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Sexual health in the International Classification of Diseases (ICD): implications for measurement and beyond.
Reproductive Health Matters. 2015 Nov; 23(46):185-92.This paper examines different dimensions of sexual health as related to the measurement of sexual health indicators and the proposed changes in the International Classification of Diseases to address issues related to sexuality and sexual health with an aim of informing health policy-making and programming. The lack of mechanisms for monitoring and evaluating sexual health outcomes has impeded the development of policies and programmes that support sexual health. The potential impact of changes to the ICD-11 is major and far-reaching given that the ICD is used by countries to define eligibility and access to health services and to formulate relevant policies and laws, and is used by health professionals as a basis for conceptualizing health conditions, treatments and outcomes. Improving the measurement of sexual health-related indicators builds the evidence base on scientific knowledge of sex, sexuality, sexual health and rights. As we stand on the cusp of the post-2015 era and the development agenda transitions to the Sustainable Development Goals, a unique opportunity presents itself to further consider how sexual health is defined, conceptualized, and monitored.
Southern Med Review. 2011 Dec; 4(2):15-21.Objectives: Although poor reproductive health constitutes a significant proportion of the disease burden in developing countries, essential medicines for reproductive health are often not available to the population. The objective was to analyze the guiding principles for developing national Essential Medicines Lists (EML). The second objective was to compare the reproductive health medicines included on these EMLs to the 2002 WHO/UNFPA list of essential drugs and commodities for reproductive health. Another objective was to compare the medicines included in existing international lists of medicines for reproductive health. Methods: The authors calculated the average number of medicines per clinical groups included in 112 national EMLs and compared these average numbers with the number of medicines per clinical group included on the WHO/UNFPA List. Additionally, they compared the content of the lists of medicines for reproductive health developed by various international agencies. Results: In 2003, the review of the 112 EMLs highlighted that medicines for reproductive health were not consistently included. The review of the international lists identified inconsistencies in their recommendations. The reviews' outcomes became the catalyst for collaboration among international agencies in the development of the first harmonized Interagency List of Essential Medicines for Reproductive Health. Additionally, WHO, UNFPA and PATH published guidelines to support the inclusion of essential medicines for reproductive health in national medicine policies and EMLs. The Interagency List became a key advocacy tool for countries to review their EMLs. In 2009, a UNFPA/WHO assessment on access to reproductive health medicines in six countries demonstrated that the major challenge was that the Interagency List had not been updated recently and was inconsistently used. Conclusion: The addition of cost-effective medicines for reproductive health to EMLs can result in enhanced equity in access to and cost containment of these medicines, and improve quality of care. Action is required to ensure their inclusion in national budget lines, supply chains, policies and programmatic guidance.
What's in a name? Policy transfer in Mozambique: DOTS for tuberculosis and syndromic management for sexually transmitted infections.
Journal of Public Health Policy. 2004; 25(1):38-55.In this paper we set out to explore the common assumption that international health policies are imposed on developing countries, owing to their high level of dependence on international aid. We examine how far two globally promoted infectious disease policies - directly observed short course therapy (DOTS) for tuberculosis (TB) and syndromic management for sexually transmitted infections (STIs) were voluntarily or coercively transferred in one particular setting, Mozambique. The findings of this case study are part of a larger study, which looked at global policy making, and compared South Africa and Mozambique. The larger study used the analytical frameworks developed to study policy transfer between jurisdictions. It showed that both policies had evolved in the 1980s through technical networks of national and international experts, and that policy transfer was not a linear, top-down process, but occurred in a series of policy loops over a long period. Experience at the country level fed into the globally promoted policies of the 1990s as part of this ‘looped process.’ The results of the global level research are being reported for policy theorists in a separate article. In this paper, we aim to present the findings of our case study of the transfer process and implementation of the policies in Mozambique and draw appropriate lessons for public health professionals working at the national level. (excerpt)
In: Programming for male involvement in reproductive health. Report of the meeting of WHO Regional Advisers in Reproductive Health, WHO / PAHO, Washington DC, USA, 5-7 September 2001. Geneva, Switzerland, World Health Organization [WHO], 2002. 88-103. (WHO/FCH/RHR/02.3)Health sector priorities are ideally set according to a number of variables, including: burden of disease; whether effective and proven ‘solutions’ are available; and the calculated cost-effectiveness of those solutions. In the case of sexual health services, we argue in this paper that this conceptual framework is useful for programme planning, but needs to take into account one important additional element: the client’s perspective. We further argue that the sexual health of men in south Asia can not be adequately addressed unless men’s beliefs about their bodies, men’s health priorities, and men’s sexual health concerns are evaluated, interpreted and acted upon. Services which do not correspond to men’s own perceived sexual health needs are unlikely to attract men as clients, and thus remove many of the opportunities for male involvement in other aspects of reproductive and sexual health prevention and care. Men’s own sexual health priorities may not correspond exactly with the priorities of public health programmes; we therefore discuss how the two sets of concerns may be reconciled and men brought more equitably into programmes. Finally, we outline areas which may be of particular concern to programme managers if this approach is adopted. (author’s)
Epidemic of sexually transmitted diseases in Eastern Europe. Report of a WHO meeting, Copenhagen, Denmark, 13-15 May 1996.
Copenhagen, Denmark, WHO, Regional Office for Europe, 1996. , 14 p. (EUR/ICP/CMDS 08 01 01)In response to the alarming rise in sexually transmitted diseases (STDs) in the newly independent states, the WHO Regional Office for Europe, WHO headquarters and the Joint United Nations Programme on AIDS organized a meeting of experts from the most affected countries to exchange information and to identify priority actions for the control of the epidemic. The participants included 15 experts from Belarus, Kazakhstan, Latvia, the Republic of Moldova, the Russian Federation and Ukraine. The participants called for urgent action, including a careful assessment of the existing systems for STD control, reallocation of resources among the various activity areas and strong advocacy to generate awareness at the top level of government and strengthen its support for the recommended initiatives. They also urged that national coordination of programmes to promote sexual health and prevent STDs and HIV be strengthened, that statutory services be made more accessible and acceptable to patients and that efforts be made to ensure that all health workers managing patients with STDs, including those in the private sector, provide high-quality care. (author's)