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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.
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)
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.
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.
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.
WORLD HEALTH. 1987 Aug-Sep; 8-11.The implications of the fact that it was concerted global effort that eradicated smallpox are discussed. The primary reason why the effort succeeded is that specific measurable goals and time deadlines were built in. The 10-year goal was met in 9 years 9 months 26 days. Universal political commitment, including provision of funds by WHO and by constituent countries, was required. A strategy of 80% vaccination and surveillance and containment of outbreaks, followed by certification of eradication, was adhered to. Whether the smallpox campaign could be used as a template for eradicating other diseases is discussed. The biology of smallpox makes it a unique candidate for eradication, while no other disease shares all of its qualifications, such as having only a human host. Lessons have been learned for control of other diseases, however. With regard to the concept of primary health care for all, the smallpox effort showed that finite, specific programs are better supported than basic health services. The eradication demonstrated the power of good leadership and common goals supported by an international institution.
WORLD HEALTH FORUM. 1988; 9(2):185-99.This article explains how the concept of health for all developed within the context of the history of the World Health Organization (WHO). By the early 1970s a new idea was taking shape in WHO. Medical services were failing to reach vast numbers. Health would have to emerge from the people themselves. In the heat of discussion the new strategy was clarified and given a name--primary health care (PHC). An ambitious target was set for it--no less than health for all by the year 2000. It was decided that the community itself had to be involved in planning and implementing its own health care. A new type of health worker was called for, chosen by the people from among themselves and responsible to the community but supported by the entire health system. In virtually all countries, the emphasis on curative care would have to be balanced by an equal emphasis on prevention. Almost 90% of WHO's Member States were prepared to share with one another detailed information about the problems facing their health systems. Industrial countries were beginning to realize that sophisticated medical technology was no guarantee of good health and that health for all through PHC offered an alternative. Millions of health workers have been trained, extending services to low-income groups that had no access to modern health care. Among health professionals, lack of understanding of the PHC concept and insufficient concern for social equity remain the principal constraints. Another problem is that expenditure on health care tends to be viewed as a drain on scarce resources rather than as an investment in the nation's future. The mommentum of health for all can be sustained only by governments implementing at home the policies they have collectively agreed on at The World Health Assembly in Geneva.
[Unpublished] 1985. 15 p.This paper reviews the development of the global Expanded Program on Immunization (EPI) initiative, reports on program progress since the 1984 EPI conference, and identifies actions needed to meet the goal of providing immunization services to all children of the world by 1990. The central EPI strategy to date has been to deliver immunization in consonance with other health services, particularly those aimed at mothers and children. The long-term goal of such efforts is to strengthen the health infrastructure so as to ensure the continuous provision of immunization and other primary health care services. Simply by reinforcing existing health services, a coverage level of 60-70% will be achieved in developing countries by 1990. If universal coverage is to be achieved, external funds will have to be provided to meet operational costs and train national managers. Acceleration of existing efforts constitutes the main EPI priority at present. Specific areas suggested for immediate action include provision of information about immunization at every health contact; a reduction in the drop-out rates between 1st and last immunization; increased attention to the control of measles, poliomyelitis, and neonatal tetanus; improved immunization services to the disadvantaged in urban areas; and, where appropriate, acceleration of the EPI through approaches such as national immunization days. Ongoing actions that need to be pursued include strengthening disease surveillance and outbreak control, reinforcing training and supervision, and pursuing applied research and development. Overall, management capacity within national programs remains the most severe constraint for the EPI.
Washington, D.C., Academy for Educational Development, 1986 Dec. 14 p. (25th Anniversary Seminar Series)This paper, delivered as part of the Academy for Educational Development's 25th Anniversary Seminar Series, outlines the World Health Organization (WHO) view of acquired immunodeficiency syndrome (AIDS) as a public health problem of paramount international importance. AIDS is transmitted sexually, through blood, and from mother to child. The combination of sexual and perinatal transmission allows identification of sexually active, pregnant women as a group at potential risk. There are currently about 36,000 reported cases of AIDS throughout the world, of which 30,000 are from the Americas. Overall, the AIDS cases come from 78 countries representing all continents. A major question for the future concerns the situation in Asia, where there are currently a small number of cases. The only strategy for preventing AIDS is monogamous sex with single partners over long periods of time, without prostitution and intravenous drug abuse. AIDS particularly threatens the health gains that have been achieved in the developing world and its control must be anchored in the context of primary health care. WHO is aggressively pursuing the function on coordinating the international exchange of information on AIDS. WHO is, in addition, helping countries to organize their own national AIDS prevention and control programs. The solution to the AIDS crisis will be a blend of technological and social advances, and the cutting edge will be education. WHO projects that US$1.5 billion/year will be required to conduct the WHO component of the global campaign against AIDS.
