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New York, New York, UNICEF, 2008 May. 54 p.Every year, the United Nations Children's Fund (UNICEF) publishes The State of the World's Children, the most comprehensive and authoritative report on the world's youngest citizens. The State of the World's Children 2008, published in January 2008, examines the global realities of maternal and child survival and the prospects for meeting the health-related Millennium Development Goals (MDGs) - the targets set by the world community in 2000 for eradicating poverty, reducing child and maternal mortality, combating disease, ensuring environmental sustainability and providing access to affordable medicines in developing countries. This year, UNICEF is also publishing the inaugural edition of The State of Africa's Children. This volume and other forthcoming regional editions complement The State of the World's Children 2008, sharpening from a worldwide to a regional perspective the global report's focus on trends in child survival and health, and outlining possible solutions - by means of programmes, policies and partnerships - to accelerate progress in meeting the Millennium Development Goals. (excerpt)
Strengthening maternal and child health programmes through primary health care. Guidelines for countries of the Eastern Mediterranean Region. Based on the deliberations of the Intercountry Meeting on the Integration of MCH into Primary Health Care, Amman, Jordan, 11-15 December 1988.
Alexandria, Egypt, WHO, EMRO, 1991. 75 p. (WHO EMRO Technical Publication No. 18)All countries in the WHO Eastern Mediterranean Region (EMRO) have had maternal and child health (MCH) programs for many years, yet maternal mortality and morbidity and infant mortality remain high. The EMRO office in Jordan, recognizing this dilemma, convened a meeting of national managers from the 22 EMRO member states to discuss how to integrate MCH programs with primary health care (PHC). The meeting resulted in the publication of guidelines and goals to help each country integrate MCH into PHC which would strengthen MCH services and improve MCH status. The managers noted the need to switch from a pregnancy-oriented approach to a holistic approach in which MCH/PHC programs and society consider women as more than childbearers. MCH/PHC programs and society need to be concerned about the well-being of females beginning with infancy and should place considerable health promotion for girls during the pubertal spurt and adolescence. They should also promote prevention of iron deficiency anemia in women. Since maternal mortality is especially high is EMRO, the national managers clearly laid out approaches for health services to reduce maternal mortality caused by obstetrical complications. They also recognized the need for a practical alternative to obstetric care provided by health workers--training traditional birth attendants in each village. They also provided guidance on improving prenatal care to reduce perinatal and neonatal mortality such as vaccination of every pregnant woman with the tetanus toxoid. Since the causes of death in the postneonatal period, MCH/PHC programs need to take action to reduce malnutrition and infection. For example, they must promote breast feeding for at least the first 6 months of life. The managers suggested the implementation of the Child Survival and Development Strategy which includes growth monitoring.
SYNOPSIS. 1998 Jan; (2):1-8.The World Health Organization (WHO)/UN Children's Fund (UNICEF) Integrated Management of Childhood Illness (IMCI) guidelines were designed to maximize detection and appropriate treatment of illnesses due to the most common causes of child mortality and morbidity in developing countries: pneumonia, diarrhea, malaria, measles, bacterial infections in young infants, malnutrition, anemia, and ear problems. The health worker first examines the child and checks immunization status, then classifies the child's illness and identifies the appropriate treatment based on a color-coded triage system. By May 1997, 17 countries had introduced IMCI and 16 others were in the process of introduction. This issue reports on field tests of the guidelines conducted in Kenya, the Gambia, Uganda, Bangladesh, and Tanzania. Health workers who used the guidelines performed well when compared to physicians who had access to laboratory and radiographic findings as well as health workers trained in full case management. Of concern, however, are research findings suggesting the potential for overdiagnosis in some disease classifications. Current IMCI research priorities include the following: 1) determining health workers' ability to learn to detect lower chest wall indrawing; 2) identifying clinical signs to increase the specificity of referral for severe pneumonia; 3) identifying other clinical signs to increase the specificity of hospital referrals, thereby reducing unnecessary referrals; 4) investigating how clinical care for severely ill children could be expanded in areas where referral is not feasible; 5) finding ways to increase the specificity of the diagnosis of malaria; and 6) recognizing clinical signs to increase the specificity of the diagnosis of severe anemia and the specificity of the diagnosis of moderate or mild anemia, with the possible goal of regional adaptation of the anemia guidelines.
