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Communities of practice: The missing link for knowledge management on implementation issues in low-income countries?
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.
Scaling up HIV / AIDS prevention, treatment and care: a report on WHO support to countries in implementing the “3 by 5” Initiative, 2004-2005.
Geneva, Switzerland, WHO, 2006. 143 p.In September 2003, LEE Jong-wook, Director-General of WHO, and Peter Piot, Executive Director of UNAIDS, declared the lack of access to antiretroviral therapy for HIV/AIDS in low- and middle-income countries to be a global health emergency. Shortly after this declaration, WHO and its partners launched a global initiative to scale up antiretroviral therapy with the objective of having 3 million people receiving antiretroviral therapy - representing half the total number of those globally in need - by the end of 2005 ("3 by 5"). Although the actual target of putting 3 million people on antiretroviral therapy was not reached by the end of 2005, countries have made significant progress in the past two years in expanding treatment coverage, strengthening prevention and building the capacity of health systems to deliver long-term, chronic care. Overall, in the two-year period, antiretroviral therapy coverage in low- and middle-income countries increased from 7% of those in need at the end of 2003 (400 000 people) to 20% of those in need at the end of 2005 (1.3 million people). Eighteen countries managed to increase antiretroviral therapy coverage to half or more of the people who needed it, consistent with the "3 by 5" target. (excerpt)
European Journal of Public Health. 2007 Oct; 17(5):409.In public health teaching, tuberculosis (TB) has been a traditional example of how disease occurrence is determined by the triad agent, environment, host. And it has since long been standard textbook knowledge that there are strong socioeconomic determinants behind all three components: The agent is more prevalent and is spread more easily in conditions of crowding and poor hygienic conditions, and under these conditions several host factors are also more prevalent, such as malnutrition and alcoholism. In recent years another dimension has been added to the socioeconomic patterning of TB: An already very solid mass of research has highlighted the social and economic aspects of care and follow-up of patients with TB. A recent example of this research is the paper by Wang et al. in this issue of the journal, on differences in both patient's delay and doctor's delay in the diagnosis of TB, when comparing residents and non-residents (rural immigrants) in Shanghai. (excerpt)
Towards universal access: scaling up priority HIV / AIDS interventions in the health sector. Progress report, April 2007.
Geneva, Switzerland, WHO, 2007 Apr. 88 p.Drawing on lessons from the scale-up of HIV interventions over the last few years, WHO, as the UNAIDS cosponsor responsible for the health sector response to HIV/AIDS, has established priorities for its technical work and support to countries on the basis of the following five Strategic Directions, each of which represents a critical area where the health sector must invest if significant progress is to be made towards achieving universal access. Enabling people to know their HIV status; Maximizing the health sector's contribution to HIV prevention; Accelerating the scale-up of HIV/AIDS treatment and care; Strengthening and expanding health systems; Investing in strategic information to guide a more effective response. In this context, WHO undertook at the World Health Assembly in May 2006 to monitor and evaluate the global health sector response in scaling up towards universal access and to produce annual reports. This first report addresses progress in scaling up the following health sector interventions. Antiretroviral therapy; Prevention of mother-to-child transmission of HIV (PMTCT); HIV testing and counseling; Interventions for injecting drug users (IDUs); Control of sexually transmitted infections (STIs) to prevent HIV transmission; Surveillance of the HIV/AIDS epidemic. (excerpt)
Geneva, Switzerland, WHO, 2003.  p.The changing face of the HIV/AIDS epidemic has resulted in new opportunities, as well as new imperatives, to increase access to HIV testing and counselling and to knowledge of HIV status. Increased access to care and treatment, and decreased stigma and discrimination in many settings present important new opportunities associated with taking an HIV test. The fact that more and more of those infected with HIV need care and treatment based on knowledge of HIV status indicates new imperatives. HIV testing and counselling services must keep pace with the new opportunities if the increasing benefits of knowing your HIV status are to be accessed (see Box One). New approaches to HIV testing and counselling must now be implemented in more settings, and on a much larger scale than has so far been the case. WHO is advocating that health-care workers should offer testing and counselling to all those who might benefit from knowing their HIV status, and then benefit from advances in the treatment and prevention of HIV infection and HIV related diseases. As such benefits increase, there is an onus on national governments to provide good-quality testing and counselling services. The time has now come to implement HIV testing and counselling more widely using existing health-care settings, moving beyond the model of provision that relies entirely upon concerned individuals seeking out help for themselves to permit broader access for all. In this new approach, such services will become a routine part of health care, for example during attendance at antenatal clinics, or at diagnosis and treatment centres for tuberculosis and sexually transmitted infections (STIs). (excerpt)
Geneva, Switzerland, World Health Organization [WHO], Department of Child and Adolescent Health and Development, 2002. 43 p. (WHO/FCH/CAH/02.14)Adolescents represent a positive force in society, now and for the future. They face dangers more complex than previous generations faced, and often with less support. The development needs of adolescents are a matter for the whole of civil society. Health services play a specific role in preventing health problems and responding to them. Many changes are needed in order for health services to become adolescent friendly. (excerpt)
