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  1. 1

    Access to drugs. UNAIDS technical update.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]; World Health Organization [WHO]. Action Programme on Essential Drugs

    Geneva, Switzerland, UNAIDS, 1998 Oct. [12] p. (UNAIDS Best Practice Collection)

    The World Health Organization (WHO) estimates that over one-third of the world's population has no guaranteed access to essential drugs. There are various reasons for this lack of access. Worldwide, the most important is affordability (drugs cost more money than is available to pay for them) but legal, infrastructural, distribution and cultural factors are also serious obstacles. The influence of each of these factors is different from country to country, just as frequencies of diseases also vary greatly. Among its activities aimed at improving drug access in developing countries (including technical services such as help in drug procurement and performance of needs estimates), WHO has drawn up a Model List of Essential Drugs, which is updated every two years. The tenth list (1997) has 308 priority drugs that provide safe, effective treatment for the infectious and chronic diseases which affect the vast majority of the world's population. The drugs are selected on the basis of cost-effectiveness within each drug class (e.g. of the dozens of penicillins only eight appear on the Essential Drugs list). With WHO's encouragement, more than 140 countries have developed their own national essential drug lists taking into account local needs, costs and available resources. (excerpt)
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  2. 2

    International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control. Summary report of the Third Meeting, Geneva, Switzerland, 8-9 December 1997.

    International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control

    Geneva, Switzerland, World Health Organization [WHO], Division of Emerging and Other Communicable Diseases Surveillance and Control, 1998. 21 p. (WHO/EMC/ DIS/ICG/98.1)

    The Third meeting of the International Co-ordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG) was held at WHO Headquarters in Geneva on the 8th and 9th December 1997. The meeting was chaired by Dr D. Barakamfitiye, Director, Prevention and Control of Diseases (DDC) of the WHO Regional Office for Africa. Dr M. Hardiman, WHO/EMC, acted as rapporteur. The agenda and list of participants are to be found in the annexes. The Chairman welcomed the participants and outlined the objectives for the meeting. Dr D.L. Heymann, Director EMC, added his welcome and commented that, although meningococcal vaccine was not in such short supply this year, there are still a number of important issues to demand global attention. These include the need to improve the speed of response to epidemic situations, the continued political sensitivity to the issue of meningitis, the relative merits of preventive vaccination versus epidemic response and the impact that the development of a new conjugate vaccine might have on efforts to control meningitis. Dr J.-W.Lee, Director, GPV, in his opening remarks looked forward to the time when preventive actions for meningitis would render epidemic response through the ICG as no longer necessary. (excerpt)
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  3. 3

    International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control. Summary report. Geneva, Switzerland, 16-17 January 1997.

    International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control

    Geneva, Switzerland, World Health Organization [WHO], Division of Emerging and Other Communicable Diseases Surveillance and Control, 1997. 19 p. (WHO/EMC/ DIS/ICG/97.9)

    This was the first meeting of the International Coordinating Group (ICG) proposed at the 2-3 December, 1996 meeting of the Ad Hoc Working Group on WHO Strategy for Provision of Meningitis Vaccine for Epidemic Prevention and Control. The meeting was chaired by Dr d'Almeida, DPM, AFRO, and the agenda and list of participants are provided as annexes. The objectives of the meeting were to define terms of reference, agree on the membership of the International Coordinating Group (ICG) and its Executive Sub-Group, to establish the criteria for determining priority distribution of vaccine for epidemic control in the 1997 season, for which only 14 million doses of vaccine would be available, and to consider a strategy for ensuring adequate vaccine supplies in future years. The expected outcome of the meeting was to obtain agreement on the responsibilities of the ICG and its Executive Sub-Group, on the criteria for vaccine distribution in 1997, on a funding mechanism for an emergency stock of vaccines and auto-destruct syringes, and on a strategy to address adequate vaccine and syringe supplies for future years. The meeting met these goals. (excerpt)
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  4. 4
    Peer Reviewed

    UNICEF asks donors to give poorer nations longer-term commitment.

    Ahmad K

    Lancet. 2002 Jun 8; 359:2009.

    Carol Bellamy, head of UN Children's Fund (UNICEF), warned that immunization programs worldwide are threatened by the gross reduction of routine childhood- vaccines despite the fact that the risk of vaccine-preventable diseases is increasing. Although production of childhood vaccines normally requires about 2 years, countries funding such programs only commit funds for 1 year at a time. This makes it difficult for their poorer counterparts to make multiyear purchase commitments. As a consequence, UNICEF has been unable to sign long-term contracts with vaccine manufacturers. Thus UNICEF has been calling for long- term commitments from donors.
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  5. 5

    Plan of action for the control of diarrheal diseases in the region of the Americas. Interagency Coordinating Committee for the Control of Diarrheal Diseases (ICC/CDD). Plan de accion para el control de las enfermedades diarreicas en la region de las Americas.

