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Providing Family Planning Services at Primary Care Organizations after the Exclusion of Planned Parenthood from Publicly Funded Programs in Texas: Early Qualitative Evidence.
Health Services Research. 2017 Oct 20;OBJECTIVE: To explore organizations' experiences providing family planning during the first year of an expanded primary care program in Texas. DATA SOURCES: Between November 2014 and February 2015, in-depth interviews were conducted with program administrators at 30 organizations: 7 women's health organizations, 13 established primary care contractors (e.g., community health centers, public health departments), and 10 new primary care contractors. STUDY DESIGN: Interviews addressed organizational capacities to expand family planning and integrate services with primary care. DATA EXTRACTION: Interview transcripts were analyzed using a theme-based approach. Themes were compared across the three types of organizations. PRINCIPAL FINDINGS: Established and new primary care contractors identified several challenges expanding family planning services, which were uncommon among women's health organizations. Clinicians often lacked training to provide intrauterine devices and contraceptive implants. Organizations often recruited existing clients into family planning services, rather than expanding their patient base, and new contractors found family planning difficult to integrate because of clients' other health needs. Primary care contractors frequently described contraceptive provision protocols that were not evidence-based. CONCLUSIONS: Many primary care organizations in Texas initially lacked the capacity to provide evidence-based family planning services that women's health organizations already provided. (c) Health Research and Educational Trust.
Challenging inequity through health systems. Final report: Knowledge Network on Health Systems. WHO Commission on the Social Determinants of Health.
[Johannesburg], South Africa, University of the Witwatersrand, Centre for Health Policy, Health Systems Knowledge Network, 2007 Jun.  p.The way that health systems are designed, financed and operated acts as a powerful determinant of health. The Health Systems Knowledge Network reviewed the evidence on different approaches to improving health equity outcomes through health systems. The focus was on innovative approaches that effectively incorporate action on the social determinants of health, and on strategies of policy development and implementation. Key themes were: Using the health sector to leverage inter-sectoral actions that address the social determinants of health; Enabling social empowerment in support of health equity; Identifying key elements of vision and health system architecture necessary to secure social protection and universal coverage; Building and maintaining national policy space for health policies that seek social justice; and Strengthening management and stewardship capacities within the health sector. The Health Systems Knowledge Network was chaired by Lucy Gilson of the Centre for Health Policy, and made up of 14 experienced policy-makers, academics and members of civil society from around the world. The Network engaged with other sections of the Commission and also commissioned a number of systematic reviews and case studies. This is the final report of the network.
Indian Journal of Community Medicine. 2010 Apr; 35(2):326-330.Background: The World Health Report, 2008, contains a global review of primary health care on the 30th anniversary of the Declaration of Alma-Ata. The period covered by the study reported on here corresponds with that of the Report, allowing for a comparison of achievements and challenges in one primary health care centre vis-a-vis the WHO standards. Materials and Methods: This study uses qualitative and quantitative data from a rural primary care facility in Western Maharashtra, collected over three decades. It analyzes the four groups of reforms defined by WHO in the context of the achievements and challenges of the study facility. Results: According to the WHO Report, health systems in developing countries have not responded adequately to peoples needs. However, our in-depth observations revealed substantial progress in several areas, including in family planning, safe deliveries, immunization and health promotion. Satisfaction with services in the study area was high. Conclusion: Adequate primary health care is possible, even when all recommended WHO reforms are not fully in place.
The global AIDS crisis, "3 by 5", and a renewed commitment to primary health care. WHO, World Social Forum, 2004.
