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  1. 1

    The hospital in rural and urban districts. Report of a WHO Study Group on the Functions of Hospitals at the First Referral Level.

    World Health Organization [WHO]. Study Group on the Functions of Hospitals at the First Referral Level


    In 1992, the WHO Study Group on the Functions of Hospitals at the First Referral Level compiled a report on the functions of the hospital in rural and urban districts. It advocates that the 1st referral level hospital should be integrated into the district health care system, which is administered by a district health council. This approach strengthens primary health care and uses hospital resources to promote health. The most pressing need for this approach to work is changing people's attitudes and motivation. Various obstacles invariably slow this integration process such as resistance by central and local government officials and inadequate funding. The district hospital should help people to find health rather than just cure disease. Further it must accept the fact that it is not the center of the health system. This means a redistribution of both finance and effort. Governments need to improve the decentralization process to facilitate integration. The study group proposes a step by step methodology to integrate the health system. The 1st step is creating a district health council with representatives from the district health office, the hospital, other sectors of the health care system, and the community. The council determines the community diagnosis including population trends, patterns of morbidity and mortality, and disease and risk distribution by age and location. It also needs to review health services in the district. The council can divide these services into preventive, promotional, curative, rehabilitative, and organizational services. It also must reassess distribution of resources including people, buildings, equipment, and materials. The council must draft a plan and deliberate on implementing the plan. Once the council has taken these steps, it can then implement, monitor, and evaluate the plan and its results.
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  2. 2

    Status of cold box testing and buyers' guide: update, December 1984.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    [Unpublished] 1984. 24 p. (EPI/CCIS/84.4)

    Since 1979, vaccine hand carriers, cold boxes, and vaccine packaging have been submitted by the World Health Organization (WHO) for laboratory testing at the Consumers Association Laboratories, Harpenden Rise, UK, and UNIVALLE, Cali, Colombia. The tests results have been summarized in this document in order to inform users and buyers of the equipment available as to its performance capacities and to serve as a guide to the selection of equipment most suited to specific conditions. Detailed tables list all equipment which has been tested. The equipment is divided into categories on the basis of vaccine storage capacity, and the following major features are listed: external dimensions (in centimeters); vaccine in storage capacity (in litres); number of icepacks necessary (as used during the tests); cold life at an ambient temperature of +43 degrees Centigrade; weight fully loaded (in kilograms); and durability (under rough handling conditions). Equipment has been subjected to 2 main types of routine test: performance or temperatur rise test; and durability or drop test. In the course of testing, a number of interesting observations were made, including: using more icepacks than specified will lengthen the cold life of a container without harming the vaccine but also will increase weight load and decrease the vaccine storage capacity; icepacks are more quickly frozen in "icepack freezers" as opposed to chest type domestic freezers; some boxes had problems with lid fastenings, which came undone on impact; and 5 factors should be taken into consideration in the purchase of any box, that is, vaccine storage capacity, cold life, weight fully loaded, durability, and price.
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