Rapid anthropologic assessment: applications to the measurement of maternal and child mortality, morbidity and health care.
[Unpublished] 1991. Presented at the International Union for the Scientific Study of Population [IUSSP] Committee on Population and Health and Cairo University Institute of Statistical Studies and Research, Center for Applied Demography Seminar on Measurement of Maternal and Child Mortality, Morbidity and Health Care: Interdisciplinary Approaches, Cairo, Egypt, November 4-7, 1991. 14 p.University Nations University (UNU) leaders requested rapid anthropological assessment procedures (RAP) guidelines in the early 1980s to examine health-seeking behavior in 16 developing countries. They were not content with the expense, time, and poor accuracy of standard survey techniques to study health care. UNU project researchers studies 42 communities in these countries. They used triangulation to assess the validity of their data and found the data to be accurate. RAP involves applied medical anthropologists and other social scientists with appropriate training to pass about 6 weeks in a community where a supposed effective primary health care (PHC) programs operates to learn the household and community perspective on PHC services. 6 weeks constitute a long time for health planners and policymakers, but for anthropologists this time period tends to be too. Yet the required time hinges on the amount and complexity of data needed. It is important that the anthropologists and/or other social scientists already know the language and the culture because they interview biomedical and indigenous health providers. RAP depends on limited objectives and on existing data and prior research. Research designers should modify the limited objectives or data collection guidelines to fit each culture and each project. RAP data collection techniques include formal and informal interviews, conversations, observation, participant observation, focus groups, and data collection from secondary sources. Indeed researchers should be able to adapt these various techniques during the project. Obstacles which RAP research designers must consider are: some anthropologists do not feel at ease with RAP; not all cultures are comfortable with an outsider coming into their community asking questions, thus highlighting the importance of using an anthropologist already known and trusted in the community; and the topic may not be appropriate for discussion in a community.
Baltimore, Maryland, Johns Hopkins University, School of Hygiene and Public Health, Dept. of Population Dynamics, 1992. v, 60 p.During most of the 1980s, Iraq was at war with Iran. Despite the war, Iraq, with the help of UNICEF, was able to improve health services that impact on child health so that child survival also improved. They were able to do so because, in 1983, UNICEF, social organizations, the community, and the health sector joined forces to improve the health of the nation's children. They set up a district based primary health care system which saved the lives of 1000s of children annually. Their efforts concentrated on immunization, oral rehydration, unsafe birth practices, and increasing mothers' knowledge of childbearing and child health practices. Some achievements in child survival in Iraq during was included a sharp rise in neonatal tetanus immunizations from 8-72.5% (1985-1989) and a fall in neonatal tetanus deaths between 1983-1989 from 0.7-<.1, a rise in full immunization coverage from 13-85.5% and a fall in all vaccine preventable deaths (e.g., 58 pertussis deaths in 1980 to 0 deaths beginning in 1986), and a rise is use of oral rehydration therapy from 9-76% and a subsequent fall in diarrhea related deaths from 600-<100 (1980-1988). This monograph examined the factors responsible for the evolution of development trends, behavioral patterns, and program management style in Iraq. These factors centered around geopolitical and economic forces. Chapter 3 explains how child survival became a national priority and what strategies were undertaken to achieve child survival goals. Program implementation and the basis of program sustainability are laid out in chapters 4-5. Program achievements are presented in chapter 6. The last chapter discusses lessons learned and assesses child survival in wartime and continuing obstacles. This monograph points out that achieving child survival under adverse circumstances is possible when political will and commitment stands behind child survival efforts.
