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  1. 1
    370754
    Peer Reviewed

    How should the post-2015 response to AIDS relate to the drive for universal health coverage?

    Poku NK

    Global Public Health. 2016 Aug 6; 1-15.

    The drive for universal health coverage (UHC) now has a great deal of normative impetus, and in combination with the inauguration of the sustainable development goals, has come to be regarded as a means of ensuring the financial basis for the struggle against HIV and AIDS. The argument of this paper is that such thinking is a case of ‘the right thing at the wrong time’: it seriously underestimates the scale of the work against HIV and AIDS, and the speed with which we need to undertake it, if we are to consolidate the gains we have made to date, let alone reduce it to manageable proportions. The looming ‘fiscal crunch’ makes the challenges all the more daunting; even in the best circumstances, the time required to establish UHCs capable of providing both essential health services and a very rapid scale-up of the fight against HIV and AIDS is insufficient when set against the urgency of ensuring that AIDS does not eventuate as a global health catastrophe.
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  2. 2
    340243

    The Global Strategy for Women’s, Children’s and Adolescents' Health 2016-2030. Survive, Thrive, Transform.

    Every Woman, Every Child

    [New York, New York], Every Woman Every Child, 2015. [108] p.

    The ambition of the Global Strategy for Women’s, Children’s and Adolescents’ Health is to end preventable deaths among all women, children and adolescents, to greatly improve their health and well-being and to bring about the transformative change needed to shape a more prosperous and sustainable future. This updated Global Strategy was developed by a wide range of national, regional and global stakeholders under the umbrella of the Every Woman Every Child movement, with strong engagement from WHO and builds upon the 2010-2015 Global Strategy for Women’s and Children’s Health. Launched by the UN Secretary-General on 26 September in New York, this updated Global Strategy, spanning the 15 years of the SDGs, provides guidance to accelerate momentum for women’s, children’s and adolescents’ health. It should achieve nothing less than a transformation in health and sustainable development by 2030 for all women, children and adolescents, everywhere.
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  3. 3
    340742

    Health in 2015: From MDGs, Millennium Development Goals to SDGs, Sustainable Development Goals.

    Boerma T; Mathers C; AbouZahr C; Chatterji S; Hogan D; Stevens G; Mahanani WR; Ho J; Rusciano F; Humphreys G

    Geneva, Switzerland, World Health Organization [WHO], 2015. [216] p.

    In 2015 the Millennium Development Goals (MDGs) come to the end of their term, and a post-2015 agenda, comprising 17 Sustainable Development Goals (SDGs), takes their place. This WHO report looks back 15 years at the trends and positive forces during the MDG era and assesses the main challenges that will affect health in the coming 15 years.
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  4. 4
    335750

    Making fair choices on the path to universal health coverage. Final report of the WHO Consultative Group on Equity and Universal Health Coverage.

    World Health Organization [WHO]. Consultative Group on Equity and Universal Health Coverage

    Geneva, Switzerland, WHO, 2014. [84] p.

    Universal health coverage (UHC) is at the center of current efforts to strengthen health systems and improve the level and distribution of health and health services. This document is the final report of the WHO Consultative Group on Equity and Universal Health Coverage. The report addresses the key issues of fairness and equity that arise on the path to UHC. As such, the report is relevant for every actor that affects that path and governments in particular, as they are in charge of overseeing and guiding the progress toward UHC.
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  5. 5
    334529

    WHO / World Bank convene ministerial meeting to discuss best practices for moving forward on universal health coverage. Joint WHO / World Bank statement.

    World Health Organization [WHO]; World Bank

    Geneva, Switzerland, WHO, 2013 Feb 19. [2] p.

    Top officials from health and finance ministries from 27 countries joined other high-level health and development stakeholders at a two-day meeting this week in Geneva to discuss ways that countries are progressing towards universal health coverage. The meeting was convened jointly by the World Health Organization (WHO) and the World Bank and took place just weeks after the United Nations General Assembly adopted a resolution supporting universal health coverage. Delegates at the Geneva meeting expressed strong support for the ideas underlying universal health coverage: that everyone, irrespective of their ability to pay, should have access to the health services they need, without putting their families at financial risk. The meeting also discussed strategies to ensure an adequate supply of good quality and affordable essential medicines and technologies, noting the value of using financial incentives to promote efficiency and quality of health services. The participants agreed on the importance of improving information systems and holding governments and health care providers more accountable for delivering results. The importance of monitoring progress towards universal health coverage was also a recurrent theme, as was the important role played by researchers, civil society, and international agencies. The WHO and the World Bank are working together at global, regional and country levels, and stand by ready to help countries confront the numerous challenges that the meeting highlighted in accelerating progress toward universal health coverage. In response to country demand, the WHO and the World Bank are already developing a monitoring framework that will help countries track their countries’ progress toward universal health coverage in a way that explicitly captures the potential importance of universal health coverage in achieving better health and higher living standards for everyone. The framework will be available for consultation with countries and other partners later this year. The UN General Assembly resolution urges Member States to develop health systems that avoid significant direct payments at the point of care. It further encourages them to establish mechanisms for pooling risks to avoid catastrophic health expenditures that drive households into poverty. (Excerpts)
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  6. 6
    357009

