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Perspectives in Health. 2003; 8(2):26-29.More and more, nurses in the Caribbean have been packing their bags and heading for countries with less-than-perfect climates to get better pay and more respect. Now the region is looking for ways to keep them from leaving – and even to lure those abroad back home. (author's)
A reassessment of the concept of reproductive risk in maternity care and family planning services. Proceedings of a seminar presented under the Population Council's Robert H. Ebert Program on Critical Issues in Reproductive Health and Population, February 12-13, 1990, the Population Council, New York, New York.
New York, New York, Population Council, 1990. x, 185 p.Conference proceedings on reassessing the concept of reproductive risk in maternity care and family planning (FP) services cover the following topics: assessment of the history of the concept of reproductive risk, the epidemiology of screening, the implementation of the risk approach in maternity care in Western countries and in poorer countries and in FP, the possible effects on the health care system, costs, and risk benefit calculations. Other risk approaches and ethical considerations are discussed. The conclusions pertain to costs and allocation of resources, information and outreach, objectives, predictive ability, and risk assessment in FP. Recommendations are made. Appendixes include a discussion of issues involved in developing a reproductive risk assessment instrument and scoring system, and the WHO risk approach in maternal and child health and FP. The results show that the application of risk assessment warrants caution and usefulness in service delivery is questionable. The weaknesses and negative effects need further investigation. Risk-based systems tend toward skewed resource allocation. Equal access to care, freedom of choice, and personal autonomy are jeopardized. Risk assessment can accurately predict for a group, but not for individuals. Risk assessment cannot be refined as it is an instrument directed toward probabilities. The risk approach must be evaluated within a functioning health care system. Screening has been important in developed countries, but integration into developing country health care systems may be appropriate only when basic health care is in place and in urban and periurban communities. Recommendations are 1) to prevent problems and detect rather than predict actual complications when no effective maternity care is available; to provide effective care to all women, not just those at high risk; and to provide transportation to adequate facilities for women with complications. 2) All persons attending births should be trained to handle emergencies. 3) Risk assessment has no value unless basic reproductive health services are in place. Cost benefit analysis precludes implementation. Alternative strategies are available to increase contact of women with the health care system, to improve public education strategies, to improve the quality of traditional birth attendants, and to improve the quality of existing services. Women's ideas about what is "risk" and the cost and benefits of a risk-based system to women needs to be solicited. All bad outcomes are not preventable. Copies of this document can be obtained from The Population Council, One Dag Hammarskjold Plaza, NY, NY 10017. Tel: (212) 339-0625, e-mail firstname.lastname@example.org.
NURSE EDUCATION TODAY. 1991 Aug; 11(4):245-7.The international aspects of midwife education are discusses: the 5 most pressing questions concerning midwife education, steps taken by world health bodies to improve midwife educationists. The most challenging issues are international health studies in all programs; including the role of WHO, and other international agencies; instruction analyzing influence of Western on developing nations; content on demographic, economic and political factors affecting health of developing countries; and how health care educationists can achieve health for all. In the light of the WHO Safe Motherhood Initiative embodied in the slogan "Health For All," midwives all over the world are committed to reduce maternal mortality 50% by 2000. ICM/WHO/UNICEF made an action statement in 1987, the World Health Assembly published a Resolution on Material Health and Safe Motherhood, and a Resolution on Strengthening Nursing Midwifery. In 1990 the Governments of 70 countries committed to safe motherhood, i.e., 50% reduction of maternal mortality, as part of the World Declaration and Plan of Action on Survival, Development and Protection of Children, at a meeting at the UN. 1990 40 midwife educationists met in Kobe, Japan at a Pre-Congress Workshop before the International Confederation of Midwives (ICM), of the WHO/UNICEF. They discussed ways to approach the 5 major causes of maternal mortality: postpartum hemorrhage, obstructed labor, puerperal sepsis, eclampsia and abortion. Each participant assessed the status of midwife education in her own country. Some of the factors affecting maternal and child health are illiteracy, low status of women, population growth, and inadequate food production and distribution. There is a shortage of midwife teachers and teaching materials, and curricula are usually based on inappropriate Western models. In Europe, midwives still have much work to do to reduce maternal morbidity.
