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Resourcing global health: a conference of the Global Network of WHO for Nursing and Midwifery Development, Glasgow, Scotland, June 2006.
Midwifery. 2006 Sep; 22(3):200-203.With the focus of the World Health Report 2006 Working for health together firmly on the issue of human resources in health, the subject is officially placed among those at the top of the international agenda. The debates at this conference, held June 7--9 and hosted by the WHO Collaborating Centre (WHOCC) for Nursing & Midwifery Education, Research & Practice, based in Glasgow Caledonian University's School of Nursing, Midwifery and Community Health, were therefore highly topical and drew significant speakers from both the host country Scotland and 20-plus other nations. The conference was held in conjunction with the Royal College of Midwives (RCM) and the Royal College of Nursing (RCN). (excerpt)
NATION'S HEALTH. 2001 Apr; 15.One topic discussed at the annual January session of the WHO's executive board was the general health and well-being of young children and mothers. The 32 members met in Geneva for a week to develop policy standards in various issues, including promoting a global strategy for infant and child feeding and nutrition, strengthening nursing and midwifery and making pregnancy safer. The board members adopted a resolution aimed at improving the nutrition of women of reproductive age and supporting breastfeeding. They also stressed the importance of increasing nursing and midwifery work. Other significant issues discussed included epidemic alert and response measures, health services performance assessment, HIV/AIDS, mental health, the Roll Back Malaria program, polio eradication, tobacco control, and schistosomiasis.
REVISTA PAULISTA DE MEDICINA. 1989 Jan-Feb; 107(1):47-52.In the fight against maternal mortality, the WHO recommended that developing countries adopt effective measures to reduce its high prevalence. One measure is the improvement of data about maternal deaths and major risk factors during pregnancy, delivery, and puerperium. Official figures are underreported by 50% or more, and the cause of death tends to be attributed to an immediate preceding complication. In the US, maternal mortality declined from 37/100,000 live births in 1960 to 8/100,000 in 1984; in Chile from 299 in 1960 to 45 in 1984; in Ecuador from 270 in 1960 to 189 in 1984; and in Paraguay from 327 in 1960 to 283 in 1984, a barely noticeable reduction. Strategies that improve knowledge include the keeping of statistics; epidemiological investigations (case control studies); and the formation of committees on maternal death, which are composed of highly regarded professionals (the UK, Chile, and Cuba obtained good results with them). The education of the populace by radio, television, and print media to utilize prenatal assistance is another measure. The human resources, location, and minimum instrumentation of these health centers are basic requirements. Most maternal deaths occur in hospitals of inadequate staff and material resources. The traditional birth assistant training program of Ceara state, Brazil, is a model for others. Caesareans save many lives in complicated deliveries, but in Sao Paulo state, more than 80% of some groups choose it without justification. Assistance Needs to be extended into the puerperium to monitor normal involution of the genital organs, to confirm normal lactation, and observe any pathology present during pregnancy. Cardiopathy, renal insufficiency, chronic hypertension, grand multiparity, and advanced maternal age are high risk factors for pregnancy. Postabortion deaths account for more than half of mortality in some Latin American countries. In the UK, mortality dropped from 35 in 1969, after the legalization of abortion in 1968 to 8 in 1975. The reverse was observed in Romania when abortion became outlawed. Nonetheless, abortion is a touchy issue and education about contraceptives should be stressed.
KRANKENPFLEGE JOURNAL. 1992 May; 30(5):204-6.The author relates her experience in Benin during a 3 and 1/2 year tenure as a nurse under the aegis of the German Development Agency. In Malanville, she was responsible for starting the operating room, caring for hygiene, sterility, and the related training of domestic staff. A septic and aseptic operating room was set up along with a storage room for instruments, a sterilization room, and a changing room. For the operating and surgical station, the following personnel were available: 2 nurses with 3 years of training, 1 nurse with 2 years of training, and 3 orderlies without training. A nurse with 3 years of training was assigned to the author to carry on the project after her departure. The standard of operating care was very low. It took a month to teach the staff what was not sterile. There was a even problem with putting on sterile gloves which required an exercise in patience. There were an average of 5 relatives per patient taking care of the patient and cooking. The undernutrition center for infants had 6 beds with 2 German nurses who administered Bacillus Calmette-Guerin (BCG), diphtheria, polio, and tetanus vaccinations. Their activity was strengthened by nutrition counselling and plans for underweight and malnourished children. Abrupt weaning that resulted in harmful diarrhea and vomiting was prevalent. Clinical signs of marasmus and kwashiorkor were frequent. In the middle of 1990, AIDS educators informed students of the public school as well as registered prostitutes about condom use. In the hospital, there were about 900 births per year, and women were asked to follow recommendations for prenatal care, especially to achieve anemia prevention by getting iron tablets. They were urged to deliver in the clinic, not at home assisted by untrained midwives. Oxytocin and syntometrin were available as was a hand-driven, vacuum evacuation pump. This experience made a lasting impression on the author who has resolved to go to another developing country to train traditional birth attendants in midwifery.