    Banking on health: World Bank and African Development Bank spending on reproductive health and HIV / AIDS in sub-Saharan Africa.

    Lauterbach C

    Washington, D.C., Gender Action, 2012. [65] p.

    This report reviews the health (2006 - 2012) expenditures of the World Bank and African Development Bank. It challenges their priorities and provides recommendations for increasing their involvement to address reproductive health and HIV / AIDS in sub-Saharan African countries. It suggests that improving health care systems as a whole, particularly reproductive health and HIV / AIDS, will go a long way in ensuring access to reproductive and sexual health for all, especially women.
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  7. 7
    333307
    Peer Reviewed

    Communities of practice: The missing link for knowledge management on implementation issues in low-income countries?

    Meessen B; Kouanda S; Musango L; Richard F; Ridde V; Soucat A

    Tropical Medicine and International Health. 2011 Aug; 16(8):1007-1014. [

    The implementation of policies remains a huge challenge in many low-income countries. Several factors play a role in this, but improper management of existing knowledge is no doubt a major issue. In this article, we argue that new platforms should be created that gather all stakeholders who hold pieces of relevant knowledge for successful policies. To build our case, we capitalize on our experience in our domain of practice, health care financing in sub-Saharan Africa. We recently adopted a community of practice strategy in the region. More in general, we consider these platforms as the way forward for knowledge management of implementation issues.
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  8. 8
    332477

    Everybody's business. Strengthening health systems to improve health outcomes: WHO’s framework for action.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2007. [56] p.

    The primary aim of this Framework for Action is to clarify and strengthen WHO’s role in health systems in a changing world. There is continuity in the values that underpin it from its constitution, the Alma Ata Declaration of Health For All, and the principles of Primary Health Care. Consultations over the last year have emphasized the importance of WHO’s institutional role in relationship to health systems. The General Programme of Work (2006-2015) and Medium-term Strategic Plan 2008-2013 (MTSP) focus on what needs to be done. While reaffirming the technical agenda, this Framework concentrates more on how the WHO secretariat can provide more effective support to Member States and partners in this domain. (Excerpt)
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  9. 9
    345009

    Improving family and community health by strengthening health systems.

    Lazdane G

    Entre Nous. 2009; (68):6-7.

    The WHO Regional Office for Europe has been promoting family and community health (FCH) interventions since 1992, including biennial meetings for FCH focal points in Member States. Our FCH activities follow a holistic approach, focusing on the health and development of individuals and families across the life course. For sexual and reproductive health (SRH) this means focusing on overall SRH, health of mothers and newborns, children and adolescents, as well as healthy aging. In recent years, the contribution of health systems to improve health has been re-evaluated in many countries. The WHO European Ministerial Conference on Health Systems “Health Systems, Health and Wealth” in Tallinn, June 2008 has discussed the impact of people’s health and economic growth, and has taken stock of recent evidence on effective strategies to improve the performance of health systems. In line with these developments, the WHO Regional Office for Europe held the FCH focal points meeting in Malta, September 2008 with the aim of contributing to the improvement of FCH in a health systems framework.
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  10. 10
    331891

    Improving effectiveness and outcomes for the poor in health, nutrition, and population: an evaluation of World Bank Group support since 1997.

    World Bank. Independent Evaluation Group

    Washington, D.C., World Bank, Independent Evaluation Group, 2009. [220] p.

    The World Bank Group’s support for health, nutrition, and population (HNP) has been sustained since 1997 -- totaling $17 billion in country-level support by the World Bank and $873 million in private health and pharmaceutical investments by the International Finance Corporation (IFC) through mid-2008. This report evaluates the efficacy of the Bank Group’s direct support for HNP to developing countries since 1997 and draws lessons to help improve the effectiveness of this support.
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  11. 11
    331817

    Coordination, management and utilization of foreign assistance for HIV / AIDS prevention in Vietnam. Assessment report.

