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The role and influence of stakeholders and donors on reproductive health services in Turkey: a critical review.
Reproductive Health Matters. 2004; 12(24):116-127.Since 1965, Turkey has followed an anti-natalist population policy and made significant progress in improving sexual and reproductive health. This paper presents a critical review of the national reproductive health policies and programmes of Turkey and discusses the influence of national and international stakeholders and donors on policy and implementation. While government health services have played the primary role in meeting sexual and reproductive health needs, international donor agencies and national non-governmental and other civil society organisations, especially universities, have played an important complementary role. Major donor agencies have supported many beneficial programmes to improve reproductive health in Turkey, but their agendas have sometimes not been compatible with national objectives and goals, which has caused frustration. The main conclusion of this review is that countries with clear and strong reproductive health policies can better direct the implementation of international agreements as well as get the most benefit from the support of international donors. (author's)
Geneva, Switzerland, World Health Organization [WHO], Communicable Diseases Programme, Stop TB Department, 2001. 39 p. (WHO/CDS/TB/2001.294)Conclusion and Recommendations: This analysis suggests that TB and HIV/AIDS programmes will need to collaborate to deliver a more effective response to TB/HIV. Consideration of the barriers to, and mechanisms to promote, future collaboration between TB and HIV/AIDS programmes give rise to the following recommendations on how WHO might promote more effective TB control among HIV-infected people: 1) At the international level, promote TB and HIV/AIDS programme collaboration through: a) development and wide dissemination of a strategic framework to decrease the burden of TB/HIV; b) clarification of the roles and responsibilities of, and linkages between, UNAIDS and WHO; c) increased political commitment to TB control among HIV-infected people through increased resources, financial and human; d) promotion of the interdependence of TB and HIV at the highest levels in WHO through administrative links and broad representation by TB and HIV leadership at each other’s meetings. 2) At the national and district level, promote TB and HIV/AIDS programme collaboration through: in-country high level political commitment; b) joint planning meetings; c) involvement of HIV and TB community groups on national interagency coordination committees; d) joint training of programme and general health service staff in the issues common to HIV and TB prevention and care; e) joint TB and HIV/AIDS programme reviews; f) utilisation of existing organisational structures and the sharing of experience; g) a strengthened referral system; h) implementation of care packages in high HIV prevalence populations, including TB prevention and care (such as those piloted in the ProTEST Initiative); i) formulation of joint health education messages. 3) Increase financial and technical assistance to TB and HIV programmes through: a) co-ordinated support from WHO HIV and TB programmes (at country, regional and HQ level); b) joint advocacy with UNAIDS and other international partners for greater international and national commitment to TB control among HIV-infected people; c) dialogue with international development assistance agencies and global financing institutions on funding joint TB and HIV programme collaborative activities. (excerpt)
The research agenda for improving health policy, systems performance, and service delivery for tuberculosis control: a WHO perspective.
Bulletin of the World Health Organization. 2002; 80(6):471-6.The development of WHOs directly observed treatment, short course (DOTS) strategy for the control of tuberculosis (TB) in 1995 led to the expansion, adaptation, and improvement of operational research in this area. From being a patchwork of small-scale studies concerned with aspects of service delivery, TB operational research shifted to larger-scale, often multi-country projects that were also concerned with health policy and the needs of health systems. The results are now being put into practice by national TB control programs. In 1998, an ad hoc committee identified the chief factors inhibiting the expansion of DOTS: lack of political will and commitment, poor financial support for TB control, poor organization and management of health services, inadequate human resources, irregular drug supplies, the HIV epidemic, and the rise of multi-drug resistance. An analysis of current operational research on TB is presented on the basis of these constraints, and examples of successful projects are outlined in the article. The authors discuss the prerequisites for success, the shortcomings of this WHO-supported program, and future challenges and needs. (author's)