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Bethesda, Maryland, Abt Associates. Private Sector Partnerships-One [PSP-One], 2006 Dec. 48 p. (Technical Report No. 6; USAID Contract No. GPO-I-00-04-00007-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ADI-754)Government health sectors in many countries face an uphill battle to reach the Millennium Development Goals (MDGs) set for 2015. In the last six years, Ministries of Health (MOHs) in many less developed countries (LDCs) have been unable to invest sufficiently in their health systems. To achieve the MDGs despite inadequate resources, new approaches for delivering critical clinical services must be considered. This paper explores the potential for private-sector midwives to provide services beyond their traditional scope of care during pregnancies and births to address shortcomings in LDCs' ability to reach MDGs. This paper examines factors that support or constrain private practice midwives' (PPMWs') ability to offer expanded services in order to inform the policy and donor communities about PPMWs' potential. Data was collected through literature reviews, stakeholder interviews, and field-based, semi-structured interviews in Ghana, Indonesia, Peru, Uganda, and Zambia. Ghana, Indonesia, and Uganda were chosen because they are countries where PPMWs provide expanded services. Peru and Zambia were selected as examples where midwives have struggled to develop private practices or they provide expanded services despite issues about midwives' roles and legal sanctions for private practices. (excerpt)
Lancet. 2007 Jun 30; 369(9580):2159-2160.Anthony Costello and colleagues call for a funder's forum for research capacity to bring Millennium Development Goals (MDGs) 4 and 5 back on track. They conclude that newborn care, skilled birth attendance, human resources, quality improvement, and participatory or empowerment interventions are high priorities. We agree fully; but we would point out that at least 15 of these 40 issues require locally trained professional staff . Being involved in such training, we agree that gaps between (new) knowledge and effective action in achieving MDGs can only be filled by a local cadre enabled to study regionally relevant child health issues and then trained to address them. Development and empowerment of a cadre in southern African child health requires funds for training and retaining local staff . WHO, The Lancet, and other journals have, over the past 5 years, published critical evidence about this urgent need. But despite billions having been pledged and spent by international and non-governmental organisations, eroded southern African child health services and under-resourced training institutions experience great difficulty in funding this critical aspect of development. In Malawi at present, we can only offer some aspects of postgraduate training through a limited number of foreign fellowships. And we do employ promising young local doctors as paediatric registrars in research studies. A collaboration established between paediatric departments in Blantyre, Malawi, and Durban, South Africa, offers post graduate child health training at the highest possible level and qualification. A real change in development strategy towards sustained commitment and funding is needed from the international community. Training, job satisfaction, and the associated remuneration in Europe have long been the main reasons for young doctors' migration from Africa. (full text)
Alternative approaches to meeting basic health needs in developing countries: a joint UNICEF/WHO study.
Geneva, World Health Organization, 1975. 116 p.Based on the failure of conventional health services and approaches to make any appreciable impact on the health problems of developing populations, this study examined successful or promising systems of delivery of primary health care to identify the key factors in their success and the effect of some of these factors in the development of primary health care within various political, economic, and administrative frameworks. In the selection of new approaches for detailed study, emphasis was placed on actual programs that are potentially applicable in different sociopolitical settings and on programs explicitly recognizing the influence of other social and economic sectors such as agriculture and education on health. Information was gathered from a wide range of sources; including members, meeting reports, and publications of international organizations and agencies, gathered country representatives, and field staff. The 1st section, world poverty and health, focuses on the underprivileged, the glaring contrasts in health, and the obstacles to be overcome--problems of broad choices and approaches, resources, general structure of health services, and technical weasknesses. The main purpose of the case studies described in the 2nd part was to single out, describe, and discuss their most interesting characteristics. The cases comprised 2 major categories: programs adopted nationally in China, Cuba, Tanzania, and, to a certain extent, Venezuela, and schemes covering limited areas in Bangladesh, India, Niger, and Yugoslavia. Successful national programs are characterized by a strong political will that has transformed a practicable methodology into a national endeavor. In all countries where this has happened, health has been given a high priority in the government's general development program. Enterprise and leadership are also found in the 2nd group of more limited schemes. Valuable lessons, both technical and operational, can be derived from this type of effort. In all cases, the leading role of a dedicated individual can be clearly identified. There is also evidence that community leaders and organizations have given considerable support to these projects. External aid has played a part and apparently been well used. Every effort should be made to determine the driving forces behind promising progams and help harness them to national plans.
New York, UNFPA, June 1979. (Report No. 13) 151 pThis report is intended to serve, and has already to some extent so served, as part of the background material used by the United Nations Fund for Population Activities to evaluate project proposals as they relate to basic country needs for population assistance to Thailand, and in broader terms to define priorities of need in working towards eventual self-reliance in implementing the country's population activities. The function of the study is to determine the extent to which activities in the field of population provide Thailand with the fundamental capacity to deal with major population problems in accordance with its development policies. The assessment of population activities in Thailand involves a 3-fold approach. The main body of the report examines 7 categories of population activities rather broadly in the context of 10 elements considered to reflect effect ve government action. The 7 categories of population activities are: 1) basic data collection; 2) population dynamics; 3) formulation and evaluation of population policies and programs; 4) implementation of policies; 5) family planning programs; 6) communication a and education; and 7) special programs. The 10 elements comprise: 1) decennial census of population, housing, and agriculture; 2) an effective registration system; 3) assessment of the implications of population trends; 4) formulation of a comprehensive national population policy; 5) implementation of action programs integrated with related programs of economic and social development; 6) continued reduction in the population growth rate; 7) effective utilization of the services of private and voluntary organizations in action programs; 8) a central administrative unit to coordinate action programs; 9) evaluation of the national capacity in technical training, research, and production of equipment and supplies; and 10) maintenance of continuing liason and cooperation with other countries and with regional and international organizations.
Social Science and Medicine. 1979 Aug; 13A(5):505-514.The focal point of Primary Health Care (PHC) is the community. PHC represents a natural outcome of a political ideology implying that health service is not something to be delivered to the people from above; with the high cost technology teaching hospital as the center of medical universe. But rather, PHC is a concept of health services generated within the community and linking up with a referral system; and it is firmly established as the avenue which most developing countries will explore in the next 20 years. This commitment is largely the result of the Alma-Ata Conference which clarified many of the political; technical; social; administrative and educational aspects of PHC. This paper summarizes this process of consolidation of the concept; gives more examples of national plans in Sudan, Tanzania, Ghana, and India; and then deals with types of support that facilitate community participation. Because PHC involves people rather than merely technology, the role of social scientists is one which needs greater emphasis.