    Pan American Health Organization [PAHO]; UNICEF; United States. Agency for International Development [USAID]

    [Unpublished] [1990]. [3], 32, [3], 32 p.

    The American made remarkable strides in reducing diarrheal mortality and morbidity during the 1980s. All of the nations here had in place a control of diarrheal diseases (CDD) program or CDD activities by early 1989. 1 goal for CDD projects in the region included ORS availability to 80% of all children <5 years old. 17 nations even produced their own oral rehydration solution (ORS). This contributed to the fact that more countries proportionally produced ORS in the Americas than in any other region. Still diarrhea continued to be 1 of the 3 leading causes of death and illness in children <5 years old in most countries in the Americas. Accordingly an Interagency Coordinating Committee (ICC/CDD) Task Force composed of representatives from PAHO, UNICEF, and USAID formed in 1989 to develop a framework for the region and countries to follow in designing plans of action. Each country in the Americas should foster effective cooperation among all organizations involved in CDD activities within that country. If an interagency process, e.g., child survival programs, already exists, the country should include the CDD program into it. National ICC/CDDs should define policies and prepare the plan of action incorporating both technical and financial support from the public and private sectors. They must also coordinate CDD training activities, especially those emphasizing correct case management. Further they should concur on communication projects and coordinate message development and relations with the mass media. These committees must also recognize problems, develop solutions, foster research, and amend national CDD programs as needed. PAHO is the technical secretariat for the regional ICC/CDD which works to foster optimum cooperation among PAHO, UNICEF, and USAID thereby providing maximum assistance to these programs.
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  6. 6

    Health economics in developing countries.

    Abel-Smith B


    This general discussion on health economics provides an historical overview as well as a discussion of some of the developments and deficiencies in health economics in developing countries, broadly focused on expenditure and financing studies, cost benefit and cost effectiveness, local costing studies and health planning. In 1963, it was found that as GDP rose so did health expenditures, that countries with similar per capita income spent different percentages of GDp on health services, that the private sector involvement was greater than the public, and that hospitals received most of the money. Countries were encouraged to conduct further studies. The World Bank has successfully stimulated discussion. However, lacking the expenditure studies, cost benefits are hampered by the availability of epidemiological data and poor cost information, and geared toward studies on how to cut costs for immediate goals, or specific diseases, rather than on practical advice to governments. 1 such study helped identify that most cost effective allocation of resources. The limited local cost studies are particular to understanding specific costs of immunization versus antenatal visits; however, the usefulness of such preliminary information reveals wide variability between countries. The Health for All initiatives and the limited resources in developing countries have placed health planning in a central position with Ministries of Health. Due to prior mistakes in planning an excess number of trained medical staff are underutilized and present needs have been defined as developing local PHC support staff. The WHO expectation of 5% of GNP for health service was unfulfilled because larger donor aid and local resources have not been sufficient even with strong posturing, and over ambitious plans were made unrealistically. Since 1987, WHO has provided economic strategies but the economic crises changed the needs. Many questions remain and consultants are too few, improperly trained, or unavailable for the appropriate time period: unacceptable solutions, coupled with a confusing World bank prospectus for action when more research is needed. Intersectorial collaboration has not provided answers to priorities or addressed the interactions among nutrition and agricultural policy, education and lifestyle, water and sanitation and the economy. The research agenda should include: the identification of the determinants of health, key elements of primary health care (PHC), cost of delivering PHC, hospital efficiency, health manpower mix, adequate procurement and distribution, appropriate technology, user charges for financing, health insurance, and community financing.
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  7. 7

    Evaluation of Village Family Planning Program, USAID Indonesia Project: 497-0327, 1983-1986.

