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Perspectives in Health. 2003; 8(3):10-17.In its 3,500-year known history, polio has robbed millions of boys and girls, men and women of their freedom to move at will. Vaccines developed in the 1950s began to rein in the virus, dramatically reducing the disease's incidence through massive immunization campaigns. The Americas region was the first to eradicate the wild strain of the virus and was declared polio-free in 1994. Luis Fermín, a 3-year-old Peruvian, was the hemisphere's last registered case. Western Europe was declared polio-free in 2002. But other regions have been less fortunate. Polio remains endemic in seven countries: Afghanistan, Egypt, India, Niger, Nigeria, Pakistan and Somalia. Twenty million people today are paralyzed as a result of the disease. (author's)
Integrated management of childhood illness: field test of the WHO / UNICEF training course in Arusha, United Republic of Tanzania. WHO Division of Child Health and Development and WHO Regional Office for Africa.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1997; 75 Suppl 1:55-64.The World Health Organization/UNICEF training course on the integrated management of childhood illness (IMCI) for health workers in developing countries was field tested in Arusha, Tanzania, during February-March 1995 to determine whether it could effectively prepare participants to correctly manage sick children and to suggest improvements in course materials and teaching procedures. The 11-day course was tested upon the most peripheral first-level facility health workers: 8 medical assistants, 8 rural medical aides, and 7 maternal-child health (MCH) aides. Each trainee individually examined 9-10 inpatients and managed more than 30 sick children as outpatients. While some trainees had problems reading the training modules in English, all 3 groups overall could assess, classify, and treat most sick children by the end of the course. Most were also able to provide adequate counseling. Improvements were suggested and incorporated into the course guidelines and training materials.
HEALTH FOR THE MILLIONS. 1993 Jun; 1(3):8-10.India has massive problems and is in need of improving and expanding non governmental organization (NGO) programs by broadening the scope of NGO activities, identifying successful NGO activities, and by moving closer to the community to participate in their activities. The problems and experience in the last few decades indicate that with expansion bureaucratization takes place. The institution begins to depend on donors and follows donor-driven agendas. As more money is given by the government, many more so called GONGO or Government-NGO projects materialize. Another problem is that the government almost always approaches the NGOs for the implementation of a project, and there is complete lack of cooperation at the planning stage. The government is considering a loan from the World Bank and UNICEF to launch a mother and child health program, but there has not been any discussion with the dozens of people who have worked on issues concerning mother and child health issues for many years. There is a need to be more demanding of the government about the various programs that are implemented for the government. Very few NGO health and family welfare projects are run by ordinary nurses or ordinary Ayurvedic doctors under ordinary conditions. Since successful NGO work has to be extended to other parts of the country, they will have to be run by ordinary people with very ordinary resources. Over the years, the NGO community has become preoccupied with its own agenda. Today, despite very sophisticated equipment and infrastructure, they are not able to reach the 60,000-70,000 workers and employees. Some of the ideas with respect to the strengthens and weaknesses of community participation have to be shared. NGOs should include all the existing non governmental organizations throughout the country, and have a dialogue with other nongovernmental bodies such as trade unions. The challenge is to adjust the current agenda, prevailing style, and present way of operating and move closer to the people.
In: Growth Promotion for Child Development. Proceedings of a colloquium held in Nyeri, Kenya, 12-13 May 1992, edited by J. Cervinskas, N.M. Gerein, and Sabu George. Ottawa, Canada, International Development Research Centre [IDRC], 1993 Feb. 33-42.UNICEF has been a vocal advocate of the widespread application of growth monitoring and promotion (GMP) for 10 years. The UNICEF Evaluation Office is an office within UNICEF responsible for conducting global thematic evaluations of a wide range of UNICEF activities. Evaluations involve reviewing literature, drafting terms of reference for evaluating activities in selected countries, and reviewing findings leading to policy changes for UNICEF at the global level. This paper describes progress made in conducting evaluations of GMP efforts coordinated together with UNICEF's Senior Nutrition Advisor. Data were collected for 1990-91 through focus groups and interviews in China, Ecuador, Indonesia, Malawi, Thailand, Zaire, Zambia and subsequently analyzed. A summary is presented of actions reported to have been stimulated by the assessment and analysis of anthropometric data at household and community levels and constraints to actions identified. The following lessons learned were agreed upon during a review meeting: resources are short for GMP; programs should be implemented only where there is demand; GMP should no longer be promoted as an entry point to improve the health system or other sectors; existing, poorly done GMP programs waste resources and incur large opportunity costs; promoting growth for child development is important especially where growth faltering is prevalent; program management may take several forms; inabilities to analyze and respond are primary constraints to good GMP in most country programs; GMP can promote empowerment where the context allows; and GM data should not be analyzed under the auspices of the health sector in order to avoid bias.
Draft team member contributions to mid-term evaluation of the Population and Family Planning Project (608-0171) in Morocco.
