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  1. 1

    Use of Service Provision Assessments and Service Availability and Readiness Assessments for monitoring quality of maternal and newborn health services in low-income and middl-income countries.

    Sheffel A; Karp C; Creanga AA

    BMJ Global Health. 2018 Dec 1; 3(6):e001011.

    Improving the quality of maternal and newborn health (MNH) services is key to reducing adverse MNH outcomes in low-income and middle-income countries (LMICs). The Service Provision Assessment (SPA) and Service Availability and Readiness Assessment (SARA) are the most widely employed, standardised tools that generate health service delivery data in LMICs. We ascertained the use of SPA/SARA surveys for assessing the quality of MNH services using a two-step approach: a SPA/SARA questionnaire mapping exercise in line with WHO’s Quality of Care (QoC) Framework for pregnant women and newborns and the WHO quality standards for care around the time of childbirth; and a scoping literature review, searching for articles that report SPA/SARA data. SPA/SARA surveys are well suited to assess the WHO Framework’s cross-cutting dimensions (physical and human resources); SPA also captures elements in the provision and experience of care domains for antenatal care and family planning. Only 4 of 31 proposed WHO quality indicators around the time of childbirth can be fully generated using SPA and SARA surveys, while 19 and 23 quality indicators can be partially obtained from SARA and SPA surveys, respectively; most of these are input indicators. Use of SPA/SARA data is growing, but there is considerable variation in methods employed to measure MNH QoC. With SPA/SARA data available in 30 countries, MNH QoC assessments could benefit from guidance for creating standard metrics. Adding questions in SPA/SARA surveys to assess the WHO QoC Framework’s provision and experience of care dimensions would fill significant data gaps in LMICs.
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  2. 2

    Adolescent pregnancy -- unmet needs and undone deeds. A review of the literature and programmes.

    Neelofur-Khan D

    Geneva, Switzerland, World Health Organization [WHO], 2007. [109] p. (WHO Discussion Papers on Adolescence; Issues in Adolescent Health and Development)

    The World Health Organization (WHO) has been contributing to meeting the Millennium Development Goals (MDGs) by according priority attention to issues pertaining to the management of adolescent pregnancy. Three of the aims of the MDGs - empowerment of women, promotion of maternal health, and reduction of child mortality - embody WHO's key priorities and its policy framework for poverty reduction. The UN Special Session on Children has focused on some of the key issues affecting adolescents' rights, including early marriage, access to sexual and reproductive health services, and care for pregnant adolescents. This review of the literature was conducted to identify (1) the major factors affecting the pregnancy outcome among adolescents, related to their physical immaturity and inappropriate or inadequate healthcare-seeking behaviour, and (2) the socioeconomic and political barriers that influence their access to health-care services and information. The review also presents programmatic evidence of feasible measures that can be taken at the household, community and national levels to improve pregnancy outcomes among adolescents. (excerpt)
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  3. 3

    The state of the world's children 1988.

    Grant JP

    Oxford, England, Oxford University Press, 1988. [9], 86 p.

    The 1988 UNICEF report on the world's children contains chapters describing the multi-sectorial alliance to support child health, the current emphasis on ORT and immunization, the effect of recession on vulnerable children, family rights to knowledge of basic health facts, and support for women in the developing world. Each chapter is illustrated by graphs. There are side panels on programs in specific countries, including Senegal, Syria, Colombia, Bangladesh, Turkey, India, Honduras, Japan and Southern Africa, and highlighted programs including immunization, AIDS, ORT, breast-feeding and tobacco as a test of health. The SAARC is a new regional organization of southern Asian countries committed to immunization and other health goals. Tables of health statistics of the world's nations, divided into 4 groups by "Under 5 Mortality Rate" present basic indicators, nutrition/malnutrition data, health information, education, literacy and media data, demographic indicators, economic indicators and data pertaining to women. The absolute numbers of child deaths had fallen to 16 million in 1980, from 25 million in 1950. Saving children's lives will not exacerbate the population problem because, realizing that their children will survive, families will have fewer children. Furthermore, the methods used to reduce mortality, such as breast feeding and empowerment of families to control their lives, are known to reduce fertility.
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  4. 4

    Shaming the politicians into action.