HEALTH POLICY AND PLANNING. 1986 Mar; 1(1):37-47.This economic analysis assesses the probable costs of implementing various activities of the World Health Organization's (WHO's) global strategy of "health for all by the year 2000" and the likelihood that developing countries will be able to afford these costs, either on their own or with the assistance of developed countries. If this policy is to be transformed into concrete results, there must be a plan complete with budgetary requirements, planned activities, and expected results specified in adequate detail. The overall costs of the activities proposed by the global strategy would amount to approximately 5% of the gross national product of most developing countries, with water supplies and primary health care comprising the most expensive activities. Although there is a good match between estimated resource requirements and planned activities, the desired outcomes are often unlikely to result from the activities proposed. At present, all 25 industrial market and nonmarket industrial developed countries have already achieved the outcome goals of the global strategy; however, these countries account for only 25% of the world's population. Of the 63 middle-income countries, 54 have already achieved a gross national product per capita of over US$500, but only 22 have an infant mortality rate better than 50/1000. Very few low-income countries are close to reaching their targets for income, infant mortality, life expectancy, or literacy. On the basis of current trends, 25-33% of countries are considered unlikely to achieve the outcome goals by the year 2000. In general, it appears that expenditure targets are too low to cover the needed health services activities. Further research on the costs of health promoting activities such as immunization and primary health care should be given high priority.
[Unpublished] 1985 Nov 19. Presented to the Executive Board, Seventy-seventh Session, Provisional Agenda Item 18. 20 p. (EB77/27)The Expanded Program on Immunization (EPI) has made major public health gains in the past decade. The central EPI strategy has been to deliver immunization in consonance with other health services, particularly those directed toward mothers and children. However, in the least developed countries and many other developing countries, it does not appear likely that national budgets will be sufficient by 1990 to support full immunization coverage on a sustained basis or that an adequate number of national managers can be assembled to staff effective programs. At the November 1985 meeting of the EPI Global Advisory Group, recommendations were made to accelerate global progress. These recommendations reflect optimism that the 1990 goal of reducing morbidity and mortality by immunizing all children of the world can be achieved, but also acknowledge that many fundamental problems of national program management remain to be resolved. 3 general actions needed are: 1) promote the achievement of the 1990 immunization goal at national and international levels through collaboration among ministries, organizations, and individuals in both the public and private sectors; 2) adopt a mix of complementary strategies for program acceleration; and 3) ensure that rapid increases in coverage can be sustained through mechanisms which strengthen the delivery of other primary health care interventions. The 4 specific actions needed are: 1) provide immunization at every contact point, 2) reduce drop-out rates between first and last immunizations, 3) improve immunization services to the disadvantaged in urban areas, and 4) increase priority for the control of measles, poliomyelitis, and neonatal tetanus. Continued efforts are also required to strengthen disease surveillance and outbreak control, reinforce training and supervision, ensure quality of vaccine production and administration, and pursue research and development.
Washington, D.C., Regional Office of the World Health Organization, 1980. x, 189 p. (Official Document No. 173)The World Health Assembly decided in 1977 that the main social target of the Governments and the WHO in the decades ahead should be "the attainment by all the citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life." Subsequently, the World Health Assembly in 1979 urged the member states to define and implement national, regional, and global strategies for attaining the goal of health for all by the year 2000. This monograph reprints UN documents dealing with this goal. The 1st document addresses 2 specific issues, the developments in the health sector in the 1971-1980 decade, and strategies for attaining the goal of health for all by the year 2000. The 2nd document addresses 8 areas of interest; 1) social and environmental aspects of the region of the Americas; 2) evaluation of the 10-year health plan for the Americas; 3) implications of the goal and the new international economic order for the achievement of the objectives; 4) a method for analyzing strategies and developing a primary health care work plan and indicators for evaluating progress towards the goal; 5) objectives for the health and social sectors; 6) regional baseline targets for priority health conditions; 7) summary of revised regional strategies for attaining the goal; 8) national, intercountry, regional, and global implications of the regional strategies. The 3rd and 4th documents are resolutions 20 and 21 of the 27th meeting of the directing council of the Pan American Health Organization. Resolution 20 addresses regional strategies for attaining the goal. Resolution 21 discusses the ad hoc working group to complement the regional strategies.