Contact. 2004 Jan; (177-178):20.On September 2003 at the United Nations General Assembly, the new Director General of the World Health Organization, Dr. Lee, stated: "The AIDS treatment gap is a global public health emergency. We must change the way we think and change the way we act. Business as usual means watching thousands of people die every single day." To address this AIDS treatment crisis, WHO and UNAIDS have committed to leading the "3 by 5" initiative, which targets delivering antiretroviral treatment (ART) to 3 million people in developing countries by the end of 2005. As evident from the experience in industrialized countries since 1996, access to ART has turned HIV/AIDS into a manageable condition, dramatically reducing mortality and morbidity, and allowing people living with HIV/AIDS to live productive, healthy lives. However, in developing countries, these drugs are currently available to only a fraction of those in need. WHO launched the "3 by 5" strategy in December 2003, basing the key elements of the strategy on information gained from numerous pilot programmes that show that it is feasible to provide ARTs in even the very poorest of settings. (excerpt)
CommonHealth. 2005 Spring; 36-43.As defined by the World Health Organization (WHO):2 Palliative medicine is the study and management of patients with active, progressive, far advanced disease for whom the prognosis is limited and the focus of care is the quality of life. [It is] the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social, and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Many aspects of palliative care are applicable earlier in the course of the illness, in conjunction with treatment. Palliative care: Affirms life and regards dying as a normal process; Neither hastens, nor postpones, death; Provides relief from pain and other distressing symptoms; Integrates the psychological and spiritual aspects of patient care; Offers a support system to help patients live as actively as possible until death; and Offers a support system to help families cope during a patient's illness and with their own bereavement. In short, palliative care comprehensively addresses the physical, emotional, and spiritual impact a life-threatening illness has on a person, no matter the stage of the illness. It places the sick person and his/her family, however defined, at the center of care and aggressively addresses all of the symptoms and problems experienced by them. Many healthcare providers apply certain elements of the palliative care treatment approach-- such as comprehensive care and aggressive symptom management-- to the care of all of their patients, not only those who are terminally ill, offering the type of care we would all like to receive when we are sick. (excerpt)
International Journal of Health Planning and Management. 1997; 12:149-157.This note seeks to sharpen our understanding of co-ordination and its significance in healthcare management by offering a picture of an activity where information, incentives and the mixing of various (professional and other) cultures are key. The research design was policy driven, and concentrated on incentives, decision-making and information gathering/ dissemination activities particularly between individuals working across different types of organizations. Data are drawn from 40 primary interviews with mostly senior staff from organizations in two countries, USA and Thailand, internal and external corporate documents, over 1000 items from a Reuters database of news items, newspaper articles and press releases, as well as secondary academic articles. The interviews, which lasted from between 20 min to more than 3 h over two visits, constitute the main source of evidence for the issues discussed below. (excerpt)
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)
Fees-for-services, cost recovery, and equity in a district of Burkina Faso operating the Bamako Initiative. [Prestation de services, couverture des coûts et équité dans une région au Burkina-Faso exploitant l'Initiative de Bamako]
Bulletin of the World Health Organization. 2003 Jul; 81(7):532-538.Objective: To gauge the effects of operating the Bamako Initiative in Kongoussi district, Burkina Faso. Methods: Qualitative and quasi-experimental quantitative methodologies were used. Findings: Following the introduction of fees-for-services in July 1997, the number of consultations for curative care fell over a period of three years by an average of 15.4% at ‘‘case’’ health centres but increased by 30.5% at ‘‘control’’ health centres. Moreover, although the operational results for essential drugs depots were not known, expenditure increased on average 2.7 times more than income and did not keep pace with the decline in the utilization of services. Persons in charge of the management committees had difficulties in releasing funds to ensure access to care for the poor. Conclusion: The introduction of fees-for-services had an adverse effect on service utilization. The study district is in a position to bear the financial cost of taking care of the poor and the community is able to identify such people. Incentivesmust be introduced by the state and be swiftly applied so that the communities agree to a more equitable system and thereby allow access to care for those excluded from services because they are unable to pay. (author's)
[Unpublished] 1993 Dec. xii, 217,  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.
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 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.
Implementation of the global strategy for Health for All by the Year 2000, second evaluation; and eighth report on the world health situation.