    Center for Community Health Research and Development [CCRD]

    Ha Noi, Vietnam, CCRD, 2006 Oct. 82 p. (CCRD Assesssment Report)

    International assistance for HIV / AIDS prevention and control in Vietnam has significantly contributed to combating this epidemic. However, while current resources have not yet fully met the needs, the management and utilization of resources still had many limitations which affect the effectiveness of foreign assistance and investments. The independent assessment was prepared for the Conference on “the Coordination of Foreign Assistance for HIV / AIDS Prevention and Control”. Analytical assessment and comments on the management and coordination of foreign aid were made on the basis of Government’s official procedures and regulations on those issues. This research was carried out in October, 2006.
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  12. 12
    331852

    Access to reproductive health in a neoliberal policy climate.

    Sandusky E

    [Wellington, New Zealand], Family Planning International, 2006 Dec. 27 p.

    This report focuses on the relationship between policies implemented by the World Trade Organisation, World Bank, and the International Monetary Fund, and access to health, particularly sexual and reproductive health. .
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  13. 13
    316236
    Peer Reviewed

    Financing tuberculosis control: the role of a global financial monitoring system.

    Floyd K; Pantoja A; Dye C

    Bulletin of the World Health Organization. 2007 May; 85(5):325-420.

    Control of tuberculosis (TB), like health care in general, costs money. To sustain TB control at current levels, and to make further progress so that global targets can be achieved, information about funding needs, sources of funding, funding gaps and expenditures is important at global, regional, national and sub-national levels. Such data can be used for resource mobilization efforts; to document how funding requirements and gaps are changing over time; to assess whether increases in funding can be translated into increased expenditures and whether increases in expenditure are producing improvements in programme performance; and to identify which countries or regions have the greatest needs and funding gaps. In this paper, we discuss a global system for financial monitoring of TB control that was established in WHO in 2002. By early 2007, this system had accounted for actual or planned expenditures of more than US$ 7 billion and was systematically reporting financial data for countries that carry more than 90% of the global burden of TB. We illustrate the value of this system by presenting major findings that have been produced for the period 2002-2007, including results that are relevant to the achievement of global targets for TB control set for 2005 and 2015. We also analyse the strengths and limitations of the system and its relevance to other health-care programmes. (author's)
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  14. 14
    303473
    Peer Reviewed

    The World Bank: false financial and statistical accounts and medical malpractice in malaria treatment.

    Attaran A; Barnes KI; Bate R; Binka F; d'Alessandro U

    Lancet. 2006 Jul 15; 368(9531):247-252.

    The World Bank has an annual budget of US$20 billion, and is the largest organisation operating with a mission to reduce poverty worldwide. Malaria destroys about 1 million lives a year; the disease is the leading parasitic cause of death for Africa's children and impoverishment for their families. Here we examine how these factors meet in the new Global Strategy & Booster Program, which is the Bank's plan for controlling that disease in 2005--10.1 We believe this plan is inadequate to reverse the Bank's troubling history of neglect for malaria. In the past 5 years, the Bank has failed to uphold a pledge to increase funding for malaria control in Africa, has claimed success in its malaria programmes by promulgating false epidemiological statistics, and has approved clinically obsolete treatments for a potentially deadly form of malaria. Crucially, the Bank also downsized its malaria staff, so that it cannot swiftly execute the restoration it plans under the Global Strategy & Booster Program. We summarise the evidence, show that the Bank possesses demonstrably little expertise in malaria, and argue that the Bank should relinquish its funding to other agencies better placed to control the disease. (excerpt)
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  15. 15
    296325
    Peer Reviewed

    Global Fund suspends grants to Burma.

    Ahmad K

    Lancet Infectious Diseases. 2006 Jan; 6(1):14.

    Burma's Health Minister Kyaw Myint has sharply criticised a decision by the Global Fund To Fight AIDS, Tuberculosis, and Malaria to cancel grants worth US$98.4 million it approved in Nov 2004 and Jan 2005 to combat the three diseases in the country over the next 5 years. "Temporary restrictions on travel, that since have been relaxed, were not adequate reasons to cancel the grants", Myint said. He complained that the Global Fund did not warn his country of its intended action and warned that the termination would affect millions of people suffering from or at risk of HIV/AIDS, tuberculosis, and malaria in the country. Peter Newsum of CARE Myanmar believes the Fund's decision to cancel the grants will have a major impact on the work of organisations involved in combating the diseases in the country. (excerpt)
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  16. 16
    292074

    Making health care accountable.

