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[Implementation of the Integrated Management of Childhood Illnesses strategy in Northeastern Brazil] Implementacao da estrategia Atencao Integrada as Doencas Prevalentes na Infancia no Nordeste, Brasil.
Revista De Saude Publica. 2008 Aug; 42(4):598-606.OBJECTIVE: The majority of child deaths are avoidable. The Integrated Management of Childhood Illnesses strategy, developed by the World Health Organization and the United Nations Children's Fund, aims to reduce child mortality by means of actions to improve performance of health professionals, the health system organization, and family and community practices. The article aimed to describe factors associated with the implementation of this strategy in three states of Northeastern Brazil. METHODS: Ecological study conducted in 443 municipalities in the states of Northeastern Brazil Ceara, Paraiba and Pernambuco, in 2006. The distribution of economic, geographic, environmental, nutritional, health service organization, and child mortality independent variables were compared between municipalities with and without the strategy. These factors were assessed by means of a hierarchical model, where Poisson regression was used to calculate the prevalence ratios, after adjustment of confounding factors. RESULTS: A total of 54% of the municipalities studied had the strategy: in the state of Ceara, 65 had it and 43 did not have it; in the state of Paraiba, 27 had it and 21 did not have it; and in the state of Pernambuco, 147 had it and 140 did not have it. After controlling for confounding factors, the following variables were found to be significantly associated with the absence of the strategy: lower human development index, smaller population, and greater distance from the capital. CONCLUSIONS: There was inequality in the development of the strategy, as municipalities with a higher risk to child health showed lower rates of implementation of actions. Health policies are necessary to help this strategy to be consolidated in the municipalities that are at a higher risk of child mortality.
Washington, D.C., The National Academies Press, 2008 Dec 15.  p.At this historic moment, the incoming Obama administration and leaders of the U.S. Congress have the opportunity to advance the welfare and prosperity of people within and beyond the borders of the United States through intensified and sustained attention to better health. The United States can improve the lives of millions around the world, while reflecting America's values and protecting and promoting the nation's interests. The Institute of Medicine-with the support of four U.S. government agencies and five private foundations-formed an independent committee to examine the United States' commitment to global health and to articulate a vision for future U.S. investments and activities in this area.
Journal of Internal Medicine. 2008 Nov; 264(5):504-8.Had there been a strong African voice contributing to World Bank decisions, it is unlikely that deliberate sidelining of HIV by health sector reforms would have taken place. However, given Bank's architecture and processes, an adequate response to the crisis was a nonstarter; unlike mediocre responses to Africa's other health needs, it has been less easy for the IDC to duck its responsibility and place the blame on its so-called African partners. Nevertheless, the lack of an African voice distorts historical analyses of the crisis often reflecting a western perspective, emphasizing the lack of political will and African governments' failure to act, whilst underplaying the IDC's shortcomings. The notion itself that the epidemic is 25 years old rather than the more accurate 75 years old reflects this distortion. Most of the responsibility rests with the Bank's Board and top management. OED reports that it 'could find no evidence that other top management raised the issue with borrowers or pushed the issue to a higher level internally'. Where there was positive response by the bank at the country level, 'the initiative for AIDS strategies and lending came primarily from individual health staff in the regional and technical operational groupings of the Bank, but not in any coherent way from the Bank's HNP leadership or top-level management. The current initiative by the British House of Commons Committee for International Development to reform the World Bank effectively reverses the notion that the reform was all but impossible because it was a zero sum game. Today, however, its donor members may find the demonstrable unfairness and ineffectiveness less tolerable. It is unlikely that the next president of the Bank will be chosen solely by the United States. Reformers will now need to revise its constitutional rules, their balancing of stakeholder rights, their decision-making rules and practices and their staffing and expertise. The course of the HIV epidemic means that the status quo is no longer acceptable. (excerpt)
American Journal of Public Health. 2008 Sep; 98(9):1594-7.In 1948, after its first World Health Assembly, the WHO took action to form a Secretariat in Geneva. It was given space for its initial years in the Palais des Nations, which had been the last home of the League of Nations. As stated in Chapter I of its Constitution, WHO was "to act as the directing and coordinating authority on international health work." This was a much broader scope than any other international agency in the orbit of the UN. (excerpt)