    Bair WD; Astawa IB; Siregar KN; Sudarmadi D

    Arlington, Virginia, International Science and Technology Insitute, Population Technical Assistance Project, 1987 Jul 15. ix, 66, [41] p. (Report No. 86-099-056)

    This evaluation of the village family planning program in Indonesia is prepared for USAID, which has supported the program for 15 years, and is to complete support in 1986. It is in general a positive evaluation, prepared by interviews, and visits to 7 out of 27 Provinces, 14 out of 246 Kabupatens (Districts), and 16 Villages. Village distribution centers have increased 38%, new acceptors by 38%, continuing user levels by 57%, and overall contraceptive prevalence by 38%. Access to varieties of contraceptives, especially longer acting methods, has improved, and costs per capita have decreased. Some problems were pointed out, generating several recommendations: physical conditions of the clinics need attention; motivation by consciousness raising has not been matched by better knowledge; the surgical program needs to be expanded; self-sufficiency in cost recovery should be fostered; operations research is needed on payment for field workers and volunteers; and social marketing should be expanded. USAID should continue support for the Outer Islands. In a final list of recommendations were the suggestions that USAID assist clinical programs further, support training of field workers, do more statistical review, continue to support the IEC program, operations research on community-based distribution, and program integration.
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  8. 8

    The decision makers. [editorial]

    Senanayake P

    British Journal of Family Planning. 1984 Jul; 10(37):37.

    This editorial takes a broad, international look at the worldwide implications of decisions taken in the United Kingdom (U.K.) and the US with regard to family planning. National authorities, like the U.K. Committee for Safety of Medicines (CSM) of the US Food and Drug Administration, address issues concerning the safety of pharmaceutical products in terms of risk/benefit ratios applicable in their countries. International repercussions of US and U.K. decision making must be considered, especially in the area of pharmaceutical products, where they have an important world leadership role. Much of the adverse publicity of the use of Depo-Provera has focused on the fact that it was not approved for longterm use in the U.K. and the US. It is not equally known that the CSM, IPPF and WHO recommeded approval, but were overruled by the licensing agencies. The controversy caused by the Lancet articles of Professors with family planning doctors. At present several family planning issues in the U.K., such as contraception for minors, have implications for other countries. A campaign is being undertaken to enforce 'Squeal' laws in the U.K. and the US requiring parental consent for their teenagers under 16 to use contraceptives. In some developing countries, urbanization heightens the problem of adolescent sexuality. Carefully designed adolescent programs, stressing the need for adequate counseling, are needed. Many issues of international interest go unnoticed in the U.K. International agencies, like the WHO and UNiCEF, have embarked on a global program to promote lactation both for its benficial effects on an infant's growth and development and for birth spacing effects. It may be of benefit to family planning professionals in the U.K. to pay attention to international activity in such issues.
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  9. 9

    Evaluation of UNFPA assistance to the family planning programme of the Dominican Republic, 1978-1982/3.

    Requena M; Echeverry G; Frieiro LB

    New York, New York, United Nations Fund for Population Activities [UNFPA], 1983 Aug. xii, 48, [11] p. (DOM/73/P01)

    This evaluation was carried out by an independent mission coordinated by the United Nations Fund for Population Activities (UNFPA) Evaluation Branch. The program's long-term objectives are to reduce the birth rate to 29/1000, reduce mortality rates, achieve a sustained reduction in fertility rates and to devise and implement a specific population policy. Immediate objectives are to acheive the functional integration and financial self-sufficiency to carry out family planning programs, offer family planning services to the entire population and increase the demand for them, to offer new methods, especially female sterilization, and alter the distribution of users by method; increase active users to 22% of the country's women and to increase the availability of health personnel. In general, the Evaluation Mission found that the project documents describing the objectives to be achieved, strategy, activities and inputs do not elaborate sufficiently on the relationship between objectives and activities and the inputs required and do not give details about the strategy for achieving objectives. The birth rate was estimated at 34.5/1000 in 1982. Infant mortality seems to be declining particularly fast in areas with active rural health promotors. No specific population policy has been enuciated. The program has, to a large extent, achieved the immediate objectives set for it, except that of financial self-sufficiency. The program's strongest elements are the considerable expansion of the physical and health personnel infrastructre; political and institutional willingness to carry out integrated maternal and child health and family planning programs; and the great demand for family planning services by the population. Week elements which have hindered the program's progress are the abence of a tradition of public health and preventive medicine in the country, which has resulted in inadequate training of medical personnel and a lack of motivation, and the extreme centralization of the health system and the consequent lack of delegation of authority and resources which limits the initiative and action of personnel at supposedly operational levels. Other weaknesses are the cultural models which favor authoritarianism and paternalism; the stressing of a clinic-based service delivery system as opposed to the Primary Health Care approach; the lack of direct information education and communication (IEC) action in the communities; the lack of a strategy to gather the knowledge existing in such communities to incorporate it in the joint planning of services, and deficiencies in supervision and evaluation which are aimed at measuring goals and results but not at identifying and analyzing problems.
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