media Center (PMC) is working with the Adolescent Orientation Center (CORA) of Mexico to produce a series of radio mini-serials mixed with talk shows in the five states of Mexico with the highest fertility rates. These programs have been developed by young people and are aimed at youth audiences. Based in Shelburne, VT, the mission of Population Media Center is to collaborate with the mass media and other organizations worldwide to bring about stabilization of human population numbers at a level that can be supported sustainably by the world's natural resources and to lessen the harmful impact of humanity on the earth's environment. The emphasis of the organization's work is to educate people about the benefits of small families, encourage the use of effective family planning methods, elevate women's status and promote the concept of gender equity. (excerpt)
The impact of a reproductive health project interventions on contraceptive use in Uganda.
This study considers whether recent increases in modern contraceptive use in Uganda are likely reflecting the impacts of reproductive health interventions related to health facilities. We employ data from the 1999 Delivery of Improved Services for Health (DISH) Evaluation Surveys, which provide quantitative information on the reproductive health status of individuals and services in the districts served by the DISH project. The surveys consisted of a Household Questionnaire administered to a representative sample of women of reproductive age, and a Facility Questionnaire implemented in all health facilities serving the sampled population. Multivariate logistic regressions were used drawing on both individuals' background characteristics as well as representative characteristics of health facilities to assess the independent impact of the quality of the health service environment on individual-level differences in contraceptive use. After controlling for a number of socio-demographic characteristics, access to a greater choice of family planning supply methods in rural areas remained significantly associated with women’s increased usage. A positive association between the number of DISH-trained family planning service providers and contraceptive use was found in urban areas. However unexpected findings of negative associations between certain indicators of programme efforts and actual family planning practices point to the need for a better understanding of any potential targeting of publicly-funded resources. (author's)
Creating a healthy environment [letter]
Amidst hubbub and furor, tens of thousands streamed to Johannesburg, South Africa in late August to participate in the World Summit for Sustainable Development - the so-called Earth Summit. Ten years earlier the monumental Rio Summit had set the stage for the debates around sustainable development throughout the '90s: the role of women in society, the need for NGOs to have a voice in fundamental policies, the common risks from environmental and climate changes, humankind's universal reliance on healthy ecosystems. Growing out of Rio came the Cairo International Conference on Population and Development, in which the reproductive needs and rights of women replaced demographic imperatives as the organizing principle of population efforts; the Beijing World Conference on Women, which reinforced the need for equality of women in all areas of society; the Montreal Protocol, which mandated reductions of ozone- depleting chemicals; and the Kyoto Protocol, which marked the world's first major effort to reverse human-caused global warming. (excerpt)
Criminal law, public health and HIV transmission: a policy options paper.
A number of cases have been reported in which people living with HIV have been criminally charged for a variety of acts that transmit HIV or risk transmission. In some cases, criminal charges have been laid for conduct that is merely perceived as risking transmission, sometimes with very harsh penalties imposed. Some jurisdictions have moved to enact or amend legislation specifically to address such conduct. The issue has also received public and academic commentary. These developments raise the question of whether criminal laws and prosecutions represent sound policy responses to conduct that carries the risk of HIV transmission. Individual cases, and accompanying media coverage, may prompt public calls for such a response. But there are few simple solutions to such a complex problem, and a rush to legislate should be avoided in favour of careful consideration. To assist in the development of sound public policy, this paper: proposes some principles that should guide thinking about, and development of, law and policy on the question of criminal law and HIV/AIDS; identifies a number of public policy considerations that states should take into account when making decisions about the use of the criminal law; considers the alternative to criminalization presented by public health laws; discusses if and how the criminal law might be justifiably applied, considering in particular: (a) whether HIV-specific legislation is warranted; (b) which acts that transmit HIV or carry the risk of transmission could be subject to criminal sanctions; (c) what degree of mental culpability should be required to impose criminal sanctions; concludes with recommendations to governments, police, prosecutors, judges and public health authorities regarding the appropriate use of criminal sanctions and coercive public health measures. (excerpt)
Untreated fistula: a condition of shame and shunning.
In many developing countries, when a girl first menstruates, she is eligible for marriage and is expected to get pregnant soon afterwards. She will be of small stature, due to her young age, gender-based malnutrition, or just genetics - all factors that vary by region. Her pelvis is usually too small for her baby to be delivered without assistance, and if obstructed labor occurs, it is imperative that help is sought, and that the baby is delivered via caesarean section (C-section). However, in many cases, it is her husband or in-laws who decide whether she may seek emergency obstetric care (EmOC). In cultures where tradition dictates that young women should deliver at home alone, the decision to seek EmOC often occurs too late, if at all. Unattended, obstructed labor can last for up to seven days. During this time, the pressure of the baby's skull cuts off the blood supply to the tissue surrounding the mother's bladder, rectum and vagina, causing a hole, or "fistula" to form. It is almost certain that this will result in a stillbirth. (excerpt)
Jong-Wook Lee sets bold new course at WHO.
On July 21, 2003, Dr. Jong-Wook Lee took office as director-general of the World Health Organization (WHO). In a world where emerging threats to global health are becoming increasingly encompassing, the individual at the helm of the pre-eminant health organization must be recognized as a major player on the world stage. In his inaugural address to WHO staff, Dr. Lee outlined his vision for the coming years of his tenure. Simply stated, he believes that WHO's work must be guided by three principles: doing the right things, in the right places, in the right way. Foremost among the 'right things' is a scaled up effort to fight HIV/AIDS to be led by a new HIV/AIDS leadership team with a mandate to develop a strategy for ensuring achievement of the "three by five" goal, i.e., providing 3 million people in the developing world with antiretroviral therapy by the close of 2005. WHO departments working on the three major infectious diseases - HIV/AIDS, tuberculosis and malaria - will be unified into one cluster that will be able to work effectively with the Global Fund. Additional 'right things' articulated by Lee include expanded attention to child and maternal health, noncommunicable diseases, tobacco control, nutrition, violence, and mental health as well as the eradication of polio. (excerpt)
Responding to the global tuberculosis threat in Russia.
The recent experience with the new disease of Severe Acute Respiratory Syndrome illustrates how we all live in a global village of infectious illnesses. An old germ, but a very potent one, is the tuberculosis bacteria. Tuberculosis (TB) was once the leading cause of death in the United States. When newly discovered antibiotics were used to treat TB in the 1940s, TB hospitals were closed, mortality rates due to TB plummeted, and the country became complacent. The old germ was down, but not out, and has returned in a mutated form resistant to many antibiotics. TB bacteria, spread through the air, cannot be ignored by any country. It is estimated that there were 3.75 million new TB disease cases worldwide in 2001. TB incidence in Russia more than doubled between 1990 and 2001. Immigration from other parts of the former Soviet Union with high TB burdens has exacerbated the problem. The situation is especially dire in correctional institutions, where case rates are around 30 times higher than in non-prison populations. Russia does not have a formal national TB program. TB control is provided by a network of specialized TB dispensaries and hospitals that are not fully integrated into the general health system. The Russian Ministry of Health is currently working to link the TB system with the primary health care network. (excerpt)
Estimation of levels and trends in age at first sex from surveys using survival analysis.
Age at first sex is an important indicator of exposure to the risk of pregnancy and risk of sexually transmitted infections, including HIV, during adolescence. In fertility studies age at first marriage is often used as a proxy measure of the onset of a woman’s exposure to pregnancy, but in many societies premarital sexual activity is common, and it has been proposed to use age at first sex as a better proxy. In the context of the AIDS epidemic, accurate monitoring of trends in age at first sex has become even more important. Interventions target youth and promote postponement of first sex or discourage premarital sexual activity. In several countries, trends in HIV prevalence among pregnant women attending antenatal clinics have shown a decline in the younger age groups, while older women do not show such changes. Such changes may be associated with changes in age at first sex, rates of partner change, sexual mixing patterns, and condom use. In Uganda, a rapid increase in age at first sex in urban areas between 1990 and 1995 was considered a major contributing factor in the observed HIV prevalence decline in young pregnant women from about 1993. Various indicators have been used to measure age at first sex from cross-sectional data in a single survey and to assess change over time from data in multiple surveys, but existing data have not been fully utilized. This paper describes how survival analysis can be used to estimate age at first sex among adolescents. The method facilitates assessment of trends, and can also be used to assess the consistency and quality of reporting between surveys. The method is illustrated with the application to data reported by women in six countries in sub-Saharan Africa with multiple cross-sectional surveys during the past ten years. (excerpt)
Training the poor to help themselves: a community health approach in India.
In the raw poverty of the slums of Kolkata - formerly known as Calcutta - visibly malnourished children with bloated stomachs and patchy hair run barefoot over paths in which human and animal waste mix with mud and garbage. Hundreds of dwellings made of straw, mud, tin and cardboard are squeezed into areas the size of one small city block. In these cramped dwellings, often only arm-span in width, entire families live with no running water, no electricity, and no furniture. The incidence of preventable diseases in the slums is shockingly high. Children routinely die of diseases that could have been prevented by vaccines, adequate nutrition, and clean drinking water. While there is a desperate need for health care, most slum residents have never seen a doctor. Few health facilities exist in these neighborhoods. And slum residents are generally reluctant to visit clinics outside of their local neighborhood, due to India's rigid caste system -which restricts interaction among different classes - and their inability to pay even modest fees for health services. As a result, many slum residents have literally no access to health services. (excerpt)
"At work they are my second eyes": glasses for midwives.
"The eyeglasses have helped me to read my [self-paced learning] units without problems, especially at night. At work they are my second eyes...work goes on as normal unlike before. I am so happy because the glasses have improved my sight." A midwifery superintendent at Yendi Hospital in the Northern region of Ghana, Beatrice Billa is one of 50 health care workers who are seeing more clearly thanks to a recent collaboration between the PRIME II Project and Helen Keller Worldwide. At a meeting just before the start-up of PRIME's self-paced learning program in safe motherhood skills for Ghanaian midwives, the Regional Resource Teams responsible for selecting trainees noted that many of the midwives appeared to need glasses. Some of the midwives themselves had requested that new curriculum and training materials be made available in Reader's Digest- style large-print versions to reduce eye strain. (excerpt)
The World AIDS Campaign for the years 2002–2003 will focus on stigma, discrimination and human rights. The main objective of the campaign is to prevent, reduce and ultimately eliminate HIV/AIDS-related stigma and discrimination, wherever it occurs and in all its forms. Stigma and discrimination associated with HIV and AIDS are the greatest barriers to preventing further infections, providing adequate care, support and treatment and alleviating impact. HIV/AIDS-related stigma and discrimination are universal, occurring in every country and region of the world. They are triggered by many forces, including lack of understanding of the disease, myths about how HIV is transmitted, prejudice, lack of treatment, irresponsible media reporting on the epidemic, the fact that AIDS is incurable, social fears about sexuality, fears relating to illness and death, and fears about illicit drugs and injecting drug use. The Declaration of Commitment, adopted by the United Nations General Assembly Special Session on HIV/AIDS in June 2001, highlights global consensus on the importance of tackling the stigma and discrimination triggered by HIV/AIDS. All over the world, the shame and stigma associated with the epidemic have silenced open discussion, both of its causes and of appropriate responses. This has caused those infected with HIV and affected by the disease to feel guilty and ashamed, unable to express their views and fearful that they will not be taken seriously. And they have led politicians and policy-makers in numerous countries to deny that there is a problem, and that urgent action needs to be taken. (excerpt)
Using new weapons to fight the TB war.
Today, as the sun rises over the rural villages of South Africa's Eastern Cape Province, community members witness what is becoming a common sight. A motorbike speeds by and its driver readily waves; today he does not stop to chat. He is Mtiteto Mfikile and he has work to do. Meanwhile, a village nurse hears the beep of her cell phone and she too gets to work - an SMS message from a nearby laboratory gives her TB smear results of a patient. She can start appropriate treatment now. It is their dedication - coupled with a novel concept in health delivery - that is making the days in these poor, remote villages brim with a renewed sense of hope for a healthier future. South Africa has one of the worst TB epidemics in the world, with an incidence rate of 362 cases per 100,000 inhabitants. In the rural areas of the Eastern Cape Province, where there are 500 cases for every 100,000 people, this fact is hard to miss. Various factors - poverty, HIV/AIDS, and lack of infrastructure - all contribute to rising TB rates, particularly in remote areas difficult to reach by standard vehicles and located a considerable distance from health facilities. (excerpt)
Reproductive health a key to the future of adolescent refugees.
Adolescence is a difficult time, wherever you are. Dramatic mood swings, the need for approval, drug and/or alcohol experimentation - and new sexual urges along with confusing body changes are common. Consider these typical teenage characteristics coupled with the devastating effects of conflict: loss of family members through separation or death, breakdown of social norms as a result of the dispersal of the community, obligation to care for younger siblings, and pressure to exchange sex to meet daily survival needs - to name just a few. These are among the challenges refugee and internally displaced adolescents face on a daily basis. Approximately 20 million young people around the world have crossed an international border or moved to another location in their own country to escape war, persecution and/or abuse; a significant number of these are adolescents. (excerpt)
Cloudy skies for global health [letter]
If the annual State of the Union message is a measure of political barometric pressure, President Bush's Jan. 19 speech means cloudy skies for efforts to improve the lot of the world's poorest citizens. In fact, this year's State of the Union address seemed to be more a rationalization and justification of the prior three years of the President's administration than it was a visionary framework for moving forward with the enormous task of lifting hope. I was disappointed. In his speech a year earlier, the President took a remarkable step in highlighting the global humanitarian and security crisis caused by the explosive spread of AIDS. And his administration, together with a willing Congress, took rapid action to follow up his words. Within four months of his speech, Congress passed and the President signed into law landmark, comprehensive legislation elevating the world's concern over international HIV/AIDS prevention and treatment programs. Congress and the President promised the resources needed to address this crisis. Those of us in the global health community were enormously heartened. (excerpt)
Toward a new guard, a second century of health in the Americas.
The Pan American Health Organization (PAHO) will turn 100 this December, providing an opportunity to celebrate the many challenges and achievements of our organization's 100-year history. But the PAHO centennial is not just a time for congratulations; it is also a time for assessing our strengths, taking stock of our surroundings, and setting a course for our work in the century ahead. PAHO is a creature of the health situation of the Americas. We started slowly and grew slowly, adapting to the health needs of the countries of the Americas - or more correctly, to those needs that required our technical cooperation. No one can predict the future health situations that will call for our support in the next century, but we can try to divine in general terms some of the challenging conditions we may face and how they may affect our work. (excerpt)
Malaria parasite diversity and evolution: more challenges for global health.
As scientists and global health agencies plan major programs of vaccine and drug development to combat malaria, it has become urgent to understand the genetic diversity and relentless evolution of the Plasmodium falciparum parasite. The number of malaria cases is increasing across the tropics, and control of the disease has become more difficult because of the evolution of drug-resistant parasites. P.falciparum, the parasite responsible for most deadly cases, infects about 300 million people annually, and 1-2 million people, mostly infants and children, die of the disease each year. Many malaria scientists have worried for some time that this may be a very variable parasite, with frightening potential to become resistant to multiple drugs and vaccines. Now, we and our colleagues have completed two detailed studies of parasites from patients worldwide that give a solid scientific basis for such concerns: P.falciparum does indeed show extensive genetic diversity and the pervasive ability to evolve resistance. (excerpt)
Principal findings from a study of the Expanded Program on Immunization in the Dominican Republic.
The CHANGE Project (funded by USAID), with the Secretariat of Public Health (SESPAS), the Government of Japan (Overseas Development Agency/JICA), the Pan American Health Organization (PAHO), UNICEF, and other partners, is taking advantage the introduction of pentavalent vaccine (the “penta” – DPT, hepatitis B, and Hib) in the Dominican Republic to strengthen the Expanded Program on Immunization (EPI). These organizations undertook a series of activities in 2001 and 2002, including communication on the introduction of pentavalent vaccine, the re-design of the immunization card, a review of EPI norms, the preparation of an immunization manual for health workers, and technical training on all aspects of EPI in all provinces. Finally, with the research firm AlConde, CHANGE planned a quantitative/qualitative study on the EPI to obtain information on its strengths as well as on barriers to increasing coverage. This summary provides the principal results of the study, carried out by AlConde in December 2001 and January 2002, and their programmatic implications for the EPI. (excerpt)
HIV / AIDS: China's titanic peril. 2001 update of the AIDS Situation and Needs Assessment Report.
At the dawn of the third millennium, China is on the verge of a catastrophe that could result in unimaginable human suffering, economic loss and social devastation. Indeed, we are now witnessing the unfolding of an HIV/AIDS epidemic of proportions beyond belief, an epidemic that calls for an urgent and proper, but currently yet unanswered quintessential response. Awareness of HIV/AIDS has increased but minimally over the last several years. Millions of Chinese have never heard the word AIDS. Many still think that one can contract HIV from mosquito bites or from shaking hands. Even so, there are already villages where the greater part of the population is infected. Most of those infected with HIV do not have access to even the most basic services for care, support and understanding. Some concerned people who dare to speak out about the pending disaster are ignored or challenged, and sometimes even opposed by local authorities. In some areas, people known to be living with HIV/AIDS are prevented from attending school, getting married, or visiting public swimming pools. The vast majority of those not infected lack basic knowledge and skills for protection from future infection and for dealing with people already infected. Condoms are yet to be promoted on a nationwide scale. (excerpt)
At the meeting, Heads of State and Representatives of Governments issued the Declaration of Commitment on HIV/AIDS. This Declaration describes in its preamble (paragraphs 1–36), the extent of the epidemic, the effects it has had, and the ways to combat it. The Declaration then states what governments have pledged to do—themselves, with others in international and regional partnerships, and with the support of civil society— to reverse the epidemic. The Declaration is not a legally binding document. However, it is a clear statement by governments concerning that which they have agreed should be done to fight HIV/AIDS and that which they have committed to doing, often with specific deadlines. As such, the Declaration is a powerful tool with which to guide and secure action, commitment, support and resources for all those fighting the epidemic, both within and outside government. This booklet simplifies and summarizes the text of the Declaration in an effort to make it more accessible to all and to encourage everyone to do his or her part to put it into action. Where possible, it pairs relevant paragraphs from the preamble with relevant sections from the body of the Declaration. The bold text in quotes is taken directly from the Declaration. Also included are quotes from some of the statements made by speakers at the meeting, as well as from people affected by HIV/AIDS. It should be stressed that the paragraphs in this booklet are simplified versions of those found in the Declaration. They should not be substituted for the full, original text when formal reference to the Declaration is needed. The original text is attached as an annex for easy reference. (excerpt)
Cost and efficiency of reproductive health service provision at the facility level in Paraguay.