Washington, D.C., World Bank, 2008.  p.The World Bank is committed to support Sub-Saharan Africa in responding to the HIV/AIDS epidemic. This Agenda for Action (AFA) is a road map for the next five years to guide Bank management and staff in fulfilling that commitment. It underscores the lessons learned and outlines a line of action. HIV/AIDS remains - and will remain for the foreseeable future - an enormous economic, social, and human challenge to Sub-Saharan Africa. This region is the global epicenter of the disease. About 22.5 million Africans are HIV positive, and AIDS is the leading cause of premature death on the continent. HIV/AIDS affects young people and women disproportionately. Some 61 percent of those who are HIV positive are women, and young women are three times as likely to be HIV positive than are young men. As a result of the epidemic, an estimated 11.4 million children under age 18 have lost at least one parent. Its impact on households, human capital, the private sector, and the public sector undermines the alleviation of poverty, the Bank's overarching mandate. In sum, HIV/AIDS threatens the development goals in the region unlike anywhere else in the world. (excerpt)
Geneva, Switzerland, UNAIDS, ASAP, 2008. 30 p.This ASAP Business Plan sets out the operational direction for 2008-2009 of the UNAIDS AIDS Strategy and Action Plan service. It presents the history of ASAP, explains how ASAP is governed, and describes operational achievements to date. These have included delivery of 15 peer reviews, provision of technical support to 29 countries, development of four technical tools for country use and initiation of a capacity building program. The document also presents conclusions of the ASAP Assessment which found that: ASAP had generally met the expectations set out in the ASAP Business Plan for 2006-07 in terms of the quantity and quality of work and adherence to agreed operating principles; ASAP is on track to meet the quantitative goal for technical support, development of tools, and capacity building; The mix of technical support has been stronger than anticipated on broad strategic planning and less on action planning, reflecting the relatively low demand received by ASAP in this area to date; ASAP outputs have been good, especially the peer reviews, the Self-Assessment Tool, and the planning effort for the capacity building program; The review noted that is was not possible to assess ASAP's impact on the quality of strategic and action planning at this early stage in the program; Finally, the assessment pointed out that since ASAP has already fully committed funds for capacity building and for the MEAN program, there is sufficient funding for new country requests only through the second quarter of 2008. (excerpt)
Supporting and sustaining national responses to children orphaned and made vulnerable by HIV and AIDS: Experience from the RAAAP exercise in sub-Saharan Africa.
Vulnerable Children and Youth Studies. 2006 Aug; 1(2):170-179.The growing number of children orphaned and made vulnerable by HIV and AIDS in sub-Saharan Africa presents an enormous socioeconomic and public policy challenge. Despite international commitments to increase resource allocation and scale up services and support for AIDS-affected children, families and communities, the national- and sub-national-level state responses have been inadequate. The rapid assessment, analysis and action planning (RAAAP) process for orphans and vulnerable children, conceived in late 2003, was intended as a multicountry incentive to identify and resource immediate actions that can be taken to scale in 16 heavily affected countries. This review of experiences to date with the RAAAP process highlights some key areas of learning, including: (a) fund mobilization has been slow and has reached approximately only one-third of what is required; (b) ownership and integration into development planning of the issue of orphans and vulnerable children at country level has been undermined by the perception that the response is an 'emergency' and externally (donor) driven exercise; (c) centralized planning has failed to appreciate the complexity of context and responses at the meso- and micro-levels within countries, entailing the need to support a comprehensive decentralization process of planning and implementation; (d) comprehensive multisectoral and interagency collaboration, involving civil society, is an important but overlooked element of the planning process; and (e) definitional variation between countries has led to large variations in budgets and coverage targets. While the RAAAP process has undoubtedly raised awareness at state level of the nature and extent of the 'orphan crisis' and raised vital resources, only full integration of the new planning process for orphans and vulnerable children within the range of macro and national development tools will allow the response to be sustainable in the longer term. (author's)
[Unpublished] 2004. Presented at the Conference on Gender Justice in Post-Conflict Situations, "Peace Needs Women and Women Need Justice”. Co-organized by the United Nations Development Fund for Women [UNIFEM] and the International Legal Assistance Consortium. New York, New York, September 15-17, 2004. 5 p.Why Women and Peace? The theme imposed itself. The last year of the 20th century represented an invitation and challenge to recapitulate and remember as well as to compare scores and balance sheets of the turbulent epoch we were leaving behind. No doubt, the 20th century was the century of wars. As never before in human history civilians paid the highest price of conflicts and conflagrations. In the two world wars and innumerable local wars, interventions, internal ethnic clashes, revolutions and coups, more than 100 million people were killed - the vast majority of them being civilians. Sometimes they were directly targeted; at other times they were "collateral damage" - to use an ugly euphemism coined by NATO during its 1999 intervention against Yugoslavia. From Hiroshima and Nagasaki to Vietnam to Pol Pot's Cambodia to Iran-Iraq to Afghanistan to Liberia to Sierra Leone to Rwanda to Burundi to Colombia to Iraq again... it is the civilians who suffered the most and among them, women and childrenas the most vulnerable ones. (excerpt)
Program scan matrix on child marriage: A web-based search of interventions addressing child marriage.