WORLD HEALTH FORUM. 1989; 10(3-4):397-402.Persons who line in developing countries are awarded fellowships for study abroad. They are given by many donors, the UN and the World Health Organization among them. It is important to know whether the money is used effectively. Many donor agencies have done evaluations, but difficulties arise. The recipient governments should evaluate the fellowships. The current selection process may be politicized, and fellowships are not officially advertised. There may also be irregularities in employing the returned fellows. It is hard to see what changes could be brought about by a donor's evaluation that hinted at a country's misuse of fellowships. Recipient countries have the right to run their own affairs. However, they should understand the advantages and responsibilities of this. Many donor's evaluations are not of much worth to recipients. Some criteria used by donors are not meaningful to recipients. There may be conflicting opinions about needs and technologies. Attempts may be made to get fellows from third world countries even if the courses are not terribly suitable. The influences that the fellows may be exposed to are very important. Many governments provide awards to their citizens for overseas training. It would be very useful for countries to analyze all fellowship activity. This could give information about overlapping. In Lesotho, too much emphasis was put on rural development. Recipient countries are in a better position to find former fellows. Donor studies tend to be bureaucratized, evaluated from habit rather than need. Occasionally reports have not come to the attention of authorities, which does no one any good. Oversimplified attempts may take place. Research should be adapted to standard methods. If recipient countries do not have the experience required to evaluate fellowships, it could be done jointly by donors and recipients.
In: Mass communication, culture and society in West Africa, edited by Frank Okwu Ugboajah. [Oxford, England], Hans Zell Publishers, 1985. 74-84.Due to the fact the most independence came in the late 1950s and early 1960s, most of the new African nations faces a broadening gap between themselves and the developed world. Their media systems were inadequate fro an ascent to modernization, and a communications revolution in the Western world was threatening to make their systems even more antiquated. A wide array of individuals and national and international medis, business and governmental organizations and foundations provided assistance and cooperation for theis catch up process. Most, but not all, were motivated by a sincere desire to aid development. A perusal of some of these external groups' activities, in the form of projects, training schemes, bilateral exchanges, broadcasts, and organizational influences, should help the reader to gain insights into the nature and effects of such outside assistance. External assistance has been given both by individual nations and by multilateral cooperation to experimental programs and projects in several newly independent African nations. A few of the more successful projects are examined. Possibly the best known cooperatively sponsored projects have been those in rural radio, with Ghana's rural radio farm forum a prime example. UNESCO and the Canadian government cooperated in 1964-65 with the government of Ghana in a 6-month pilot project in which rural radio forums were tested in 60 villages. The project promoted the educational programs, organized listener groups, led follow-up discussions, and encouraged group action. A number of unique educational projects utilizing radio or television have been cooperatively supported. A wide range of bilateral programs involving the receiving countries have been devised to help the development of African media. Sometimes, due to their government-to-government nature, these programs have been suspect in the eyes of Africans. Several universities outside Africa have provided resources for assisting the African media systems. Most university programs are at least partially supported by governmental grants, but they usually are careful to avoid promulgation of a specific political viewpoint. Possibly the most significant and welcome external cooperation and aid has been in the form of training of African media personnel. Help in this task has come from numerous sources, including organizations in former colonial mother countries. Short courses and training institutes ranging from a few days in length to 6 months or more have been sponsored by outside media organizations, governments, and foundations. In 1972, 40 nations outside Africa were broadcasting to the African continent. This situation remains virtually unchanged today. There is little question that outside broadcasts have influenced Africans.
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.
Population problems and international cooperation, statement made at a meeting of the Scientific Council of the Moscow State University, Moscow, Union of Soviet Socialist Republics, 29 September 1982.
New York, N.Y., UNFPA, . 19 p. (Speech Series No. 80)This statement discusses certain population problems within a framework of international cooperation. Specifically, linkages between population and development, basic data collection, population and development research, policy formulation, family planning, communication and education, training, population migration, urbanization, aging of the population, and integration of population with development planning, are all issues examined. Solving the problems generated by population growth of developing countries are social and economic development, accumulation of resources and economic growth. All countries need data on population structure and its changes in order to plan effectively. There is a continuous need to learn more about the dynamics of population change, especially for demographers in developing countries. Data gathering, processing, analysis and research are crucial components in the formulation of policies. UNFPA devotes a great amount of its resources to family planning, education and training programs within countries. The inability to find employment opportunities has led to considerable internal and international migration, increasing and promoting urbanization and overcrowded cities. Aging of the population is becoming an important issue for developed countries and will necessitate further policy formulation. Population planning needs to become a more effective arm of overall development planning.
Defining population education, statement made at the University of Nevada, Reno, Nevada, 7 March 1983.