[Unpublished] 1992 Mar 6. 171 p. (A45/3)This 2nd evaluation of the global strategy for health for all (HFA) by 2000/8th report on the world health situation indicates a need for a new approach for sustainable health development which includes mobilizing resources for high priority populations and health needs, more effective and intersectoral health promotion and protection, and improving access to primary health care (PHC) via higher quality services and integrating health services into all social services. The data cover 96% of the world's population and the years 1985-90. The 1st chapter looks at the interaction among political, economic, demographic, and social development trends and their effects on health. It mentions the health development trend of increased involvement of individuals, communities, professional groups, and development agencies. The 2nd chapter centers on the progress of countries towards reaching HFA by examining the differences between the haves and the have nots. The 3rd chapter examines improvement and obstacles in health care coverage, PHC coverage, and quality of care. Chapter 4 reviews health resources including financial and human resources and health technology. The next chapter focuses on trends in mortality, morbidity, and disability and life style factors of health such as smoking. Chapter 6 examines policies and programs of environmental health, evaluation, and monitoring of environmental health hazards and risks, and environmental resources management. The 7th chapter brings together highlights and implications expressed in the previous chapters and states that health improvements have indeed occurred such as increased life expectancy. The last chapter uses the information in the preceding chapters to project future trends and mentions 5 challenges facing the world today.
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 TECHNICAL REPORT SERIES. 1992; (819):i-vii, 1-74.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.
Report of the Expanded Programme on Immunization Global Advisory Group Meeting, 20-23 October 1980, Geneva.
[Unpublished] 1980. 39 p. (EPI/GEN/80/1)This report of the Expanded Program on Immunization (EPI) Global Advisory Group Meeting, held during October 1980 in Geneva, Switzerland, presents conclusions and recommendations, global and regional overviews, working group discussions, and outlines global advisory group activities for 1981. In terms of global strategies, the EPI confronts dual challenges: to reduce morbidity and mortality by providing immunizations for all children of the world by 1990; and to develop immunization services in consonance with other health services, particularly those directed towards mothers and children, so they can mutually strengthen the approach of primary health care. Increased resources are needed to support the expansion of immunization services and to establish them as permanent elements of the health care system. The Global Advisory Group affirms the importance of setting quantified targets as a basic principle of management and endorses the principle of setting targets for the reduction of the EPI diseases at national, regional, and global levels. The primary focus for the World Health Organization (WHO) in promoting the EPI continues to be the support to national program implementation in all its aspects. The Group reviewed current EPI immunization schedules and policies and concurs in the following: for measles, for most developing countries, the available data support the current recommendations of administering a single dose of vaccine to children as early as possible after the child reaches the age of 9 months; for DPT, children in the 1st year of life should receive a series of 3 DPT doses administered at intervals of at least 1 month; for tetanus toxoid, the control of neonatal and puerperal tetanus by immunizing women of childbearing age, particularly pregnant women, is endorsed; for poliomyelitis, the Group endorses the "Outline for WHO's Research on Poliomyelitis, Polioviruses and Poliomyelitis Vaccines" prepared by the WHO Working Group convened in October 1980, i.e., for oral (live) vaccines, a 3-dose schedule, administered simultaneously with DPT vaccine, is recommended again; and for BCG concurred with the Advisory Committee on Medical Research conclusion that the use of BCG as an anti-tuberculosis measure within the EPI should be continued as at present. The implementation of programs at the national level remains the foremost priority for the EPI. National commitment, evidenced in part by the designation of a national manager, the establishment of realistic targets, and the allocation of adequate resources, is essential if programs are to succeed.
Provisional summary record of the fourteenth meeting, WHO headquarters, Geneva, Thursday, 16 January 1986, at 9h30.