[Washington, D.C.], International Center for Research on Women [ICRW], . 25 p.The international community and U.S. government are increasingly concerned about the prevalence of child marriage and its toll on girls in developing countries. One in seven girls in the developing world marries before 15. Nearly half of the 331 million girls in developing countries are expected to marry by their 20th birthday. At this rate, 100 million more girls-or 25,000 more girls every day-will become child brides in the next decade. Current literature on child marriage has primarily examined the prevalence, consequences and reported reasons for early marriage. Much less has been analyzed about the risk and protective factors that may be associated with child marriage. Also, little is known about the range of existing programs addressing child marriage, and what does and does not work in preventing early marriage. The work presented here investigates two key questions: What factors are associated with risk of or protection against child marriage, and ultimately could be the focus of prevention efforts? What are the current programmatic approaches to prevent child marriage in developing countries, and are these programs effective? (excerpt)
The Global Campaign for the Health MDGs: Challenges, opportunities, and the imperative of shared learning.
Lancet. 2007 Sep 22; 370(9592):1018-1020.On Sept 5, the International Health Partnership (IHP) was launched by the UK, and on Sept 26, Women and Children First: the Global Business Plan for Maternal, Newborn and Child Health will be launched by Norway. These two new efforts, along with the Canadian Catalytic Initiative to Save a Million Lives, have been packaged as part of a broader Global Campaign for the Health Millennium Goals (MDGs). Such an explosion of proposals, which is meant to accelerate action for achieving MDGs 4, 5, and 6, should be welcomed by the world's health community. The proposals are further recognition of the continued commitment by high-income countries to address key health challenges in low-income and middle-income countries. Building on a decade of expanding work in global health, we can hope that these high-profile initiatives will sustain interest and address major obstacles to improving the health of the poorest people in the magnitude and time-frame demanded by the MDGs. Nevertheless, as is often the case with new policy efforts, the main operative aspects of the proposals and their likely consequences can be difficult to identify. We frame questions on five key issues that these announcements highlight. (excerpt)
Support to mainstreaming AIDS in development. UNAIDS Secretariat strategy note and action framework, 2004-2005.
Geneva, Switzerland, UNAIDS, . 10 p.Twenty years into the pandemic, there is now ample evidence for the complex linkages between AIDS and development: development gaps increase people's susceptibility to HIV transmission and their vulnerability to the impact of AIDS; inversely, the epidemic itself hampers or even reverses development progress so as to pose a major obstacle to the achievement of the Millennium Development Goals. The growing understanding of this two-way relationship between AIDS and development has led to the insight that, in addition to developing programmes that specifically address AIDS, there is a need to strengthen the way in which existing development programmes address both the causes and effects of the epidemic in each country-specific setting. The process through which to achieve this is called 'Mainstreaming AIDS'. In recognition of this, the 2001 United Nations General Assembly Special Session Declaration of Commitment on HIV/AIDS requires countries to integrate their AIDS response into the national development process, including poverty reduction strategies, budgeting instruments and sectoral programmes. (excerpt)
Danish Medical Bulletin. 2007 May; 54:150-152.In general, children and adolescents in the WHO European Region today have better nutrition, health and development than ever before. There are striking inequalities in health status across the 52 countries in the Region, however, with over ten-fold differences in infant and child mortality rates. Inequalities are also growing within countries, and several health threats are emerging. Against this background, the WHO Regional Office for Europe has developed a European strategy for child and adolescent health and development. The purpose of the Strategy, together with a tool kit for implementation, is to assist member states in formulating their own policies and programmes. (author's)
Prevention and control of sexually transmitted infections: draft global strategy. Report by the Secretariat.
