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Global Blood Safety Initiative. Minimum targets for blood transfusion services. Geneva, 20-22 March 1989.
[Unpublished] 1989. 4 p. (WHO/GPA/INF/89.14; WHO/LAB/89.5)The World Health Organization's minimum targets for blood transfusion services are multiple and may be implemented at different levels of sophistication. The following outline is to be a minimum requirement to ensure a safe blood supply. A national blood transfusion advisory committee should be formed and a blood policy should be formulated. Directors, supporting personnel, and ancillary staff must be of adequate numbers and possess levels of training that meet a minimum standard set by the committee. Operational responsibility should be clearly defined. collaboration with the military should create a national pool of resources in order to better respond to emergencies. Blood donations must collected in an organized manner with adequate record keeping to ensure a healthy and adequate supply. Safety must be of a minimum level in order to ensure adequate public response. Blood collection centers should include refrigerators that can reliably maintain a temperature of 20-6 degrees C. Rh typing and ABO grouping must be consistent and reliable. Screening for HIV, hepatitis, and other blood transmittable diseases must be reliable and efficient. Verifiable records must be kept and inventory must be tightly controlled. Hospital transfusion services should be similarly set up. Training and education programs must be set up for health care professionals.
NATIONAL MEDICAL JOURNAL OF INDIA. 1994 Nov-Dec; 7(6):288-91.Salient points of AIDS control in India are summarized. An autonomous national AIDS control organization has been set up, which received a sizable loan from the World Bank. As a result, the central health budget became skewed with one-fourth of its expenditures going for AIDS and not enough spent on general health services. Among issues inadequately addressed are: 1) HIV surveillance; 2) diagnosis of AIDS; 3) appropriate and safe medical care; 4) wasteful expenditure; 5) educating health workers; and 6) blood bank services. HIV surveillance and testing centers have been attached to a few large hospitals and medical colleges, but more testing and treatment services will be needed. The World Health Organization (WHO) recommends testing only after informed consent has been obtained; however, in India this is impossible because of the high rate of illiteracy. Instead, counseling is provided by special social workers and testing is prescribed by doctors. Special AIDS clinics might be the solution, although they lead to isolation and stigmatization of patients. Doctors and nurses should be made aware about the importance of informed consent and counseling to encourage voluntary and anonymous testing. The present WHO definition of AIDS for diagnosis is too general and is based on the African experience. Its use may lead to misdiagnosis of many cases of tuberculosis, diarrhea, and malnutrition as AIDS. Clinical criteria applicable to the Indian reality need to be developed urgently. Private practitioners have also entered HIV testing, but often they rely only on the ELISA test without confirmation which might result in a high rate of false positives. General medical care of AIDS cases have to be strengthened with routine sterilization to avoid wasteful expenditures, health workers have to be reeducated, blood bank services need to be streamlined, and more AIDS-related research is also required.
Geneva, Switzerland, WHO, 1991. vii, 72 p.Members of WHO's Technical Working Group on Essential Obstetric Functions at First Referral Level have prepared a book geared towards district, provincial, regional, national, and international decision makers, particularly those in developing countries, whose areas of expertise include planning, financing, and organization and management of obstetric services. The guidelines should allow them to improve referral services' standards at the district level. They should also help them decide how far and by what means they may possibly expand some of these services to more peripheral levels, e.g., renovating facilities and improving staff. When developing these guidelines, WHO took in consideration that many countries confront serious economic obstacles. The book's introduction briefly discusses maternal morbidity and mortality in developing countries and maternity care in district health systems. The second chapter, which makes up the bulk of the book, addresses primary components of obstetric care related to causes of maternal death. This chapter's section on surgical obstetrics examines cesarean section and repair of high vaginal and cervical tears among others. Its other sections include anesthesia, medical treatment, blood replacement, manual procedures and monitoring labor, family planning support, management of women at high risk, and neonatal special care. The third section provides guidelines for implementation of these services, including cost and financial considerations. It emphasizes the need at the first referral level to have the least trained personnel perform as many health care procedures as possible, as long as they can do so safely and effectively. Other implementation issues are facilities, equipment, supplies, drugs, supervision, evaluation, and research. Annexes list the required surgical and delivery equipment, materials for side ward laboratory tests and blood transfusions, essential drugs, and maternity center facilities and equipment.