In: Issues in contemporary international health, edited by Thomas A. Lambo and Stacey B. Day. New York, New York, Plenum Medical Book Company, 1990. 113-33.The causes of mortality and disability in the world are reviewed, and the 4 most important mechanisms for promoting maternal and child health are proposed: female literacy, family planning, community-based efforts and global strategies for international cooperation. The health needs of women, children and adolescents, who make up the majority and the most vulnerable segment of the population, must be met. Malnutrition is the single most important cause of health problems through adult life, and affects 20 million children in Africa alone. Statistics are cited for infant mortality, vaccine-preventable diseases, diarrheal diseases and respiratory infections, infant mortality and maternal mortality. The key determinant of infant survival is female literacy. Existing scientific cooperation is the closet thing we have to a global international community. An example of applied scientific solutions to health care is the risk approach in maternal health care. 2 strategies of scientific cooperation have emerged: the international center model in a country or region to address a specific problem, and the task force model, as used effectively by WHO, UNICEF, and the Task Force for Child Survival. Research topics on health in developing countries are listed that could be tackled by universities and scientific networks, e.g. scientific research is lacking on how to make household hygiene effective in poor countries. A concerted global research effort and surveillance effort is needed for AIDS.
Child survival and development toward Health for All: roles and strategies for Asia-Pacific universities.
ASIA-PACIFIC JOURNAL OF PUBLIC HEALTH. 1989; 3(2):118-28.The child survival and development movement in relation to universities in the Asia-Pacific region were the subject of recent discussions of medical practitioners and academics. There are 14 million deaths of children that could be avoided if they could benefit from immunizations, pure water, sanitation, nutrition, and oral rehydration therapy. Also there is a large loss of physical and mental ability. Many international agencies have helped improved children's health and survival, and life expectancy has risen 40% in the last 40 years. In countries such as China, India, Pakistan, Thailand, and Indonesia there has been an exceptional achievement in child survival and development. In many developing countries health services have been patterned after western medical systems that promote treatment rather than prevention. Universities' role in relation to these problems has been the conducting of research, providing instruction, education, and training. The areas of success are in vaccine development and mass communications research. New roles can be taken in technical assistance and introduction of technology in planning and evaluation. There are also possibilities in the pooling of information and resources to help in child survival and development. In long range strategies and roles, universities can use conventional methods. In midrange areas the universities can use new modes and share and interact with governments and international organizations. In the short term they can use the less conventional methods and follow the leadership of the international organizations. In short term, universities can provide help in planning of national campaigns, provide resources, and participate in evaluations of campaigns. In the mid-range they can be involved in joint initiatives in operations research, specialized training, and clinical trials. In the long range universities are best suited to conventional research, training, laboratory science and technology development.
JOURNAL OF TROPICAL PEDIATRICS. 1989 Aug; 35(4):197-8.The 'Child Survival Revolution' (CSR) which emphasizes the technological approaches of Primary Health Care (PHC) as defined in Alma Ata, disregards the structural conditions and processes that lead to seldom diminishing morbidity and mortality rates among the poor in the Third World. The CSR may save some lives, but will not attack the underlying and basic causes of child mortality in developing countries. We must not rely on GOBI as a technical solution to what is essentially a socioeconomic and political problem. Choices to seek or not to seek better health for family members are all intimately linked to the state of poverty of most potential beneficiaries of GOBI-FF. Some additional empowerment of the people is needed for meaningful choices to become realistic options. GOBI-FF and the CSR are a combination of new technologies communicated by social marketing with mostly a top-down implementation, taking for granted the existing social and political institutions. Although the messages of the program call for political will, for social mobilization, for involvement of the population, and for changes in the health infrastructure, these concepts are used in a very inconsistent, demagogic, fuzzy and empty way. GOBI is too strongly supply oriented and ignores the social constraints behind a weak demand for the effective utilization of existing or new health services. Third World countries often end up following rules dictated from or set-up outside the country. Social marketing too, makes people mostly consumers, not protagonists and promoters. People need access to significant remedial interventions; knowledge is not enough. Evidence shows that people are 'patterning' their behavior to what the provider wants from them just to receive the program's benefits. Health professionals must help create the necessary support systems to empower the poor. (author's modified)
Oxford, England, Oxford University Press, 1988. , 86 p.The 1988 UNICEF report on the world's children contains chapters describing the multi-sectorial alliance to support child health, the current emphasis on ORT and immunization, the effect of recession on vulnerable children, family rights to knowledge of basic health facts, and support for women in the developing world. Each chapter is illustrated by graphs. There are side panels on programs in specific countries, including Senegal, Syria, Colombia, Bangladesh, Turkey, India, Honduras, Japan and Southern Africa, and highlighted programs including immunization, AIDS, ORT, breast-feeding and tobacco as a test of health. The SAARC is a new regional organization of southern Asian countries committed to immunization and other health goals. Tables of health statistics of the world's nations, divided into 4 groups by "Under 5 Mortality Rate" present basic indicators, nutrition/malnutrition data, health information, education, literacy and media data, demographic indicators, economic indicators and data pertaining to women. The absolute numbers of child deaths had fallen to 16 million in 1980, from 25 million in 1950. Saving children's lives will not exacerbate the population problem because, realizing that their children will survive, families will have fewer children. Furthermore, the methods used to reduce mortality, such as breast feeding and empowerment of families to control their lives, are known to reduce fertility.