    Rowley J

    PEOPLE. 1987; 14(3):10-1.

    Dr. Halfdan Mahler, Director-General of the World Health Organization (WHO), is interviewed on the safe motherhood campaign. WHO is planning to spend US $5 million on operational research into safe motherhood. The US $5 million is a symbolic expression designed to bring safe motherhood into the mainstream of primary health care. The US $5 million will put pressure on technocrats and politicians to start addressing the problem. With the US $5 million WHO will offer governments its assistance in looking at how they can upgrade their health care systems. WHO will put pressure on politicians in the developing world, few of whom seriously believe that health is a good investment. Countries can be made to feel ashamed when they see that 1 country has taken the issue seriously. Prime Ministers and Heads of States open their ears when economists take an interest and The World Bank's involvement has been shown to make the difference in a number of WHO flagships. The Health for All movement is moving fast in the industrialized countries. In the developing countries, victimized in so many ways, you constantly need to find new entry points to keep the fire alive.
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  5. 5

    Report on the evaluation of UNFPA assistance to the family health programme of Zambia: project ZAM/74/PO2 (February - March 1984).

    Ryder B; Burton J; McWilliam J

    New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Sep. x, 38, [5] p.

    The objective of the Family Health Program of Zambia is to enhance the health and welfare of Zambians, particularly mothers and children, through an increase in coverage of the population served through under-5s clinics, pre- and post-natal services and child spacing activities. The Mission found that the strong points of the project are the increasing commitment of the Government to incorporate family planning activities as an essential component of its family health and primary health care programs; the training and health education components of the program; and the enthusiasm and ability of the Zambian Enrolled Nurse/Midwives in organizing maternal child health/family planning services at service delivery points. Factors which appear to have hindered a more effective project performance have been the restriction on prescribing contraceptives by anyone but physicians; the imbalance in implementation among the project components; the failure to appoint international and national staff to key positions and with a timing that would have enabled staff members to support each other as members of a coordinated team; weak supervision; no research and evaluation activities; transport problems; the lack of use of, and updating of, the project plans; and the absence of a tripartite review early in the project's life to address implementation problems.
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  6. 6
    Peer Reviewed

    Traditional birth attendants.

    Leedam E

    International Journal of Gynaecology and Obstetrics. 1985 Sep; 23(4):249-74.

    In many countries 60-80% of deliveries are assisted by traditional birth attendants (TBAs). Over the last several decades efforts have been made to regulate, upgrade through training or replace the TBA. The strength of the TBA comes from the fact that she is part of the cultural and social life of the community in which she lives. Her weakness lies in the traditional practices which may have dangers for her clients. With suitable training and supervision these dangers can be minimized and her potential used to improve the health of mothers and babies. Increasingly countries are recognizing that the TBA will represent a major resource where women do not have access to services for either cultural or geographic barriers. An understanding of the TBA's role and contribution by all health authorities is necessary. The TBA's role is always associated with the actual birth process, but in some instances her influence extends to prenatal and postnatal period. Based on suggestions from midwives, obstetricians, anthropologists and educators, WHO has issued guidelines, encouraged consultations, and held conferences and seminars all designed to widen the acceptance of this concept and disseminate the knowledge available on both traditional birth customs and on the training needed to effectively utilize the traditional practitioners. The WHO's approach has been successful in stimulating countries to undertake TBA training and utilization programs. There is overwhelming evidence that TBAs are acceptable to the population, accessible in numbers where they are needed, capable of absorbing training, cost effective and perhaps the surest means by which maternal and infant health in developing countries can be improved. TBAs still deliver most of the world's babies and will continue to do so for many years to come. Many of WHO's Member States are now collaborating with TBAs to extend health service coverage to unserved populations.
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