[Unpublished] 1986 Jan 16. 20 p. (EB77/SR/14)This document provides a progress and evaluation report of the Expanded Program on Immunization (EPI), a summary record of the 14th Meeting, held in Geneva, Switzerland during January 1986. Dr. Uthai Sudsukh began by saying that the Program Committee had undertaken a review and evaluation of immunization against the major infectious diseases in relation to the goal of health for all and primary health care. This was the second in a series of evaluations and reviews of World Health Organization (WHO) programs corresponding to the essential elements of primary health care. The Program Committee had requested the Secretariat to revise the progress and evaluation report in light of its observations as well as those of the EPI Global Advisory Group. The revised report was before members in document EB77/27, which contained a draft resolution proposed for submission to the 39th World Health Assembly in May 1986. Dr. Hyzler indicated that the revised report provided an excellent picture of the present situation, and he supported the recommendations of the EPI Global Advisory Committee and the draft resolution proposed for submission to the Health Assembly. The underlying concern that was expressed in the report was that EPI might become isolated as a vertical program at the expense of encouraging infrastructure development. Consequently, it was important to ensure that rapid increases in EPI coverage were sustained through mechanisms that also strengthened the delivery of other primary health care interventions. The efficiency of EPI was linked closely to the efficacy of maternal and child health services. The real commitment to the success of immunization that was needed was that of the health workers providing day-to-day care to mothers and children and their families. Those countries that had realized the most progress in immunization had done so because of a very strong maternal and child health component in their national health services. Dr. Otoo made the point that 1 of the major constraints in EPI programming was the shortage of managerial skills and that more effort must be made to improve managerial capabilities. Comments of other participants in the 14th Meeting are included in this summary document.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1987; (755):1-61.This is a WHO technical report reviewing how control of disease vectors may be integrated into the primary health care system. The concept of vector is defined broadly as any primary or intermediate invertebrate or vertebrate host or animal reservoir of human disease. The section headings are: present magnitude and status of vector control; means of delivering vector control in primary health care at the community level; communication, feedback and epidemiology; suitability of specific control measures for primary health care; human resource development and the core concept; research topics and recommendations. It is estimated that the size of the problem is hundreds of millions of cases of vector-born disease, with malaria, chagas disease, schistosomiasis, filariasis probably leading the list. Recent efforts on the community level, in Africa for example, have garnered enthusiastic support of villagers, while many nationally sponsored programs on the Health Department level have been less effective. Dozens of specific examples of how vectors may be controlled at the household and village level are cited. Some of these are bed-nets, repellents, aerosols and fumigants, fly traps, water filters, clean-up, biological control agents such as larvivorous fish . In many cases the peridomestic hosts are inhabiting man-made environments, such as thatched roofs, poorly stored food or discarded containers. The primary health care model includes planning at the local level, intersectorial cooperation, and a district management team. Information flow should involve use of the microcomputer and simple flow charts or algorithms, to facilitate feedback between the core group in the central government and the local district health management team. The operations aspects of vector control are emphasized, in both the research needs and the broad agenda of recommendations that end the report.
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.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1974; (552):1-40.This document represents the work of a World Health Organization (WHO) Expert Committee on Tuberculosis, which met in Geneva in 1973. Chapters in this volume focus on epidemiology, Bacillus Calmette-Guerin (BCG) vaccination, case finding and treatment, national tuberculosis programs, research, WHO activities in this field, and the activities of the International Union against Tuberculosis and voluntary groups. The Committee emphasized that tuberculosis still ranks among the world's major health problems, particularly in developing countries. Even in many developed countries, tuberculosis and its sequelae are a more important cause of death than all the other notifiable infectious diseases combined. The previous WHO report, issued in 1964, set forth the concept of a comprehensive tuberculosis control program on a national scale. The implementation of this approach has encountered many problems, including deficiencies in the health infrastructure of many countries (shortages of financial, material, and physical resources and a lack of trained manpower) and resistance to change. However, many countries have instituted comprehensive programs and tuberculosis control has become a widely applied community health activity. A priority will be control of pulmonary tuberculosis. The Committee stressed that national programs must be countrywide, permanent, adapted to the expressed demands of the population, and integrated in the community health structure. Steps involved in setting up such programs include planning and programming, selection of technical policies, implementation, and evaluation. Research priority areas identified by the Committee include epidemiology, bacteriology and immunology, immunization, chemotherpy, the systems analysis approach to tuberculosis control, and training methods and instructional materials.