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Strengthening the provision of adolescent-friendly health services to meet the health and development needs of adolescents in Africa. A consensus statement emanating from a regional consultation on strengthening the provision of adolescent-friendly health services to meet the health and development needs of adolescents in Africa, Harare, Zimbabwe, 17-21 October 2000.
Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2001.  p. (WHO/FCH/CAH/01.16; AFR/ADH/01.3)Health ministers in the WHO African Region at the 45th regional Committee for Africa (1995) requested WHO to assist Member States in their efforts to address the health problems of adolescents in an integrated manner. In addition, the WHO reproductive-health strategy for the African Region includes a framework which provides for equitable access to quality health services through the establishment of youth-friendly services and counselling for all adolescents. There have been many initiatives, largely donor-driven, in many African countries to provide health services to adolescents. On the other hand, there is ample evidence that even when health services are available adolescents do not utilize them for various reasons, ranging from the organization of services; the attitude of health workers, and community acceptance of services for adolescents. (excerpt)
Hospitals and health for all. Report of a WHO Expert Committee on the Role of Hospitals at the First Referral Level.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1987; (744):1-82.The World Health Organization (WHO) Expert Committee on the Role of Hospitals at the First Referral Level met from December 9-17, 1985, to review the role of the hospital in the broader context of a health system. The Expert Committee recognized that different strategies could be used to define the role of hospitals in relation to primary health care and that, for example, it would be possible to begin by analyzing what hospitals currently are doing with respect to primary health care, describe the different approaches being used, and then formulate guidelines to be followed by hospitals that are seeking to strengthen their involvement in primary health care. A shortcoming of this strategy is that it is based on what hospitals are already doing in particular circumstances, rather than helping people to decide what is required in a wide range of different settings. Consequently, the Expert Committee undertook to provide an analysis of primary health care, particularly in relation to the principles of health for all, to specify the components of a district health system based on primary health care, and to use this information as a basis for describing the role of the hospital at the first referral level in support of primary health care. This report of the Expert Committee covers the following: hospitals versus primary health care -- a false antithesis (the need for hospital involvement, the evolution of health services, expanding the role of hospitals, delineation of primary health care, hospitals and primary health care, and the common goal of health for all); components of a health system based on primary health care (targeted programs, levels of service delivery, and the functional infrastructure of primary health care); role and functions of the hospital in the first referral level (patient referral, health program coordination, education and training, and management and administrative support); the district health system; and approaches to some persistent problems (problems of organization and function; problems of attitudes, orientation, and training; and problems of information, financing, and referral system). The report includes recommendations to WHO, to governments, to nongovernmental organizations, and to hospitals. The Expert Committee considered that the conceptual focal point for organizational and functional integration should be the district health system encompassing the hospital and all other local health services. Further, the Expert Commitee was convinced that organizational and functional interaction (focused on the district health system) is imperative if full and effective use is to be made of the resources of the hospitals at the first referral level and if the health needs of the population are to be met.
Network. 2001; 21(2):13.In many settings, domestic violence is accepted by both women and men, and will only be reduced as basic human rights are recognized. Since many health care workers do not have the time, training, resources, or support to help victims of domestic violence, the WHO recommends several ways that they may be able to perform their duties at a minimum. The provider's first priority should be to evaluate the woman's safety in terms of risk of recurrence of violence, adverse reproductive health outcomes, or death through homicide or suicide. They should also keep in mind the credo "do no harm." This includes not blaming a woman for the domestic violence she has suffered. In general, a provider who wishes to take the first step of trying to identify victims of domestic violence should have a specific goal either to give better care, counseling, or refer the victim to the appropriate services. One source of guidance on integrating gender-based violence into sexual and reproductive health is the International Planned Parenthood Federation/Western Hemisphere newsletter. In the winter 2001 and summer 2000 newsletters, it describes how to create a protocol for implementing screening and services for victims of domestic violence and tells how to create a referral network and begin implementing client screening and staff training, respectively.