In this paper we develop a methodology for estimating facility level service provision cost disaggregated to the service level that makes use of survey data collected from 52 public health facilities in Paraguay. In addition, a method is developed to calculate facility level measures of staff use utilization rates to provide information on the efficiency of input use in the Paraguayan health care system. The current paper is part of a larger study of health care decentralization in Paraguay. The broader study was designed to measure changes in cost, efficiency, and other attributes of the public heath care system that might be attributed to the change from a centralized system to one where the responsibility for managing basic health care services provided through public facilities is devolved to the municipal governments. The sample was selected to include a census of public health facilities from 20 municipalities in Paraguay, 11 of which were to be subject to decentralization and 9 were to remain under centralized control. The current paper reports the baseline cost and efficiency results. (excerpt)
Voluntary counselling and testing (VCT) is the process by which an individual undergoes counselling, enabling him or her to make an informed choice about being tested for HIV. In recent years, voluntary HIV testing, in combination with pre- and post-test counselling, has become increasingly important in national and international prevention and care efforts. Knowledge of serostatus through VCT can be a motivating force for HIV-positive and -negative people alike to adopt safer sexual behaviour, which enables seropositive people to prevent their sexual partners from getting infected and those who test seronegative to remain negative. This intervention also facilitates access to prevention services for seronegative people and is a key entry point to care and support services for those who are HIV-infected. This includes access to interventions to reduce mother-to-child transmission (MTCT) of HIV, interventions to prevent opportunistic infections (e.g. tuberculosis preventive therapy and prophylaxis for other infections) and other medical and supportive services that can help HIV-positive people to live longer and healthier lives. (excerpt)
Improving routine immunization in Africa. Draft.
Despite progress in polio eradication and other disease-control activities, half or more of the children in many African countries have not completed their basic series of vaccinations by the time they reach their first birthday. Such low rates of routine immunization coverage are very troubling for many reasons: Each year low routine immunization coverage exposes millions of African children to easily preventable disease and death. Low routine coverage may well delay reaching polio eradication and other disease-control and eradication goals. A well functioning vaccine delivery system is needed for incorporating new and under-used vaccines (particularly hepatitis B, Hib, and yellow fever) as well as future vaccines against major global killers such as malaria and HIV/AIDS. Why are there so many unvaccinated and partially vaccinated children in Africa? Although the following categories of reasons for no vaccinations or incomplete vaccination are not mutually exclusive, they are nonetheless a useful framework for analysis and planning appropriate actions. (excerpt)
In the 20 years that it has been with us, AIDS has continued its relentless spread across continents. By the end of 2000, the United Nations Joint Programme on HIV/AIDS (UNAIDS) reported that 36.1 million men, women and children were living with HIV around the world and 21.8 million had died. Though AIDS is now found in every country, it has most seriously affected sub-Saharan Africa—home to 70% of all adults and 80% of all children living with HIV, and the continent with the fewest medical resources in the world. AIDS is now the primary cause of death in Africa and it has had a devastating impact on villages, communities and families on the continent. In many African countries, the numbers of new infections are increasing at a rate that threatens to destroy the social fabric. Life expectancies are decreasing rapidly in many of these countries as a result of AIDS-related illnesses and socioeconomic hardships. And of the 13.2 million children orphaned by HIV/AIDS worldwide, 12.1 million are in Africa. In the past, AIDS-control activities relied on giving information about HIV transmission, and imparting practical skills to enable individuals to reduce their risk of HIV infection and care for themselves if infected. There is a growing awareness, however, that sociocultural factors surrounding the individual need to be considered in designing both prevention and care interventions. As the epidemic continues to ravage the low- and middle-income world, it becomes increasingly evident that diverse strategies to confront the wide-ranging and complex social, cultural, environmental and economic contexts in which HIV continues to spread must be researched, tested, evaluated, adapted and adopted. (excerpt)
Doctors of the World / USA Maternal and Infant Health Project, 1998-2002. Final report.
In 1998, Doctors of the World was awarded a grant by USAID to develop the maternal and infant health (MIH) infrastructure in Kosovo. The project faced the following initial challenges: a delay in project start-up due to interference by Yugoslav authorities and two evacuations of staff from Kosovo for security reasons; the need to completely revamp the project due to changed circumstances after the war; and the resultant compressed time frame for project implementation. Despite these challenges, Doctors of the World has made a significant positive impact on the provision of MIH care in Kosovo and, following project completion, is continuing to address MIH issues with the support of other donors. The overall goal of the project was to reduce maternal and infant morbidity and mortality in Kosovo. This goal would be achieved by increasing reproductive health knowledge and utilization among consumers; addressing poor health infrastructure; improving the skills of health providers in primary, secondary and tertiary health facilities (Health Houses, Regional Hospitals and a Reference Hospital); and creating a knowledge base of maternal and infant health status and health service outcomes. (excerpt)
The faces, voices and skills behind the GIPA Workplace Model in South Africa. UNAIDS Case Study.
South Africa has begun to explore how best to involve people living with HIV/AIDS (PLWHA) in workplace responses to the HIV/AIDS epidemic. A pilot programme, the GIPA Workplace Model, has been developed over the past four years with the support of the United Nations Development Programme (UNDP) and the World Health Organization (WHO). Its aim was to place trained fieldworkers, living openly with HIV/AIDS, in selected partner organizations in different sectors so that they could set up, review or enrich workplace policies and programmes. For partner organizations, the GIPA Workplace Model has added value by: adding credibility to its HIV/AIDS programmes by giving a face to HIV and personalizing it; creating a supportive environment for people living with HIV/AIDS (PLWHA) and others to speak about HIV/AIDS and issues related to it. (excerpt)
Documenting impact of quality of care on women's reproductive health, Philippines and Senegal.
The Population Council initiated the Impact Studies Program to provide a sound empirical basis to demonstrate the feasibility and impact of improving quality of reproductive health services. The hypothesis being tested is that improvements to service quality will help women achieve their reproductive intentions. Unwanted and mistimed childbearing can be reduced through improved quality of care, thus ultimately lowering fertility. Services that help individuals achieve their reproductive goals are both clientoriented and humane. The Impact Studies Program has conducted field studies in Asia (the Philippines and Pakistan) and Africa (Senegal and Zambia). The two studies in the Philippines and Senegal are a direct continuation of work completed under the ANE and Africa OR/TA Projects. The experiences and findings from these country studies are documented including the feasibility of improving quality, the process, replicability, and sustainability. The purpose of the documentation is to inform policy makers and program managers about feasible alternatives to standards of care. Further, it is envisaged that the scientific information will assist government and donor agencies in mobilizing and allocating resources for high-quality services. The research orientation and emphasis of the Impact Studies Program is shared by FRONTIERS: Documenting the Impact of Quality of Care on Women’s Reproductive Behavior. As part of the collaboration between the Impact and FRONTIERS projects, two FRONTIERS staff (Marilou Costello in the Philippines and Diouratié Sanogo in Senegal) provided technical assistance to ensure successful completion of their respective country studies. The two country studies were undertaken by the Population Council in collaboration with the Provincial Health Office of Davao del Norte, the Ateneo de Davao University, and with EngenderHealth in the Philippines; and with the Service National de La Sante de La Reproduction (SNSR) in Senegal. (excerpt)
Employer's handbook on HIV / AIDS: a guide for action.
Across the world, AIDS is having a direct and indirect impact on business. In southern Africa, for example, it is estimated that more than 20% of the economically active population in the 15–49-year-old age group are infected with HIV. In the workplace, employers are experiencing reduced productivity as a result of employee absenteeism and death. Consequently, employers are being challenged to manage the impact of HIV/AIDS in the workplace, which includes dealing with issues of stigma and discrimination, changing requirements for health-care benefits, training of replacement staff, and loss of skills and knowledge among employees. One of the missions of the International Organisation of Employers (IOE) is to facilitate the transfer of information and experience to employers’ organizations in the social and labour fields. It is hoped that this Handbook will serve as a guide to employers’ organizations and their members in their endeavours to mitigate the impact of HIV/AIDS on their companies and business environments. The Handbook outlines a framework for action by both employers’ organizations and their members, providing examples of innovative responses to the pandemic by their counterparts in other parts of the world. Constructive and proactive responses to HIV in the workplace can lead to good industrial relations and uninterrupted production. (excerpt)
After several attempts over a 20-year period, Peru enacted its National Policy on Population in July 1985. Using data from the 1991 Peru Demographic and Health Survey (PDHS91), a linked Peru Situation Analysis (PSA92) community and facility data set collected in 1992, and a unique region-level data set gathered specifically for this analysis, this paper examines the determinants of fertility in rural Peru before and after this important date. Particular attention is paid to assess the effect of family planning services on fertility. The empirical model that is used combines a model of the timing and spacing of births with a model of the timing of the placement of family planning (FP) services in communities. This modeling strategy allows us to control for the non-random placement of FP services that could potentially bias the measures of program impact. An illustration of the potential relationship between fertility and FP services can be seen in Figures 1 and 2. Figure 1 presents age-specific fertility rates (ASFR) for the period 1972-1991 from the fertility histories for women in the rural sample of the PDHS91. For all age groups except the youngest, fertility appears to be declining, and the rate of the decline seems to have accelerated in the 1980's. Figure 2 depicts the expansion of FP services within 5 kilometers of the rural PDHS communities for different type of providers. Public FP services were virtually non-existent in rural Peru during the 1970's and the expansion in services really started after the passage of the National Policy on Population in 1985. The timing and extent of the fertility decline appear to coincide with the growth of the government provision of FP services. Our data set allows us to estimate the determinants of the annual probability of a birth for every year between 1972 and 1991 and so we completely span this period of marked change. Clearly, any change in FP policy will not have an immediate impact on fertility. One of the goals of this paper will be to measure the lag in program impact if, in fact, there is an impact at all. The next section of this paper presents a brief review of Peru’s family planning program. This context will be important in the interpretation of our empirical results. Section III discusses estimation difficulties that arise when programs are not randomly implemented and our estimation strategy that overcomes these difficulties. Section IV presents the data used to estimate the model, and Section V discusses the results. We conclude in Section VI. (excerpt)
Sources and prices of selected drugs and diagnostics for people living with HIV / AIDS.
This report sets out to provide market information that can be used to help procurement agencies make informed decisions on the source of drugs and serve as the basis for negotiating affordable prices. The aim is to help increase access to drugs for people living with HIV/AIDS in developing countries. The data provided by the manufacturers serves to highlight the multiplicity of suppliers and the variation in price of some essential HIV/AIDS related drugs on the international market. Without this information, there is a risk that low-income countries may be paying more than needed to obtain essential drugs. Price variations are highlighted through the tables and graphs included. Provision of price information addresses only one barrier to access to drugs in countries with limited resources and, it is appreciated that many other factors will affect the availability of drugs. Some of the other issues that must be considered in relation to the purchase of drugs for HIV/AIDS and related conditions are health infrastructure, human resources, and supply and distribution systems. (excerpt)
What drives HIV in Asia? A summary of trends in sexual and drug-taking behaviours.
BSS (Behavioural Surveillance Surveys) generally focuses on measuring behaviours among groups at especially high risk for HIV. In the Asian context that includes men who buy sex and the women who sell it, men who have sex with other men, and, increasingly, injecting drug users. Almost all countries in this report have measured risk behaviour in commercial sex, and a growing number are also including drug injectors and men who have sex with men in their behavioural surveillance systems. In addition, some countries occasionally monitor sexual behaviour among groups thought to be at low risk for HIV, such as students or factory workers. This document gathers together the results of BSS collected by a number of countries and states with technical assistance from Family Health International. The findings are extremely diverse, and hard to compress into a few paragraphs. In several countries and states in Asia, condom use in commercial sex has risen sharply over time. Over seven out of 10 encounters between sex workers and clients are protected by condoms in some countries. However this success is by no means universal. In a number of countries where almost all sex workers and clients know that condoms protect them against HIV, consistent condom use in paid sex still lags well below 10 percent. (excerpt)
Food and Nutrition Technical Assistance Project assessment.
The Nutrition Results Package is a ten-year program framework authorized in 1998. Under this authorization, The Food and Nutrition Technical Assistance (FANTA) project was awarded competitively in September 1998 to the Academy for Educational Development (AED) as the prime contractor, with Cornell University and Tufts University as subcontractors. The FANTA proposal included a memorandum of understanding with Food Aid Management (FAM), a consortium of Private Voluntary Organizations (PVOs), referred to as Cooperating Sponsors (CS), implementing Title II food aid development and emergency programs. The overall purpose of FANTA is "improved food and nutrition policy, strategy, and program development". Three Intermediate Results (IRs) were identified to achieve this purpose: USAID's and Cooperating Sponsors' nutrition and food security-related program development, analysis, monitoring, and evaluation improved, USAID, host country governments, and Cooperating Sponsors establish improved, integrated nutrition and food security-related strategies and policies, and Best practices and acceptable standards in nutrition and food security-related policy and programming adopted by USAID, Cooperating Sponsors, and other key stakeholders. (excerpt)
A rapid assessment of injection practices in Mongolia, 2001. Draft.
Anecdotal reports of unsafe practices and a high prevalence of HCV infection suggest that poor use of injections may transmit bloodborne pathogens in Mongolia. To achieve safe and appropriate use of injections, the Ministry of Health of Mongolia conducted a rapid assessment. Information on injection practices, their determinants and their consequences was collected through interviews and observations of a convenience sample of prescribers, injection providers and members of the general population. The 65 members of the general population reported receiving an average of 13 injections per year. New, locally produced, disposable injection equipment was used in the 28 health care facilities visited. There were breaks in infection control practices while administering injections, including observations of 500 ml intravenous infusion bottles used as multi-dose diluent vials and eight of the 28 providers (28.5%) reporting reusing syringes for the same patient. Injection providers reported an average of 2.6 needlestick injuries per year. Contaminated sharps were burned in the open air. Among persons interviewed, XX of the 21 prescribers (90.5%) and 49.2% of the population was aware of the potential risk of HIV transmission through unsafe injections. A multi-disciplinary initiative is necessary to achieve safe and appropriate use of injections in Mongolia through development of key behaviours among patients and health care workers to reduce injection overuse and to ensure safe practices, increasing availability and affordability of injection equipment and sharps boxes and appropriate sharps waste management. (author's)
In the development of the papers presented in this publication, experts from Africa, Asia, Europe, North America and South America were consulted during the year 2001. They are members of a Technical Network on Access to Care comprised of 155 experts from 27 countries and 57 national and international organizations. This publication reflects their mobilisation in sharing their experiences and advocating for accelerating access to care to people living with HIV/AIDS in developing countries. It features papers developed by the experts, collating lessons learnt and analysing key issues in the implementation of the care agenda, and a Declaration for a Framework for Action, which was adopted at a meeting of these experts held in Paris from 29 November – 1 December 2001, at the invitation of the French Ministry of Foreign Affairs. (excerpt)
Assessment of the process and impact of operations research in Guatemala: 1988 - 2000.
Population Council/Guatemala and the FRONTIERS Regional Associate Director for Latin America proposed this evaluation to document the utilization of the results from the portfolio of OR projects conducted over the past decade in Guatemala. The objectives of the evaluation were: To determine the impact of the OR activities conducted on reproductive health services during this 12 year period, given the substantial level of project activity in Guatemala; To provide documentation of accomplishments and shortcomings of this OR work as the current cooperative agreement comes to a close; To identify factors that have facilitated and hindered either conduct or utilization of OR findings; and To test recent modifications to the FRONTIERS evaluation methodology. (excerpt)
Accelerating access to HIV / AIDS commodities in sub-Saharan Africa: cost estimates.
In response to the devastating impact of the AIDS epidemic, expanding access to commodities of special interest to people living with HIV infection, and those vulnerable to HIV infection, is receiving the urgent attention of global leaders. As the main advocate for global action on HIV/AIDS, UNAIDS requires a strong evidence base from which to determine programme needs and costs, including commodity needs and costs, in order to mobilize additional resources. It is estimated that, by 2005, a total of US$9 billion in funding will be required annually for prevention, care and treatment and to provide support for orphans. About half of this funding is needed in sub-Saharan Africa. This paper presents the key findings of a modelling analysis conducted by Options for UNAIDS to provide need and cost estimates of HIV-related commodities for the 36 sub-Saharan African countries worst affected by HIV/AIDS, over the period 2000–2005. The term ‘commodities’ covers principally male and female condoms, drugs for STI treatment, equipment for collecting and testing blood for HIV, equipment for the safe disposal of needles for injecting drug users, and drugs for treating HIV and related infections. This model does not estimate total commodity needs for HIV control. Rather, it estimates the future commodity requirement that could be delivered through existing health infrastructures with optimistic projections for how coverage will improve over the next five years. (excerpt)
Famine is defined as a catastrophic food crisis that results in widespread acute malnutrition and mass mortality. It is a process, rather than an event, with a beginning, a middle, and an end. The context of famine is important in defining why and how widespread acute malnutrition and mass mortality can affect populations. In Amartya Sen's theory, individuals and households are described as having 'bundles' of assets and entitlements. As the environment changes through time in a drought or conflict, individuals sell personal assets and call on social and familial entitlements until they are exhausted. When all assets and entitlements are exhausted, then either the individual and their household will have to migrate or starvation ensues. If we understand the genesis of famines and how people cope with them, we can see that they are preventable. There are a number of stages where timely intervention can forestall or reverse the downward spiral caused by an episodic shock such as a drought or conflict. (excerpt)
Expanding antiretroviral treatment in developing countries creates critical new challenges.
