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Geneva, Switzerland, WHO, 1985. 101 p. (WHO/CDD/85.13)The Diarrheal Diseases Control (CDD) Program, initiated in 1978, is a priority program of WHO for attainment of the goal of Health for All by the Year 2000. Its primary objectives are to reduce diarrheal disease mortality and morbidity, particularly in infants and young children. This report describes the activities undertaken by the Program in the 1983-1984 biennium. During this period, the Program collaborated with more than 100 countries in the implementation of national diarrheal disease control and research activities. The biennium has witnessed a growing interest of other international, bilateral, and nongovernmental agencies in diarrheal disease control; their financial support and commitment have contributed in a large measure to furthering the development of CDD programs and related research in many countries. During the biennium, the services component continued to expand both the quantity and scope of its activities at global, regional, and national levels. This is readily seen from the increase in global acess to Oral Rehydration Salts (ORS) packets from less than 5% in 1981 to 21% in 1983. Other significant developments were a substantial increase in the number of countries planning and implementing programs and the initiation of a new management course in supervisory skills. Successful implementation of national primary health care systems was recognized as necessary for the achievement of the Program's objectives. Efforts of both developing and industrialized countries must continue in a joint endeavor to reduce the problem of diarrheal diseases, especially cholera, the most severe diarrheal disease. The following areas are discussed: the health services component; the research component; information services; program review bodies; program resources and obligations; and program publications and documents for 1983-1984.
International Workshop on Youth Participation in Population, Environment, Development at Colombo, 28th Nov. 83 to 2nd Dec. 83.
Maribo, Denmark, WAY, . 120 p.The objectives of the International Youth Workshop on Population and Development were to provide a forum to the leaders of national youth councils and socio-political youth organizations. These leaders were brought together to review national and local youth activities and their plans and action programs for the future. The outlook for these discussions was local, regional, and global. In addition the Workshop aimed at providing interaction among the youth organizations of the developing and the developed countries. These proceedings include an inaugural address by Gemini Atukorata, Minister of Youth Affairs, Government of Sri Lanka and presentations focusing on the following: youth and development; the key role of youth in production and reproduction -- important factors of development; 60% of the aid goes back to the giving country in several ways; adolescent fertility as a major concern; social development for the poor with particular reference to the well-being of children and women; commitment for the cause is the key to attract funds; and observance of the International Youth Year under the themes of participation, development, and peace. The 11th workshop session dealt with follow-up and the future direction of the World Assembly of Youth (WAY). The following points emerged in this most important session: WAY should emphasize "Youth Participation in Development" as the major program; WAY's population programs should not be limited to just information, education, and communication, and youth groups should be encouraged to become service delivery agents for contraceptives wherever possible; environment awareness should become an integral part of population and development programs; youth in the service of children, health for all, and drug abuse should be the new areas of operation for WAY; and programs of youth working in the service of disabled, especially disabled young people, and youth and crime prevention programs also found favor with the participants. Recommendations and action programs are outlined. Proceedings include a summary of WAY activities and resolutions.
New York, New York, Oxford University Press, 1990. xvii, 423 p.This text on international health covers historical and contemporary health issues ranging from water distribution systems of the ancient Aztecs to the worldwide endemic of AIDS. The author has also included areas not in the 1979 version: the 1978 Alma Ata conference on primary health care, infant and maternal mortality, health planning, and the role of science and technology. The 1st chapter discusses how each population movement, political change, war, and technological development has changed the world's or a region's state of health. Next the book highlights health statistics and how they can be applied to determine the health status of a population. A text on international health would be incomplete without a chapter on understanding sickness within each culture, including a society's attitude towards the sick and individual behavior which causes disease, e.g. smoking and lung cancer. 1 chapter features risk factors of a disease that are found in the environment in which individuals live. For example, in areas where iodine is not present in the soil, such as the Himalayas, the population exhibits a high degree of goiter and cretinism. Others present the relationship between socioeconomic development and health, e.g., countries at the low socioeconomic development spectrum have low life expectancies compared to those at the high socioeconomic end. An important chapter compares national health care systems and identifies common factors among them. An entire chapter is dedicated to organizations that provide health services internationally, e.g., private voluntary organizations. 1 chapter covers 3 diseases exclusively which are smallpox, malaria, and AIDS. The appendix presents various ethical codes.