World Health. 1986 Apr; 23.Diarrheal diseases are the leading cause of sickness and death in Thailand. The problem is particularly severe in children under age 5 who account for about 40% of all cases and about 50% of all deaths due to diarrhea. In October 1980, Thailand began a program of national control of diarrheal disease. It had as its target a substantial reduction in mortality from acute diarrheal diseases through oral rehydration therapy (ORT) by way of the primary health care approach and reduced morbidity by promoting better nutritional and maternal and child health practices and safer water supply and sanitation. The government's Pharmaceutical Organization produces 750 milliliter packets of oral rehydration salts (ORS) according to the World Health Organization (WHO) formula specifications. These are purchased by the Department of Communicable Diseases and distributed to all health facilities and to village health volunteers through the provincial health offices. Some villages have their own drug cooperatives run by village committees or by volunteers, where people also can buy ORS and other essential drugs. WHO and the UN International Children's Emergency Fund (UNICEF) are helping to supply training materials in the Thai language for health staff at all levels to familiarize them with clinical and program management. The volunteers themselves receive training as providers of ORS and as disseminators of health information. Since 1983, more and more messages reach the public through the mass media, especially television and radio. Most hospitals are able to screen slide sets and video cassettes about ORT and diarrhea prevention while the mothers sit in the waiting rooms. Between 1981-84, the proportion of the population under 5 years of age with access to ORT has risen from 12% to about 60% in areas where the program is fully developed. In areas where the program is fully developed, the use rate of ORS in the same group has gone up from 12% to 30%. Throughout Thailand as a whole, the use rate in children under 5 suffering from diarrhea is about 18%. The mortality rate from diarrhea in these young children fell from 4.97/100,000 in 1981 to 2.35/100,000 in 1983, a reduction of 53%. In 1984, the mortality rate increased from the previous year while the morbidity rate decreased. One reason may be that the most non-severe cases can be self-managed by ORT, while more severe cases are detected and referred by the village health volunteers and other health workers. This results in a higher number of deaths reported.