Geneva, Switzerland, WHO, 2006 May 18. 67 p. (A59/11)Nearly a million people acquire a sexually transmitted infection (STI), including the human immunodeficiency virus (HIV), every day. The results of infection include acute symptoms, chronic infection, and serious delayed consequences such as infertility, ectopic pregnancy, cervical cancer, and the untimely deaths of infants and adults. The presence in a person of other STIs such as syphilis, chancroid ulcers or genital herpes simplex virus infection greatly increases the risk of acquiring or transmitting HIV. New research suggests an especially potent interaction between very early HIV infection and other STIs. This interaction could account for 40% or more of HIV transmissions. Despite this evidence, efforts to control the spread of STIs have lost momentum in the past five years as the focus has shifted to HIV therapies. Prevention and control of STIs should be an integral part of comprehensive sexual and reproductive health services in order to contribute towards the attainment of the MillenniumDevelopment Goals and respond to the call for improved sexual and reproductive health as defined in the programme of action of the United Nations International Conference on Population and Development. The draft global strategy for the prevention and control of sexually transmitted infections 2006-2015 has two components: technical and advocacy. The technical content of the strategy deals with methods to promote healthy sexual behaviour, protective barrier methods, effective and accessible care for STIs, and the upgrading of monitoring and evaluation of STI control programmes. The steps needed to develop health systems capacity to deliver the programme are explained. Emphasis is placed on a public health approach based on sound scientific evidence and cost-effectiveness. (excerpt)
The Maputo report. WHO support to countries for scaling up essential interventions towards universal coverage in Africa.
Brazzaville, Congo, WHO, 2006. 33 p. (WHO/CCO/06.02)The African region accounts for 10% of the world's population yet is confronted with 20% of the global burden of disease. African nations are faced with high levels of poverty, with 39% of the population below the poverty line; and slow economic growth, with annual per capita expenditure on health in most countries limited to between US$ 10 and US$ 29. Other well-documented challenges to the region include limited financial and human resources, uncoordinated and inconsistent policy action on the determinants of health, limited use of knowledge and evidence to inform policies, and frequent occurrences of natural and man-made disasters. Although much has happened, WHO requires radical new approaches for how it does business in the region. The 21st century presents extensive opportunities for improving health in the region -- building on the momentum of the Millennium Development Goals (MDGs), resolutions of the WHO World Health Assembly (WHA) and the Regional Committee, coordinated work of the African Union, and the strategic framework of the New Partnership for Africa's Development (NEPAD) -- offering opportunities for the mobilization of political, technical and other resources for the region. In addition to health investments from national, bilateral and multilateral sources, commitments are being crystallized in distinct initiatives such as the Millennium Challenge Account, the Presidential Emergency Plan for AIDS Relief (PEPFAR), the Report on the Commission for Africa, the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM), and the Global Alliance for Vaccines and Immunizations (GAVI). These initiatives come at a time when international agreements such as the Paris Declaration reaffirm the importance of countries taking the lead in their own health agendas in regards to international development assistance. (excerpt)
UN Chronicle. 1987 May; 24: p..While the media focus on Africa from 1984 to 1986 brought extraordinary assistance to that crisis-ridden continent, it may have tended to obscure everyday emergencies wrought by disease and malnutrition elsewhere in the world. Recent events in Africa have alerted United Nations agencies once again that ways must be found to sensitize politicians as well as the press to what the United Nations Children's Fund (UNICEF) Executive Director James P. Grant has called the "silent emergencies'--the less dramatic continuum of death and human suffering imposed by poverty and ignorance. In the UNICEF State of the World's Children Report for 1987, Mr. Grant notes that over the past two years, more children died in India and Pakistan than in most nations of Africa combined. "In 1986, more children died in Bangladesh than in Ethiopia, more in Mexico than in the Sudan, more in Indonesia than in all eight drought stricken countries of the Sahel', he says. (excerpt)