WORLD HEALTH. 1988 Aug-Sep; 10-5.The 1978 International Conference on Primary Health Care (PHC) in Alma-Ata, USSR, sponsored by the World Health Organization (WHO) and by UNICEF, culminated in the Declaration of Alma-Ata. This Declaration, signed by representatives of 134 nations, pledged urgent action for the development of PHC and toward the goal of "Health for All by the Year 2000." Among the most important principles of PHC are these 5: 1) that care should be accessible to all, especially those in greatest need; 2) that health services should promote popular understanding of health issues, and should emphasize preventive as well as curative measures; 3) that health services should be adapted to local economic and cultural circumstances, and be effective; 4) that local communities should be actively involved in the process of defining health problems and developing solutions; and 5) that health development programs should involve cooperation among all the community and national development efforts that have an impact on health. Even before the Declaration 10 years ago, the concepts underlying PHC had been taking root around the world. Progress toward the ideals of PHC has been made. Immunizations rates increased from 5% in 1970 to 40% in 1980. Only 34 countries had under-5 mortality rates of 178/1000 or more in 1985. 1/2 the number of 25 years earlier. However, PHC has in general achieved much better coverage in the developed countries than in the developing ones. The increase in world poverty -- to 1 billion people in absolute poverty today -- is a major setback for PHC. A major cause of health problems in the 3rd World is the too-rapid growth of unwieldy cities. Another common problem is that the training of medical professionals has not prepared them for leadership roles in community-oriented, preventive health programs. The ideals of PHC have been widely accepted throughout the world, and progress has been made, but much remains to be done.
WORLD HEALTH. 1988 Jan-Feb; 10-11.In 1979 WHO invited its member states to participate in a global strategy for health and to monitor and evaluate its effectiveness using a minimum of 12 indicators. Members' 1982 implementation reports and 1985 evaluation reports form the basis for evaluating each measure. Indicators 1-6 have strong political and economic components in both developed and developing countries and are not complete. Indicator 7, for which rates of reply are satisfactory, asks whether at least 5 elements of primary health care are available to the whole population. The 8th gauge seeks information on the nutritional status of children, considering birth weight (a possible indicator of risk) and weight for age (a monitor of growth). Infant mortality rate and life expectancy at birth, indicators 9 and 10, are difficult to estimate in developing countries, and health services are not always kept informed of current estimates. Indicator 11 asks whether the literacy rate exceeds 70%; it can provide information on level of development and should emphasize literacy for women, for whom health information is critical. The last global measure yields information about the gross national product, which is not always the most recent, despite the trend of countries to publish their gross domestic product. Failure to make use of the best national sources, such as this, is one of several problems encountered by WHO's member states in collecting accurate data. Other problems include lack of universally acceptable definitions, different national accounting systems, disinterest of health authorities in economic matters, lack of staff, lack of financial resources in developing countries, and inadequately structured health system management. Each country must choose the most appropriate methods for collection of data. If an indicator cannot be calculated, the country is encouraged to seek and devise a substitute. WHO must produce more precise and reliable indicators. It must respond to requests for ways of improving or strengthening national systems.
WORLD HEALTH FORUM. 1988; 9(2):185-99.This article explains how the concept of health for all developed within the context of the history of the World Health Organization (WHO). By the early 1970s a new idea was taking shape in WHO. Medical services were failing to reach vast numbers. Health would have to emerge from the people themselves. In the heat of discussion the new strategy was clarified and given a name--primary health care (PHC). An ambitious target was set for it--no less than health for all by the year 2000. It was decided that the community itself had to be involved in planning and implementing its own health care. A new type of health worker was called for, chosen by the people from among themselves and responsible to the community but supported by the entire health system. In virtually all countries, the emphasis on curative care would have to be balanced by an equal emphasis on prevention. Almost 90% of WHO's Member States were prepared to share with one another detailed information about the problems facing their health systems. Industrial countries were beginning to realize that sophisticated medical technology was no guarantee of good health and that health for all through PHC offered an alternative. Millions of health workers have been trained, extending services to low-income groups that had no access to modern health care. Among health professionals, lack of understanding of the PHC concept and insufficient concern for social equity remain the principal constraints. Another problem is that expenditure on health care tends to be viewed as a drain on scarce resources rather than as an investment in the nation's future. The mommentum of health for all can be sustained only by governments implementing at home the policies they have collectively agreed on at The World Health Assembly in Geneva.
