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Human Resources for Health. 2003 Jul 22; 1: p..Background: Human resources are an essential element of a health system’s inputs, and yet there is a huge disparity among countries in how human resource policies and strategies are developed and implemented. The analysis of the impacts of services on population health and well-being attracts more interest than analysis of the situation of the workforce in this area. This article presents an international comparison of the health workforce in terms of skill mix, sociodemographics and other labour force characteristics, in order to establish an evidence base for monitoring and evaluation of human resources for health. Methods: Profiles of the health workforce are drawn for 18 countries with developed market and transitional economies, using data from labour force and income surveys compiled by the Luxembourg Income Study between 1989 and 1997. Further descriptive analyses of the health workforce are conducted for selected countries for which more detailed occupational information was available. Results: Considerable cross-national variations were observed in terms of the share of the health workforce in the total labour market, with little discernible pattern by geographical region or type of economy. Increases in the share were found among most countries for which time-trend data were available. Large gender imbalances were often seen in terms of occupational distribution and earnings. In some cases, health professionals, especially physicians, were overrepresented among the foreign-born compared to the total labour force. Conclusions: While differences across countries in the profile of the health workforce can be linked to the history and role of the health sector, at the same time some common patterns emerge, notably a growing trend of health occupations in the labour market. The evidence also suggests that gender inequity in the workforce remains an important shortcoming of many health systems. Certain unexpected patterns of occupational distribution and educational attainment were found that may be attributable to differences in health care delivery and education systems; however, definitional inconsistencies in the classification of health occupations across surveys were also apparent. (author's)
OUTLOOK. 1990 Jun; 8(2):7-9.This article summarizes the most recent data on WHO's multicenter clinical trial test of the low dose progestin-releasing vaginal ring as an effective contraceptive for women. The study involved 1005 women aged 19-34 and was carried out from 1980-86 at 19 centers in 13 countries, including 9 developing countries. The overall findings on vaginal ring use included: the ring's effectiveness was comparable to oral contraceptive (OC) effectiveness, pregnancy rates increased with increasing body weight, about 1/2 of the users had discontinued the ring by 1 year, the ring disrupted menstrual bleeding patterns in about 1/2 of all users, and about 1/4 of all users expelled the ring at least once but most continued to use it. The irregular bleeding pattern was the main reason for discontinuation. Part of the reason for having different ring contraceptive effectiveness in different countries could be due to differing average weights of the women. Increasing risk of expulsion was directly related to increasing age by approximately 3% with each year of age. For effective use of 90-day low-dose levonorgestrel-releasing vaginal ring, appropriate clients should have the following: a dislike for inserting and removing vaginal devices, low weight, counselling on potentially irregular bleeding, and counseling on how to deal with an expulsion. (author's modified)
DEVELOPMENT: SEEDS OF CHANGE; VILLAGE THROUGH GLOBAL ORDER. 1987; (4):117-21.In this article the relations between government and non-government organizations (NGOs) are analyzed. In many countries, government and NGOs are 2 different worlds with little interaction between them. The differences between the 2 types of organizations could be summarized as the difference in the scale of operations, in the approach to development, different underlying philosophies, a different way of operating, different counterparts in developing countries, different projects and programs and a different way of dealing with the political context of development projects and programs. Collaboration between developed countries' governments and NGOs to stimulate development could be improved through: 1) a more systematic exchange of information between the 2 types of organizations; 2) the formulation of conditions for success in a particular country; 3) more sub-contracting of certain kinds of projects and project components to NGOs; 4) carrying out activities together; 5) improving the modalities and procedures of financial support to NGOs and in some cases its volume as well; and 6) moving from emergency to prevention. It is important to search for new fields of collaboration between government and non-government organizations. Examples are working with NGOs to formulate and implement food policies, relying on NGOs for feedback on certain policies, or in trying to achieve structural adjustment with a human face.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1987. 180 p.This report on the work of the United Nations Fund for Population Activities (UNFPA) in 1986 also contains a review of the state of world population in 1987. The review considers the demographic contrasts between the developed and developing worlds, the implications of rapid population growth, and rebuttals to the arguments in favor of population growth. (ANNOTATION)
Editorial Research Reports. 1985; 2(20):887-904.The author discusses aspects of urbanization, living conditions in urban centers, and selected policies, summarizing findings from recently published sources. U.N. population projections for selected urban areas for the year 2000 are compared with 1950 estimates, and the proportions of the population living in urban areas in various regions of the world are contrasted. Attention is given to living conditions in rapidly growing and crowded cities, including Mexico City, Mexico; Sao Paulo and Rio de Janeiro, Brazil; Lagos, Nigeria; and Cairo, Egypt. Statements on urban growth issued by the U.N. Fund for Population Activities are considered.