In the face of a swiftly expanding global HIV/AIDS pandemic, world opinion has shifted significantly in favor of providing access to antiretroviral treatment (ART) in developing countries. Treatment is now seen as a critical component of a comprehensive program against HIV/AIDS, along with prevention and the improvement of health care infrastructures for the delivery and monitoring of care. Indeed, more than half the programs approved by the Global Fund to Fight AIDS, TB, and Malaria in its first round of approvals call for funding for such treatment. Until recently, that goal had not seemed feasible. High costs, demanding treatment regimens, and the lack of even basic health infrastructure in many heavily affected regions were all cited as potentially insurmountable barriers. But then the “Call to Action” enacted at the June 2001 UN General Assembly Special Session on HIV/AIDS pushed forward a new global consensus on the need for ART. At the same time, pressure from various sources led many pharmaceutical manufacturers to reduce drug prices dramatically. (excerpt)
New research on birth intervals (the time from one child's birth date until the next child's birth date) has revealed important new findings on maternal and child health: Neonatal, Infant and Child Mortality: Three-year intervals, or longer, are associated with lower levels of infant and child deaths than any shorter interval. Infant/Child/Maternal Nutritional Status: Three year intervals, or longer, are associated with the lowest risk of stunting and underweight in infants and children. Longer intervals between births allow women needed time to replenish nutritional stores. Maternal Health: Very short birth intervals --14 months --are associated with increased risk of maternal death and complications of pregnancy. Lifetime fertility is reduced when women space births at desired intervals. Perinatal Mortality: Three year intervals are associated with the lowest risk of perinatal death (still births, and deaths in the first week of life). Risks may increase when intervals are longer than three years. USAID is sponsoring research to address this question. (excerpt)
An effective, easy to use vaginal microbicide would provide women with a method under their own control with which to protect themselves against infection with the human immunodeficiency virus (HIV). While many novel compounds are currently being developed and tested, it will be many years before a new product can be fully evaluated and distributed to users. The spermicide Nonoxynol-9 (N-9) has been widely available as a contraceptive for many years and has been shown to be effective against HIV in laboratory studies. If it also provided effective protection against HIV in clinical studies, N-9 could be made rapidly available to women who require protection. The World Health Organization Global Programme on AIDS (GPA) and the Joint United Nations Program on HIV/AIDS (UNAIDS) sponsored a clinical trial of a gel containing N-9 to assess its effectiveness in protecting against HIV. Preliminary results from the study were presented in July 2000 at the 13th International AIDS Conference in Durban, South Africa, and showed, contrary to expectation, that the HIV incidence was higher in women using N-9 than in women using a comparison product. While a disappointment with regard to the rapid deployment of an effective microbicide, these results also raised questions about the safety of N-9 when used for its main indication, protection against unwanted pregnancy. After presentation of the preliminary results from the study in July 2000, the World Health Organization (WHO) was approached to provide an assessment of the scientific information regarding the safety and effectiveness of N-9 when used for family planning purposes. This summary should permit Member States to assess the risks and benefits of N-9 use among women in their country who may be at risk of HIV infection from inadequately protected sexual activity. Accordingly, the WHO Department of Reproductive Health and Research (RHR) convened a Technical Consultation in October 2001, in partnership with the CONRAD Program, Arlington, VA, USA, to review the available evidence and provide advice to member states on the use of N-9. The Consultation included experts from developed and developing countries with experience in product development, safety assessment, and public health and representatives from collaborating agencies (Annex). Reviews of key issues were commissioned prior to the meeting and are summarised in this report. The meeting also considered the submitted manuscripts from recently completed studies directly relevant to the safety and effectiveness of N-9. This report summarises the evidence presented to the meeting on the safety of N-9 and its effectiveness for protection against pregnancy, sexually transmitted infections (STIs) and HIV. The meeting concluded with recommendations on the use of N-9 and identified key areas of uncertainty where more research was urgently required. (excerpt)
Cross-country determinants of declines in infant mortality: a growth regression approach.
The past decade has seen a profusion of research that estimates growth regressions. Using cross-sections or short cross-country panels, these models regress the growth in real per capita income on real per capita income in a base year and other possible determinants of economic growth. While some of the questions that this research addresses are of theoretical interest, most notably the question of conditional convergence of real incomes across countries, most of the papers are quite practical, attempting to inform policy by identifying variables that explain growth rates. It is easy to be skeptical of these regressions. Specifications are often ad hoc. Many regressors would seem to be endogenous, but are not instrumented, or are instrumented poorly. And early on, there was clear indication that results are not robust. Levine and Renelt (1992) showed that almost all of the regressors that authors have proposed as important determinants of economic growth do not survive an extreme bounds analysis. These problems are compounded by the abundance of potential explanatory variables that authors have proposed – Durlauf and Quah (1999) found more than 90 in a recent review of the literature – and the relative scarcity of data, there being only about 120 countries with data available for the basic set of regressors. In such an environment, statistics alone cannot determine the appropriate model of growth determinants. Despite these limitations, many of the growth regression papers have figured prominently in the debate about economic policy and economic growth. Some economists, and probably more policy makers, have been persuaded of the value of open trade, low budget deficits, financial deepening, and an educated workforce. In this paper, I pursue the growth regression model, warts and all, but with a change of variable. Rather than explaining increases in GDP per capita, I attempt to explain decreases in the infant mortality rate. (excerpt)
USAID / Nigeria HIV / AIDS strategy assessment report.
This report includes the findings of a six-person team that carried out a preliminary assessment of the USAID HIV/AIDS assistance portfolio in Nigeria, in March 2002. USAID/Nigeria is in the third year of a four-year transition strategy that has included substantially more support for HIV/AIDS prevention and care activities. The team was asked to review the HIV/AIDS transition strategy and program, meet with partners, assess recent program changes, suggest priorities for the remaining 18 months of the current strategy, determine information gaps, and recommend analytical activities to support the Mission’s design of a new multiyear strategic plan later this year. Nigeria’s social indicators are among the worst in the world. The Bureau for Global Health recently assessed the needs in all USAID supported countries and determined that Nigeria has the fourth largest number of adults infected with HIV in the world—3.47 million—the highest number in West Africa and the third highest in sub-Saharan Africa. (excerpt)
Cambodia has experienced years of political turmoil that have significantly impaired its development, including its health care system. In 1975, the Khmer Rouge took control of Cambodia, installing a repressive regime that decimated the country and its educated class, including health professionals. By the end of the Khmer Rouge’s reign, there were less than fifty western-trained doctors left in the entire country. Vietnam invaded Cambodia in 1978, toppling the Khmer Rouge. However, civil war continued until relatively recently. Over the past four or five years, Cambodia has achieved a degree of stability, which has led to some economic and social improvements. Despite this progress, Cambodia has some of the worst health indicators in Southeast Asia and continues to suffer from a shortage of adequately trained medical staff. Health care quality is tremendously uneven, while large portions of the population continue to use traditional health care or do not seek health care at all. In Cambodia, the international community has focused most of its efforts on rebuilding the public health sector, which is typical in post conflict settings. While this effort has achieved significant results, the private sector also has an important role to play in rebuilding a country’s health systems and contributing to positive health outcomes. In fact, it is estimated that most Cambodians obtain outpatient health services from the private sector. In Cambodia, however, the private sector is not without problems. The private sector has grown quickly; is largely unregulated; and there is a huge variation in the quality of products and services provided. (excerpt)
Condom social marketing assessment in Guyana.
The objective of this condom social marketing assessment is to provide an analysis of objective, current information and the views of stakeholders on the viability of a condom social marketing program in Guyana. The report will be used primarily by the USAID/Guyana Mission to facilitate its FY2003 obligation for HIV/AIDS programming. The report may also be circulated to other interested parties, including the National AIDS Program Secretariat in the Ministry of Health, and to other donor agencies. The consultancy was conducted in Guyana March 11–28, 2002 by Alan Handyside, an independent social marketing consultant. The consultant met with USAID/Guyana officials and a variety of stakeholders and potential partners who were identified by USAID/Guyana and the consultant. They included officials in the Ministry of Health, the National AIDS Program Secretariat, the chief medical officer, and representatives of nongovernmental organizations and religious groups. Additional meetings were held with other donors, advertising agency representatives, and private sector distributors of condoms and other pharmaceutical and consumer goods. The consultant gathered information on condom procurement, distribution, and importation statistics from government and private sources. He also visited public sector condoms distribution sites and private sector wholesale trade and retail outlets that sell condoms in Georgetown and other semiurban areas. The consultant met with USAID officials again on March 26th to relay his assessment, and delivered a draft report on March 28th. (excerpt)
Compendium of indicators for evaluating reproductive health programs. Volume I.
The general objective of this Compendium is to encourage program evaluation and to improve the quality of work in this area. To this end, the Compendium provides a comprehensive listing of the most widely used indicators for evaluating reproductive health programs in developing countries. Moreover, the indicators are organized according to a revised version of the conceptual framework originally developed under the Evaluation Project. This framework maps the pathways through which programs achieves results, and it constitutes a logical framework for developing an evaluation plan with appropriate indicators. The original framework, created for family planning programs, is readily adaptable to other areas of reproductive health. Many sections of the Compendium contain more detailed frameworks that explain the pathways for program effects specific to the topic area in question. Whereas some past evaluation efforts have treated the operations of reproductive health programs as a "black box," this framework specifies how those who design the program expect it to work to achieve results at both the program and population level. Moreover, the framework draws attention to the different aspects of programs (operational areas, access to services, quality of care) that must be working satisfactorily to achieve the desired end result. The specific objectives of this Compendium are: To compile in a single publication a menu of reproductive health indicators judged most useful in evaluating reproductive health programs at both the program level and population level; To define these indicators in an effort to enhance the consistent use of terms across programs, countries, and donor agencies; and To promote evaluation of programs by making indicators readily available to evaluators. (excerpt)
Because resources for HIV prevention programs and monitoring and evaluation of AIDS prevention interventions are extremely limited, there is an urgent need to focus interventions where they are most cost-effective. Areas with higher incidence of HIV infection have been dubbed high transmission areas (HTAs). Empirical population based studies to identify areas with high HIV incidence are rarely conducted due to cost, feasibility, logistics, loss to follow-up, and ethical concerns. This protocol describes a rapid and systematic assessment method to identify areas likely to have high incidence of HIV and specific sites within these areas where AIDS prevention programs should be focused. The method does not include any STD or HIV testing. The PLACE method was developed based on epidemiological models of the HIV epidemic and empiric data showing geographic clustering of sexually transmitted infection in communities. The initial “core group” concept introduced by Yorke in 1978, the mathematical models developed by Anderson and May, and the recent phasespecific model described by Aral and Wasserheit all highlight the importance of the rate of new sexual partner acquisition in a community and its pattern of sexual networks. An important barrier to developing network informed interventions has been the lack of rapid, reliable and valid field methods for describing the dynamic web of sexual partnering and needle sharing in a defined population in a way that is useful for intervention planning. (excerpt)
Literature database for evaluating HIV / AIDS interventions. Version 1.0.
HIV/AIDS interventions are currently being designed and carried out in the developing world. Some of these interventions are evaluated by randomized controlled trials, with accompanying cost analyses, and others are evaluated with small cross-sectional surveys. The process of designing and evaluating interventions can be difficult and time-consuming due to the wide variety and complexity of epidemiologic and ethical issues related to HIV/AIDS. In order to provide assistance to those responsible for implementing prevention studies and to those studying the results, a systematic review of the HIV/AIDS and sexually transmitted infections (STI) intervention literature was conducted. The literature review was used to develop a searchable Excel workbook of published and nonpublished HIV/AIDS intervention studies in the developing world. (excerpt)
Relationships between abortion and contraception in republics of the former Soviet Union.
The principle objective of this paper is to examine the current balance and interactions between contraception and abortion in four countries of the former Soviet Union. We describe current levels and recent trends in contraceptive use, as well as the extent to which women/couples utilize induced abortion as a means of preventing unintended births. Having described the current situation in regard to birth prevention methods within union (i.e., contraception and abortion), we then attempt to determine how abortion and contraception interact in the population as a whole. The purpose of this exercise is primarily to make determinations as to the likely impact on abortion rates of various changes in contraceptive and other behaviors that directly or indirectly affect abortion. It will be potentially of considerable value for policymakers and others involved in reproductive health programs to know what types of changes are likely to have the greatest effect on abortion incidence. (excerpt)
The assessment was conducted during March-April 2001. PSI's regional representative for CEE/NIS, Michael Holscher, and product specialist Richard Harrison spent almost four weeks in the three countries conducting interviews with key representatives of USAID, host government institutions, health providers, leading non-governmental organizations (NGOs), international donors and multilateral agencies, advertising agencies, television and radio outlets, market research firms, consumer product and pharmaceutical distribution companies, and pharmacists and commercial retailers. Mr. Holscher and Mr. Harrison toured cities, transportation hubs (e.g. train stations, truck stops), communities of internally displaced persons (IDP), needle exchange points, and other potentially high-risk environments for HIV/STI transmission, and talked informally with members of potential at-risk populations for HIV and STIs. The purposes of this report are to: 1) summarize the activities and findings of the March- April 2001 assessment; 2) make recommendations to USAID/Central Asia concerning whether and how to proceed with a social marketing intervention; and 3) provide a preliminary action plan for any such intervention. This report includes a summary of relevant data concerning the current HIV/STI situation in Kazakhstan, Kyrgyzstan and Uzbekistan. Since social marketing is primarily concerned with issues surrounding delivery of prevention information, products and services, the authors have not included detailed technical data related to HIV/STI diagnostics and surveillance. (excerpt)
Representative national nutrition survey, Tajikistan (Sughd, RRS, Kouliab and Kurgan Teppe regions).
The survey goal was assess the nutritional status of children aged from 6 to 59 months old and their caregivers in 4 administrative regions of Tajikistan and to conduct a causal analysis of the current situation to provide insights into specific factors causing malnutrition in each of the 4 regions. The specific objectives of the survey were to: To evaluate the rates of malnutrition of children aged 6-59 months; To evaluate the nutritional status of the primary caregivers of these same children; To identify variations in malnutrition and influencing factors among the 4 administrative regions of Tajikistan; To assess the relative importance of different factors that cause acute malnutrition of children and their caregivers; To make relevant comparisons between the present survey and the National Nutrition Surveys of 2000 and 1999 where possible. (excerpt)
We evaluated the impact on HIV-related risk of two models of a 100% condom use intervention among establishment-based female sex workers in the Dominican Republic. In Santo Domingo a solidarity-based “100% condom use” model was implemented. This was compared to a combined solidarity and government policy model implemented in Puerto Plata. Both models were evaluated using data from pre- and post- intervention crosssectional surveys, participant observations, and LCR testing for STIs among participating sex workers. Monthly cross-sectional data monitoring participating sex establishments’ compliance with the intervention was also collected over the course of the one-year intervention to support pre-post evaluation findings. Statistically significant improvements in all study outcomes were observed among female sex workers in Puerto Plata where the integrated solidarity and government policy intervention arm was implemented. For example, among participating sex workers in Puerto Plata, reported consistent condom use with all sexual partners in the last month increased from 44.0% to 66.0 (OR 2.46; CI 1.63-3.72); ability to reject unsafe commercial sex increased from 50.0% to 77.9% (OR 3.85; CI 1.79-8.29) and STI prevalence decreased from 28.8% to 16.3% (OR 2.08; CI 1.28-3.37). Environmental-structural interventions that combine institutional and community-based solidarity with government policy and regulation were effective in reducing HIV-related risk among female sex workers. (excerpt)
USAID TB joint assessment team report.
The main objective of the team's visit was "to prepare a proposal for a USAID/Santo Domingo two-year strategy to mitigate TB in the Dominican Republic”. The purpose of the team's visit was to assist USAID/SD in the review of the new TB activity with the following expected outcomes: (1) Recommendations to strengthen various components of the TB control program including policy development or reform, case detection by smear microscopy, lab capacity and quality control, drug availability, monitoring and information systems, and directly observed treatment (DOT); (2) Recommendations regarding geographic focus of USAID supported programs; (3) Estimation of the quantities of medications required for TB treatment; (4) Estimation of the resources needed to accomplish the objective; (5) Provisional monitoring plan, including results and indicators. (excerpt)
The African Growth and Opportunities Act (AGOA) was signed into law on May 18, 2000. The act provides opportunities for African nations to increase their economic cooperation with the United States by exempting from duties and quotas most products made in the eligible countries. AGOA is intended to foster economic and political development in sub–Saharan African countries by expanding access to U.S. trade and investment markets, thereby leading to long-run prosperity based on free markets and more democratic governments. Specifically, the objectives of AGOA are to Promote increased trade and investment between the United States and sub– Saharan African countries; Promote economic development and reform in sub–Saharan Africa; and Promote increased access and opportunities for U.S. investors and businesses in sub–Saharan Africa. (excerpt)
This manual is for community health program managers, field supervisors, and others who need to monitor and evaluate their programs. Most often people who have such a responsibility, also have to collect data as one of their tasks. The manual will aid them to train others in a simple and rapid method for collecting data to use for monitoring and evaluation of community health programs. It is called Lot Quality Assurance Sampling. LQAS has been used for about 75 years for industrial quality control purposes. But it has been adapted for community health practitioners to use over the past 15 years. Now it is used all over the world to assess coverage in communities with programs in maternal and child health, family planning, and HIV/AIDS; to assess the quality of health worker performance, and even to assess disease prevalence. This manual presents LQAS in a very user friendly way so that they can train almost any supervisor or community health worker how to use the method for the first type of application – which is the most often used application. This manual is written from the point of view of NGOs as the users. However, all of the materials can be easily adapted for any other user. We encourage Ministry of Health staff, UN Agencies and any others to use this manual. Where ever you read NGO or NGO catchment area, think of a large area that corresponds to your administrative unit. For example, an NGO catchment area could be a district or sub-district area. (excerpt)
A half of all pre-school children and pregnant women in rural Bangladesh are anemic, a prevalence that indicates a severe public health problem, according to new data from the Nutritional Surveillance Project. A national anemia survey completed in November 2001 during routine nutritional surveillance has also shown that about one third of school-age children, adolescents and non-pregnant mothers had low hemoglobin concentrations. The data indicate that 23 million children in rural Bangladesh and 9 million women of reproductive age are anemic. The scale of the problem, the harmful effects of anemia on child growth and development, and the danger anemia poses to the lives of pregnant women and their unborn babies are clear reasons for key stakeholders to urgently tackle this problem. Until fortified foods become widely available, or until poor rural people eat enough foods rich in micronutrients, iron supplements will be a key means to prevent and control anemia in Bangladesh. All opportunities to deliver iron supplements to children and women need to be explored. (author's)
Family planning financial analysis and projections for 1995 to 2020. Kenya.
This report is based on (1) an analysis of family planning expenditures and costs in Kenya during the two-year period 1995-97, the most recent period for which data are available, and (2) recent population and family planning projections based on the results of the 1998 Kenya Demographic and Health Survey (KDHS-III) (NCPD 2000). Initial results of the expenditures and cost analysis were presented at a workshop held in Nairobi in November 1998, co-sponsored by the National Council for Population and Development (NCPD), the Division of Primary Health Care (DPHC) of the Ministry of Health, and USAID's POLICY Project. Appendix C gives a list of workshop participants. Data collection and technical analysis of family planning expenditures and costs were carried out by POLICY Project consultant Amos Kimunya in collaboration with staff of the NCPD, the Ministry of Health, and the Family Planning Association of Kenya. Many international organizations were also very helpful and cooperative in providing information on expenditures related to family planning. (excerpt)
In early 2003, UNDP and UNIFEM launched a project to prepare a gender analysis of the Millennium Development Goals (MDGs) in Cambodia in tandem with the preparation of the First Country MDG Report for Cambodia. The project was intended to provide support for gender mainstreaming to the on-going national MDG localization process, as well as produce a stand-alone gender assessment of the MDGs in Cambodia. The description of the project is summarized in the project document: "The over-arching objective of the initiative is to promote a broader national constituency on Gender and the MDGs through strategic and information-based partnership development approach involving key counterpart institutions from Government and civil society. The principal means to achieve the objective is to carry out analyses complementary to the scheduled MDG report for Cambodia (2003) towards achieving the MDG on Gender Equality and Empowerment of Women and as an input for developing the CCA (2004), UNDAF (2006-2010), and the NPRS review process. The SPPD shall assess the present situation and trend, including policy and institutional review, in relation to gender equality and women's empowerment with a view to localizing feasible and realistic targets, including addressing statistical needs to engender the MDGs. Such an exercise will be complemented with ongoing opportunities to further develop capacity within Council for Social Development (CSD), Ministry of Women and Veteran Afairs (MO WVA) and Poverty Monitoring and Analysis Technical Unit (PMATU) in support of the national MDG localization and assessment exercise. In the course of the process advocacy activities will be carried out in partnership with local Women NGOs.” (excerpt)
Population and family planning projections, 1989 to 2020. Kenya.