HEALTH POLICY AND PLANNING. 1986 Mar; 1(1):37-47.This economic analysis assesses the probable costs of implementing various activities of the World Health Organization's (WHO's) global strategy of "health for all by the year 2000" and the likelihood that developing countries will be able to afford these costs, either on their own or with the assistance of developed countries. If this policy is to be transformed into concrete results, there must be a plan complete with budgetary requirements, planned activities, and expected results specified in adequate detail. The overall costs of the activities proposed by the global strategy would amount to approximately 5% of the gross national product of most developing countries, with water supplies and primary health care comprising the most expensive activities. Although there is a good match between estimated resource requirements and planned activities, the desired outcomes are often unlikely to result from the activities proposed. At present, all 25 industrial market and nonmarket industrial developed countries have already achieved the outcome goals of the global strategy; however, these countries account for only 25% of the world's population. Of the 63 middle-income countries, 54 have already achieved a gross national product per capita of over US$500, but only 22 have an infant mortality rate better than 50/1000. Very few low-income countries are close to reaching their targets for income, infant mortality, life expectancy, or literacy. On the basis of current trends, 25-33% of countries are considered unlikely to achieve the outcome goals by the year 2000. In general, it appears that expenditure targets are too low to cover the needed health services activities. Further research on the costs of health promoting activities such as immunization and primary health care should be given high priority.
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.
Who Chronicle. 1984; 38(4):155-60.The voice of the World Health Organization's (WHO) internal world is reassuring and tells of widespread political will to attain the goal of health for all, yet another voice says that if the policies adopted in WHO are slowly trickling into national health systems, the process of infiltration is much too slow and may still be far from completion by 2000. A number of developed countries are taking the challenge of health for all very seriously both within their own boundaries and in their dealings with less developed countries, but too many of them did not even take the trouble to report on the results of their monitoring of the health for all strategy. Some claimed off the record that it would have been too complicated in view of the size and complexity of their health system; others that they were not really in need of a strategy since their health service was so comprehensive. If the developed countries shy away from the responsibilities they accepted, why should more be expected of the developing countries. At Alam Alta there was enthusiastic support for action from all countries, no matter what their level of development. Most difficult to assess is the extent to which people themselves are taking the goal of health for all seriously. If the social aspects of the strategy are difficult to monitor, one would expect that the financial aspects should be clearer. This is not the case. Few countries, including the most economically developed, were able to assess the amount and flow of resources for health for all. In particular, they were unable to distinguish between the allocation of funds for the continuation of old policies and for the promotion of new ones. WHO has embarked on a new General Program of Work -- the 7th in the history of the organization. The program aims at making member nations more self-reliant than ever in the fields of health. The major task is to build up solid health infrastructures that are capable of delivering the most needed programs to the most people on the basis of equality of access for all. Unfortunately, only the sounds of the 7th program have made themselves heard, not the substance. Among the organization's successes can be included many of WHO's publications, particularly the "Health for All" series, but these publications are being used much too sparingly. New managerial arrangements have been introduced to help countries make the best use of everything WHO has to offer, yet all moves too slowly.
Doctors--barefoot and otherwise. The World Health Organization, the United States, and global primary medical care.
Jama. 1984 Dec 14; 252(22):3146-8.The international effort to provide primary health care (PHC) services for all by the year 2000 requires the development of appropriate manpower resources in the developing countries. Given the limited health budgets of developing countries, research on manpower development is necessary to ensure that funds for manpower development are used in the most efficient manner. In recognition of this need, the World Health Organization (WHO) and the International Organization for Medical Sciences convened a workshop, entitled "Health for All - A Challenge to Health Manpower Development Research" in Ibadan, Nigeria in 1982. The participants at the workshop agreed that manpower development strategies must be developed in the context of PHC, and that the current manpower development strategies in most developing countries do not provide the type of manpower required in PHC systems. Specifically, the workshop recommended that health manpower development strategies must 1) take into account the fact that health improvement is dependent not just on health services but on improvements in sanitation, water, housing, and nutrition; 2) recognize that PHC systems require an extensive cadre of health workers, paramedics, and auxiliary personnel, and that PHC systems are not highly physician dependent; and 3) recognize that medical schools must train physicians capable of serving the needs of the entire population rather than just the needs of the elite few. Participants also recognized that the development of effective strategies may be hindered by various professional, technical, financial, and bureaucratic factors. Given the pressing needs and scarce resources of developing countries, manpower development research must be highly policy oriented. The recommendations of the workshop were endorsed by WHO's Advisory Committee on Medical Research in 1983 and then distributed to WHO's 6 regional offices. The regional offices are currently discussing the recommendations with individual countries in an effort to determine how each country can implement the recommendations. The success of the effort to train appropriate manpower will require the assistance of developed countries and especially the US. The US can assist by providing training in US institutions for individuals from developing countries. Training programs, however, must be reoriented in such a way as to equip students to work in PHC settings. Medical personnel from the US can provide technical assistance in the developing countries, but efforts must made to ensure that this assistance is directed toward the development of PHC prsonnel and services.