New York, N.Y., UNFPA, . 16 p. (Speech Series No. 87)This statement defines population education, and discusses some related areas such as human sexuality, social and economic change, ecology, and the family and its social structure. Population education may have a direct impact on development at the level of the community by encouraging attention to the relationship of natural to human resources. It may promote development goals: Universities and ministries of education play an important part in the spread of population education. They introduce to teachers new training methods and ideas regarding material and curriculum development. Population education is not a prescriptive program dealing only with a limited range of population scenarios. It is a relevant issue that is not only limited to countries where growth is perceived as a problem. UNFPA assisted population education programs to 42 countries in 1982. Many national projects in countries such as Sri Lanka, Egypt, and the Philippines have been created by the support and assistance of UNFPA. Present programs will be further developed and refined in teacher training, refresher courses, and continued monitoring and evaluation.
El papel de la universidad en la esfera de la poblacion. The role of the university in population, statement made at Special Convocation of the University of Panama, Panama City, Panama, 29 November, 1983.
New York, N.Y., UNFPA, . 8 p. (Speech Series No. 104)The University of Panama, as an academic and research institution, is the key to the joint implementation of government population and development programs. Many Latin American universities now have a better understanding of the complexity of the relationship between popultion and development and therefore devote more attention to this field by including demographic components in the curricula for existing specialties or creating new specialties. It is recommended that the University of Panama work constructively with the relevant technical experts to determine the position that Panama will adopt at the World Population Conference, in Mexico. If possible, such participation could help to strengthen the link between the academic community and the government in the area of population. In the final analysis, this will promote a better understanding of the dynamic relationship that exists between population and development.
Assignment Children. 1983; (63/64):45-57.Despite recent advances in research and practice, improvements in services have reached only a relatively small proportion of handicapped people. The potential of the many people who work first hand with handicapped children--professionals, volunteers, and parents--needs to be developed. What training should be provided? Who should be trained? How can manpower be used most effectively? Special education is moving beyond the schools and into the community. Another major development in special education is the development of a closer working relationship between professionals and parents. Teachers are likely to work with other professionals--psychologists, physicians, social workers, speech therapists, physiotherapists and occupational therapists. Teachers have become better at setting short-term objectives and more skilled in the use of relevant assessment techniques of the child. These trends are discussed for both developed and developing countries. 2 modes of staff training are discussed: 1) the "pyramid model," in which a small team receives intensive practical training on the understanding that they will then run similar courses for other people in their locality; this second generation then assumes a commitment to train a third generation, resulting in a large number of people being trained; 2) the "manpower model," a vertical structure of workers with 4 different levels of training and responsibility. International cooperation is discussed. The Final Report of the UNESCO Expert Meeting on Special Education made a number of recommendations for international action.
New York, N.Y, United Nations. Department of Technical Co-operation for Development, 1983. v, 42 p. (no. ST/ESA/SER.E/28)This report examines the origins of the UN program in population training and the main methods adopted over the past 20 years to implement it. Its 6 chapters cover the following: origins of the UN population training program (the urgency for population training, initial objectives of the UN training program, the state of the art in the 1950s, the role of the UN, and initial dimensions of the UN training programs); establishment of the UN demographic training centers (International Institute for Population Studies, IIPS, in Bombay, India; Latin American Demographic Centre, CELADE, in Santiago, Chile; Cairo Demographic Centre, CDC, Cairo, Egypt; Institut de formation et de recherche demographiques, IFORD, Yaounde, United Republic of Cameroon; Regional Institute for Population Studies, RIPS, Accra, Ghana; UN-Romania Demographic Centre, CEDOR, Bucharest, Romania; and the Joint UN/USSR Interregional Demographic Training and Research Program in Population and Development Planning, Moscow, USSR); individual characteristics and program differentials of the UN demographic training centers (language of instruction, admission requirements, length of training programs, curricula, specialized training programs in interrelationships between population and development, and specialized training programs in interrelationships between population and development, and output of the training centres); the UN international fellowship program in population (placement of successful fellowship candidates, distribution of fellows by region of origin, subjects of study of successful candidates, comparison with the training offered through the UN demographic training centres); country projects for creating population training facilities; and the future of the UN population training program. Apart from the programs in Bucharest and Moscow, the basic terms of reference of all the regional and interregional demographic training centers are to provide courses of training in demography, to carry out demographic research, and to provide technical assistance in the field of demography and the population disciplines generally in response to government requests. Beyond these basic objectives, each centre has its own individual characteristics. In the years since their foundation, the UN sponsored regional and interregional training centers and programs have contributed significantly to an increase in the number of trained demograhers worldwide. From the academic year 1972-73 to 1979-80, a total of 1323 students were registered at these centres. The international fellowship program is notable in that the methods for the selection, placement, and evaluation of fellowship holders are designed to ensure that the skills acquired become available to the fellows' country of origin.