International Journal of Gynaecology and Obstetrics. 1985 Sep; 23(4):247-8.The WHO is certain that the health of mothers and babies can be improved by giving traditional birth attendants (TBAs) special training and support to enable them to carry out their activities with greater safety. This is probably one of the most cost effective approaches to reducing maternal and infant mortality and morbidity. Some workers, however, stress that this approach is inappropriate to the real needs of the impoverished majority. They believe that the real causes of mortality are socioeconomic deprivation, top managerial incompetence and mass illiteracy. In addition to TBA training the WHO suggests strengthening the referral and support system and improvement and wide spread use of appropriate technologies. TBAs have been most successful when trained for a special skill, such as reducing neonatal tetanus. This supplement shows some of the achievements and problems that still exist. The material is presented to gain better understanding of obstetricians and support for simplified maternity care for mothers and babies in rural areas. Obstetricians can influence decision makers who allocate funds for health care to achieve a more equal distribution of resources. The articles are presented as part of a broader program of collaboration between the WHO and the International Federation of Obstetrics and Gynecology (FIGO) in their common objective of improving the health of women and children based on the principles and programs for primary health care. The 2 organizations have joined to form a WHO/FIGO Task Force for the Promotion of Maternal and Child Health (MCH), including Family Planning (FP), and Primary Health Care. The activities of the Task Force are: to put into effect the specific recommendations of the Joint WHO/FIGO workshop; to promote and support the MCH/FP elements of PHC at the national levels; and to promote the transfer, adaptation and further development of appropriate technologies for pregnancy, perinatal and family planning care.
Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C.
Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 210 p. (International Conference on Oral Rehydration Therapy, 1983, proceedings)With over 600 participants from more than 80 countries, the International Conference on Oral Rehydration Therapy (ICORT) was a testimony to the international health community's recognition of the seriousness of diarrheal disease, the value of oral rehydration therapy, and the commitment to primary health care. The conference, initiated by the Agency for International Development, was cosponsored by the International Center for Diarrheal Disease Research, Bangladesh, the United Nations Children's Fund, and the WHO. The conference focused on oral rehydration therapy, an important treatment of diarrhea. 1 out of 10 children born in developing countries dies from the effects of diarrhea before the age of 5. A 70% reduction in the mortality rate can result from ORT--a major breakthrough for primary health care. Excellent laboratory investigation, well-conducted clinical studies, and careful field observation have led to this effective therapy. Many papers presented at the conference demonstrated the effectiveness of ORT. Participants agreed on the best formula for ORT in terms of electrolyte content and on the need for an international commitment to expand implementation of ORT. Problems in implementing oral therapy programs are discussed. Possible areas of investigation include: 1) improving the solution through the addition of glycine, other amino acids, or cereal-based substrates; 2) developing methods for teaching ORT; and 3) investigating better methods of program evaluation. Innovative approaches to informing the public about the use and benefits of oral therapy were also discussed. Participants, recognizing that problems are shared among many different programs and nations, exchanged ideas and addresses, pledging to keep each other abreast of their ORT research and implementation efforts. The conference closed with a strong call for action to attain near universal availability of ORT in the next 10 years.
Geneva, Switzerland, WHO, 1982. 153 p. (Health for All Series, No. 8)This document contains the World Health Organization's (WHO's) 7th General Programme of Work for the period 1984-89 as approved by the World Health Assembly in May, 1982. WHO's major task between 1984-89 will be to provide coordination and technical support for the development, implementation, monitoring, and evaluation of strategies for attaining the world's goal of health for all by 2000. WHO will seek to strengthen primary health care (PHC) systems in member states by promoting the use of appropriate technology, by assisting in the development of health systems for the delivery of integrated services, and by encouraging a high level of community participation in health care systems. The 4 major components of the program are 1) the direction, coordination, and management of the overall program; 2) the development of health system infrastructures; 3) the collection and dissemination of information on health technology and science and support for research to develop new health technologies; and 4) program support. In reference to the 1st component, WHO, through its governing bodies, i.e., the World Health Assembly, the 6 regional committees, and the executive board, will seek to maintain a unity of purpose and direction for the program as it is implemented in each country and region. In regard to the 2nd component, WHO will provide assistance for 1) collecting the information required for effective health planning 2) conducting research aimed at determining optimal organizational structures for PHC systems, 3) determining if legislation is needed to facilitate the development of effective and efficient health systems, 4) ensuring the efficient management of health systems, 5) mobilizing the required health manpower, 6) engendering support for the program among health personnel and policy makers, and 7) monitoring and evaluating the program. The health sciences and technology component will deal with the content of health care. Existing technologies for diagnosing, treating, preventing, and controlling specific disease must be evaluated in reference to their appropriateness for inclusion in health systems. Research to develop new technologies will also be encouraged. Specific programs will focus on nutrition, oral health, accident prevention, maternal and child health, family planning, reproductive health, worker safety, the elderly, mental health, environmental health, diagnostic technology, therapeutic and rehabilitation technology, and the prevention and control of numerous communicable, infectious, and noncommunicable diseases. WHO's support component will provide primarily health information and administrative support.