In: Third Asian and Pacific Population Conference (Colombo, September 1982). Selected papers. Bangkok, Thailand, Economic and Social Commission for Asia and the Pacific, 1984. 9-40. (Asian Population Studies Series No. 58)This report summarizes the recent demographic situation and considers prospective trends and their development implications among the 39 members and associate members of the Economic and Social Commission for Asia and the Pacific (ESCAP). It presents data on the following: size, growth, and distribution of the population; age and sex structure; fertility and marriage; mortality; international migration; growth and poverty; food and nutrition; households and housing; primary health care; education; the working-age population; family planning; the elderly; and population distribution. Despite improvements in the frequency and quality of demographic data collected in recent years, big gaps continue to exist in knowledge of the demographic situation in the ESCAP region. Available evidence suggests that the population growth rate of the ESCAP region declined between 1970 and 1980, as compared with the preceding decade, but that its rate of decline was slow. Within this overall picture, there is wide variation, with the most developed countries having annual growth rates around 1% and some of the least developed countries having a figure near 3%. The main factors associated with the high growth rates are the past high levels of fertility resulting in young age structures and continuing high fertility in some countries, notably in middle south Asia. The population of countries in the ESCAP region is expected to grow from 2.5 billion in 1980, to 2.9 billion in 1990, and to 3.4 billion persons by the year 2000. This massive growth in numbers, which will be most pronounced in Middle South Asia, will occur despite projected continuing moderation in annual population growth rates. Fertility is expected to continue its downward trend, assuming a more widespread and equitable distribution of health, education, and family planning services. Mortality is expected to decline further from its current levels, where life expectancy is often at or around 50 years. In several countries, more than 10 in every 100 babies born die before their 1st birthday. The extension of primary health care services is seen as the key to reducing this figure. Rapid population growth and poverty tend to reinforce each other. Low income, lack of education, and high infant and child mortality contribute to high fertility, which in turn is associated with high rates of natural increase. High rates of natural increase feed back to depress socioeconomic development. High population growth rates and their correlates of young age structures and heavy concentrations of persons in the nonproductive ages tend to depress production and burden government expenditure with high costs for social overhead needs. Rapid population growth emerges as an important factor in the persistence of chronic undernutrition and malnutrition. It increases the magnitude of the task of improving the educational system and exacerbates the problem of substandard housing that is widely prevalent throughout Asia.
The World Health Organization's Expanded Programme on Immunization: a global overview. Le Programme Elargi de Vaccination de L'Organization Mondiale de la Sante: apercu mondial.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(2):232-52.In recognition that immunization is an essential element of primary health care, the World Health Organization (WHO), with other agencies, is sponsoring the Global Program on Immunization whose goal is to reduce morbidity and mortality from vaccine-preventable diseases by providing immunization for all children of the world by 1990. A global advisory group of experts meets yearly to review the program. This paper summarizes the most salient features of the 1984 meeting. The major event for the Expanded Program on Immunization (EPI) in 1984 was the Bellagio Conference on protecting the world's children. Activities undertaken as a result of this conference are discussed. 1 outcome was the formation of the Task Force for Child Survival whose main objective is to promote the reduction of childhood morbidity and mortality through acceleration of key primary health care activities. Focus is on supporting Colombia, India and Senegal in accelerating the expansion of their immunization programs and strengthening other elements of primary health care, such as diarrheal diseases control, family planning and improved nutrition. The 5-point action program consists of the following components: promoting EPI within the context of primary health care; investing adequate human resources in EPI; ensuring that programs are continuously evaluated and adapted so as to achieve high immunization coverage and maximum reduction in target-disease deaths and cases; and pursuing research efforts as part of program operations. EPI has continued to collaborate with other programs to help assure that immunization services are provided to support delivery of other services. Integration of EPI in Africa, the Americas, the Eastern Mediterranean Region, Europe, the South-East Asia Region, and the Western Pacific Region is examined.
[Unpublished] 1984 Jul. , 520, 20 p.This 2-volume, 520-page report represents the 1st attempt at a situation analysis of Ghana. Its focus is the effect of Ghana's economic crisis on women and children. Volume I characterizes the macroeconomic situation in Ghana, the dimensions of poverty in the country, recent demographic trends, and the factors affecting infant, child, and maternal nutrition and mortality. Volume II discusses environmental sanitation, Ghana's health sector, education, general living conditions of families, and social services available for children. It is concluded that external assistance is needed to address the massive and widespread problems created by poverty in Ghana. Since the immediate problems of children and mothers are social, assistance is particularly needed in the form of outright grants or official development assistance. It is suggested that UNICEF should support both local and national interventions. There must be clear indications that all projects or programs are within government priorities. In the case of area-specific projects, local support should be assured and the main beneficiaries should be women and children. Finally, 4 possible areas of interventions are outlined: health, water and sanitation, education, and programs for slums. In the area of health, it is recommended that UNICEF devote particular attention to nutrition, immunization, oral rehydration, growth monitoring, and infection control within the context of general support to the development of primary health care.