ENTRE NOUS. 1988 Oct; (12):10-2.Beginning in the 1960s, the Turkish government placed a emphasis on the importance of family planning in an effort to improve maternal and child health (MCH) services. While the IUD has proven adequate for women in Turkey, insertion and proper use have created problems. The IUD program has had difficulty in gaining the acceptance of male physicians in Turkey, and because there are few female physicians in the country, a problem with implementation of the program arose. 1 solution suggested that non-physician personnel learn to insert the IUD and be able to examine IUD patients. Assistant nurse-midwives were surveyed in a 3-phase project carried out by the staff of the Department of Public Health of Hacettepe University in Ankara with WHO. In the 1st phase, a training method was created with competence comparison of the assistant midwives to physicians following in the 2nd phase. The 3rd phase of the project studied the use of non-physician services throughout the country. It was found that assistant nurse-midwives were equally capable of IUD insertions and check-ups and that IUD services can now reach rural areas of the country beyond the range of traditional medical services.
Alternative approaches to meeting basic health needs in developing countries: a joint UNICEF/WHO study.
Geneva, World Health Organization, 1975. 116 p.Based on the failure of conventional health services and approaches to make any appreciable impact on the health problems of developing populations, this study examined successful or promising systems of delivery of primary health care to identify the key factors in their success and the effect of some of these factors in the development of primary health care within various political, economic, and administrative frameworks. In the selection of new approaches for detailed study, emphasis was placed on actual programs that are potentially applicable in different sociopolitical settings and on programs explicitly recognizing the influence of other social and economic sectors such as agriculture and education on health. Information was gathered from a wide range of sources; including members, meeting reports, and publications of international organizations and agencies, gathered country representatives, and field staff. The 1st section, world poverty and health, focuses on the underprivileged, the glaring contrasts in health, and the obstacles to be overcome--problems of broad choices and approaches, resources, general structure of health services, and technical weasknesses. The main purpose of the case studies described in the 2nd part was to single out, describe, and discuss their most interesting characteristics. The cases comprised 2 major categories: programs adopted nationally in China, Cuba, Tanzania, and, to a certain extent, Venezuela, and schemes covering limited areas in Bangladesh, India, Niger, and Yugoslavia. Successful national programs are characterized by a strong political will that has transformed a practicable methodology into a national endeavor. In all countries where this has happened, health has been given a high priority in the government's general development program. Enterprise and leadership are also found in the 2nd group of more limited schemes. Valuable lessons, both technical and operational, can be derived from this type of effort. In all cases, the leading role of a dedicated individual can be clearly identified. There is also evidence that community leaders and organizations have given considerable support to these projects. External aid has played a part and apparently been well used. Every effort should be made to determine the driving forces behind promising progams and help harness them to national plans.
[Unpublished] 1979. Paper prepared for the Technical Workshop on the Four Country Maternal and Child Health/Family Planning Projects, New York, Oct. 31-Nov. 2, 1979. (Workshop Paper No. 2) 10 p.An integrated health care system which combined the maternal/child health with other services was undertaken in the Yozgat Province of Turkey from 1972-77. The objective was to train midwives in MCH/FP and orient their activities to socialization. The first 2 years of the program was financed by UNFPA. 52 health stations were completed and 18 more are under construction. The personnel shortage stands at 33 physicians, 21 health technicians, 30 nurses, and 67 midwives. Yozgat Province is 75% rural and has about a 50% shortage of roads. The project was evaluated initially in 1975 and entailed preproject information studies, baseline health practices and contraceptive use survey, dual record system, and service statistics reporting. The number of midwives, who are crucial to the program, have increased from an average 115 in 1975 to 160 in 1979. Supervisory nurses are the link between the field and the project managers. Their number has decreased from 17 to 6. Until 1977 family planning service delivery depended on a handful of physicians who distributed condoms and pills. The Ministry of Health trained women physicians in IUD insertions. The crude death rate in 1976 was 13.2/1000; the crude birth rate was 42.7/1000. The crude death rate in 1977 was 14.8/1000; birth rate, 39.9/1000. Common child diseases were measles, enteritis, bronchopneumonia, otitis, and parasitis.
World Health. 1978 Aug-Sept; 26-29.For family planning program administrators, there is frequent need for research to resolve important questions or to provide planning information, with the type of service research required ranging from pilot projects to evaluation of major innovations. A series of case studies illustrates this broad spectrum of research. In developing countries, a significant area for research is utilization of nonphysicians, due to a doctor shortage, and a preference by women family planning clients for women, who predominate the other personnel categories. 1 study of IUD insertions by nurses and midwives in Korea, the Philippines, and Turkey compared the performance of nonphysician personnel in medical diagnosis to that of physicians, with the conclusion that the nonphysician personnel were equally competent. Other areas for service research include administrative decisions about contraceptive methods to offer, and provision of suitable program settings. Due to the problems facing the delivery of health and family planning care, the significance of service research lies not only in program operation, but often has an impact on the views of the medical profession and other influential officials who can amplify the outcome of limited research projects by applying results on a national scale.