CHILD SURVIVAL ACTION NEWS. 1988 Apr; (9):1-2.Present thinking regarding the control of neonatal tetanus (NT) suggests that the accepted protocol in the past, i.e., immunizing pregnant women with tetanus toxoid (TT) during antenatal care, is not sufficient in countries where antenatal care may be unavailable. Current control strategies, experts, and official World Health Organization (WHO) recommendations now indicate that efforts should reach beyond immunization of pregnant women and the training of traditional birth attendants in hygienic cord care practice to immunization of all women of childbearing age. Babies continue to die form NT because it is so difficult to reach women during pregnancy for immunization. Lack of commitment to expanding immunization programs as Who recommends stems in part from failure at both national and local levels to acknowledge the extent of the neonatal tetanus problem. NT is vastly underreported for several reasons: cultural practices often include the seclusion of women and their babies during the period after birth; people in developing countries have a fatalistic attitude because so many children die within the 1st year of life; newborns are rarely taken to health centers for treatment; health workers may fail to report NT for fear that their superiors will blame them for failure to immunize or for poor care of the umbilical cord; Western medicine and research has a curative rather than a preventive focus; and gathering information on NT by asking mothers to recall deaths of newborns with symptoms of NT is difficult because many women are ashamed or otherwise unwilling to report the event. The WHO believes that conventional reporting systems in developing countries identify only 2-4% of actual NT cases. Without sound documentation of the problem, it is difficult to gain financial and political commitment to eradicating NT. The VIII International Conference on Tetanus that occurred in Leningrad during 1987 outlined WHO's recommendation for a mixed strategy to control and eliminate tetanus: immunize all women of childbearing age, with special emphasis on pregnant women and women known to belong to high risk groups; assure hygienic delivery and umbilical care through training and supervision of birth attendants; and investigate cases to determine what action could have prevented them.
INTERNATIONAL HEALTH NEWS. 1988 Apr; 9(4):4-5.In the effort to realize Universal Child Immunization by 1990, an active search is underway to find ways to raise immunization coverage levels. The World Health Organization's (WHO) Expanded Program on Immunization (EPI) has developed excellent systems that develop such program components as supply management, equipment maintenance, disease surveillance, clinical practice, and supervision. Program performance has shown a steady improvement over the years in those countries which have adopted such systems, yet the trend has not been as marked as expected. Coverage levels in many countries have remained below 60%, and figures show a "dropout" with the multi-dose vaccines. The dropout figures suggest that parental acceptance of immunization is difficult to sustain throughout the entire series, which is spread over the first 9 months of life. To reduce dropout and boost coverage levels still further, recent program directions have emphasized social mobilization to increase the public response to immunization. It is tempting to conclude that with the implementation of improved management systems the final success will come from persuading parents to avail themselves of immunization services, but field reports suggest that this may not be the case. Health records show missed immunizations despite numerous visits to clinics, suggesting widespread problems in the implementation of the WHO systems. A combination of causes seem to ensure that children attending with their mothers do not get immunized, including errors and omissions on the part of field staff which reduce the chances for immunizations by families making return visits to the clinics. Few programs incorporate immunizations in daily practice. In a series of immunization coverage surveys conducted recently in 1 African country, the most striking fact was that the limitations of the data collected meant that the calculated contribution of clinical error could only be a gross underestimation of true clinical error contribution. This suggests that social mobilization to improve clinical attendance is likely to be ineffective until problems with the provision of services have been solved, but improving services has the potential to increase coverage levels as well as the potential to motivate parents to bring their children to the clinics.
POPULATION EDUCATION NEWS. 1987 May; 14(5):6-9.Population education incentives, voluntary action, community participation, and improved program management are 5 family planning areas recently redefined by the government of India. Population education, integrated with the educational system, is important in influencing fertility behavior. The Adult Education program, and the nonformal educational system will be strengthened, with aid from UNFPA. Incentives, which are presently available to government employees, will be increased. Economic incentives, rural development program incentives, and insurance, lottery, and bond incentive schemes are being considered. Voluntary organizations will be encouraged to work in the family welfare sphere, and organized sector units will be urged to provide family welfare services to their employees. Cooperatives, which cover 95% of villages, will be used as a means of educating, motivating, and communicating population control objectives on the local level. Tax incentives will be offered to the corporate sector for providing integrated family welfare services. Community participation, which is crucial to the success of the programs, will be addressed on several levels. Popular committees, youth and women's groups, and medical students will increase community involvement through various means. In addition, political and community leaders will be involved in motivational work, and a village Women's Volunteer Corps is planned. Social marketing of contraceptives, although fairly extensive for the last 15 years, leaves much to be desired in creating a large demand. A marketing board will be created to ensure aggressive marketing, advertising, and promotion, with expansion to include oral contraceptives. Reorganization and reorientation toward modern program management will be undertaken, so that policy, planning, implementation, review, and evaluation are carried out efficiently. At the state, district, and the block level, more effective coordination is the goal, as well as strengthening the District Family Welfare Bureau.