The potential of national household survey programmes for monitoring and evaluating primary health care in developing countries. L'apport potentiel des enquetes nationales sur les menages a la surveillance et a l'evaluation des soins de sante primaires dans les pays en developpement.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(1):38-64.National programs of household sample surveys, such as those being encouraged through the National Household Survey Capability Program (NHSCP), are a principal source of information on primary health care in developing countries. Being representative of the total population, the major population subgroups and geographic subdivisions, they permit calculation of health status and utilization of health services. Household surveys have an important role to play in monitoring and evaluating primary health care since they sample directly the intended beneficiaries, and so can be used to judge the extent to which programs are meeting expected goals. Caution is necessary, however, since methodological problems have been experienced for many evaluation surveys. National surveys are especially appropriate for measuring many indicators of progress towards national goals within a broad socioeconomic perspective. Future directions in making the optimum use of household surveys for health program purposes are indicated. The NHSCP is a major undertaking of the UN system including WHO to collaborate with developing countries to establish a continuing flow of integrated statistics on a recurrent basis to support the national development process and information priorities. It brings together the principal users and producers of data to plan and conduct surveys which respond to national needs and priorities. The NHSCP encourages countries to employ a permanent national field organization for data collection. Areas of discussion are: the potential for monitoring and evaluation, the household survey as a source of health indicators, the demand for household surveys of health, followed by a summary of the health and health-related topics covered by 6 national health and nutrition surveys conducted in several developing countries. The special themes of infant and child mortality, morbidity and nutritional surveillance are also considered. The experience of many developed countries has been very positive with the use of nonmedically organized health surveys. Although the sample survey can be used in many settings to obtain population-based data, it must be carefully designed and implemented according to scientific procedures in order for the results to be validly extrapolated to the population or subgroups of primary concern.
In: Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C., edited by Richard Cash. Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 8-13. (International Conference on Oral Rehydration Therapy, 1983, proceedings)The worst economic setbacks since the 1930s do not augur well for the 100s and millions of children already trapped in the day-to-day silent emergency resulting from the conjunction of extreme poverty and underdevelopment which contributes so greatly to the death and disability toll which afflict over 40,000 small children per day. In the absence of special measures to accelerate health progress significantly, millions more children and mothers in low income areas are likely to die in the decade ahead. This meeting on promoting oral rehydration therapy is a concrete reminder that the key to the effectiveness in improving children's conditions is a refusal to accept a limitation upon what can be done with the available resources. In September, 1982, UNICEF invited a group of experts drawn from international agencies and nongovernmental groups involved in improving the lives of children to meet and discuss the problem. They recognized that certain elements of the primary health care strategy, including oral rehydration therapy, could greatly contribute to the realization of the health for all goal. They focused on community-based services and primary health care and how to improve health services. The improved techniques and technologies, the increased acceptance of the primary health care approach, and a new capacity of social organization for reaching low-income families could save a high proportion of children's lives. Nutritional surveillance, oral rehydration, breastfeeding and better weaning practices, immunization, family spacing, food supplements, and health education will contribute to the health of millions of mothers and families. Everyone is urged to make a commitment to strive for the health for all goal. The media, private organizations and ministeries of health must all join in the effort.
Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C.
Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 210 p. (International Conference on Oral Rehydration Therapy, 1983, proceedings)With over 600 participants from more than 80 countries, the International Conference on Oral Rehydration Therapy (ICORT) was a testimony to the international health community's recognition of the seriousness of diarrheal disease, the value of oral rehydration therapy, and the commitment to primary health care. The conference, initiated by the Agency for International Development, was cosponsored by the International Center for Diarrheal Disease Research, Bangladesh, the United Nations Children's Fund, and the WHO. The conference focused on oral rehydration therapy, an important treatment of diarrhea. 1 out of 10 children born in developing countries dies from the effects of diarrhea before the age of 5. A 70% reduction in the mortality rate can result from ORT--a major breakthrough for primary health care. Excellent laboratory investigation, well-conducted clinical studies, and careful field observation have led to this effective therapy. Many papers presented at the conference demonstrated the effectiveness of ORT. Participants agreed on the best formula for ORT in terms of electrolyte content and on the need for an international commitment to expand implementation of ORT. Problems in implementing oral therapy programs are discussed. Possible areas of investigation include: 1) improving the solution through the addition of glycine, other amino acids, or cereal-based substrates; 2) developing methods for teaching ORT; and 3) investigating better methods of program evaluation. Innovative approaches to informing the public about the use and benefits of oral therapy were also discussed. Participants, recognizing that problems are shared among many different programs and nations, exchanged ideas and addresses, pledging to keep each other abreast of their ORT research and implementation efforts. The conference closed with a strong call for action to attain near universal availability of ORT in the next 10 years.