    Hecht R; Batson A; Brenzel L

    Finance and Development. 2004 Mar; 41(1):16-19.

    DEVELOPING countries and their international partners are increasingly adopting methods of financing health care activities in developing countries that link the availability of funding to concrete, measurable results on the ground. Such “performance-based” financing was advocated a decade ago in the World Bank’s 1993 World Development Report—Investing in Health and other policy documents in the early 1990s, although relatively little practical experience with this type of financing was available. Since then, much experimentation has taken place, and we are seeing with growing clarity the important potential—as well as the challenges—of performance-based financing for achieving national and global health goals. Governments and partner agencies are interested in performance-based financing for health for a number of reasons. First, there is a growing focus worldwide on achieving measurable results with development assistance, and performance-based financing spotlights such results. In terms of health care, these results are being closely tracked as governments and their partners strive to achieve the Millennium Development Goals (MDGs). The goals include reductions in child and maternal deaths; reductions in rates of infection from HIV, malaria, and tuberculosis; and improvements in the nutritional status of children. Governments and their partners are thus naturally attracted to the idea of providing funds for programs that achieve or make progress toward the MDGs in health or that at least show increases in some of the key services needed to reach the goals. For example, where immunization and prompt treatment of pneumonia are crucial for halting child deaths, funding for health care might be tied to advances in the coverage of these services. (excerpt)
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  17. 17
    280250

    Exchanging debt for health in Africa: lessons from ten years of debt-for-development swaps.

    Rosen S; Simon J; Thea D; Zeitz P

    In: Economics of AIDS and access to HIV / AIDS care in developing countries, issues and challenges, [compiled by] Agence Nationale de Recherches sur le Sida. Cambridge, Massachusetts, Harvard University, Harvard Institute for International Development, 1999 Nov. 69-88. [29] p. (Development Discussion Paper No. 732)

    Of the dozen or so issues on the agenda when the Group of Seven held its annual meeting in Cologne in June, 1999, few captured the attention of the world as much as debt relief for the poorest and most indebted nations. In the past half-decade, wide-ranging and active support has developed for reducing the debt owed by poor countries to banks, governments, and multilateral institutions in the developed world. Most proposals for debt relief have also called for more resources to be invested in improving the welfare of the poorest people, often through direct investment in social programs of the savings generated by debt relief. The purpose of this paper is to describe and assess one feasible approach to debt relief in sub- Saharan Africa: the debt-for-health exchange. Following up on proposals recently put forward by several international organizations and governments, it presents and assesses the past decade of experience with transactions that involve the exchange of poor country debt for a commitment to invest local resources in a social good, such as environmental protection, child health, or education. From this experience, it draws a set of lessons for designing debt-for-health exchanges for sub-Saharan Africa. The lessons provide guidance on how exchanges should be structured and emphasize the importance of transparency and accountability in managing the debt savings funds. (author's)
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  18. 18
    189286

    Financial resource flows for population activities in 2000.

    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, 2002. x, 103 p.

    Financial Resource Flows for Population Activities in 2000 is the fourteenth edition of a report previously published by UNFPA under the title of Global Population Assistance Report. The United Nations Population Fund has regularly collected data and reported on flows of international financial assistance to population activities. The Fund’s annual Reports focused on the flow of funds from donors through bilateral, multilateral and non-governmental channels for population assistance to developing countries1 and countries with economies in transition. Also included were grants and loans from development banks for population activities in developing countries. (excerpt)
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  19. 19
    184637
    Peer Reviewed

    Norms in tension: democracy and efficiency in Bangladeshi health and population sector reform.

    Shiffman J; Wu Y

    Social Science and Medicine. 2003 Nov; 57(9):1547-1557.

    Spurred on by donors, a number of developing countries are in the midst of fundamental health and population sector reform. Focused on the performance-oriented norms of efficiency and effectiveness, reformers have paid insufficient attention to the process-oriented norms of sovereignty and democracy. As a result, citizens of sovereign states have been largely excluded from the deliberative process. This paper draws on political science and public administration theory to evaluate the Bangladeshi reform experience. It does so with reference to the norms of efficiency, effectiveness, sovereignty and democracy as a means of making explicit the values that need to be considered in order to make health and population sector reform a fair process. (author's)
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  20. 20
    173180
    Peer Reviewed

    Increasing transparency in partnerships for health -- introducing the Green Light Committee.