Politics and population. U.S. assistance for international population programs in the Reagan Administration.
[Unpublished] .  p.US support for family planning programs in developing nations has become more and more controversial as the existing consensus on the rationale for these programs has been lost. This article discusses the major issues of the current debate on international family planning assistance and some of the reasons why bipartisan support for the program has eroded in recent years. During the 1960s, 2 factors contributed to the advent of the international family planning movement: the development of modern contraceptive technology in the form of the oral contraceptive (OC) and the IUD, technologies which, it was believed, could be made readily available and used easily, even in the poorest developing countries; and the growing realization that as mortality rates were declining rapidly due to improved health care in developing countries, the rate of population growth was increasing at a pace never before achieved. After some initial reluctance, efforts to stabilize population growth rates came to be accepted as in the US national interest, and by the 1970s both Republican and Democratic administrations and bipartisan congressional coalitions supported regular increases in funding for population programs as part of the foreign aid program. The US, together with several European countries, was instrumental in the development and early support for the UN Fund for Population Activities and the nongovernmental International Planned Parenthood Federation. In general, US support for international population programs was not a controversial issue in foreign aid debates until last year. Since President Reagan took office in January 1981, both the advocates and opponents of population programs have become more active and organized. Foreign aid in general and international family planning programs in particular are a favorite target for conservative groups, which include several antiabortion groups. Consequently, early in the Reagan administration efforts were made to slash the foreign aid budget. These efforts went so far as to propose eliminating all funding for international family planning programs. These efforts failed, and the US maintained its position as preeminent donor for family planning until 1984. In its final version, the US policy paper for the 1984 Mexico City Conference made 2 important revisions regarding US international population policy: the explanation of population growth as a "neutral phenomenon," caused by counterproductive, statist economic policies in poor countries, for which the suggested remedy is free market economic reform; and the assertion that the US does not consider abortion an acceptable element of family planning programs and will not contribute to nongovernmental organizations that perform or actively promote abortion as a family planning method in other nations. How this controversy over US International population policy is resolved depends largely on how Congress defines the issue.
Report on the evaluation of various family life education projects with particular emphasis on youth in the English-speaking Caribbean: general conclusions and recommendations.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Nov. xii, 39,  p.Most family life education (FLE) projects included in this evaluation have the longterm objectives of reducing the incidence of teenage prognancy, and promotion of self-reliance and positive, responsible behavior among youth. The immediate objectives and project strategies are also very similar across projects, e.g., in-school and out-of-school FLE, comprehensive youth services, including family planning (FP) and training. The evaluation shows that project design has improved over the years (clearer and measurable formulation of objectives, more comprehensive workplans and better explanation of budgetary items) and projects have moved from addressing a wide variety of broad issues to a more focused consideration of adolescent fertility. However, the Evaluation Mission in concerned that due to the similarities in project design, country-and-time-specific factors have not always been adequately taken into consideration. Other concerns include the lack of systematic needs assessment and use of baseline data to guide implementation. All the projects evaluated have contributed to the training in FLE/FP of a large number of family life educators, teachers and nurses and have thus significantly strengthened professional national capability. Nevertheless, training needs still exist in motivational/attitudinal variables, sex roles, teaching/learning technics. The projects have made a significant contribution to the introduction of FLE into schools and teacher training institutions. The focus at present should be the institutionalization of FLE within the in-school sector, including the development of a policy approving FLE in schools. The development of community-based health centers was often the central activity of the out-of-school FLE component of the projects. These centers have contributed to shaping the countries' attitudes by creating an awareness of teenage pregnancy, by developing an acceptable strategy, by providing a focal point for discussing sensitive issues, and by becoming a mechanism for community mobilization. The projects have also contributed to making FP services available and specialized services for adolescents are being established. The emphasis has been more on education and awareness creation than on contraceptive distribution to adolescents. At present the need is to strengthen the service delivery components. The limited availability of data suggests that adolescent pregnancy remains an urgent problem in the region. Sustained and more focused FLE/FP program efforts directed to adolescents continue to be needed in the region. The most important general lesson learnt from the programs is that programs in adolescent fertility can be started and implemented in countries even prior to declaration of policy by governments. However, at a certain stage of implementation the programs cannot be carried further without explicit government policies and control.