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1985; (728):1-113.This document represents the work of a World Health Organization (WHO) Expert Committee on the Control of Schistosomiasis which met in Geneva in 1984. Chapters in this volume focus on epidemiology, disease due to schistosomiasis, methods of control, progress in national control programs, and a strategy for morbidity control. At present, the aim is to control the morbidity due to schistosomiasis rather than to control its transmission. The simplicity of diagnostic techniques, the safety and ease of administering oral antischistosomal drugs, the use of snail control measures based on specific epidemiologic criteria, and precise methods of data collection and analysis mean that control activities can be adapted to suit any level of the health care delivery system. Drug treatment reduces the prevalence and intensity of infection, prevents or reduces pathologic manifestations in infected persons, and is generally the most cost-effective way of achieving schistosomiasis control. On the basis of the severity of schistosomiasis in the area, its priority rating as a public health problem, and available resources, those operational approaches most suited to a particular area should be identified. Active community participation is necessary to ensure that the maximum benefits are derived from chemotherapy. Maintenance of transmission control by the primary health care system, through monitoring of both parasitologic indexes and clinical signs and measurements, is essential. In most endemic areas, schoolchildren are regarded as the most appropriate target group for monitoring. The WHO Expert Committee has recommended that schistosomiasis control programs be integrated into primary health care and noted the need for greater administrative and managerial expertise in schistosomiasis control. Improvement in socioeconomic conditions in endemic areas provides the longterm solution to schistosomiasis control.
Geneva, Switzerland, WHO, 1985. 101 p. (WHO/CDD/85.13)The Diarrheal Diseases Control (CDD) Program, initiated in 1978, is a priority program of WHO for attainment of the goal of Health for All by the Year 2000. Its primary objectives are to reduce diarrheal disease mortality and morbidity, particularly in infants and young children. This report describes the activities undertaken by the Program in the 1983-1984 biennium. During this period, the Program collaborated with more than 100 countries in the implementation of national diarrheal disease control and research activities. The biennium has witnessed a growing interest of other international, bilateral, and nongovernmental agencies in diarrheal disease control; their financial support and commitment have contributed in a large measure to furthering the development of CDD programs and related research in many countries. During the biennium, the services component continued to expand both the quantity and scope of its activities at global, regional, and national levels. This is readily seen from the increase in global acess to Oral Rehydration Salts (ORS) packets from less than 5% in 1981 to 21% in 1983. Other significant developments were a substantial increase in the number of countries planning and implementing programs and the initiation of a new management course in supervisory skills. Successful implementation of national primary health care systems was recognized as necessary for the achievement of the Program's objectives. Efforts of both developing and industrialized countries must continue in a joint endeavor to reduce the problem of diarrheal diseases, especially cholera, the most severe diarrheal disease. The following areas are discussed: the health services component; the research component; information services; program review bodies; program resources and obligations; and program publications and documents for 1983-1984.
Health manpower requirements for the achievement of health for all by the year 2000 through primary health care. Report of a WHO Expert Committee.
World Health Organization Technical Report Series. 1985; (717):1-92.Health manpower development is central to effective primary health care, and appropriate manpower policies must form the basis for national strategies aimed at health for all. Moreover, these policies must be coordinated with the political, social, and economic goals at the national level and anchored in national strategies to achieve health for all. This volume sets forth numerous recommendations for strengthening health manpower development. It is urged that the World Health Organization (WHO) support Member States in their efforts to formulate or revise national health manpower requirements to achieve health for all by the year 2000. Permanent mechanisms for manpower development should be established or strengthened, in conjunction with national health councils and health development networks. It is further urged that Member States design country-specific mechanisms to ensure the fair participation of all sectors of the community, including the less privileged, in health manpower development activities and community involvement in all aspects of manpower development. Decentralization of decision-making power and management functions will make the health system infrastructure more responsive to community health needs. In addition, WHO should encourage Member States to include in training programs for all health workers the acquisition of skills needed to elicit community involvement, undertake activities aimed at changing the value orientations of health workers from profession-based to people-oriented, and develop a system of accountability of training institutes and health services to community bodies. Also recommended is the development of a global health manpower data base system. It is noted that trained health manpower will have only a limited role in the development of health systems based on the primary health care approach unless such manpower is properly deployed and utilized through effective management.