This report is based on several documents as well as a five-day workshop, held from 9-13 November 1998 in Nairobi, titled "Using the spectrum Models and Data from KDHS-III to Produce Revised and Updated Population and Family Planning Projections for Kenya." Spectrum is a family of models of the POLICY Project. The projections produced by the workshop participants and described in this Report used the following three Spectrum models: DemProj, FamPlan, and AIM (AIDS Impact Model). The principal document used for this analysis is the Final Report of the Kenya Demographic and Health Survey 1998 (National Council for Population and Development, 1999). The November 1998 workshop was co-sponsored by the National Council for Population and Development (NCPD) of the Ministry of Finance and Planning, the Division of Primary Health Care (DPHC) of the Ministry of Health, and USAID's POLICY Project. Appendix C gives a list of workshop participants. The workshop was timed to take advantage of the publication of the Report of the results of the 1998 Kenya Demographic and Health Survey, the KDHS-III. (excerpt)
A diagnostic study on the involvement of people living with HIV/AIDS (PLHA) in the delivery of community-based prevention, care and support services was conducted in Burkina Faso, Ecuador, Zambia, and Maharashtra State in India. The study was one of the activities of the USAID funded Horizons Program of the Population Council, that is implemented in partnership with five other organisations, including the International HIV/AIDS Alliance, which co-ordinated this research with the participation of local researchers and non-government organisations (NGOs) and community-based organisations (CBOs) in each of the four countries. The objectives of the study are to: Describe the current types of PLHA involvement in NGOs and CBOs. Identify factors limiting or enhancing PLHA involvement in these organisations. Identify the impact of involvement on the quality of life of PLHA beneficiaries, on families and communities, on the NGOs and CBOs themselves, and on the relevance, quality and effectiveness of services provided by these organisations. Assist participating organisations to identify strategies to increase PLHA involvement, in order to improve the relevance, quality and effectiveness of their services. (excerpt)
Women's reproductive rights in Egyptian legislations.
The 1971 Egyptian Constitution provided that "The family is the basis of the society, founded on religion, morality, and patriotism", and that "the State is keen on preserving the genuine character of the Egyptian family with all values and traditions represented by it while affirming and promoting this character in the interplay with the Egyptian society" (article 9). The Constitution also stated that "The State shall guarantee the protection of motherhood and childhood, look after children and youth and provide the suitable conditions for the development of their talents" (article 10). It also stated in Part Three on freedoms, rights, and public obligations that all citizens are equal in rights and obligations, regardless of their gender, race, language, or religion. "The State shall guarantee coordination between women's duties towards her family and her work in the society, considering her equal to man in the political, social, cultural, and economic spheres without detriment to the rules of Islamic jurisprudence (Sharia)" (article 11). Islam as well constitutes a revolution in emphasizing the status of woman, as it opened the door wide for her education, and ranked her high in all stages of her life. It also gave her full legal and financial capacity when she reaches the age of maturity. However, there is a wide gap between the legal and the actual situation of women, due to many reasons: 1) Women's ignorance of their legal rights and obligations. 2) Women's illiteracy and school leaving. 3) Some habits and traditions that marginalize the role of women. 4) Difficult social conditions as well as low standards of living. We shall discuss the position of women in the personal status legislations, labor legislations, and social insurance laws. (excerpt)
Increasing the coverage of reproductive health issues in Egyptian press project.
This project was designed to contribute to the strategic objective of the USAID/Egypt Mission of reducing the total fertility rate from 3.63 to 3.45 by the year 2001 through its intermediate result of improving the policy environment. It also contributed to the FRONTIERS Project's intermediate result of disseminating and utilizing research for policy and program improvement. The POLICY Project's intermediate results of promoting effective advocacy for family planning and reproductive health and using information for policy and program development also were addressed. 1. Ultimate Objective The ultimate objective of this project was to increase the use of contemporary reproductive health and family planning research by multiple audiences and to maximize the impact of research findings on policy and program management by increasing the coverage in Egyptian Arabic newspapers and magazines. 2. Immediate Objectives This 14-month project addressed the following short-term objectives: Enhance journalists' knowledge of specific topics related to population and reproductive health issues. Improve the content and the quality of reporting in the Egyptian Arabic language press. Increase the coverage of reproductive health issues in leading daily and weekly newspapers and magazines in Egypt. Strengthen the professional network of talented journalists interested in and committed to covering reproductive health issues. (excerpt)
A diagnostic study on the involvement of people living with HIV/AIDS (PLHA) in the delivery of community-based prevention, care and support services was conducted in Burkina Faso, Ecuador, Zambia, and Maharashtra State in India. The study was one of the activities of the USAID funded Horizons Program of the Population Council, that is implemented in partnership with five other organisations, including the International HIV/AIDS Alliance, which co-ordinated this research with the participation of local researchers and non-government organisations (NGOs) and community-based organisations (CBOs) in each of the four countries. The objectives of the study are to: Describe the current types of PLHA involvement in NGOs and CBOs. Identify factors limiting or enhancing PLHA involvement in these organisations. Identify the impact of involvement on the quality of life of PLHA beneficiaries, on families and communities, on the NGOs and CBOs themselves, and on the relevance, quality and effectiveness of services provided by these organisations. Assist participating organisations to identify strategies to increase PLHA involvement, in order to improve the relevance, quality and effectiveness of their services. This Summary highlights the main findings from the Society of Friends of Sassoon Hospitals (SOFOSH), one of the four organisations that participated in the diagnostic study in India. (excerpt)
NGOs and family planning in Egypt.
The family planning (FP) program in Egypt is not confined to its contribution to economic growth, but also extends to social change and human development. Since the end of the 1960s, FP has been considered a human right. Moreover, the state should provide all information and services which help individuals and couples voluntarily choose the number of children suitable for them. With better health and greater control over their reproductive lives, women can thus take advantage of education, employment, and civic opportunities. NGOs can play an important role in expanding the use of FP methods and in raising awareness of FP in the near future. NGOs interact with people in villages, and their outreach can be more effective than governmental agencies. NGOs are better able to ascertain community needs and resources and meet those needs. (excerpt)
National strategies for women's health and family planning.
Strategic planning is the process through which an institution or an organization determines what it intends to be in the future and how it will get there. Strategy is a military term; it is the art, or science, of planning and managing wide-scale maneuvers and campaigns. Tactic, on the other hand, is the action plan or the means to reach a basic target. The private sector and the business world have accumulated considerable experience regarding strategic planning. The acknowledgment of family planning's impact on women's and children's health indicators, women's and human rights, socioeconomic development, and the increased demand for these services; innovations in technology and service standards; developments in policies and public expectations; and global financial cuts have brought the family planning sector face to face with problems awaiting solutions. Family planning has become the key factor in the holistic approach to primary health care services. Strategic planning involves fundamental choices that relate to the future of family planning, such as the mission of the sector, its basic objectives, the program and services required to fulfill this mission, and the resources the sector will identify and tap into (human, monetary, technical expertise, service sites, etc.). In other words, in strategic planning the sector forms a common vision of what shape women's health and family planning will take by the year 2000. It chooses the opportunities it will use and miss to reach the desired future. (excerpt)
Nigeria national policy on population for sustainable development. Draft.
In 1988, the Government of the Federal Republic of Nigeria adopted the National Policy on Population for Development, Unity, Progress and Self- Reliance. This population policy was designed to improve standards of living and quality of life, promote maternal and child health, achieve a lower rate of population growth, and address questions of internal migration and population distribution. In part, because of protracted political instability and poor governance, limited progress was made in implementing the 1988 policy. The commitment of government to improve the quality of life of the Nigerian population is expressed in the series of development plans it has embarked upon since 1960. The government recognises the intricacy of population-development relationships and the importance of population factors in the development of the country. At present, there is increased awareness of population issues and the need to integrate population elements into development planning. All stakeholders need to appreciate the linkages of population factors with broader developmental issues like housing, education, health, agriculture, energy, environment, gender concerns, food security and security of life and property. In spite of previous efforts at improving the quality of life, poverty persists among a large proportion of the Nigerian people. Nationally, the level of social and economic development is low. Public and private sector enterprises suffer from low productivity, and there is a high rate of unemployment and underemployment. The low per capita income, especially among people in rural areas, limits their access to quality health care and other basic social services. A number of socio-economic and cultural factors, including the high infant mortality rate, encourage parents to want many children. This situation further adversely affects the reproductive health status of women and the survival of children. (excerpt)
African Development Foundation. Annual performance report to the Congress, Fiscal Year 2002.
This report discusses the African Development Foundation's (ADF) performance during Fiscal Year 2002. It responds to the Government Performance and Results Act of 1993 (GPRA), as amended by the Reports Consolidation Act of 2000, which requires U.S. Government agencies, including independent agencies and Government corporations, to submit strategic plans, annual performance plans and annual program performance reports to the President, Congress, and OMB. (excerpt)
Social franchising reproductive health services: Can it work? A review of the experience.
The objectives were to provide an introduction to social franchising and examine its potential to help improve access to sexual and reproductive health (SRH) services in developing countries and to develop guidelines for social franchising in reproductive health. The methods used were a review of the experience of franchising in the reproductive health field, particularly two initiatives in Mexico and the Philippines funded by the United States Agency for International Development (USAID). The study evaluates various social franchises and compares social and commercial franchising in order to develop guidelines for social franchising in reproductive health. Social franchises in Mexico and the Philippines were visited and evaluated as part of the study. The two franchises exhibited advantages and disadvantages in common, but neither represented an entirely successful example of social franchising from which to build a model. In terms of benefits, users received consistent standards of care at affordable prices, nongovernment organisation (NGO) franchisors were able to focus on financial sustainability and franchisees benefited (perhaps disproportionately) from subsidies and support in running their businesses. The study found that social franchising has some potential to be used in reproductive health. Franchising can employ a wide range of skilled, semi-skilled and unskilled but trainable people in developing countries to expand access to good quality, affordable family planning and other reproductive health services in the private sector. (author's)
Purpose of the LQAS Workshop: Train participants in how to conduct surveys to collect data for establishing baselines and for regular monitoring. Train participants in how to analyze data to identify priorities for improving program coverage. Skills to Be Learned: LQAS Sampling Methods; Interviewing Techniques. (excerpt)
A diagnostic study on the involvement of people living with HIV/AIDS (PLHA) in the delivery of community-based prevention, care and support services was conducted in Burkina Faso, Ecuador, Zambia, and Maharashtra State in India. The study was one of the activities of the USAID funded Horizons Program of the Population Council, that is implemented in partnership with five other organisations, including the international HIV/AIDS Alliance, which co-ordinated this research with the participation of local researchers and non-government organisations (NGOs) and community-based organisations (CBOs) in each of the four countries. The objectives of the study are to: Describe the current types of PLHA involvement in NGOs and CBOs. Identify factors limiting or enhancing PLHA involvement in these organisations. Identify the impact of involvement on the quality of life of PLHA beneficiaries, on families and communities, on the NGOs and CBOs themselves, and on the relevance, quality and effectiveness of services provided by these organisations. Assist participating organisations to identify strategies to increase PLHA involvement, in order to improve the relevance, quality and effectiveness of their: services. (excerpt)
The U.S. Agency for International Development (USAID) has a long track record in working with community- and faith-based organizations. This worldwide work has included issues as varied as promoting models of good governance to improving the economic prospects of vulnerable populations. This basis of firm commitment has been extended to the realm of HIV/AIDS, where increasingly community and faith responses to the epidemic are playing a central role. Actively addressing the HIV/AIDS epidemic requires a strong and coordinated response from all sectors of society - government, civil society, the private sector, and the international community. This report highlights the meaningful role that community- and faith-based efforts play within our larger and collective response. (excerpt)
Gender-responsive programming for poverty reduction.
Despite all the efforts made at the national and international level to understand and reduce poverty, little success has been achieved in narrowing the gender gap. Actually a woman's multiple responsibilities continue to subject her to time constrains and time poverty. In Sub-Saharan Africa (SSA), girls spend four times more on productive tasks than boys'. While girls spend most of their time working on the farms and doing house chores, the boys go to school. Women in Africa are under represented in public institutions at the local and national levels and have very little to say in decision-making. Women in SSA represent only 6% of national legislatures, 10% at the local level and 2% in national cabinets. There is need to focus on promoting gender equality since men and women experience poverty differently and are affected differently. Women are more vulnerable to poverty because of inequalities in access to productive resources, lack of control over their labour and earned income. Since men and women experience poverty differently, these difference need to be taken into account if the causes of poverty are to be adequately understood and addressed. In some societies, women are also subjected to socially imposed constrains that further limit their opportunities to improve their economic and social conditions or to enjoy equal access to public services and consumption with required goods. While some poverty alleviation initiatives need to identify and address the engendered root causes of poverty that target both men and women and the values and structures that promote gender inequality, others should be designed to specifically target poor women so as to immediately initiate the processes of addressing and redressing the sex specific imbalances in the causes, experiences and effects of poverty. The World Bank has identified four dimensions of poverty that can be used as a framework for the analysis design, implementation, monitoring and evaluation of gender-responsive poverty alleviation programmes. These are opportunity, capacity, security and empowerment dimensions. UNFPA's efforts to address poverty from a gender perspective are based on integrating gender concerns in all its programming processes and addressing specific issues that contribute to poverty related gender disparities. Infact, gender concerns are part and parcel of the core UNFPA programming. It is very important that UNFPA and its collaborating partners strengthen the gender analysis components of country programmes, poverty reduction and common country assessments. It is also important to ensure that approaches to participatory research and policy dialogue address the gender biases that currently exist between men and women. Strategic gender interests are related to gender-response programming for poverty reduction that takes into account women's status and equity. In the African context these include legislating for equal rights, reproductive choice and increased participation in decision-making. This publication is about gender-responsive programming for poverty reduction in Africa. It demonstrates how gender inequality contributes to poverty, slows economic growth and reduces human well-being. Eliminating gender gaps and gender inequality means bringing the disadvantaged at par with the favored, something that is yet to be achieved in access to education and health in many African countries. (author's)
Final evaluation of the pilot health project in the West Bank and Gaza.
The goal of the Pilot Health Project (PHP) was to improve the health status of Palestinian mothers and their children. It was the first major initiative in support of the "Healthier Palestinian Families" Strategic Objective later adopted by the USAID/WBG Mission. Given the history of its development, its main technical reference (the Concept Paper), and the course of its implementation, the evaluators summarize the purposes of the PHP as follows. 1. To develop and implement a pilot activity that could serve as a basis for a national scale-up to improve the health status of Palestinian women and their children. This aspect of the PHP explains part of the investments made and the challenges faced by the Mission. 2. To offer and test the effectiveness of a basic package of health services in approximately 27 health clinics in 3 pilot areas. This package, initially based on integrated antenatal, postpartum, and related outreach services, slightly changed during the course of the project implementation. 3. To test 3 experimental service delivery interventions to improve health practices and health seeking behavior related to antenatal and postpartum care and to birth spacing: Involvement of male motivators in promotion of reproductive health; Enhanced postpartum services to low parity mothers; Coordinated hospital and clinic follow-up post delivery. 4. To design a Management Information System for reproductive and child health within primary health care settings. This activity, initially aimed at monitoring service enhancements within the scope and timeframe of the PHP, embraced a broader goal in the course of project implementation. (excerpt)
Indonesia ICPD + 10 field inquiry questionnaire.
Population factors have been integrated in the Indonesia's development efforts aimed at improving people's welfare ensuring the adequacy of basic needs and services: food, clothing, dwelling, as well as the availability and accessibility of education and health services. Even before the ICPD 1994, Indonesia enjoyed the increase in employment and income; educational attainment of boys and girls, decreasing infant and child mortality, declining fertility largely attributed by family planning programme. These in turn reducing the speed of population growth caused demographic transition leading to changes in age structure bearing economic and social consequences of the lives of Indonesian, and government's responsibility in providing ever increasing basic needs and services to the changing society. Economic growth is the underlying factors in the success of social development programmes. (excerpt)
Adolescents: profiles in empowerment.
More than 1 billion girls and boys around the world are in their second decade of life. About 85 per cent of these young people live in developing countries. Young people face enormous challenges to learn, form relationships, shape their identities and acquire the social and practical skills they need to become active and productive adults. Adults, parents, decision makers and the world community at large have a moral and legal obligation to ensure the rights of adolescents and help them develop their strengths in a supportive and safe environment. Adolescence can be perilous, particularly for young people struggling in poverty, especially for girls. Adolescence is often the time when "the world expands for boys and contracts for girls. Boys enjoy new privileges reserved for men; girls endure new restrictions reserved for women. Boys gain autonomy, mobility, opportunity and power; girls are systematically deprived of these assets." (excerpt)
Regional Technical Assistance Project 5825, Strengthening Safe Motherhood Programs. Final report.
Over an 18-month period from 1999 to 2001, six Asian countries - Cambodia, Indonesia, Lao PDR, Nepal, Pakistan, and Papua New Guinea - participated in a regional technical assistance (RETA) project under the auspices of the Asian Development Bank (ADB) and UNICEF's East Asia and the Pacific (EAPRO) and South Asia (ROSA) regional offices. The Futures Group International (Futures) provided technical assistance. The project (a) conducted in-depth reviews of the six countries' current maternal care situations, and reexamined reasons for the lack of progress in improving maternal care and redefining strategic priorities; b) visited Malaysia to learn first hand from its successful program; and (c) prepared five-year implementation plans. Three regional meetings held during the RETA project (in Bangkok, Kuala Lumpur, and Katmandu) encouraged cross-national learning. Bangladesh participated in these meetings to share lessons learned from its approaches to safe motherhood. This report is based mainly on the learning during this process. All RETA project countries adopted a common framework for examining their safe motherhood policy and program situations and for engaging in strategic planning activities. The framework reflects elements of clinical and public health approaches and is composed of three dimensions: communities and households, service delivery, and institutions and policies. Major issues with each dimension were identified as impeding RETA countries' progress toward safer pregnancy outcomes. AZ1 three framework dimensions embody women's rights, reflecting this issue's cross-cutting nature. (excerpt)
When people first learn about obstetric fistulas and their disastrous effects, the usual reaction is to reject hearing more-the subject is just too unpleasant. Rejection is exactly what happens to fistulas' survivors. An obstetric fistula is an injury of a woman's birth canal that most often occurs when a very young girl is pregnant and experiences a long and obstructed labor. The baby usually dies. The mother, if she survives, suffers tissue damage to the birth canal that becomes an opening between the vagina and the bladder or rectum. This creates a constant leakage of urine or feces, sometimes both. The results are devastating. The girl is unable to stay dry. Her genital area ulcerates from the wetness and she suffers from frequent infection. The smell of urine or feces is constant and humiliating. Rather than being comforted as a survivor, the girl may be considered unclean and ostracized from her family and community, even blamed for her own condition. Often she is abandoned by her husband. On top of this, the girl grieving for her stillborn child may also suffer pain or crippling from nerve damage to her legs. (excerpt)
Radio broadcasting for health: an issues paper.