New York, N.Y., United Nations Fund for Population Activities [UNFPA]  54 p. (Population Profiles No. 20)This review traces how various population programs in Africa have evolved since the 1960s. Before the establishment of the United Nations Fund for Population Activities (UNFPA) in the late 1960s, the efforts of private groups or non-governmental organizations in the areas of family planning, are highlighted. The vital contribution of private donors in facilitating the work of the Fund in Africa is given emphasis throughout the review. Early studies show that family planning activities in Africa, and governmental population policies fall into a definite pattern within the continent and that the distribution of colonial empires was a major determinant of that pattern. In most of Africa, the 1st stirrups of the family planning movement began during the colonial period. During the 1960s there was marked increase in the demand for family planning services. Lack of official government recognition and not enough assistancy from external sources made early family planning programs generally weak. The shortage of trained personnel, the unsureness of government support, opposition from the Roman Catholic Church to population control, and the logistics of supplying folk in remote rural areas who held traditional attitudes, all posed serious problems. The main sectors of the Fund's activities are brought into focus to illustrate the expansion of population-related programs and their relevance to economic and social development in Africa. The Fund's major sectors of activity in the African region include basic data collection on population dynamics and the formulation and implementation of policies and programs. Family planning, education and communication and other special programs are also important efforts within the Fund's multicector approach. The general principles applied by UNFPA in the allocation of its resources and the sources and levels of current finding are briefly discussed and the Fund's evaluation methodology is outlined. A number of significant goals have been achieved in the African region during the past 15 years through UNFPA programs, most prominently; population censuses, data collection and analysis, demographic training and reseaqrch, and policy formulation after identification of need. This monograph seeks to provide evidence for the compelling need for sustained commitment to population programs in Africa, and for continuing international support and assistance to meet the unmet needs of a continent whose demographic dynamism is incomparably greater than that of any other part of the world.
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):452-9.This summary of the worldwide impact of measles discusses epidemiology, reported incidence, clinical severity, community attitudes toward measles, and the impact of immunization programs on measles. Measles, 1 of the most ubiquitous and persistent of human viruses, occurs regularly everywhere in the world except in very remote and isolated areas. Strains of measles virus from different counties are indistinguishable, and serum antibodies from diverse population have identical specificity. Yet, the epidemic pattern, average age at infection, and mortality vary considerably from 1 area to another and provide a contrasting picture between the developing and the developed countries. In the populous areas of the world, measles causes epidemics every 2-5 years, but in the rapidly expanding urban conglomerations in the developing world, the continuous immigration from the rural population provides a constant influx of susceptible individuals and, in turn, a sustained occurrence of measles and unclear epidemic curves. In the economically advanced nations, measles epidemics are closely tied to the school year, building up to a peak in the late spring and ceasing abruptly after the summer recess begins. Maternal antibody usually confers protection against measles to infants during the 1st few months of life. The total number of cases of measles reported to WHO for 1980 is 2.9 million. Considering that in the developing world alone almost 100 million infants are born yearly, that less than 20% of them are immunized against measles, and that various studies indicate that almost all nonimmunized children get measles, less than 3 million cases of measles in 1980 is a gross underestimate. There was adecrease in the global number of reported cases of measles during the 1979-80 period due primarily to the reduction in the number of cases in the African continent and, to a lesser extent, in Europe. It is premature to conclude that such a reported decline is real and that it reflects the beginning of a longterm trend. The contrast between the developed and the developing worlds is most marked in relation to the severity and outcome of measles. Case fatality rates of more than 20% have been reported from West Africa. It has been estimated that 900,000 deaths occur yearly in the developing world because of measles, but data available to WHO indicate that the global case fatality rate in the developing world approaches 2% (in contrast to 2/10,000 cases in the US), and the actal mortality may be greater than 1.5 million deaths per year. The advent of WHO's Expanded Program on Immunization has brought about an awareness of the measles problem. Whenever and wherever measles vaccine has been used effectively on a large scale, a marked reduction in the number of cases has been recorded.