Chinese Primary Health Care. 2000; 14(9):11-14.To set up the research priorities for the broader reproductive health programmes, the World Health Organization (WHO) has given a high priority to planning and programming for reproductive health, which aims at improvement of the delivery of reproductive health services. In 1998, with a financing support by Ford Foundation, the Foreign Loan Office of the China Ministry of Health (MoH) initiated a program in poor rural areas of China entitled reproductive health improvement project (RHIP) in 4 of the 71 World Bank/MoH of China "Health VIII Project" Counties. This paper reports the approaches and entry points of RHIP: (1) Participatory planning; (2) Operations research; and (3) Listening to women's voice at the rural communities. It is expected that these approaches and entry points will be useful for improvement of reproductive health services in other rural areas of China. (author's)
Charters, declarations, world conferences: practical significance for health promotion practitioners "on the ground" [editorial]
IUHPE - Promotion and Education. 2005; 12(1):6.We are on the cusp of the twentieth anniversary of the Ottawa Charter for Health Promotion. In 2005 in Bangkok, the World Health Organization will lead a re-examination of the Ottawa Charter, and the Bangkok Charter on health promotion will have been launched. At the International Union for Health Promotion and Education’s global conference in Vancouver in 2007, the Ottawa Charter will again be in the spotlight, as will, for that matter, the new Bangkok Charter. One might wonder about the need for a new Charter, and what impact such documents have on the practical work of health promotion practitioners, if any. The need for a new Charter is the subject of lively debate at the time of this writing, a sign that the Ottawa Charter continues to have significance, even though the world has changed remarkably in the twenty years since its adoption. Perhaps the best test of the Bangkok Charter’s impact will be the degree of attention it receives in 2025, when the young readers of this book have aged into the vanguard of health promotion leadership. That still leaves the question of if, and how, the high level political machinations which culminate in health promotion Charters and Declarations have significance for the day-to-day work of health promotion practitioners. For a start, it is clear that health promotion provides common ground for many health professionals, which enhances the quality and effectiveness of cross-discipline team work. Education in health promotion stimulates and enables cross-discipline dialogue, respect, and eagerness for collaboration. (excerpt)
Geneva, Switzerland, WHO, 2003. 79 p.The purposes of the HDRST include: 1) to work with the National AIDS Committee to consider the specific public health uses of HIV drug resistance surveillance in the country, and to assess feasibility of surveillance; 2) to develop an appropriate time line for resistance surveillance activities, in coordination with other important implementation plans such as expanding HIV treatment; 3) to assess the country's capacity for HIV drug resistance surveillance, to decide on the populations and groups to be targeted, and to identify additional resources and activities needed; 4) to perform HIV drug resistance threshold surveys to assess when the frequency of resistance in persons newly diagnosed with HIV has reached the 5% threshold indicating a need for resistance surveillance; 5) to implement, when appropriate, HIV drug resistance surveillance; 6) to collaborate with the National AIDS Committee and the national treatment programme; to explore the feasibility of treatment programme monitoring by adding a resistance monitoring component to other year-end programme monitoring activities; 7) after routine surveillance is established, to consider implementing other special studies for in-depth evaluation of certain aspects of drug resistance within the country; 8) to insure implementation of all activities in accordance with international ethical standards designed to promote the well- being and health of individuals and communities; 9) to insure the dissemination of results in order to promote and support the public health of the country. (excerpt)
Paris, France, UNESCO, 2001 Apr 24.  p. (161 EX/18)At its 159th session, the Executive Board of UNESCO requested the Director-General to draw up a strategic plan of action concerning UNESCO’s contribution to the United Nations system strategy against HIV/AIDS for the five-year period 2001-2005. Fighting HIV/AIDS is one of the top priorities of the United Nations. At its fifty-fifth session, the General Assembly, in its resolution 55/13 of 3 November 2000, decided to convene, as a matter of urgency, on 25 to 27 June 2001, a special session of the General Assembly to review and address the problem of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in all its aspects. The aim of the special session is to secure a global commitment to enhancing coordination and the intensification of national, regional and international efforts to combat the epidemic in a comprehensive manner. All entities of the United Nations system, including programmes, funds, specialized agencies and regional commissions, is to be actively involved in the preparatory activities and are encouraged to participate at the highest level in the special session. (excerpt)
Report of the expert meeting: “3 by 5”, What Are the Implications? Organized by the Royal Tropical Institute, Aids Fonds and Share-Net, 16 September 2004, Amsterdam.