Grass roots, herbs, promoters and preventions: a reevaluation of contemporary international health care planning. The Bolivian case.
Social Science and Medicine. 1983; 17(17):1281-9.In evaluating a United States Agency for International Development (USAID) project in Bolivia, the author argues that the program unwittingly contributed to the situation that created Bolivia's political problems. A 5-year pilot project which covered 39 villages and colonies in the Montero district in the state of Santa Cruz began in 1975 and was completed in 1980. In 1980 the project was "deobligated" when all but essential economic aid to Bolivia was halted following a political coup. The pilot project was based on 1) community participation through health care; 2) a referral system from health post of the promotor to the center with an auxiliary nurse midwife, to secondary and tertiary care in hospitals by physicians; 3) an emphasis on preventive medicine; and 4) the use of traditional medicine along with other therapy by the promotor. Although these concepts sound appropriate, they are in fact derived from contemporary thought in advanced industrial societies. The assumptions about social reality that are inherent in these plans actually misconstrue Bolivian society. The unintended consequences of the project actually diminish rural health care. A difference between the Western health planner's conception and the Bolivian conception--of community, of effective referral systems, of preventive and indigenous medicines--can have the effect of producing a health care program that has little resemblance to what was originally intended. The Bolivian elite actually manipulated the USAID health care programs through hegemony in the villages. The Jeffersonian concept of community is not applicable in Bolivia where resources are only exchanged through personal contacts. In villages of multiple class or ethnic groups or both or in villages with close ties or histories of ties with larger, more cosmopolitan groups, multiple different interests exist. These work against each other to prevent the very cooperation envisioned by the health care programs. The author suggests that developed countries should consider native ideologies, native social relations, and indigenous medicine more sensitively in design.
Report of the Technical Work Group on the Participation of Organizations Related to Women in Primary Health Care Activities, 26-28 April, 1983, Washington, D.C., Volume I. Final report.
Washington, D.C., Pan American Health Organization, 1983. 30 p.Women from Colombia, Honduras, and Peru met with Pan American Health Organization (PAHO) advisors April 26-28, 1983, to discuss how women's organizations can participate more effectively in primary health care. Specific objectives of the meeting were to define the current and potential roles of women as promoters and beneficiaries of primary care; to define ways women's groups can collaborate with ministries of health in the planning, implementation, and evaluation of primary health care services; and to determine how PAHO can facilitate such collaboration. The obstacles to women's fuller utilization of primary health care were noted. These barriers include a lack of information on health problems and availability of services, cultural beliefs, real or perceived negative attitudes of health care providers, and the fragmentation of services. Other areas of discussion concerned the need to raise women's awareness of their responsibilities and rights as individuals, employment of women in key positions within the Ministry of Health, enhancement of women's influence on the health care system, and the lack of interagency coordination. As a hypothetical exercise, conference participants from each country drafted proposals for specific primary health care projects involving women. The Honduran and Peruvian projects, based on real experiences, concerned local construction of latrines and cancer screening, respectively. The Colombian project was aimed at sex and self-awareness education for teenage girls. Recommendations emerging from the meeting focused on 4 broad areas: 1) increasing awareness and concern for women's health issues among health personnel and policy makers, 2) establishing improved communication and coordination between the Ministry of Health and women's groups, 3) improving women's health care to more effectively meet women's needs, and 4) increasing the influence of women's groups on health activities. Specific tasks outlined for PAHO include the development and dissemination of educational materials, funding of research on women's health, technical assistance, definition of specific areas of primary health care (e.g., oral rehydration, breastfeeding, family planning, and immunization) in which women's groups are especially qualified to work effectively, and the promotion of communication about and coordination of health activities between the Ministry of Health and nongovernmental women's organizations.