Mothers and Children. 1985 Nov-Dec; 5(1):5, 7.Currently standards from industrialized countries are used to assess the growth patterns of breastfed infants in developing countries. Infant growth faltering is interpreted as an indicator of insufficient lactational capacity on the mother's part. 2 recent articles suggest the need for a critical reappraisal of current growth standards and their use for evaluating the adequacy of infant feeding practices. The most commonly used standards to evaluate infant growth are derived from the US National Center for Health Statistics based on anthropometric data collected in the US population 3-month intervals up to the age of 3. During this period, infant feeding practices varied greatly. Many babies were bottle-fed and given supplemental feedings early in life. No large sample of exclusively breastfed infants has been studied from birth on, and thus a standard for breastfed infants is not available. A study of fully breastfed infants was done in England and suggests that there are differences in growth rates. Among a population of 48 exclusively breastfed boys and girls, for the 1st 3 to 4 months of life, growth of breastfed infants was greater than National Center for Health Statistics Standards, while after 4 months growth velocity decelerated more quickly than the standard. The growth of infants studied in Kenya, New Guinea and the Gambia appears to falter at 2-3 months of age using the NCHS standard. Findings suggest that current FAO/WHO recommended energy intakes may be excessive. Recent studies in the US support this assertion. The adequacy of the milk production for the infants in this US study done in Texas was illustrated by their growth rates. Length for age percentiles were higher than the NCHS standards throughout the study though at birth they did not differ significantly. 1 reason these breastfed infants were able to maintain growth despite less than recommended energy intakes is that the ratio of weight gain/100 calories of milk consumed was 10-30% higher among the breastfed infants compared to formula fed infants, suggesting a more efficient use of breastmilk than formula. There is a need for studies of exclusively breastfed infants with larger samples to determine what growth pattern should be considered the norm.
In: Intrauterine contraception: advances and future prospects, edited by Gerald I. Zatuchni, Alfredo Goldsmith, and John J. Sciarra. Philadelphia, Pennsylvania, Harper and Row, 1985. 354-64. (PARFR Series on Fertility Regulation)Little data is available from developing countries on the incidence of ectopic pregnancy and the associated risk factors: pelvic inflammatory disease (PID), sexually transmitted diseases (STDs), intrauterine devices (IUDs), and abortion. To address this problem, the World Health Organization conducted a multinational case-control study between 1978 and 1980 of factors associated with ectopic pregnancy in 12 centers, 8 in developing countries and 4 in developed countries. Results suggest that risk factors are similar in women from developing and developed countries. The only exceptions were increased risks of ectopic pregnancy associated with spontaneous abortion or smoking in developing but not developed country centers. This may reflect misreporting of illegal induced abortion or postabortion complications, and behavioral differences between smoking and nonsmoking women in developing countries. All methods of contraception prevent pregnancy and so provide protection against ectopic pregnancy. This protective effect is least with the IUD, however, and accidental conceptions during IUD use or after sterilization carry an increased risk of ectopic pregnancy. With the IUD, this probably reflects both differential protection against intrauterine and extrauterine pregnancy and an increased risk of IUD-related PID resulting in tubal damage. The risk of ectopic pregnancy is also increased in women with a previous history of PID or a prior pregnancy. However, cesarean section was found to reduce the risk of ectopic gestations in all comparison groups.