This paper sets out, analyses and discusses a number of key issues that DFID decision makers may face when considering support for radio based health information initiatives. Radio interventions are now a common facet of health sector programmes, such as HIV/AIDS, TB and Malaria prevention, in most of the partner countries in which DFID works. Radio constitutes just one of many different electronic and social fields through which information may be obtained. Therefore, decision makers need to first ask themselves if radio is the most appropriate and effective communication option to build community involvement in health issues or to reach the specific risk groups. Sections 1.3, Box 2 and Footnote 2 point the reader to a wider range of Information and Communication for Development (ICD) options, both mass and interpersonal media, that may be employed in the health context. Radio provides a very useful example and the selection, assessment, and evaluation criteria that are applied to this popular medium can broadly be applied to other ICD interventions and initiatives. (excerpt)
Fact Sheet No. 23: Harmful traditional practices affecting the health of women and children.
Despite the apparent slowness of action to challenge and eliminate harmful traditional practices, the activities of human rights bodies in this field have, in recent years, resulted in noticeable progress. Traditional practices have become a recognized issue concerning the status and human rights of women and female children. The slogan "Women's Rights are Human Rights", adopted at the World Conference on Human Rights in Vienna in 1993, as well as the Declaration on the Elimination of Violence against Women, adopted by the General Assembly the same year, captured the reality of the status accorded to women. These issues have been further emphasized in the reports of the Special Rapporteur on harmful traditional practices, Mrs. Halima Embarek Warzazi, appointed in 1988, and in the draft Platform for Action for the Fourth World Conference on Women, to be held in September 1995. The Special Rapporteur on violence against women, its causes and consequences, Ms. Radhika Coomaraswamy, appointed by the Commission on Human Rights in 1994, has also examined all forms of traditional practices referred to in this Fact Sheet, as well as other practices, including virginity tests, foot binding, female infanticide and dowry deaths, all of which violate female dignity. In her preliminary report, the Special Rapporteur pointed out that blind adherence to these practices and State inaction with regard to these customs and traditions have made possible large- scale violence against women. States are enacting new laws and regulations with regard to the development of a modern economy and modern technology and to developing practices which suit a modern democracy, yet it seems that in the area of women's rights change is slow to be accepted. (E/CN.4/1995/42, para.67.) The harmful traditional practices identified in this Fact Sheet are categorized as separate issues; however, they are all consequences of the value placed on women and the girl child by society. They persist in an environment where women and the girl child have unequal access to education, wealth, health and employment. In part I, the Fact Sheet identifies and analyses the background to harmful traditional practices, their causes, and their consequences for the health of women and the girl child. Part II reviews the action taken by United Nations organs and agencies, Governments and organizations (NGOs). The Conclusions highlight the drawbacks in the implementation of the practical steps identified by the United Nations, NGOs and women's organizations. (excerpt)
Actor John Cusack highlights refugee health programs.
Increasingly, actors and entertainers around the world are expressing their concern for various global health issues such as HIV/AIDS, hunger, and education. From U2's Bono to Oprah Winfrey, these high-profile figures are publicizing the need for the world to focus on its poorest and neediest citizens. John Cusack has become the latest celebrity to call attention to the plight of the world's most vulnerable people. In late January, Cusack visited several refugee camps in Guinea, west Africa, where he toured the programs and operations of the American Refugee Committee (ARC). "It's amazing to me what a difference we can make in the lives of these people," explains Cusack. "They've lost their homes, members of their families, all of their possessions. Yet somehow, with the help of aid organizations like ARC, they recovered. They receive medical care, their kids get immunizations, and they learn job skills. And all of these services work together to slow the spread of diseases like HIV/AIDS. (excerpt)
In the slums of Metro Manila, a sprawling metropolis of more than 12 million people, little turquoise buildings peep out from rows and rows of battered one-story dwellings. With the median income of less than US $150 per month, health care is not a financial priority for most Filipinos and the need for affordable, quality health services is immense. But throughout the country, a quiet revolution by more than 200 midwives is changing the demographics of health care - one woman, one clinic at a time. (excerpt)
This past year has been historic. The global community, and particularly the U.S., has demonstrated a profound shift in the importance it accords to fighting AIDS around the world. With record levels of funding from the U.S. and indications that other donor nations are moving in the same direction, money is no longer our principal constraint in addressing the pandemic. Of course it's not enough, but now we'd better make sure it's spent wisely or this spigot could close as quickly as it was opened. The challenge of public health is that we must always be looking a decade or a generation ahead to the consequences of today's decisions. The focus that this new initiative places on treatment and care of those living with HIV gives those of us directly involved in the implementation of programs the opportunity to show that care and prevention truly are mutually reinforcing, and that the benefits of extending and improving life for those already infected will not come at the expense of those tens of millions at-risk but not yet infected, but rather lessen their risks. (excerpt)
Philippine government unveils new approach to tuberculosis treatment.
A chemonics study on the economic impact of tuberculosis in the Philippines has prompted the Philippine government to adopt a new policy for treating tuberculosis victims. The policy provides training and certification programs for medical professionals and financial resources to reimburse accredited healthcare facilities that diagnose and treat tuberculosis patients. "This policy standardizes diagnosis and treatment in public and private health- care facilities, and ensures that comprehensive and effective treatment will become available to more Filipinos," said Earle Lawrence Chemonics manager of the USAID-funded Philippine Tuberculosis Initiatives for the Private Sector (TIPS) project. Co-authored by a team of public health experts led by Dr. John Peabody, the "Burden of Disease" study concludes that "premature deaths due to tuberculosis are causing approximately PhP 27 billion (about U.S. $500 million) a year in forgone income." (excerpt)
What works in the fight against malaria?
A new Global Health Council report, Reducing Malaria's Burden: Evidence of Effectiveness for Decision Makers, highlights proven, feasible but often underutilized strategies in the fight against malaria. The report, written in collaboration with international health specialists and public health scientists, details the best available evidence on what works to prevent and treat malaria. Malaria kills an estimated 1-3 million people annually and inflicts life-long disabilities on millions more. The illness disproportionately affects women and children, particularly in sub-Saharan Africa where 90 percent of malaria deaths occur. While effective treatment has been available for decades, a rise in resistance to antimalarial drugs has made fighting malaria more difficult. "Tragically, more people die from malaria today than 40 years ago. In order to reduce the intolerable toll of malaria, we must use existing knowledge and treatments effectively and deliver them to those who are in greatest need," said Nils Daulaire, president and CEO of the Global Health Council. (excerpt)
CMMB helps community TB program become national model.
In a sun-drenched park in Monze, Zambia, a group of children dressed in their school uniforms join hands and, with bright smiles exclaimed, "DOTS cured me - it can cure you too!" Such was the theme of last year's World TB Day, when medical professionals, former tuberculosis sufferers and their families convened not to mourn the resurgence of the disease, but to celebrate the success of the DOTS (Direct-Observed Therapy Short-Course) program in helping combat tuberculosis in their community. Since 1999, Catholic Medical missions Board's (CMMB) TB-DOTS program, in collaboration with the Monze District Health Board and the Christian Health Association of Zambia (CHAZ), has been working to reduce the threat of tuberculosis in the Monze community. Due to its success, the program has become a model for nationwide implementation. Through the provision of tuberculosis medicines, as well as training, infrastructure building and the provision of modern laboratory equipment, CMMB has helped treat an estimated 6,000 people over the course of four years and has continued its support with the addition of training programs in the Lusaka, Eastern and Southern Provinces in Zambia. (excerpt)
Introduction of post-abortion care in a conservative context: the case of Niger.
Niger, vast and dry, is a very poor country even by comparison to its West African neighbors. It is ranked next-to-last in the U.N. Development Index, above only war-torn Sierra Leone. On average, girls marry by 15 years of age, and give birth before their 18th birthdays, At 7.5 births per woman, total fertility rates are among the world's highest, yet less than one in five births is attended by skilled personnel. Over her lifetime, a Nigérien woman faces a one in 10 threat of dying from maternal causes - even higher than the one in 16 risk for sub-Saharan Africa overall. Culturally, Niger is a deeply traditional, pronatalist society with strong religious values. It has among the most restrictive abortion laws in the world (only to save the woman's life), and there is very low social tolerance for abortion. Discussions around abortion-related questions tend to be uncomfortable and contentious. Yet hospital personnel treat many women with complications of induced abortion. (excerpt)
In recent weeks, a long-simmer conflict in Haiti has erupted to trouble an already troubled world. As an American doctor working in Haiti, I am writing to air my concerns about the conditions under which health care delivery must now take place. For weeks, the country's only large public teaching hospital has been paralyzed by violence and dissent. For years, economic pressure largely, though not wholly, resulting from an international aid embargo, has left almost nothing to invest in the care of destitute sick. For a sense of how meager the health investments have been, consider the experience of an American doctor who commutes between a Harvard teaching hospital and a squatter settlement in rural Haiti. In 2003 the budget of the entire Republic of Haiti, population 8 million, was less than $300 million. The 2003 budget of a single Harvard teaching hospital - and there are two-dozen Harvard teaching hospitals - was pegged at $1.3 billion. A longstanding dearth of funds for health care and other services coupled with a rising tide of violence and disarray have led to a terrible humanitarian crisis in Haiti, a crisis with deep roots. The past two weeks have seen an almost complete shutdown of services in much of Port-au-Prince. A report from the Pan American Health Organization, worth citing at length, offers small reason for optimism: (excerpt)
Highlighting children, adolescents on congressional study tour.
India is a feast for the senses - a rich tapestry of colors, textures and aromas enhanced by the warmth of its people. But balanced against its incredible beauty is a side characterized by widespread poverty and disease. Like many of its south Asian neighbors, India is engaged in a constant struggle to provide accessible health care services to its ever-growing population. From Jan. 6-12, 2004, the Global Health Council hosted a study tour of India with both Republican and Democratic congressional staff. Stopping in Mumbai (Bombay), Chennai (Madras) and New Delhi, the study tour focused on the health of children and adolescents. It provided participants with a comprehensive look at the challenges that face India - challenges that include basic child health interventions such as immunizations, the persistent problem of tuberculosis and the burgeoning threat of HIV/AIDS. Endemic to India's health care challenges are key infrastructure issues including poverty and the lack of clean water, adequate sanitation and good transportation systems. These exacerbate the prevalence of preventable illnesses for children under five such as diarrhea, malnutrition and tuberculosis. (excerpt)
During the 1980s, worldwide efforts to reduce childhood mortality achieved spectacular results. The rate of death for children under age five fell by 20 percent, from an average of 117 per 1,000 in 1980 to 93 per 1,000 by 1990. In that year, the World Summit for Children set a goal for the year 2000 of a further one-third reduction worldwide in childhood mortality, or to a rate less than 70 per 1,000, whichever was lower. Now the Bellagio Study Group on Child Survival, a team of child health experts assembled through the Rockefeller Foundation, has published a series of articles in The Lancet looking at the current health status of the world's children. The findings are discouraging. By the turn of the century, the death rate had fallen by just 10 percent, to 83 per 1,000. Only five of the 55 countries that had an under five-year death rate above 100 per 1,000 in 1990 achieved the targeted mortality reduction. Twenty children are dying every minute somewhere in the world, and the Bellagio Group estimates that two-thirds of these deaths could be readily averted by preventive and therapeutic strategies that are feasible but have not been fully implemented. The fact that so many children continue to die is a result of stagnated progress, missed opportunities, and growing inequities in provision of basic services - in short, what a Lancet editor termed a "worldwide public health disaster." (excerpt)
The world today is home to the largest number of young people between the ages of 10 and 24 that has ever existed - nearly 2 billion. On the one hand, in developed nations, this represents a force with incredible potential for notable achievement, but it also suggests the possibility of a major catastrophe as poverty and disease take their toll on too many young people in Africa, Asia, Latin America and the Caribbean. Truly, then, this is a generation on the edge. During the 31st Annual Conference of the Global Health Council, Youth and Health: Generation on the Edge, experts of all ages examine the critical issues that will determine what the future holds for today's youth. (excerpt)
Built on a dream: Gates winner builds futures.
Fazle Hasan Abed is a visionary. His dream is "a just and enlightened Bangladesh" where social equality, economic stability and access to quality health care are enjoyed by every man, woman and child in the country, regardless of their social status or where they live. But Abed is not simply a dreamer; he's also a doer who finds ways to convert dreams into realities. In 1971, the country of Bangladesh was torn out of tragedy and despair, carved out of eastern Pakistan after a typhoon devastated the region, which then exploded into a war of liberation that sent thousands into exile in India. At the time, Abed, who was living in Europe and working for Shell Oil, couldn't stand by and watch his new country struggle for survival against what seemed like insurmountable odds. At the war's conclusion, he left Shell and established a relief organization, the Bangladesh Rural Advancement Committee, to help with the resettlement and rehabilitation of the flood of refugees returning to Bangladesh from India. That was just the beginning. Recognizing the wider humanitarian needs of the Bangladeshi people, especially those oppressed by poverty and gender inequity, Abed has expanded BRAC, as it is now known, in ever broader directions, but always focused on the alleviation of poverty and empowerment of the poor, particularly women and children. Today BRAC has a staff of more than 26,000, in addition to 34,000 who work as part-time teachers in one-room schools, carrying that mission forward into 60,627 villages in all of the country's 64 districts. (excerpt)
Lusanda stares ahead, wide-eyed and scared, like a small child whose mother can't help her. She is only 13 and her mother is dead. She sits alone, listening to what the next 30 minutes will entail. She will first be given some basic information and asked a series of questions, repeating back what she has understood. Then she will sign her name on a form and take the test. Thirty minutes of anxiety will pass, and she will be given the results. Despite her age, Lusanda is not taking a test in school nor is she in a classroom with her friends. She is sitting with a nurse at her local health clinic, about to find out if she has HIV, the virus that causes AIDS. More than half of South Africa's adults with HIV - the largest number in the world - were infected before the age of 25; half of them will die before they reach their 35th birthdays, mostly of TB. A young woman like Lusanda, already sexually active, is at highest risk. Lusanda lives with her aunt in a sprawling township in South Africa's Eastern Cape, the country's poorest province. Sometimes, she spends the night at her boyfriend's, even though afterwards she is afraid to go home. Such was the case last weekend, and it is the reason she is in the clinic. Her aunt doesn't trust her and Lusanda and her partner don't always use protection. (excerpt)
Offering new hope with ancient remedies.
She is wearing her finest dress, shaded light green and splattered bright with white, yellow and fuscia flowers that jump as if to greet you as she sits down. Around her neck she has carefully tied a bright blue and green scarf, bringing her ensemble together with fuscia lipstick that matches the flowers in her dress. She sits with poise on the health clinic chair, located near her home in Tanga, Tanzania. Only her slight stature and a dress that is several sizes too big offer any hint that she may not be well. Like many of her fellow Tanzanians, Rose Kika is HIV-positive and showing signs of a disease that kills hundreds of Tanzanians every day. However, with the support provided by Tanga AIDS Working Group, 42-year-old Rose is optimistic about her future. In Tanga, located on Tanzania's east coast, the Tanga AIDS Working Group works to reduce HIV transmission and to assist people living with AIDS through health education, counseling and testing services and home-based care - all done in collaboration with traditional healers. Prior to 2003, this non-profit organization sensed program gaps as it struggled to find way of working more closely with traditional healers and to help HIV-infected community members. Unable to access expensive antiretrovirals, these patients increasingly looked to traditional healers for support. (excerpt)
Science, global health, and open debate [letter]
The Global Health Council's annual international conference, Youth and Health: Generation on the Edge, held in Washington in the beginning of June, was notable in several respects. In terms of sheer participation, it was the most successful conference in our 32 year history. We hosted more than 1,600 participants, representing a remarkably diverse constituency from more than 60 countries, and with our largest youth contingent ever. It was also notable for who was absent. For the first time in three decades, the U.S. government was not among the conference's sponsors, and I felt it was important to address the reasons behind this unfortunate decision in my opening speech. Since the Council's founding in 1972, countries public health scientists and development professionals from the U. S. government's technical agencies have been an important part of our efforts to make sure that practitioners, researchers, program manager's, advocates and policymakers have access to the best that science and experience have to offer. Yet because of a political decision taken to distance the U.S. government from the sensitive issues related to youth, sexuality and health that would be discussed, fewer than half the usual number of government technical staff attended. (excerpt)
In the last century, a lot has been accomplished in the realm of sexual and reproductive health and rights. However, a lot has yet to get done. One of the areas where important challenges still lay, one that needs special attention, is that of young peoples' rights - specifically, their sexual and reproductive rights. Youth sexual and reproductive health and rights remain important topics, not only in the international sphere, but also within both developing and developed countries. In recognition of the work needed to address the needs of millions of young people, the strong resistance in some sectors to openly talk about youth sexuality, and the recognition that this task won't be accomplished while our voice - the voice of youth - is not heard, a group of young people decided to make this work our personal and professional struggle. In Mexico and around the world, there are programs that provide reproductive health information and services for youth, but they rarely see youth as anything other than a target population with a specific set of health needs. The services these programs provide often are not based on what young people say they need and want. Such an approach results from the common perception that young people are just a "problem," or a group in need of "protection" from a variety of risks. What this view discounts is the potential for youth to act proactively and positively. Moreover, this approach neglects an enormous resource for social development and change - the youth themselves. (excerpt)
A,B,C, and "E..." - cultivating behavior change among youth by engaging them.