In: American University of Beirut. Faculty of Health Sciences. Human resources for primary health care in the Middle East. Beirut, Lebanon, American Univeristy of Beirut, 1980. 13-21.During 1979, the International Year of the Child, the World Health Organization (WHO) encouraged efforts to improve the collection of information on health and health related problems faced by underprivileged populations. To focus attention on health care for children, the theme of this year's World Health Day on April 7 was the well being of the child. The slogan, "a healthy child, a sure future," was chosen to promote breastfeeding, oral rehydration, nutrition, education, and immunization against the 6 major childhood diseases included in WHO's expanded immunization program. Currently, less than 10% of children in developing countries receive immunization. WHO and its member countries have committed themselves to providing immunization services for every child in the world by 1990, as part of the goal of "health for all by 2000." WHO recommends that each country appoint a program manager and supporting staff to provide detailed plans of operation for immunization. Emphasis in the planning stage should be on the integration of immunization services within the primary health care network for each country. Diarrheal diseases rank among the 1st 3 leading causes of death in children, taking an estimated 5-18 million lives a year, particularly among children under age 5. Dr. Halfdan Mahler, Director General of WHO, has said that the task of safeguarding the health of children cannot be realized through conventional means. What is required is a "radical new approach" which emphasizes the mobilization of national and international resources, the imaginative use of traditional medicine, and the development of health technologies relevant to local needs. A WHO study in 8 developing countries found that 90% of all child deaths could be avoided by safe water and sanitation. This can be regarded as the core of the problem, which indirectly relates to population dynamics and community attitudes. There also appears to be a link between child deaths and births. Maternal and child health care services are not well established in developing nations. Guidelines, quoted from David Werner's book "The Village Health Worker" are quoted to help bridge the gap in reaching the masses. Community health programs will have to be organized on the basis of local needs and priorities. Local health workers from within the community will have to be selected and trained in the delivery of simple basic health care and be responsible to the community.
Journal of Tropical Pediatrics. 1983 Aug; 29(4):217-9.The World Health Organization (WHO) launched the Expanded Program of Immunization (EPI) in 1974 based on the belief that most countries already had some elements of national immunization activities which could be successfully expanded if the program became a national priority with a commitment from the government to provide managerial manpower and funds. The federal government of Nigeria quickly adopted the policy of WHO on EPI and urged the state governments to set up administrative arrangements for planning and implementation of EPI. The program started off in Oyo State of Nigeria after a pilot study conducted at Ikire in Irewole Local Government area in 1975. The stated objectives of the programs were: to provide immunization service to at least 85% of the target population e.g. children under 4 years; and to integrate immunization programs into routine activities of all static primary health centers in the state. This study focuses on administration of the immunization program in the Oranmiyan Local Government area of Oyo State, within the structure of the local government health system and the field health administration of the state government. This study shows that the stated objectives of the EPI are not likely to be achieved in the near future because of low coverage of the eligible population, due to inadequate community involvement in the planning and implementation of the program; 2) poor communication between different government departments; and 3) inadequate publicity. The effect of improvement in health status because of immunization programs, has been very difficult to demonstrate in Nigeria because a lack of accurate data on birth, morbidity, and mortality patterns of the population. Other socioeconomic and health factors of significance in the battle against infectious diseases include environmental sanitation, adequate and safe water supply, housing and nutrition. Nevertheless, immunization programs constitute one of the most economical and effective approaches to the prevention of communicable diseases and can produce dramatic effects in the battle to lower infant and childhood mortaltiy rates in the developing countries if they are well implemented.