Health and health services in Judaea, Samaria and Gaza 1983-1984: a report by the Ministry of Health of Israel to the Thirty-Seventh world Health Assembly, Geneva, May 1984.
Jerusalem, Israel, Ministry of Health, 1984 Mar. 195 p.Health conditions and health services in Judea, Samaria, and Gaza during the 1967-83 period are discussed. Health-related activities and changes in the social and economic environment are assessed and their impact on health is evaluated. Specific activities performed during the current year are outlined. The following are specific facets of the health care system that are the focus of many current projects in these districts; the development of a comprehensive network of primary care programs and centers for preventive and curative services has been given high priority and is continuing; renovation and expansion of hospital facilities, along with improved staffing, equipment, and supplies for basic and specialty health services increase local capabilities for increasingly sophisticated health care, and consequently there is a decreasing need to send patients requiring specialized care to supraregional referral hospitals, except for highly specialized services; inadequacies in the preexisting reporting system have necessitated a continuting process of development for the gathering and publication of general and specific statistical and demographic data; stress has been placed on provision of safe drinking water, development of sewage and solid waste collection and disposal systems, as well as food control and other environmental sanitation activities; major progress has been made in the establishment of a funding system that elicits the participation and financial support of the health care consumer through volunary health insurance, covering large proportions of the population in the few years since its inception; the continuing building room in residential housing along with the continuous development of essential community sanitation infrastructure services are important factors in improved living and health conditions for the people; and the health system's growth must continue to be accompanied by planning, evaluation, and research atall levels. Specific topics covered include: demography and vital statistics; socioeconomic conditions; morbidity and mortality; hospital services; maternal and child health; nutrition; health education; expanded program immunization; environmental health; mental health; problems of special groups; health insurance; community and voluntary agency participation; international agencies; manpower and training; and planning and evaluation. Over the past 17 years, Judea, Samaria, and Gaza have been areas of rapid population growth and atthe same time of rapid socioeconomic development. In addition there have been basic changes in the social and health environment. As measured by socioeconomic indicators, much progress has been achieved for and by the people. As measured by health status evaluation indicators, the people benefit from an incresing quantity and quality of primary care and specialty services. The expansion of the public health infrastructure, combined with growing access to and utilization of personal preventive services, has been a key contributor to this process.
Primary health care systems and services for the twenty-first century. Statement of the Seventh Consultative Committee on Organization of Health Systems Based on Primary Health Care.
[Unpublished] 1997.  p. (WHO/ARA/97.7)This summary presents the conclusions of the 7th Consultative Committee on Organization of Health Systems Based on Primary Health Care conducted in Geneva on February 10-13, 1997. The meeting aimed to take stock of the challenges to health that will confront the world in the coming century and assess the implications of these challenges for the development and organization of future health systems and services. The meeting agenda comprised the failure of health systems worldwide to recognize the implications of the fundamental shift in the paradigm that has come to dominate economic and social development over the past decades. In addition, the need to recognize health as the central component of overall human development and not simply a technical process of delivery of medical care by health professionals was also emphasized. Furthermore, the Committee recommends a shift towards a comprehensive, population-based view of health status improvement, with national governments taking primary responsibilities in ensuring equity in health status and access to health care. The success or failure of poor people and poor countries in making a progress in human development would profoundly influence the situation in the 21st century. The implications noted in the meeting would serve as guidelines for future agenda of WHO and its Member States in supporting the development of sustainable health services and systems for the 21st century.