Youth need more than just correct information about sex and reproductive health. They also need the skills and power to carry out informed choices and to be able to focus on protective factors such as personal orientation toward and commitment to health. They especially need to feel that their communities support them attempting healthy behaviors. A creative learning process that engages them to cope with hard facts about behavior in a fun way has the best chance to make all of this happen. Many key physical, social and psychological changes occur when a person is between 10-24 years old. This critical period is when key attitudes are defined, long-term skills are acquired, and many health behaviors are formed. It is also a window of opportunity when caring adults can nurture young people's aspirations and capabilities. The development challenge for this age span is to capitalize on the assets of youth, while modifying the behaviors, cultural norms and social conditions that threaten their health and well-being. Because people are social beings, helping them change their behavior is best accomplished in a supportive social environment. Previous behavior change efforts often encouraged "Do as I say" techniques, conveyed by parents, teachers and well-meaning public health staff. This approach did not work very well, particularly for young people going through their normal development stage of challenging authority. (excerpt)
Mihai makes his way to the small patch of grass near the metro station where he usually finds the street children. Under a small plastic sheet held in place by string and twigs, one boy is asleep. Soon, another boy, a teenage girl, and a young man in his twenties approach the makeshift shelter. They greet Mihai with enthusiasm and exchange greetings. These are just a few of the street children that Mihai has come to know so well. One of 30 peer educators who provide health information to Romanian street children, Mihai is all too familiar with the plight of street children as he was once homeless himself. In a city of 3 million people, the homeless population in Bucharest stands at approximately 2,000 - half of whom are a part of a group referred to as street "children." Street children, most of whom are between the ages of 11 and 30, live in difficult circumstances, often having run away from abusive parents or with no parents at all, driven out by poverty and fear. Many sleep in subway stations or in parks, until being run off by the police. Once on the street, they are vulnerable to physical and sexual abuse, sexually transmitted infections, drug use, and are deprived of many normal activities, such as attending school. (excerpt)
A new tool for teaching young people about fertility.
My Changing Body, Fertility Awareness for Young People, is a training manual developed by Family Health International (FHI) and the Institute for Reproductive Health of Georgetown University (IRH) to teach girls and boys ages 10 to 14 years about their fertility and the changes they experience as they approach puberty. It was a natural fit that the two organizations should collaborate on such an effort as FHI has a wealth of experience working with young people and adolescents around reproductive health issues, while IRH has significant experience teaching fertility awareness. Although designed for adults who teach human development and fertility to youth, the manual can also be used by teachers, youth group leaders, religious instructors and others who work with young people. This interactive manual can be used as a stand-alone curriculum or as a supplement to other reproductive health training materials for youth. The manual is divided into six educational sessions consisting of a set of interactive lessons around an issue related to fertility, puberty and sexuality. Sessions include: 1) "Puberty: My Body, My Self," which describes the physical and emotional changes experienced during puberty; 2) "Female and Male Fertility" focuses on the signs of female and male fertility; 3) "Combining Female and Male Fertility: Fertilization" covers the menstrual cycle, fertilization and pregnancy; 4) "Concerns About My Fertility" dispels myths and concerns that girls and boys have about their fertility; and 5) "Hygiene and Puberty" explains how young people can take care of their bodies during puberty. A final, sixth session, includes a review and a course evaluation exercise. The sessions can be conducted at different levels of depth, depending on the instructor and the amount of time available. The instructor need not be an expert on these issues as the manual includes answers to common questions that young people pose and a glossary of terms and useful diagrams. An effort has been made to make the manual accessible and relevant to people of diverse cultural backgrounds, including the developing world, and includes activities for low-literacy populations. (excerpt)
Achieving global health goals.
In Georgia 71 percent of people do not seek health care when they fall ill and 32 percent of these identify the high cost of seeking care to be the primary obstacle. In Bangladesh it is reported that doctors are absent from their posts 42 percent of the time, so that even if clients did make the effort to visit the health care facility they may still be unlikely to receive care from a physician. In India where about 80 percent of outpatient care consultations take place in the private for-profit sector, there is extensive documentation of poor quality care among many private sector providers including lack of trained staff, lack of hygienic practices, and inappropriate referrals and treatments resulting from a common practice that enables doctors to get a "out" of the fees charged by another doctor to whom they refer a patient. These are but a few examples that illustrate how weak health systems prevent the effective delivery of health services. Such weaknesses in health systems cannot be resolved through the strategies typically used to strengthen service delivery such as the development of treatment protocols, training of health workers or procurement of equipment and supplies. Alleviating a constraint within a health system requires an understanding of the multiple underlying causes of that constraint or weakness. So, for example, health worker absenteeism in the public sector may be due to low pay and more lucrative opportunities associated with private practice, or perhaps health workers are posted a long way from their family homes and are absent in order to attend to family business. Additional contributing factors may be that health worker do not feel accountable to the community that they serve, or to their supervisors, and there are few consequences for them is they fail to show up at work. (excerpt)
The Sphere Project: increasing the quality and accountability of disaster response.
The Sphere Project is one of the most important initiatives ever undertaken within the fields of disaster response and humanitarian assistance. It represents a major effort by operational agencies to improve the quality, consistency and accountability of humanitarian assistance. The main products of Sphere, the Humanitarian Charter and the Minimum Standards in Disaster Response, are widely accepted and applied by a broad range of agencies, including non- governmental organizations, United Nations agencies, governments and donors. Sphere is a collaborative, time-bound project established by non-governmental organizations (NGOs) in 1997 to increase the quality and accountability of disaster response. It is perhaps best known for the Sphere handbook, which outlines minimum programming standards for disaster response in six key sectors: Water, sanitation and hygiene promotion; food security; nutrition; food aid; shelter, settlement and non-food items; and health services. The first version of the handbook was published in 2000 and has already been well received and widely applied by humanitarian agencies. A revised version has recently been released, including an extensively revised health chapter. This new version of Sphere is certain to further contribute to the quality and accountability of humanitarian action. (excerpt)
Infant feeding options for HIV-positive women.
Aware of the risk of HIV transmission through breastfeeding, policy makers, program managers and health care providers are struggling to develop guidelines on appropriate and feasible infant feeding strategies. Uncertainty about factors that influence HIV transmission rates and the risks associated with different feeding alternatives hampers the development of programs and policies. The recently released report by the U.S. Agency for International Development-funded LINKAGES Project on "Infant Feeding Options in the Context of HIV" addresses the need for clear guidelines. The document identifies the specific behaviors required of a mother or caregiver to act upon the infant feeding recommendations and informed choice policy of World Health Organization, UNICEF, UNAIDS and UNFPA. The United Nations (UN) agencies recommend that HIV- infected women avoid breastfeeding when replacement feeding is acceptable, feasible, affordable, sustainable and safe. Replacement feeding means giving an infant who is not receiving any breast milk a nutritionally adequate diet until the age at which the child can be fully fed on family foods. The five criteria for replacement feeding, referred to as AFASS, are explained in Box 1. (excerpt)
Preparing for war in Iraq: making reproductive health care a priority.
Reproductive health care is rarely a priority in emergencies, but crisis preparation for the war in Iraq marked a milestone. Emergency reproductive health care supplies had been pre-positioned in the region, and for perhaps the first time, the need for training on how to use the supplies and how to incorporate reproductive health care into the initial phase of emergency response was identified before the crisis began. "For the most part, health care officials hadn't asked for training because they didn't know that it was needed," says Dr. Henia Dakkak, Emergency Obstetrics Technical Adviser, Reproductive Health for Refugees Consortium (RHRC). Dakkak observed this gap during a January 2003 assessment visit to the region for the Women's Commission for Refugee Women and Children, which coordinates the RHRC and leads its advocacy efforts. During war, pregnancy women are particularly vulnerable as hospitals are often difficult to access and those that are reachable must cope with war casualties and dwindling supplies. Approximately 25 percent of women of reproductive age in any refugee population are pregnant at one time. As with all women, 15 percent of them will suffer from unforeseen complications of pregnancy and childbirth. Every day, 1,440 women die from these complications; 90 percent of them are in the developing world. (excerpt)
What makes someone an expert in his or her chosen profession? Often, expertise in a given discipline or profession comes down to knowing the right systematic diagnostic and process tools or frameworks to use to guide analysis and decision-making. This knowledge is what distinguishes physicians from non- physicians or engineers from non-engineers. In the area of communication, designing a strategic health communication program to encourage healthier behaviors can be a daunting task without the availability of good tools, processes or frameworks. One such tool is the P- Process, which has withstood the test of time and evolved over the past 20 years to become a benchmark and major standard in the design, implementation, monitoring and evaluation of health communication programs worldwide. The P- Process has been adapted and translated in at least six major languages and 30 country versions and is now taught in hundreds of training programs and at premier universities worldwide. It is the heart of an interactive computer-based training and planning software called SCOPE (Strategic Communication Planning and Evaluation) used to train health communication professionals. As the field of health communication has evolved, so has the P-Process. But the P-Process remains a simple, easy-to- follow guide that leads program designers to implement successful projects with positive health outcomes. (excerpt)
As we, the global health community, expand our knowledge of the causes of poor health and disease, the profound impact of the environment - physical, economic and social - on human well-being becomes increasingly clear. Each year 6 million people die and tens of millions more suffer serious illness from a combination of water-related disease, indoor air pollution, urban air pollution and toxic chemical exposure. The role of the global health community is not only to respond to these problems with effective services, but also to diagnose and directly improve the environmental conditions that cause them. As we seek to improve both human health and the health of the environment, we must share what we have learned about both effective and ineffective action. At the Global Health Council's 30th Annual Conference, Our Future on Common Ground: Health and the Environment, practitioners, researchers, leaders and advocates in the global health and environmental fields will come together to exchange information on how to better address the burdens of disease caused by environmental factors. (excerpt)
In 2000, roughly 11 million children died before their fifth birthday, almost all of them in the developing world. An estimated 140 million children under the age of five were underweight, almost half of them living in South Asia. In 1995, 515,000 women died during pregnancy or childbirth, only 1,000 of whom died in the industrialized world. Tuberculosis claimed another 2 million lives. As these numbers might well suggest, death and illness act as a brake on economic growth, and contribute to income poverty: health and demographic variables account for as much as half of the difference in growth rates between Africa and the rest of the world over the period 1965-1990. Nearly half of the Millennium Development Goals (MDGs) concern, directly or indirectly, health, nutrition and population issues. But based on present trends, relatively few low-income countries will achieve these goals. Only 17 percent of countries are on target for the under-five mortality goal (a two-thirds reduction between 1990 and 2015). Also, on present trends, sub-Saharan African as a whole will take 100 years to achieve the under-five mortality MDG. In all regions other than the Europe and Central Asia region, the under-five mortality rate declined faster during the 1980s than it did during the 1990s. The slowdown was particularly pronounced in Africa and the Middle East. In many countries, improvements in child mortality and malnutrition have been smallest among the poor. (excerpt)
Catalyst consortium addresses family planning and reproductive health needs in developing countries.
In countries such as Afghanistan, Pakistan, India, Bolivia and Peru, there is an unmet need for family planning programs that must be addressed. This deficit has a detrimental impact on mothers and children, including higher infant and maternal mortality. The USAID funded CATALYST Consortium is a partnership of five organizations created to reach women, men and young people who have unmet reproductive health, STI/HIV/AIIDS prevention and care needs. CATALYST began in September 2000 and works in Latin America, Asia and the Near East, Europe and Eurasia. CATALYST activities focus on increasing access to and improving quality of family planning/reproductive health programs, increasing capacity for informed reproductive decision-making among clients and communities, helping the public and private sectors sustain quality programs, and scaling up and improving service delivery through other agency/donor/foundation programs. CATALYST is comprised of five member organizations as equal partners: the Academy for Educational Development (AED), Centre for Development and Population Activities (CEDPA), Meridian Group International, Inc., Pathfinder International, and PROFAMILIA/Columbia. (excerpt)
The environmental impacts on children's health.
Humanity's hopes resonate in a child's laughter, yet for nearly 11 million children annually, the laughter abruptly stops resonating due to readily preventable diseases. In this childhood state of affairs, environmental threats are increasingly recognized as playing significant roles. Overall, environmental conditions are responsible for 33 percent of the global burden of disease with over 15 percent of the burden borne by children under age 15 associated with environmental factors. Environmental threats are commonly divided into two categories: a) Traditional environmental hazards, which remain the primary source of ill-health today for much of the world's population, al of which are usually associated with poverty and social exclusion: biologically contaminated water, poor sanitation, indoor smoke, rampant disease vectors (i.e., mosquitoes), deficient food hygiene, and unsafe waste. b) Modern environmental hazards closely associated with unsustainable patterns of production and consumption: air, water and soil pollution, unsafe use of chemicals, inadequate solid and hazardous waste management, climate change, ozone layer depletion, and acid rain due to the use of fossil fuels. (excerpt)
Situation analysis of obstetric fistula in Bangladesh. Report.
This report on "Situation Analysis of Obstetric Fistula in Bangladesh" is the first attempt to find out the obstetric fistula situation in Bangladesh was undertaken by UNFPA (United Nations Population Fund) and EngenderHealth. This report finds that the number of women living with fistula is estimated to be 1.69 per 1000 ever married women. This number is not a meager figure. However there is a need of a comprehensive study to find out the actual prevalence of obstetric fistula in Bangladesh. The report shows that many fistula sufferers are abandoned by their husbands, forced out of their homes, ostracized by family and friends and even disdained by health workers, who consider them 'unclean'. Without skills to earn a living, some have no choice but to beg to survive. They are so ashamed that they even do not like to share their experiences with others. However, they could not hide the smell. Women living with fistula in Bangladesh are usually in the age group of 15-30 years, illiterate, poor and unaware that treatment is available, or cannot access or afford it according to the findings of this report. The report assessed the capacity to treat the fistula patients of 12 hospitals i.e six Medical College Hospitals and six District Hospitals and outlines their needs for equipment, surgical supplies and skilled professionals. All of the six Medical College Hospitals have one or two trained professionals but all the six District Hospitals have no trained professionals. The District Hospitals refer the fistula cases to Medical College Hospitals. The report highlights the need to train more local doctors in fistula reconstruction surgery and recommends a specialized training center in the country. (excerpt)
Addis Ababa Fistula Hospital annual report (October 2001 - September 2002).
Ethiopia has an estimated population of 63.5 million, of which, more than 85.1 percent live in rural areas spread across an area of about 1.25 million square kilometres. Bearing this in mind consider the annual birth per 100 women between the ages of 15 and 19 years of age is currently at 15.2. That of course excludes the under 15 year olds. There are a mere 20 % of women receiving antenatal care. Deliveries by skilled assistants in only 8%, with figures for HIV/AIDS in women being as high as 12% add to that the seven children most women average in a lifetime and the picture become bleak. But just how dismal can only be reflected with the WHO figures for maternal mortality of 1,400 per hundred live births. Few of the women with fistulae have a live birth so they would be excluded from these statistics. Ethiopia tops the list of the Reproductive Risk Index at 72.3 points out of a possible 100, this means that women in Ethiopia are 99% more likely to die in pregnancy or childbirth than in countries like Italy or Sweden. Further study shows that one in seven teenage girl gives birth annually. What are the chances of old age for women in Ethiopia when one out of seven women will die from complications of pregnancy or childbirth during her lifetime. So it is no wonder that we see large numbers of women with obstetric fistula. Combine an increasing population with inadequate health coverage and the outcome is inevitable, culminating in the tragedy we see daily all bearing the marks of inadequate or non-existent maternal health services. (excerpt)
Fistula was once common throughout the world, but has been eradicated in areas such as Europe and North America through improved obstetric care. Fistula is virtually unknown in places where access to maternal health care services is near universal, women and girls are empowered to make their own health care decisions and communities are educated about reproductive health. Most fistulas can also be repaired surgically, even after several years. The cost ranges from $100-$400, but this amount is far beyond what most patients can afford. If done properly, surgical repair can have a success rate as high as 90% and in most cases women can give birth again. Attentive post-operative care, for a minimum of 10- 14 days, is critical to prevent infection while the surgery heals. Education and counselling are also needed to help restore the young woman's self-esteem and allow her to reintegrate into her community once she is healed. To raise awareness of the issue and to stimulate international action, UNFPA has launched a Global Campaign to End Fistula in partnership with UN and NGO partners. Its goal is to make fistula as rare in Africa and Asia as it is in industrialized countries today. To reach that goal, a two-pronged strategy of prevention and treatment is pursued. These are preceded by needs assessments in participating countries and the development of a national plan which includes prevention, advocacy and lobbying, media outreach, community mobilization, training providers, establishing and upgrading treatment centres, and providing treatment and social reintegration. Currently, 32 countries in sub-Saharan Africa have joined the Campaign and are at different stages of implementation. (excerpt)
Lessons from the developing world: obstructed labor and the vesico-vaginal fistula.
Perhaps one of the most famous accounts of obstructed labor is the case of Princess Charlotte of England. In 1817, Princess Charlotte, daughter of George IV, was the only eligible heir to the British throne in her generation. Her grandfather, George Ill, had 7 sons and 5 daughters, but Charlotte was the only legitimate grandchild. Thus, when the newspapers announced her pregnancy in early July 181 7, the entire country was closely following this most important event in British history. On November 3, 1817, 42 weeks after her last menstrual period, Princess Charlotte went into labor. Fifty hours later -- after 24 hours of being in the second stage of labor and 6 hours of perineal pressure - Charlotte delivered a 9-pound stillborn. Five and one half hours after delivery, the Princess died, presumably from hypovolemic shock after a postpartum hemorrhage from uterine atony, likely a direct result of her obstructed labor. Three months later, Sir Richard Crofts, Princess Charlotte's obstetrician, committed suicide, unable to bear the burden of responsibility for the death of the heir. As this event resulted in the death of the infant, the patient, and the physician, it has historically been referred to as the "Triple Obstetric Tragedy." Nonetheless, some will question how tragic this truly was for the country, as after Charlotte's death, her uncle married Princess Mary Louisa Victoria, who went on to give birth to the famous heir, Queen Victoria.['] This story serves to illustrate the consequences of obstructed labor. Fortunately, advances in obstetric care have made the serious consequences of obstructed labor nearly obsolete in the developed world. However, in the developing world, obstructed labor continues to be a common, serious medical problem, with thousands of women suffering significant morbidity each year. This review discusses the morbidity associated with pregnancy in the developing world. In particular, the morbidity of obstructed labor will be emphasized, with a specific focus on the vesico-vaginal fistula. (excerpt)
The partograph: an essential tool for decision-making during labor.
Prolonged labor is a leading cause of death among mothers and newborns in the developing world. It is most likely to occur if a woman's pelvis is not large enough for her baby's head to pass through or if a woman's uterus does not contract sufficiently. If her labor does not progress normally, the woman may experience serious complications such as obstructed labor, dehydration, exhaustion, or rupture of the uterus. Prolonged labor may also contribute to maternal infection or hemorrhage and to neonatalinfection. Skilled management of labor using a partograph, a simple chart for recording information about the progress of labor and the condition of a woman and her baby during labor, is key to the appropriate prevention and treatment of prolonged labor and its complications. Following the recommendation of the World Health Organization (WHO), the Maternal and Neonatal Health (MNH) Program promotes the use of the partograph to improve the management of labor and to support decision-making regarding interventions. When used appropriately, the partograph helps providers identify prolonged labor and know when to take appropriate actions. (excerpt)
DRC: Focus on rampant rape, despite end of war.