[Unpublished] 1979. Paper prepared for World Health Organization Regional Office for South-East Asia Inter-country Consultation to Develop a Regional Programme on Diarrhoeal Disease Services and Research, New Delhi, 18-23 June 1979 (SE ICP RPD 002.104) 6 p.Reviews, from the global perspective, the development and direction of the new WHO Programme for the Control of Acute Diarrhoeal Diseases. Examines briefly the magnitude of the problem of diarrheal diseases, the relatively new research findings which have greatly stimulated the effort at control, and the global strategies for control that Member States may employ in technical cooperation with WHO.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1982; 35(1):2-10.The goal of health for all by the year 2000 was first stated at the 1977 World Health Assembly and global strategy was launched at the 32nd World Health Assembly in 1979. This article focuses on life expectancy at birth as the most widely used indicator of the health status of populations and also the health status indicators most closely correlated with socioeconomic development. Developing countries have set a target of life expectancy of 60 years; at present 86% of these countries are exposed to mortality conditions which leave life expectancy at age 50. Among 80 countries with GNP per capita of more than $500 61 have life expectancy over 60 years and of the 35 with a life expectancy of 70 or more 28 have GNP over $2500. The largest concentration of countries below the target level is in Asia. Discovering the leading causes of death is crucial in raising life expectancy; in developed countries they are cardiovascular disease, malignant neoplasms, and accidents, accounting for 70% of all deaths. In developing countries there is variation with regard to level of modernization of the cause of death structure but in at least 1/2 the 3 latter causes are also predominant with diarrheal disease and infectious and parasitic conditions related to malnutrition the main causes in the other 1/2. When assessing the health care needs of developing countries the difference between countries regarding their ability to reduce mortality from the traditional diseases must be considered before deciding on use of resources.
Journal of the Indian Medical Association. 1983 Apr; 80(7-8):108-11.In 1977 the World Health Assembly launched the movement for "Health for all by the year 2000." The 1st step was taken at the International Conference on Primary Health Care in Alma Alta, USSR, in 1978. The conference declared that primary health care (PHC) was the key to realizing the goal of health for all by 2000. It also emphasized the need for urgent and effective national and international action to develop and implement a PHC program throughout the world. A general review of the progress in terms of the indicators will facilitate tracing the progress and realizing the magnitude of the tasks ahead. In terms of the 1st 2 indicators, the target has been endorsed at the highest official level by parliaments or governments in most countries and the mechanism has been strengthened in most of the developing countries to involve people in the implementation of the health development programs. The trouble begins with the 3rd indicator which requires countries to spend at least 5% of the gross national product (GNP) on health. For most of the developing countries where health development is inextricably linked with socioeconomic development, investing 5% of the GNP on health is difficult. It is almost an impossibility for the least developed countries (LDCs). The position of the developing countries like India, though somewhat better than that of the LDCs, is not very encouraging either. In India's 6th Plan the allocation on health as percentage of total allocation in the budget was 2.40 in 1978-79 and 2.10 in 1979-80. India's position with regard to the 4th global indicator, requiring that a reasonable percentage of national health expenditure be devoted to the local health care, is not yet satisfactory though considerable efforts have been made in this area. In regard to the 5th indicator, namely, equitable distribution of resources on various population groups or geographical areas, the desired standard has not been achieved. A most important indicator, indicator 7, set by the WHO for monitoring the progress of the global strategy is that PHC should be available to the entire population. About 361 million of India's rural population do not have adequate drinking water facilities and sanitation facilities. In respect to the drug requirement of indicator 7, only a few of the essential drugs of the 20 required, are available. About 50% of the children live in conditions of poverty, deprivation, and malnutrition, and about 40% of all deaths in the country occur among children below age 5 and 10% of all children born do not live to celebrate their 1st birthday. Despite the conditions, child care continues to receive low priority from the government of India. Nutrition programs have been launched, but most of these programs have only touched on the problem.