Bulletin of the World Health Organization. 2003 Nov; 81(11):777.During the last quarter-century or so there has been a revolution in both health and information technology. For the globe as a whole we have seen tremendous strides made in life expectancy and disease control, together with an explosion of information technology and techniques. Humanity now has the potential to make all existing health knowledge available simultaneously to the entire population of the planet. By no means everyone has benefited from the overall trend of increased life expectancy, however, or from that of increased knowledge and its communicability. This gap goes beyond the notion of the “digital divide”. It is a “knowledge divide”, in which large sections of humanity are cut off not just from the information that could help them but from any learning system or community that fosters problem-solving. (excerpt)
ANNALS OF THE NEW YORK ACADEMY OF SCIENCES. 1991; 626:1-10.WHO defines reproductive health as people having the ability to reproduce, to regulate fertility, and to practice and enjoy sexual relationships. It also means safe pregnancy, child birth, contraceptives, and sex. Procreation should include a successful outcome as indicated by infant and child survival, growth, and healthy development. 60-80 million infertile couples live in the world. Core infertility, i.e., unpreventable and untreatable infertility, ranges from 3% to 5%. Sexually transmitted diseases, aseptic abortion, or puerperal infection are common causes of acquired infertility. Sub-Saharan Africa has the highest prevalence of acquired infertility. In 1983, the world contraceptive use rate stood at 51% with the developed countries having the highest rate (70%) and Africa the lowest rate (14%). About 40 countries in Africa and the Arabian Peninsula practice female circumcision. The percent of low birth weight infants is greater in developing countries than in developed countries (17% vs. 6.8%). Intrauterine growth retardation is responsible for most low birth weight infants in developing countries while in developed countries it is premature birth. About 15 million infants and children die each year. Maternal mortality risk is highest in developing countries especially those in Africa (1:21) and lowest in developed countries (1:9850). Sexually transmitted diseases continue to be a major problem in the world especially in developing countries. Chlamydia afflicts 50 million people each year. The proportion of women with AIDS is growing so that between the 1980s and 1990s it will grow between 25% and 50%. More available contraceptive choices enhance safety in fertility regulation. Socioeconomic conditions that determine reproductive health are poverty, literacy, and women's status. Sexual behavior, reproductive behavior, breast feeding, and smoking are life style determinants of reproductive health. Availability, utilization, and efficiency of health care services and level of medical knowledge also determine women's reproductive health.
Oxford, England, Oxford University Press, 1988. , 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.
POPULATION MANAGER: ICOMP REVIEW. 1987 Jun; 1(1):19-22.Communication plays an essential role in creating the necessary social climate for the development and adoption of population policies and in supporting actions undertaken to implement these policies. To be effective, however, there must be integrated communication for population and development programs. In addition to knowledge of the mass media and community organizations, communicators in the field of population must have the ability to collaborate with other development programs in an intersectoral effort, Toward this end, UNESCO, in collaboration with the Asia-Pacific Institute for broadcasting Development, has organized specialized courses in the management of population communication programs. A review of the situation at the time this program was initiated revealed that IEC directors had minimal knowledge and understanding of the role of IEC in family planning programs, little practical experience in planning and managing multimedia, community-based, interpersonal communication activities, and these programs had no scientifically established data base. As result, a pilot 2-week course comprised of o modules was held in India in 1983. Module 1 focused on a systematic problem-solving approach to IEC program situations, Module ii emphasized human resource management, and Module III was designed to impart specific communication skills. The course was subsequently expanded to 3 weeks, and has in the past 3 years involved 54 persons from 20 countries. Unesco has also developed a population communication course in collaboration with the Arab States Broadcasting Union.
Targets for health for all. Targets in support of the European regional strategy for health for all.
Copenhagen, Denmark, WHO, Regional Office of Europe, 1985. x, 201 p.This book sets out the fundamental requirements for people to be healthy, to define the improvements in health that can be realized by the year 2000 for the peoples of the European Region of the World Health Organization (WHO), and to propose action to secure those improvements. Its purposes are as follows: propose improvements in the health of the people in order to achieve health for all by the year 2000; indicate where action is called for, the extent of the collective effort required, and the lines along which it should be directed; provide a tool for countries and the Region to Monitor progress toward the goal and revise their course of action if necessary. The targets proposed are intended to indicate the improvements that could be expected if all the will, knowledge, resources, and technology already available were pooled in the pursuit of a common goal. The target levels set are based on historical trends in the fields concerned, their expected future evolution, and the knowledge available on the probable effects of intervention. These levels are intended to inspire and motivate Member States when they are determining their own priorities, targets, and capabilities and thus the degree to which they can contribute to reaching the regional targets. The base year for all the targets in 1980. The year 2000 is the completion data retained for all targets related to health improvements. Targets related to lifestyles, the environment and care respectively have 1990 or 1995 as their date of completion unless specific problems justify the allocation of a later year. Targets embodying measures to bring about the changes in research and health development support should be reached before 1990. The aim is to give people a positive sense of health so that they can make full use of their physical, mental, and emotional capacities. A well informed, well motivated, and actively participating community is a key element to the attainment of the common goal. The focus of the health care system should be on primary health care -- meeting the basic health needs of each community through services provided as close as possible to where people live and work, readily accessible and acceptable to all, and based on full community participation. Health problems transcend national frontiers.