Widespread rape of women and children in the Democratic Republic of the Congo (DRC) has continued to increase despite the inauguration of a transitional national government and related institutions, organizations in the fight against sexual violence have said. While there are no precise figures on this abuse, the Joint Initiative on the Fight Against Sexual Violence Towards Women and Children has tried to assemble some statistics. Created after the DRC's five-year war, the group includes representatives from the UN, NGOs and the Congolese government. "There were 25,000 cases of sexual violence record in South Kivu [Province], 11,350 cases in Maniema [Province], 1,625 cases in Goma [capital of North Kivu Province], and some 3,250 cases in Kalemie [a town in southeastern DRC]" since war first erupted in August 1998, Flora Tshirwisa, a member of the Joint Initiative and director of the health and reproduction programme and the World Health Organization (WHO), told IRIN. She added that this phenomenon could also be found in areas that were not directly affected by the war, such as in the capital, Kinshasa, with 1,162 cases of rape of women and children recorded since August 1998. (excerpt)
Compendium of indicators for evaluating reproductive health programs. Volume 2.
Part III of the Compendium covers 12 programmatic areas for reproductive health, beginning with the 3 that command the largest percentage of government and donor budgets: family planning, STI/HIV/AIDS, and safe motherhood. Additional areas include women's nutrition, newborn health, and breastfeeding. During the 1990s governments and/or NGOs developed programmatic initiatives to meet a broader range of RH needs, including adolescent reproductive health programs, postabortion care (PAC), male involvement, violence against women (VAW), female genital cutting (FGC), and reproductive health in emergency situations. Part III begins with two sets of RH indicators intended to measure RH status in countries worldwide. The first represents the response of the World Health Organization (WHO) in collaboration with selected reproductive health experts to monitor the extent to which programs/countries achieve progress toward the ICPD goals. The short list consists of 17 indicators that measure progress in a particular area (e.g., contraceptive prevalence rate, availability of basic essential obstetric care, HIV prevalence in pregnant women). The second set of indicators - developed by Population Action International (PAI) - is the Reproductive Risk Index, which rates countries on 10 RH measures (many of which overlap with the WHO global monitoring indicators). (excerpt)
Global tuberculosis control: surveillance, planning, financing. WHO report 2002.
This is the 6th annual report on global TB control. It includes data on case notifications and treatment outcomes from all national control programmes that have reported to WHO, together with an analysis of plans, finances, and constraints on DOTS expansion for 22 high-burden countries (HBC). Seven consecutive years of data are now available to assess progress towards the 2005 global targets for case detection (70%) and treatment success (85%). During 2001, a standard form for reporting surveillance data was sent to 210 countries via WHO regional offices. The form requests information about policy and practice in TB control, the number and types of TB cases notified in 2000, and the outcomes of treatment and retreatment for smear-positive cases registered in 1999. NTP managers in the 22 HBC were asked to identify the major constraints to DOTS expansion, and to present 3–5 year plans and budgets to overcome these constraints as they move towards target case detection and cure rates. (excerpt)
Evaluation of the Asia Pacific Inter-Country Team. Final report, 7 April 2002.
Located in Bangkok, Thailand, the Asia and Pacific Inter-Country Team (APICT) was established in July 1996. The original mandate, composition, and profiles of the Team members were discussed and finalized in regional meetings of cosponsors following a needs assessment. In view of the recent changes, it was decided to conduct an evaluation of APICT to assess its relevance, effectiveness, and efficiency, its relationships with other UNAIDS entities, and to make recommendations on its future direction - taking into account the new mandate. The evaluation was initiated by the Evaluation Unit in consultation with Country and Regional Support Department (CRD) and carried out by the Evaluation Unit together with two consultants through desk review and key informants interviews. Main findings on APICT performance in key areas, management, relationships with other entities, as well as recommendations are summarized below. (excerpt)
Demographic impact of HIV / AIDS in Mozambique (update 2000).
Without a doubt, all of humanity is alarmed by the HIV/AIDS pandemic, due to its negative effects on both population and socio-economic development. These effects already touch day-to-day life of ordinary Mozambicans. In the future, the impacts of the epidemic may even worsen unless we all take precautions to prevent the infection and its spread. Providing the most accurate possible knowledge about the size and geographic distribution of HIV/AIDS in our country will contribute greatly to decision-making and more comprehensive and integrated policy formulation to combat the epidemic. The present publication emerges from this context. It attempts to provide updated information about HIV/AIDS prevalence and its demographic impact. It is worth mentioning that the information contained therein should be treated and interpreted with care from both the longitudinal and cross-sectional point of view, since it was obtained from different sources. As has been described previously, the calculations for HIV/AIDS prevalence rates are based on information gathered from sentinel sites whose geographic coverage has increased during the past few years. While only four sentinel sites existed at the time of the 1998 epidemiological surveillance round, the number increased to 20 in 2000. (excerpt)
Ghana urban health assessment.
USAID's Environmental Health Project (EHP), together with EGAT/UP and the USAID/Ghana Mission, conducted a rapid assessment of urban health needs in Ghana in July 2002. Although Ghana's cities are growing rapidly, national development policies and international assistance packages have not yet focused attention on the needs of urban populations. USAID/Ghana requested this assessment in preparation for a strategic planning exercise that will determine the future direction of its population, health and nutrition assistance. (excerpt)
This report summarizes the achievements of the first program year of Project HOPE CS-17 extension project in the Boca Costa of Guatemala and four highland municipalities in the South West of Guatemala (see map, Attachment 1). Project HOPE was awarded a four-year extension to extend and expand its successful CS-13 project, aimed at improving the health of women and children residing in or migrating to coffee plantations in the Boca Costa region of southwestern Guatemala. The CS-13 project provided benefits for more than 200,000 migrant and resident children and women of reproductive health on about 150 coffee plantations in the departments of San Marcos (SM), Quetzaltenango (Q), Suchitepequez (Su), Retalhuleu (R), and Sololá (So). The extension project is planning to expand the activities, adding 100 plantations and 4 municipalities within these five departments. The current project will provide targeted assistance to some of the municipalities of origin of the migrant – as well as increase the program’s reproductive health focus and strengthening overall sustainability. As with the CS-13 sites, the new plantations are all privately owned, large enough to employ migrant families during the harvest season, and have, sufficient resident and migrant population to warrant the establishment of a health unit and training a health promoter. (excerpt)
Maternal night blindness: a new indicator of vitamin A deficiency. IVACG statement.
Night blindness—the inability to see after dusk or at night—is the most common ocular manifestation of moderate to severe vitamin A deficiency. Poor dark adaptation leading to night blindness occurs when there is decreased production of a vitamin A–dependent photosensitive pigment, rhodopsin, in the retinal receptors responsible for seeing under low levels of illumination (rods). Normally, when these photoreceptor cells are stimulated by light, rhodopsin is transformed, initiating neural signals that are transmitted to the brain, resulting in vision in dim illumination. In vitamin A deficiency, less rhodopsin is transformed and the level of light needed for vision rises. This results in delayed dark adaptation or, when sufficiently severe, in night blindness. Where prevalent, night blindness may be known by local terms that refer to evening or twilight blindness or, in some cultures, to “chicken eyes” or “chicken blindness” (chickens lack rod cells). Night blindness is frequently reported in young children in developing countries, but only recently has it been recognized as a public health problem in women of reproductive age. Two small studies in India in the 1960s suggested that night blindness was common in poor pregnant women, often occurring in the third trimester, and that it responded to treatment with high-potency vitamin A. In some cultures, night blindness is thought to be a normal consequence of pregnancy, given its common occurrence and tendency to disappear without treatment shortly after childbirth. Recent reports from poor populations in different regions of the world suggest that ~10% of women experience night blindness during pregnancy. Extrapolations suggest that 6 million women become night-blind during pregnancy each year. (excerpt)
The main purpose of this update is to ensure you have a current project listing. Because the agency reorganization has not yet been finalized as of this writing, we plan to use the next version of the Users’ Guide, to be issued in both hard copy and electronic formats, to convey information on the organizational structure and staffing of the new Bureau for Global Health. Part I of the guide provides a basic overview of USAID's PHN program, as well as a short description of the PHN Center and the offices that comprise it. Parts II, III, IV, and V give a comprehensive listing of PHN projects, including selected regional bureau projects. The descriptions are organized by office, alphabetically within the offices by division, and alphabetically within the divisions by project title. Each project/activity description includes a short summary of the services and activities that each performs, as well as names of contractors and USAID contact persons. Additional information, such as project/activity number, agreement number, and completion date are given. Part VI of the guide includes contact lists for parties listed in this Guide, as well as other useful resources. (author's)
Food security, the sustainable ability of a household to feed its members in sufficient quantity and quality to ensure healthy lives for each, is often compromised during periods of conflict. Throughout the last 20 years, humanitarian aid agencies and government donors have been challenged by the multiple causes of food insecurity world-wide. Massive food shortages, large-scale diarrheal epidemics, poverty, and natural disaster have all contributed to food insecurity and subsequent malnutrition, anemia, and micronutrient deficiencies. Since the onset of the second intifada in the West Bank and Gaza Strip (WBGS) that began in September 2000, no reliable, systematic assessment of food security and humanitarian indicators has been done. The nutritional assessment consists of a household survey to directly measure levels of acute and chronic malnutrition and anemia and evaluate food consumption; a market survey to determine the market’s capacity to function; and a clinic survey to evaluate the health provider’s capacity to recognize and treat malnutrition and anemia. This report will provide the preliminary findings of the completed household and market surveys. The clinic survey will finish in late- August. A final comprehensive report will be made available at the conclusion of all three components in early September. (excerpt)
Urban poverty in Bangladesh: the perspective of the Nutritional Surveillance Project.
Many tens of thousands of people live in desperately poor circumstances in the slums of towns and cities in Bangladesh, and all the evidence suggests that their numbers are rising. How can they be raised from poverty and employed, housed, fed, educated and cared for? This bulletin presents data from the Nutrition Surveillance Project that show how living conditions and food security vary widely from one poor area to the next suggesting that the solutions to urban problems may not be the same everywhere. Accurate and up-to-date information is needed to understand the manifestations and causes of poverty and how they vary between and within cities. This information can then be used to design policies and programs adapted to local circumstances. A surveillance system can provide the data needed to inform, guide and evaluate this process. (author's)
The Child survival and health indicators in Guinea are considered among the lowest in the Developing world. According to the 1999 DHS, infant and maternal mortality are estimated at 98/1000 and 528/100,000 births respectively. The complete vaccination coverage for Children, 12–24 months, is estimated at 26 percent. At the request of the people in the prefecture and the support of the Ministry of Health (MOH), ADRA/Guinea Submitted a child survival and safe motherhood project proposal to the BHR/PVC of USAID/Washington and was approved. The grant was $1 million and the life of The project is 4 years (Oct. 1, 2000 – Sept. 30, 2004). The project is being implemented in the Prefecture of Siguiri in the upper Guinea region. The prefecture has 12 sub-prefectures and 129 districts (equivalent to villages). According to the most recent demographic information (MOH, 2000), the population of the prefecture is about 311,000 persons. The project intervenes in six sub-prefectures, namely Doko, Franwalia, Kintinia, Siguiri Center, Niagassola and Norassoba. And it covers 72 villages. The major intervention areas are nutrition, vaccination, malaria prevention and safe motherhood. The project targets 38,610 WRA and 33,332 children between 0-60 months. (excerpt)
Evaluation of the EngenderHealth Cooperative Agreement, 1998-2003.
This report presents the evaluation of the 1998 to 2003 cooperative agreement between the U.S. Agency for International Development (USAID) and EngenderHealth. The evaluation looks at the impact of EngenderHealth’s activities on the access, quality, scaling up, and institutionalization of clinical services delivery since 1998. This includes family planning (FP) clinical services, postabortion care (PAC), voluntarism and informed choice, quality improvements, male involvement in FP, research and evaluation, and global leadership activities. The evaluation team analyzed national Demographic and Health Survey (DHS) data (on clinical method prevalence, desire for additional children, and unmet need for limiting methods) in EngenderHealth-supported countries and available service statistics reported from EngenderHealth-affiliated project sites. The team enriched findings from the statistical data with qualitative assessments of the key project components based on a review of project documents, an appraisal of EngenderHealth’s detailed background self-assessment document incorporating both quantitative and qualitative findings used to draw conclusions, discussions with USAID/Washington and EngenderHealth staff, structured interviews with knowledgeable representatives from 13 USAID Missions, and visits to four countries in which EngenderHealth operates (Ghana, Kenya, Philippines, and Bangladesh) to observe field activity and to discuss progress with USAID Mission and EngenderHealth in-country staff, stakeholders, and partners. (excerpt)
Executive summary of the Rapid Nutritional Assessment for West Bank and Gaza Strip.
In December 2001, the Palestinian Minister of Health requested the USAID West Bank/Gaza (WB/G) Mission to undertake an assessment of the nutritional status of preschool aged children and women of reproductive age throughout the West Bank and Gaza Strip. USAID WB/G accepted this task and added it to the portfolio of the Emergency Medical Assistance Program (EMAP), a cooperative effort of USAID and CARE International (CARE)/American Near East Refugee Aid (ANERA). CARE had a pre-established contractual relationship with Johns Hopkins University (JHU) to provide technical assistance in health. Within that context, JHU developed a comprehensive three component nutritional assessment to evaluate the extent and causes of malnutrition and anemia and to identify areas for strategic programmatic interventions. The assessment contained: 1) a household interview and examination survey; 2) a survey of market places; and 3) a survey of maternal child health (MCH) clinic practices and capabilities. The surveys of the Nutritional Assessment for West Bank and Gaza Strip (NA/WBGS) were field tested and carried out during June-August 2002 by Al Quds University and the Global Management Consulting Group under sub-contracts with CARE. (excerpt)
Council brings Congress to the field.
"What do they want to know?" ask a group of inquisitive youth, of the American guests who are to speak to them. The group consists of Haitian youth participating in a reproductive health and rights educational program run by the Foundation for Reproductive Health and Family Education (FOSREF). Their guests are key staff members from the U.S. Congress on a study tour organized by the Global Health Council, Aug. 11 to 15. Less than two hours by plane off the Miami coast, Haiti's natural beauty is marred by the poverty of its people. Unlike its Caribbean neighbors, Haiti has been unable to attract legions of tourists to pour money into its coffers. Centuries of political instability and international sanctions have left this small island nation with few resources to combat tuberculosis, malaria and dengue, as well as high maternal and infant morbidity and mortality rates. Poor water sanitation systems, or lack thereof, result in thousands of cases of diarrhea each year. Its already poor health care statistics are further compounded by a burgeoning AIDS epidemic, which further perpetuates the cycle of ill health and poverty. (excerpt)
Bush outlines FY 2004 budget, Congress passes FY 2003.
President Bush raised the profile of global health issues during his State of the Union speech with his announcement of a $15 billion commitment of funds to address the global HIV/AIDS crisis over the next five years. In the speech, President Bush stated, "Because the AIDS diagnosis is considered a death sentence, many do not seek treatment. Almost all who do are turned away. A doctor in rural South Africa describes his frustration. He says, 'We have no medicines. Many hospitals tell people, you've got AIDS, we can't help you. Go home and die.' In an age of miraculous medicines, no person should have to hear those words. AIDS can be prevented. Anti-retroviral drugs can extend life for many years. And the cost of those drugs has dropped from $12,000 a year to under $300 a year - which places a tremendous possibility within out grasp. Ladies and gentlemen, seldom has history offered a greater opportunity to do so much for so many." During the first week of February, President Bush released the full details of his proposed fiscal year 2004 budget. Overall, the budget includes a significant increase for humanitarian programs but the majority of this increase is targeted to new Presidential initiatives. The chart below provides information on these new initiatives. (excerpt)
Brazilian AIDS program receives Gates Award.
When Brazil's first case of AIDS emerged in 1982, the power of the disease remained unknown. But even at that premature stage, Brazil made a political commitment to an aggressive response to the epidemic before it burgeoned within its borders. But it is because of this preemptive and sustained action the Brazil has avoided the crippling fate currently being faced by many African and Caribbean nations. Such a reversal of a trend that is devastating other populations represents a remarkable victory in the fight against AIDS. In 1992, the World Bank estimated that more than 1.2 million Brazilians would be HIV-positive by the year 2000. That year has come and gone, and the toll of AIDS in Brazil was less than half that number. This success in stabilizing the epidemic is the result of sustained political will. It has done this through the Brazilian National AIDS Program (NAP), established by the country's Ministry of Health in 1985 to curb the spread of the disease and address the needs of those affected by HIV/AIDS. Brazil's proactive move almost 20 years ago has decreased its current burden of AIDS and ensured a better quality of life for its HIV- positive citizens. (excerpt)
Promoting evidence-based practice in the former Soviet Union and Central and Eastern Europe.
In the remote town of Schuche, nestled behind the Ural Mountains of Russia, most physicians have had limited access to current medical literature. In part as a result of this isolation, health institutions have largely been dependent on the often outdated protocols provided by the health ministry to guide them in the practice of medicine. In one local hospital, however, health professionals have found a way to update their practices using the best available research evidence with the help of the Internet. At Schuche Central District Hospital, a group of gynecologists, concerned about growing numbers of undiagnosed and untreated cases of vaginal infections (which often lead to complications during pregnancy) decided to search the Internet for up-to-date information on diagnostic techniques. Noting that hospital staff have been following regulations and methods that had not been reviewed or evaluated since the Soviet period, they established a task force to conduct a literature search using MEDLINE and other on-line medical databases. After conducting the search, task force members assessed the quality of their findings to determine whether the research was valid and applicable to their conditions. Based on their assessment, the task force launched a successful campaign to convince and educate the hospital administration and staff about the advantages of using more effective (and less expensive) diagnostic methods. As a result, staff at the hospital are now using the Gram stain method for diagnosing bacterial vaginosis, and more patients are being diagnosed early and treated for this condition. (excerpt)
The essential nutrition actions.
Malnutrition, even in its milder forms, weakens the immune system and increases the likelihood of mortality from other diseases such as malaria, diarrhea and acute respiratory infection. It is one of the most important public health problems in developing countries, where inadequate access to food and nutrients, inadequate care of mothers and children, inadequate health services, and unhealthy environments are more common. Leading scientists link 60 percent of all childhood deaths to malnutrition. The Basic Support for Institutionalizing Child Survival (BASICS II) project, the flagship child health project of the U.S. Agency for International Development (USAID), has made nutrition a central piece of its child health package. The focus of its interventions is on achieving 80 percent coverage with a combined package of health and nutrition services, with nutrition defined as a group of evidence- based micronutrient and infant feeding interventions known as Essential Nutrition Actions (ENA). (excerpt)
Raising awareness and changing attitudes about ITNs.