[Unpublished] 1988 Mar. 13 p.The draft team member contributions to the mid-term evaluation of the population and family planning project in Morocco examine current progress and address future needs. Increased awareness of at least 1 method of family planning was attributed to a USAID-funded project. But, problems of access, religious constraints, and lack of method-specific media campaigns need to be addressed. An increased effort to direct promotion efforts toward men is needed, as a prior immunization program showed that the husband was a key factor in encouraging mothers to bring their children to be vaccinated. Because the local health worker plays a critical role at the community level, training and support for these workers should be emphasized. Media-specific and audience-specific campaigns, by the government and private sector, should focus on the most cost-effective means of reaching the provincial level population. Donor organizations (such as UNICEF, UNFPA and USAID) should address the IEC needs identified by the central health education office, whose role and supporting functions need to be strengthened. Content of family planning materials must be method-specific, using a systematic methodology to address problems of inappropriateness, inadequate contraceptive mix, and lack of field worker training materials. Improved distribution methods for existing materials, as well as increased use of television and mass media are viable options. Using the community more effectively by encouraging leader motivation and instituting incentives could help to improve promotional and distributional activities at the provincial level. An evaluation of training needs revealed that the workshop method of training may be overemphasized, and most health workers expressed a desire for lengthened training. The private sector could be sensitized to public health issues and needs and, in conjunction with out of country technical assistance, produce effective social marketing of contraceptives within the Moroccan context. Coordination with other donors would be beneficial, with the exchange of documents and meetings between the groups.
Geneva, Switzerland, World Federation of Public Health Associations, 1983 Jul. 20 p. (Information for Action Resource Guide)Women in developing countries have special nutritional needs because of the tremendous physical burdens they bear in daily tasks, pregnancy, and lactation. Poverty and custom often cause these needs to go unmet. Poor maternal nutrition affects not only the mother's health, but also that of her children. While some elements of maternal nutrition are well known, discussion and experimentation continue on important nutritional and delivery issues. This Resource Guide, aimed at field staff who are not nutritionists, summarizes recent literature on this important topic. The annotations discuss both the causes and effects of maternal undernutrition. They also describe simple monitoring techniques to gauge maternal nutrition status and short-term programmatic interventions such as food fortification, food supplementation, vitamin distribution, and health education. The documents chosen synthesize important issues and experiences. The documents included are highly selective; some important literature and projects are not mentioned as this guide is mainly designed for busy program officials. Readers are encouraged to consult the references cited thorughout the guide for in-depth studies. Non-technical language is used throughout the text to facilitate understanding of the main concepts and issues.
IPPF Situation Report, June 1973. 10 p.The Indonesian Planned Parenthood Association (IPPA) was founded in 1957 and pioneered family planning services. It made little headway duri ng the pronatalist Sukarno regime, but in 1967 the present government announced an intensive family planning program and the IPPA was named as an implementing unit in 1971. 2 primary roles now are the training activities for fieldworkers and the development of community education and motivation programs. This complements the national mass media program. In 1970 the government took over all clinics except those in the Outer Islands (the islands outside Java, Bali, and Madura). The IPPA runs 150 clinics in the Outer Islands, is responsible for all supplies and maintenance, and has a number of model clinics in Java and Bali. The Community Education program has 8 components: speakers bureau, family planning clubs, mobile audiovisual units, exhibitions, tr aditional media, special events, local mass media support, and evaluatio n. In 1971 the 'ippa trained 2951 people; in 1972 this was increased by 25%. In 1973 the target is training 3000 fieldworkers with 16 centers for training and 16 field demonstration areas. An agreement with the U.N. Fund for Population Activities/International Development Association (UNFPA/IDA) will provide for building, equipping, and staffing. The research and evaluation function is also expanding to complement government activities. The government program aims to train 20,250 medical and paramedical personnel over 5 years and medical schools have incorporated the teaching of population and family planning. Government allowances are being curtailed for all children over 3 for government workers. An active clinic program aims to set up 1200 fully equipped and 1250 moderately equipped facilities by 1973. An active media campaign has been launched and for the 1st time in the population field the UNFPA and the IDA are helping to finance a project to expand a family planning program and broaden its activities. This su pport will provide for physical facilities, technical assistance, training, motivation, evaluation, research, and population education.
World Development. 1982; 10(7):573-84.Current efforts at involving communities in health activities are analyzed from a number of perspectives. Participation may be mainly aimed at easing resource constraints, through involvement in the implementation of health activities. Examples are the construction of health infrastructure, or the enlistment of community health workers--though in Latin America strong medical resistance to delegation has severely restricted their tasks. Participation in decision making has been even more limited, with the exception of some small scale NGO (nongovernmental organizations) sponsorship projects with conservative or progressive orientations also differ in degree of participation. The structure of the community, and the sociopolitical context in which it exists, are examined for the different constraints and opportunities they present to community participation for health. (author's modified)