Geneva, Switzerland, WHO, 1999. , 28 i. (WHO/CHS/RHR/99.7)The WHO has contributed significantly to the technical discussions on reproductive health. In preparation for the International Conference on Population and Development (ICPD), WHO has defined the concept, summarize the available epidemiological evidence, identify the range of conditions that comprise reproductive health, and outline principles of care. To implement the ICPD Program of Action, WHO itself has made a number of important structural changes so that it is now better positioned to support countries in confronting the challenges of implementing the reproductive health agenda of the ICPD. Behind the concept, people have different interpretations of reproductive health; to elaborate, reproductive health refers to a spectrum of conditions, events and processes through life, ranging from healthy sexual development, comfort and closeness and the joys of childbearing, to abuse, disease, disability and death. The ICPD refers to reproductive health as an approach that tackles rights, equity, empowerment, self-determination and responsibility in relationships. It is used to analyze and then respond to the needs of women and men in their sexual relationships and reproduction. In reproductive health, as with primary health care, it is necessary to define the division of labor among sectors and professions in promoting and carrying out an agenda that is as much about social justice as it is about health care.
A fundamental shift in the approach to international health by WHO, UNICEF and the World Bank: instances of the practice of "intellectual fascism" and totalitarianism in some Asian countries.
INTERNATIONAL JOURNAL OF HEALTH SERVICES; PLANNING, ADMINISTRATION, EVALUATION.. 1999; 29(2):227-59.This article comments on the practice of "intellectual fascism" and totalitarianism in some Asian countries. It demonstrates how the imposition of an enormous, high-priority, prefabricated health service agenda by the rich countries on the poor ones has destroyed the promising growth of people-oriented health services in countries such as India. In order to protect their political and social interests, the rich countries "invented" Selective Primary Health Care and used the WHO, the UN Children's Fund (UNICEF), the World Bank (WB), and other agencies to initiate global programs on immunization, AIDS, and tuberculosis. These programs were proven to be defective in concept, design, and implementation. There are five major areas of the principles and practice of international public health that have been distorted by the WHO, UNICEF, and WB: 1) the "public health" practiced by exponents of the international initiatives is starkly ahistorical; 2) the scientific term "epidemiology", which forms the foundation of public health practice, has been grossly misused by a new breed of experts; 3) suppression of information, use of doctored information, spread of misinformation and disinformation, and lack of effective evaluation/surveillance result when programs are designed to serve power managers, required by their paymasters to satiate the greed of the marketplace; 4) directors-general of two top public health institutions in India found high positions in WHO after supporting the WHO/WB Global Programme for Tuberculosis despite its serious flaws; and 5) those who are expected to be the conscience keepers of ethics and morality in public health practice -- public health school teachers, key public health administrators, nongovernmental organizations, political leaders--are even the worst offenders in inflicting humiliations among people.
WORLD HEALTH FORUM. 1997; 18(3-4):287-93.With the industrial revolution, peasants began moving into towns in industrializing countries, beginning a slow, but steady process of urbanization. At the beginning of the 19th century, just 3% of the world's population lived in towns. However, after the Second World War, large numbers of people migrated to urban areas at rapid rates, especially in the newly independent and Latin American countries. By 2015, approximately 20% of the urban population in developing countries will be living in 27 megacities and an additional 28% will be living in approximately 700 cities with populations larger than 500,000. Weak administrative structures and limited resources will be the norm in many of these cities as populations grow rapidly and uncontrolled. In the shantytowns of developing countries, health hazards are associated with the prevailing poverty, lack of water and sanitation, and substandard housing; changes in living conditions and lifestyles; chronic diseases related to modernization; lung diseases; accidents; mental and psychosomatic disorders; and social instability, cultural and social alienation, and the social and mental ill-effects of degrading living conditions and extreme crowding. While urban health care absorbs the bulk of most national health budgets, up to 85% of those funds are spent on curative services delivered through large specialist hospitals located in the cities. Many people in the surrounding shantytowns and slums have no access to cities' services or do not use them because they do not respond to their needs. The health services which are available tend to be poorly managed. Political will can, however, lead to improved urban health.