Prepared for World Population Society Meeting, Washington, D.C., December 6, 1976. 28 pWHO, in response to resolutions adopted at the World Population Conference, will give highest priority to developing new and alternative approaches to the promotion of the health of the underserved and vulnerable groups, especially in rural areas of developing countries. 4 annexes reflect WHO's policy, program areas, and activities. Annex 1 outlines the WHO Sixth General Programme of Work, which covers 5 major areas: 1) development of comprehensive health services, 2) disease prevention and control, 3) promotion of environmental health, 4) health manpower development, and 5) promotion and development of biomedical and health services research. Annex 2 lists quotations from relevant paragraphs of the World Population Plan of Action concerning health-related aspects of population. Annex 3 contains a list of WHO-supported activities in population 1976-1977 and 1978-1979 by field of activity and description of activity. Annex 4 details collaborative activites of WHO with member states and lists WHO collaborative efforts with country projects funded by UNFPA.
In: World Health Organization (WHO). Third report on the world health situation, 1961-1964. Geneva, Switzerland, WHO, April 1967. 28-35. (Official Records of the World Health Organization No. 155)The specific replies of 86 governments to the questionnaire for the Third Report are analyzed. The questionnaire asked for 3 things; 1) a description of the major public health problems still to be solved in order of magnitude; 2) how that assessment had been made; and 3) assignment of, where possible, priorities to the solving of the problems. The 46 problems cited fell into the following 10 major groups, listed in order of importance; environmental deficiencies, malaria, tuberculosis, malnutrition, helminthiases (including bilharziasis), communicable diseases (exclusive of malaria, tuberculosis and venereal diseases), chronic degenerative diseases and accidents, administrative and organizational deficiencies (including personnel deficiencies), venereal diseases, and mental health. Though the health record for each country was different, common patterns tended to emerge on a regional basis. The African region profile was drawn from the experience of 28 countries, and the general picture was of a region where effort needed to be concentrated on the control of communicable diseases, requiring large expenditures in basic sanitation, training of personnel and administrative and organizational improvements. In Canada and the U.S. the major problems were cardiovascular diseases, cancer, and accidents, and the organization and financing of health care services. The Central and South American and the Caribbean profile was drawn from the replies of 36 countries. Their problems in order of importance were: 1) malnutrition, 2) environmental deficiencies and diarrheal and venereal diseases, and 3) malaria. 7 countries in the Southeast Asia region provided information. Major problems there were environmental deficiencies, diarrheal diseases and dysentary, communicable diseases, and to a lesser extent population pressure. In the European region, priority was given to problems of administration and organization, followed fairly closely by cancer, cardiovascular disease, venereal diseases, tuberculosis, respiratory virus diseases, and infectious hepatitis. In the Eastern Mediterranean malaria and tuberculosis were the outstanding diseases and half the respondents had important administrative and organizational problems. In the Western Pacific, Australia, Japan, and New Zealand have problems comparable to those of the developed countries of Europe and North America. In the other countries in the region the emphasis was on communicable diseases with tuberculosis in the lead. Other problems mentioned that did not fit under 1 of the 10 headings were human rabies, alcoholism, dental health, and problems associated with urbanization and industrialization. Problems of population pressure and manpower deficiencies in the health field are also discussed on a regional basis.
World Health Forum. 1982; 3(2):236-8.Only 3 of Turkey's 44 socialized provinces have been able to meet the demand for midwives. Currently there are 28 midwifery colleges but there is widespread feeling that the midwife is not being adequately prepared for her role and is unable to provide the quality of services required under the present health system. The following are lacking: 1) task analysis, 2) sufficient supervision systems, 3) training curricula, 4) trained teachers, 5) postgraduate training facilities, and 6) teaching materials. To solve the last problem the Center for Medical Education Technology prepared a manual for midwives. A committee of professionals including midwives, nurses, pediatricians, gynecologist/obstetricians, educators, health administrators, family planning experts, and nutritionists collaborated in the effort. A problem-based approach was used and the role of the midwife as an agent for preventive measures and health communicator was stressed. The language of the text was kept simple and the contents were divided into 2 groups: maternal care/family planning and child care. The contents reflect the major health problems encountered by midwives: among children, disorders of the respiratory and digestive tracts, malnutrition and accidents, and among women, disorders relating to pregnancy and diseases of the urogenital tract as well as dental problems. Illustrations of processes inside the body are included. The manual is printed in type large enough to be read in poor light.