    Gupta R; Cegielski JP; Espinal MA; Henkens M; Kim JY

    Tropical Medicine and International Health. 2002 Nov; 7(11):970-976.

    Public–private partnerships have become central to efforts to combat infectious diseases. The characteristics of specific partnerships, their governance structures, and their ability to effectively address the issues for which they are developed are being clarified as experience is gained. In an attempt to promote access to and rational use of second-line anti-tuberculosis (TB) drugs for the treatment of multidrug-resistant TB, a unique partnership known as the Green Light Committee (GLC) was established by the World Health Organization. This partnership relies on five categories of actors to achieve its goal: academic institutions, civil society organizations, bilateral donors, governments of resource-limited countries, and a specialized United Nations agency. While the for-profit private sector is involved in terms of supplying concessionally priced drugs it is excluded from decision-making. The effectiveness of the partnership emerges from its review process, flexibility to modify its modus operandi to overcome obstacles, independence from the commercial sector, and its ability to link access, rational use, technical assistance, and policy development. The GLC mechanism may be useful in the development of other partnerships needed in the rational allocation of resources and tools for combating additional infectious diseases. (author’s)
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  21. 21
    093362

    Better health in Africa.

    World Bank. Africa Technical Department. Human Resources and Poverty Division

    [Unpublished] 1993 Dec. xii, 217, [2] p. (Report No. 12577-AFR)

    The World Bank has recommended a blueprint for health improvement in sub-Saharan Africa. African countries and their external partners need to reconsider current health strategies. The underlying message is that many African countries can achieve great improvements in health despite financial pressure. The document focuses on the significance of enhancing the ability of households and communities to identify and respond to health problems. Promotion of poverty-centered development strategies, more educational opportunities for females, strengthening of community monitoring and supervision of health services, and provision of information on health conditions and services to the public are also important. Community-based action is vital. The report greatly encourages African governments to reform their health care systems. It advocates basic packages of health services available to everyone through health centers and first referral hospitals. Health care system reform also includes improving management of health care inputs (e.g., drugs) and new partnerships between public agencies and nongovernmental health care providers. Ministries of Health should concentrate more on policy formulation and public health activities, encourage private voluntary organizations, and establish an environment conducive to the private sector. African countries need more efficient allocation and management of public financial resources for health to boost their effect on critical health indicators (e.g., child mortality). Public resources should also be reallocated from less productive activities to health activities. More commitment from governments and domestic sources and an increase of external assistance are needed for low income African countries. The first action step should be a national agenda for health followed by action planning and setting goals to measure progress.
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  22. 22
    083349

    The role of health centres in the development of urban health systems: report of a WHO Study Group on Primary Health Care in Urban Areas.

    World Health Organization [WHO]. Study Group on Primary Health Care in Urban Areas

    WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1992; (827):i-iv, 1-38.

    The WHO Study Group on Primary Health Care (PHC) in Urban Areas has written a report after examining the development of reference health centers in urban areas in various parts of the world. It considers such centers to be a potentially important way to improve urban health services. Reference health centers, with real roots in the community and good links to first level and referral level care, can address the problems of access to health care and intersectoral collaboration. Each center should be based on a general model, but its exact operation depends on local conditions and on a comprehensive situation analysis that considers social and financial factors and the level of organizational development. Each reference center should determine what needs to be done locally with local and national resources. Outside donors should only provide assistance for operational costs and a last resort. To plan services adequately, decision makers must define geographical catchment areas and travel times. These definitions must see to it that services integrate with each other vertically (with services at health post and hospital levels), and horizontally (with government, and nongovernmental, and community projects). A solid epidemiological understanding of major local health problems is essential for expanding PHC through reference health centers. This knowledge comes from an assessment of demographic, morbidity, mortality, and social data an evaluation of coverage of underserved and marginal groups. Reference health centers would be in an ideal position to gather and analyze these data. Innovative ways to obtain the resources for urban PHC are collection of user fees and close supportive links with universities and nongovernmental organizations. The Study Group looks at how reference health centers in Cali, Colombia; Manila, the Philippines; and Newark, New Jersey in the US, developed.
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  23. 23
    082167

    Evaluation of recent changes in the financing of health services. Report of a WHO Study Group.

    World Health Organization [WHO]. Study Group on the Evaluation of Recent Changes in the Financing of Health Services

    WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1993; (829):i-v, 1-74.