Amsterdam, Netherlands, KIT, 2004. 27 p.In 2003, the WHO started an initiative to expand access to HIV treatment. “3 by 5” is the name of the global target of providing anti-retroviral therapy (ART) to three million people living with HIV/AIDS in resource-limited countries by the end of 2005. It is a step towards the goal of providing universal access to treatment for all who need it. The WHO’s framework for emergency scaling up of anti-retroviral therapy contains 14 key strategic elements. These elements fall into five categories – the pillars of the “3 by 5” campaign: i) global leadership, strong partnership and advocacy; ii) urgent, sustained country support; iii) simplified, standardized tools for delivering antiretroviral therapy; iv) effective, reliable supply of medicines and diagnostics; and v) rapid identification and application of new knowledge and successes. The strategy also aims to develop guidelines for ensuring the quality of anti-retroviral drugs and to build country-level capacity for delivery and utilization of simple diagnostics for monitoring patient adherence to treatment as well as drug resistance. In the first six months of this strategy, progress was made towards the goal of increasing access to treatment. But much remains to be done, and urgently, if the world is to meet its target of providing treatment to three million people by the end of 2005. (excerpt)
Lancet. 2004 Jun 26; 363(9427):2191-2192.We agree with Vasant Narasimhan and colleagues that in many developing countries, international players have substantial influence over the agenda-setting and policy-making with respect to human resources for health. The joint poverty-reduction strategy paper and debt initiative for heavily indebted poor countries (PRSP-HIPC) is a prime example of an interface between international actors and national decision-makers with real clout. Unfortunately, human resources for health often do not even figure on its agenda. A review of the PRSP in six selected African countries by the UK’s Department for International Development Health Systems Resource Centre indeed shows that, at best, the human resources crisis is merely acknowledged, and that an indepth analysis of the issue and how it relates to civil service conditions is conspicuously absent in most papers. (excerpt)
Arlington, Virginia, Camp Dresser and McKee International, Environmental Health Project, 2004 Mar. vi, 80 p. (Activity Report No. 128; USAID Contract No. HRN-I-00-99-00011-00)The tools presented in this report relate to technical support provided by USAID through the Environmental Health Project (EHP) to the Public Private Partnership (PPP) for Handwashing with Soap Initiative, which was started by UNICEF and implemented with financial assistance from USAID and the World Bank. As part of USAID/EHP’s technical support, EHP worked with Howard Delafield International (HDI) and prepared a series of program/planning tools used in the preparation of the first-phase of the Nepal Handwashing with Soap Initiative. These tools were based on a literature review of “lessons learned” from the Central American Handwashing Inititiative, as well as a review of other background material prepared for other handwashing with soap activities, and were developed in partnership with UNICEF /Nepal during 2003. The planning tools can be used and/or adapted by other organizations, public or private sector, interested in initiating a PPP in their country. For more information on PPP initiatives, please refer to www.globalhandwashing.org. (excerpt)
Geneva, Switzerland, WHO, 2003.  p. (WHO/HIV/2003.17)Country support is central to global efforts to reach the 3 by 5 target of providing antiretroviral therapy (ART) to 3 million people in resource-limited countries by the end of 2005. Achieving the 3 by 5 target will require the concerted efforts of all concerned parties in countries and at the global level. However, countries must take the lead. International partners will need to assist in meeting the resource gap and also in helping to build the necessary capacity to deliver ART. The World Health Organization (WHO), as the UNAIDS Cosponsor responsible for care and treatment, together with UNAIDS and the other Cosponsors and partners, is taking the lead in catalyzing action to reach 3 by 5 by building on existing national and global efforts. (excerpt)
Science in Africa. 2004 Jan;  p..Short-term relief followed by long-term disaster is not sound policy. Nonetheless, that could be a result of the Aids strategy being contemplated by the World Health Organisation, which on December 1 - World Aids Day - announced a plan to treat 3-million people with HIV/Aids by 2005. The WHO is proposing that billions of dollars be spent on increasing access to anti-retroviral drugs. That is a noble intention. However, it may not be the most cost-effective way to stem the tide of HIV/Aids: it may even be counterproductive. Let's be clear. Reducing the cost and increasing the supply of medicines to the poor is a good thing. But on its own it is not enough. Nor should it be today's priority. The roots of Africa's health care crisis run far deeper and broader than a mere shortage of drugs. Spending billions on drugs is likely to prove a disappointing waste. (excerpt)
Bulletin of the World Health Organization. 2003 Dec; 81(12):855.Today’s global health situation raises urgent questions about justice” says Dr Jong-wook LEE as he introduces The world health report 2003 — Shaping the future, the first World health report to be published during his term as Director General. The report begins with an overview of the stark and growing inequalities in health on a global scale. Although the average life expectancy at birth has increased by almost 20 years during the last half-century, in parts of sub-Saharan Africa current adult mortality rates now exceed those of 30 years ago. More than 10 million children die of preventable causes each year. In 16 countries, the under-5 mortality rate is higher than it was in 1990. Governments have committed themselves to address the challenges posed by poverty and its consequences, by agreeing to work towards the Millennium Development Goals (MDGs). Progress is falling short of that needed to achieve the MDGs by 2015. WHO will focus on working with countries in order to help them tailor MDGs to their needs; to ensure that disadvantaged groups within countries share in benefits of the progress; and to urge developed countries to live up to their part of the contract. Trade, development assistance and debt are particularly important areas. WHO will also continue to advocate an increase in health assistance to reach a total of US$ 27 billion annually by 2007. (excerpt)