Asha Mwanachawa, a young wife and mother in Kwale, Kenya, wanted desperately to talk to her husband about purchasing an insecticide-treated net (ITN) to protect their growing family from the dangers of malaria. Asha had learned about ITNs from an educational session at her clinic while pregnant with her first child. But her pleas to her husband to purchase one went unanswered. Asha is of the Digo ethnic group, a highly patriarchal coastal people, and Digo men make all the major decisions. When PSI/Kenya's Supanet ITN brand sponsored a water sports festival in her village, her husband was enticed by the fishing contest and prizes. In the course of information sessions given during the festival, he learned about malaria and the benefits of ITNs. Asha is now the proud owner of two Supanet ITNs, her husband's fishing team won a television and, most importantly, her family is protected from malaria. This is one example of how Population Services International (PSI), a nonprofit organization working in more then 70 countries, uses social marketing to popularize healthy behavior in poor countries. Such social marketing programs have sold more than 4 million ITNs and 5.4 million home insecticide re-treatment kits, which have together provided 10.3 million person-years of malaria protection (through April 2003) in Africa, South America and Asia. These programs are among the most cost-effective health interventions available - protecting individuals from malaria at a cost often less than $2 per person per year. PSI's programs are also sustainable, motivating consumers to contribute a substantial share of the cost and stimulating the commercial sector to increase the production and distribution of ITNs. (excerpt)
Competitive After nearly two decades of use, the IUD remains "a generally safe, effective and useful form of birth control". With fewer than six pregnancies per 100 woman-years of use and fewer than ten deaths per one million woman-years of use, according to a comprehensive new review by the United States Food and Drug Administration, the IUD has an important place in modern family planning programs. The number of women using IUDs is growing slowly but steadily. Most extensive use is In the People's Republic of China, where visitors have been told that half or more of all those using contraception have accepted IUDs. In Korea and Taiwan, where successful programs have been underway since the mid-1960s, the IUD is also the principal method. In about a dozen other developing countries more than 5 percent of all married women of reproductive age use IUDs. In Europe IUD use ranges from less than 5 percent in Italy to as high as 20 percent in Scandinavian countries. In the USA about 6 percent of married women of reproductive age have IUDs. Worldwide, approximately 50 to 60 million devices may be in use, 40 million or more in China and 15 million in the rest of the world. (excerpt)
For more than half the world's couples the fundamental decision whether or when to have a child is seldom a real decision at all. Despite the progress of the last decade, few of these 600 million men and women have adequate information about the health implications of ill-timed childbearing; few receive feedback on the impact of their fertility decisions on their community; and few have access to modern family planning methods. To narrow these family planning gaps, many governments have begun to expand family planning programs, extending services at the community level and using peer pressure to promote the acceptance of contraception and of small families. It is true that more couples are effectively planning their family size than ever before. In the first half of this decade, the use of oral contraceptives, intrauterine devices (IUDs), and both male and female sterilization-the three most effective means of preventing unwanted pregnancies rose markedly in both rich and poor countries. Yet, despite dramatic progress, a majority of couples still do not use these methods. Primitive contraceptive practices and old prejudices against contraception remain, Archaic laws make contraceptives and safe abortion difficult to obtain. Family planning's disenfranchised minorities-the poor, the young, and the rural-still cannot time their childbearing effectively. (excerpt)
The guidance set forth in this document serves to assist those PVOs, who were awarded cooperative agreements as a result of the FY 2002 Child Survival and Health Grants Program (CSHGP – previously the Child Survival Grants Program) competitive review process, in drafting Detailed Implementation Plans (DIPs). Due to changes in the DIP review process including a Mini-University event, the due date for the final DIP will be June 30, 2003 with a first draft DIP submitted by April 30, 2003. In addition to this guidance, PVOs should utilize the CSHGP’s "Technical Reference Materials" (TRMs) which describe the important elements of the child survival and health interventions and several cross cutting strategies. The DIP should provide: results of baseline studies; changes in program interventions/strategies and/or a revised budget based on those studies; the overall approach to each technical intervention, and a detailed plan of action for the first two years of the project. Thereafter, annual work plans and budgets should be provided (by October 31 of each project year) to the appropriate Cognizant Technical Officer (CTO) for approval. At the time of the DIP, a PVO may change the selection of interventions and implementation strategies from what was proposed in the original Cooperative Agreement, with a clear and sufficient justification for these changes. (excerpt)
POLICY II began on July 7, 2000 and continues until July 6, 2005. The Futures Group International implements the project in collaboration with Research Triangle Institute (RTI) and The Centre for Development and Population Activities (CEDPA). This report covers POLICY’s HIV/AIDS activities and accomplishments during the period from October 1, 2001 to September 30, 2002. The POLICY Project endeavors to improve policies affecting family planning/reproductive health (FP/RH), HIV/AIDS, and maternal health programs and services in developing countries. Multisectoral collaboration, community empowerment, respect for human rights and gender equality, and support for vulnerable populations, including orphans and other children affected by HIV/AIDS, characterize POLICY’s approach to policy and program development. In working to promote and sustain access to high-quality FP/RH, HIV/AIDS, and maternal health services, the project addresses the full range of policies, including: National policies as expressed in laws and official statements and documents; Operational policies that govern the provision of services; Policies that impact gender, youth, and human rights; and Policies and plans in related sectors, such as education, labor, and the environment. (excerpt)
Overview of contraceptive and condom shipments, FY 2001.
The Commodities Security and Logistics Division of USAID provides a centralized system for contraceptive and condom procurement, maintains a database on commodity assistance, and supports a program for health commodity logistics management. This report details both the quantities and the values of USAID contraceptives and condoms shipped worldwide during FY 2001 as well as shipment trends over the past 10 years. It should be noted that significant changes in contraceptive and condom shipments from one year to the next do not always represent major programmatic shifts. Often a large change appears only because of production and shipment scheduling that leads to a change in the number of shipments within one year. Therefore, the average flow of contraceptives and condoms to a particular region over a number of years provides a better picture for trend comparisons. (excerpt)
PVO Child Survival and Health Grants Program. Technical reference materials. Revised.
Welcome to the 2002 revised Technical Reference Materials (TRMs) from the USAID/BHR/PVC Child Survival Grants Program. This document is a guide (not an authority) to help you think through your ability and needs in choosing to implement any one technical area of child survival. An attempt has been made to keep the language simple to encourage translation for use as a field document. The TRMs were completely revised in 2000 and BHR/PVC has made several upgrades to other essential program documents over the last few years (DIP, annual report, mid-term and final evaluation guidelines, and the RFA). The current revision is based on feedback on the 2000 edition solicited from and volunteered by experts and CORE working groups. (excerpt)
Population, health, and nutrition results reporting from FY 2002 annual reports.
Angola: USAID assisted with the establishment of eight regional sites that monitor potential polio cases in all 18 provinces. Polio surveillance systems identified an average of 1.4 AFP cases per 100,000 children. During the July NIDs campaign, 93% of children under 5 were vaccinated. Angola conducted sub-NIDs for the first time in three high-priority provinces. There were only two reported cases of wild poliovirus, compared with 55 in 2000 and 1,117 in 1999. In target areas, 92% of women demonstrated correct knowledge of the danger of dehydration and diarrheal diseases and of the best methods for caring for sick children, up from 72% at baseline. (excerpt)
Thukela District Child Survival Project, HIV MED grant amendment. Third annual report.
This amendment project aims to increase the capacity of vulnerable households to respond to the social, health, and economic impact of HIV/AIDS on the households, by addressing some of the factors mentioned above. It is doing this by providing micro-enterprise training, facilitating a home based care network, raising community capacity to deal with orphans, and developing awareness messages and labour saving technologies. This is an integrated response, that involves many sectors, and community based organisations. A feature of the project is the linking of micro-enterprise activities with home-based care and orphan activities. This has generated the necessity of developing tools to measure whether microenterprise activity does indeed allow vulnerable individuals and households to respond positively to the impact of HIV and AIDS. (excerpt)
The Committee met, pursuant to call, at 10:15 a.m. in Room 2172, Rayburn House Office Building, Hon. Henry Hyde presiding. Chairman HYDE. We will come to order. The AIDS pandemic continues to claim lives in sub-Sahara and Africa, the epicenter of the scourge. Seventy percent of the AIDS cases exists there. Each day more than 5000 Africans are dying from the disease. Children are suffering profoundly. Approximately 6000 African children are getting infected each year with the HIV virus. They were infected through their mothers, either when they were born or when they were breast-fed. They have become orphans or otherwise vulnerable because their parents, either have fallen ill or died. These children rarely live past the age of 6 because they die from an AIDS-related illness or hunger. Some of these children are the head of their household at age 8, and others as young as 3 years old are left roaming the streets for survival. They suffer from psychological distress, economic hardship, forced withdrawal from school, malnutrition and the increased exposure to abuse. If they grow up at all, they grow up poor and uneducated and they face every kind of abuse imaginable. (excerpt)
Access to drugs for HIV / AIDS and related opportunistic infections in Nigeria.
This report was designed to characterize the legal, policy, and economic climate on the issue of access to drugs for HIV/AIDS and related opportunistic infections (OIs) in Nigeria. Local nongovernmental organizations (NGOs) and international organizations have produced information on drug availability and accessibility (especially by Médecins Sans Frontières (MSF) and the World Health Organization (WHO)). However, there has not been a comprehensive report on how the intersecting issues of health and drug policies, pharmacy laws, drug distribution, prescribing practices, research and manufacturing, and drug resistance impact drug accessibility. The authors of this report have been researching and working with civil society organizations in Nigeria on the issue of access to drugs for HIV/AIDS. We conducted a number of meetings with many different institutions and organizations that are involved with drug quality, availability, and resistance. We also met with government officials/institutions that provided information dealing with legal and policy issues relating to drugs. Most of these meetings were confined to Lagos and Abuja and virtually no visits were made outside of these urban areas. We relied on current and existing statistical data from various professional organizations, the Internet, and libraries to assess information. Moreover, we consulted NGOs and people living with HIV/AIDS (PLWHA), both of whom provided data and documents and shared their experience with access to drugs in both urban and rural areas. (excerpt)
Examining HIV / AIDS in Southern Africa through the eyes of ordinary Southern Africans.
This paper marries public opinion survey data from the Afrobarometer with epidemiological data about the HIV/AIDS epidemic in seven Southern African countries. We use this data to examine the degree to which people are aware of the pandemic, and are willing to speak about it. We also use it to examine whether it yields any palpable consequences of the disease in terms of public health. In turn, we also ask whether data on public awareness of AIDS deaths and individual health status corroborate, broadly, existing epidemiological data on HIV/AIDS. Finally, we examine the degree to which HIV/AIDS affects southern Africans’ political priorities, political participation, and expectations for government action. Substantively, we find that nationally representative survey data supports the epidemiological data in many ways, providing an independent corroboration of expected levels of AIDS illness and death across the region. The epidemiological data tell us that people in all seven of these countries are growing ill and dying from AIDS in large numbers. The Afrobarometer surveys tell us that large numbers of the people, in all seven countries, say they know someone who has died of AIDS and are willing to speak about it. Epidemiological estimates of AIDS deaths and popular experiences of AIDS deaths are closely correlated. Many people in these countries tell us that they are frequently ill, although the data do not disclose the nature of their illness. Epidemiological estimates of AIDS illnesses closely mirror the frequency with which people tell us that they are seriously ill. In political terms, the Afrobarometer tells us some surprising things. Even where HIV/AIDS has reached severe levels and people are dying in large and rising numbers, and even where people recognise those deaths as the result of HIV infection, very few of them place HIV/AIDS high on the agenda for government intervention. Rather, the epidemic is superseded in most countries by demands for government action to create jobs, expand the economy, and improve crime and security, or is masked by demands for overall improvements in health-related services. Perhaps Southern Africans perceive HIV/AIDS as a problem for families and communities, and not for governments. Or perhaps – and perhaps more likely – they are engaging in rational prioritisation. Faced with grinding poverty and widespread unemployment, people may be more concerned with getting a chance to earn an income, feed their families, protect themselves from crime and insecurity, and obtain basic health care, than with being saved from a largely invisible killer. (author's)
The 2000 International AIDS Conference focussed worldwide attention in a new way on the desperate scale of the HIV/AIDS pandemic in developing countries (particularly Africa). Front and centre was the "iniquity of very considerable proportions"1 that few of the millions of individuals and families living with (and dying from) the disease have access to medicines that are cheap to produce and can extend or save lives, while the technology and the resources to intervene to prevent untold human suffering and socioeconomic degradation are held by the world's richest. What that gathering highlighted was the absence of moral concern, political will, and financial commitment on the part of the powerful; what it catalysed was a growing activist movement that seeks to generate that concern, that will, those resources. Thanks to the domestic and international work of those activists — from demonstrations to court cases, from acts of public courage by individual people living with HIV/AIDS to ongoing lobbying of politicians and trade negotiators — some very significant developments have occurred. But the reality remains that the vast majority of people living with HIV/AIDS still lack access to affordable, quality medicines. This satellite, "Putting Third First", aims to contribute to one aspect of the movement. The objective is to identify and discuss strategies for using the law—as one tool among, and in conjunction with, other tools—to advance access to medicines for people living with HIV/AIDS in developing countries. Discussion among community organizers, lawyers and others will provide an opportunity for activists from different countries and regions to learn from each other’s experiences working for improved access to treatment using various legal (and non-legal) strategies. (excerpt)
Telephone helplines (also known as hotlines2) are telephone lines set up to take calls from people seeking information on specific topics—such as (in the case of this Best Practice study) HIV/AIDS. Four programmes were chosen to illustrate the Best Practice criteria for helplines: the AIDS Helpline of South Africa’s Department of Health, the reproductive health and sexuality helpline offered by a New Delhi-based nongovernmental organization (NGO) called Talking about Reproductive and Sexual Health Issues (TARSHI), the National AIDS Hotline of Trinidad and Tobago, and the hotline run by Remedios AIDS Foundation of Manila, the Philippines. Together, they illustrate the principles that make helplines so successful in providing HIV/AIDS information and counselling, the challenges helplines face, and the creative approaches that can be taken to meet those challenges. (excerpt)
Human security through women's eyes.
The events of Sept. 11, 2001, and all that has followed, make clear that in a global world, our destinies are linked. No one country can ensure global peace and human security alone. The common values and ethics that we develop to guide our interactions with each other - whether as states or local communities, organizations or individuals - are the best, and maybe the only, guarantors of human security. In times of global crisis, the United Nations is one of the few places where the world community can use dialogue and negotiation to build understanding and hold each other to these values. This is particularly clear in post-conflict situations, such as East Timor, Afghanistan, the Democratic Republic of Congo, Iraq, as the day-to-day business of restoring vital services and rebuilding communities becomes a priority. Rebuilding lives and communities demands that we again unite the local and global. Because in today's global world, national borders no longer protect us from viruses, conflicts or extremisms. They cannot guarantee human security. Over the last decade, at a series of U.N. conferences, countries committed themselves to a core set of norms and values. It is these norms and values that inspired the Millennium Summit in September 2000 and agreement on a set of eight development priorities, known as the Millennium Development Goals. Progress on every one of these goals demands bold leadership and shared commitment of all countries and all people. For it is clear that progress toward each and every one of these goals can be destroyed by war and violence. (excerpt)
At the heart of sustainable development lies the integration and balancing of social, economic and environmental priorities. In a world where pockets of privilege exist amid vast deprivation, such a quest fundamentally requires improving the well-being of those who are poor, marginalized or excluded, and sustaining those improvements. None of this is possible unless human resources are placed at the centre of sustainable development. Despite welcome progress in many respects since the end of the Cold War, the world remains cleaved by grave inequalities, deep deprivation and continuing environmental degradation. Those features are hardening in the ever-larger areas of the world that find themselves in the grip of the HIV/AIDS epidemic. Hard-hit parts of the world are seeing socioeconomic progress wane and, in some cases, reverse. By robbing communities and nations of their greatest wealth—their people—AIDS drains the human and institutional capacities that fuel sustainable development. These are not just temporary setbacks. AIDS is sapping vital components and attributes of potentially successful development strategies. By draining human resources, the epidemic distorts labour markets, disrupts production and consumption, and ultimately diminishes national wealth. Some countries bearing the brunt of such effects now face the prospect of ‘un-developing’—of seeing their development achievements dissolve in the wake of the epidemic. Allowed to spread unchecked, HIV/AIDS weakens the capacity of households, communities, institutions and nations to cope with the social and economic effects of the epidemic. Productive capacities—including in the informal sector—are eroded as workers and managers fall prey to the disease. Flagging consumption, along with the loss of skills and capacities, in turn drains public revenue and undermines the State’s ability to serve the common interest of development and human well-being. The cycle is dynamic and vicious. Typically, it is the poor who are edged further towards the margins and exclusion, as revealed by worsening social indicators in countries with serious AIDS epidemics. (excerpt)
Integrated vector management for malaria control in Africa.
Vector control is a critical element of malaria control programs in Africa. To reduce human exposure to infective Anopheles mosquitoes, most programs rely on methods that kill adult mosquitoes. These include promoting the use of insecticide-treated bednets (ITNs) or spraying long-lasting insecticides on the interior walls of houses (“indoor residual spraying,” or IRS). IRS became popular in the 1950s, when effective and inexpensive insecticides such as DDT first became available. Before then, many malaria control programs relied on methods for killing mosquito larvae, before they mature to the adult stage. These methods are more labor-intensive and include “source reduction” (draining and filling, or avoiding the creation of, mosquito breeding sites) and “larval control” (killing larvae with oil or insecticides applied to the water surface). Vector control is a critical element of malaria control programs in Africa. To reduce human exposure to infective Anopheles mosquitoes, most programs rely on methods that kill adult mosquitoes. These include promoting the use of insecticide-treated bednets (ITNs) or spraying long-lasting insecticides on the interior walls of houses (“indoor residual spraying,” or IRS). IRS became popular in the 1950s, when effective and inexpensive insecticides such as DDT first became available. Before then, many malaria control programs relied on methods for killing mosquito larvae, before they mature to the adult stage. These methods are more labor-intensive and include “source reduction” (draining and filling, or avoiding the creation of, mosquito breeding sites) and “larval control” (killing larvae with oil or insecticides applied to the water surface). (excerpt)
Making the link: population, health, environment.
The number of people on Earth, where they live, and how they live all affect the condition of the environment. People can alter the environment through their use of natural resources and the production of wastes. Changes in environmental conditions, in turn, can affect human health and well-being. Human demographic dynamics, such as the size, growth, distribution, age composition, and migration of populations, are among the many factors that can lead to environmental change. Consumption patterns, development choices, wealth and land distribution, government policies, and technology can mediate or exacerbate the effects of demographics on the environment. The precise impact of a given change depends on the interplay among all these factors, but it is clear that demographic change can affect the environment. (excerpt)