    A study group was convened at World Health Organization (WHO) headquarters over December 10-17, 1991, to evaluate recent changes in the financing of health services. Specifically, they were to review, compare, and analyze the principal types of change in health financing which countries have implemented over the past decade; review evidence on the effects of these changes on the provision and utilization of health services including health status where possible; make conclusions on the contribution of different methods of financing to the functioning of health systems based on primary health care; and recommend strategies and actions which countries and WHO could use to improve the performance of health systems by changes in financing, and to support the prospective and retrospective appraisal of financing options. To that end, the group looked at changes in the mix of sources of finance for the health sector; changes in the methods of paying care providers; changes in the relative roles of government, care providers, purchasers, and consumers in organizing and delivering health services; consequences of these changes; and approaches to evaluating financing changes. The group found common trends toward liberalization, increased use of nongovernment financing sources, and greater emphasis upon market mechanisms and incentives to help structure health sector operations. While these trends may be evident, however, the exact form of changes in health care financing has varied according to the structure of the existing health system and the political viability of change in the system in different countries; reforms may complement each other or have negative effects upon one another. Policy objectives must be carefully defined before making broad decisions about changes in financing. Further, as the interactions between market-driven systems and government policy and practice are considered, one must not lose sight of the government's role in policymaking, regulation, information gathering, and dissemination. Governments also finance vector control, water supply, and the control of infectious diseases. Recommendations are made to countries, WHO, and other international agencies concerned with health.
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  24. 24
    080677

    Latin American and Caribbean Region health care financing activities, 1982-1988. An annotated compilation. Draft.

    John Snow [JSI]. Resources for Child Health [REACH]

    [Unpublished] 1989 Mar. [2], 87 p. (USAID Contract No. DPE-5927-C-00-5068-00)

    The Resources for Child Health Project (REACH) presents an overview of health care financing (HCF) activities in the Latin American and Caribbean regions for the period 1982-88. REACH is compiling regional health care financing initiatives, preparing detailed case studies of USAID health financing experiences in 3 countries, and developing a set of general guidelines to be used by health officers to identify opportunities for HCF activities. A draft version of the first of these components is presented and includes an updated annotated list of health finance activities, studies, and projects conducted in the region since 1982. The USAID approach to HCF as put forth in policy statements and other official documents is summarized; World Bank, Inter-American Development Bank, and Pan American Health Organization viewpoints are reviewed as well as social security issues and their relationships to HCF; and country overviews are provided under Caribbean, Central America, South America, and North America subheadings. Brief overviews of HCF activities for each country are given followed by summaries of individual activities funded by USAID and other organizations. Summaries indicate whether activities are public or private sector, main areas of emphasis, and describe content. Activity costs are also given for USAID-funded initiatives.
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  25. 25
    273275

    Report of the eleventh meeting of the technical advisory group (Geneva, 7-8 March 1990).

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Unpublished] 1990. 12 p. (WHO/CDD/90.33)

    Findings from the 11th meeting of the Technical Advisory Group (TAG) of the Diarrheal Diseases Control Program are reviewed. Progress made in health services during 1988-1989 include training in supervisory skills for an estimated 17% of the staff and in case management for 11% of the staff, endorsal of breast feeding and rational drug use, 61 countries producing oral rehydration salts (ORS), a 60% access rate to ORS and 34% rate of use of oral rehydration therapy, increased communication activities, and improved assessment for diarrheal management. Major research progress includes determining the effectiveness of rice-based ORS, continued feeding, and breast feeding in diarrheal management. Revisions in research management include the utilization of multi- disciplinary research teams and the replacement of Scientific Working Groups (SWG) with experts to review research priorities, determine study methods, review proposals, and confer with investigators on research design. Research priorities are vaccine development and childhood diarrhea which involves case management research by employing clinical trials, epidemiology and disease prevention, and determining cost effectiveness and optimal delivery of intervention methods. 1995 goals are increased production of ORS, improved supervisory skills training, and improved case management of oral rehydration therapy. During 1988- 1989, the program had access to US$ 20.9 million. US$ 4.7 million carried over at the end of 1989 into 1990. The 1990-1991 overall budget was reduced by 26% because increased contributions were not acquired. Recommendations for the health services component of the program include program implementation which utilizes effective diarrheal assessment tools, focuses on lowering childhood mortality due to diarrhea in 24 countries, and correcting the misuse of antibiotics and antidiarrheal drugs; training for the medical profession in diarrheal management, improved training materials and additional training units; increased accessibility to ORS; improved communication which involves promoting diarrheal treatment in the educational system; and preventing diarrhea by encouraging breast feeding. Recommendations for research includes revised research management guidelines and close collaboration between TAG and investigators.
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