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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.
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)
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.
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.
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.
NUOVI ANNALI D IGIENE E MICROBIOLOGIA. 1987 Sep-Dec; 38(5-6):471-6.Community medicine (CM) addressing the global problems of human health has been intensifying in concert with primary health care (PHC) in developing countries, especially since the 1977 session of the WHO launched a program called "Heath for all by 2000" whose central component was PHC. An international conference in Alma Ata in 1978 on PHC stressed essential health care for all communities supported by practical methods that were scientifically valid and socially acceptable, assistance that was accessible to all members of the community. The objectives of PHC were: promotion of proper nutrition, safe water supplies, basic hygiene, maternal-child hygiene, vaccination against major infectious diseases, prevention and control of endemic local diseases, health education, and proper treatment of common diseases and injuries. A PHC post on the village level of Cm would have 1 community health worker (CHW) and 1 traditional birth assistant (TBA) providing health care for 500-1500 people. On the district level, a PHC unit would have 2 CHWs and 2 TBAs for 10,000 people. On the regional level, a PHC center would have 1 physician, 2 attendant nurses, 2 obstetricians, 1 technician, 1 pharmacist, and 1 administrator. Finally, on the national level, hospitals would take care of health needs. The lack of properly trained staff and resources poses the biggest problem in the organizational structure of Cm, but this could be overcome by collaborating with rural medicine and traditional medicine.
Policy aspects of community participation in maternal and child health and family planning programmes.
Geneva, Switzerland, World Health Organization, 1989. , 56 p. (WHO/MCH/89.14)The International Conference on Primary Health Care (PHC) organized by WHO and UNICEF in Alma Ata in 1978 pointed to involving the public in health care services including planning, implementation, and evaluation. These projects, experience in other areas of community participation (CP) as well as a meeting that was organized by WHO and the UN Fund for Population Activities (UNFPA) in Zimbabwe in October 1986 are detailed. The rationale for CP is to improve health service delivery and to enable health service users to have more control. Emphasis is placed on women in communities as the key participants in maternal and child health/family planning (MCH/FP) programs to increase their status. Women are the beneficiaries of MCH/FP services with traditional responsibility for the health of their families. They make up the majority of nurses, modern and traditional midwives, and paramedical workers within the formal system. In traditional communities women become community health workers (CHWs) and village development workers. WHO has supported research to assess the health impact of community participation in health services. UNICEF has focused on a more integrated approach where community participation is promoted through community development activities. UNFPA has supported projects in which traditional birth attendants or village health workers are trained to improve their skills in MCH/FP. Some policy issues for CP implementation in MCH/FP programs include: decentralization of the health care systems; health care information and education; training; resources for CP in MCH/FP activities; implementing MCH/FP activities in the community (antenatal care, delivery care, child care, and FP care); promoting multi sectoral collaboration; and evaluating and monitoring community participation. Some international research projects initiated are the PRICOR operations research project on the implementation of the PHC (supported by USAID), and ESCAP's cross-cultural research project about constraints on community participation in national FP programs (supported by UNFPA). Governments are urged to hold workshops for policymakers, train district and local officials in managerial skills, develop guidelines for medical preventive health training curricula, and develop management information systems.
Washington, D.C., World Bank, Population, Health and Nutrition Dept., 1986 Dec 31. 124 p.In the current environment of general budget stringency in developing countries, it is unrealistic to push for more public spending for health services. The answer to this health crisis is to relieve government of much of the responsibility for financing those kinds of health services for which the benefits to society as a whole (as opposed to direct benefits to the users of the service) are low, freeing public resources to finance those services for which benefits are high. The intent is to relieve government of the burden of spending on health care for the rich, freeing public resources for more spending for the poor. Individuals with sufficient income should pay for their curative care. The financing and provision of these "private" health services should be shifted to a combination of the nongovernment sector and a public sector reorganized to be more financially self-sufficient. A shift such as this would increase the public resources available for those types of health services which are "public goods" and currently are underfunded "public" health programs, such as immunization, vector control, some prenatal and maternal care, sanitary waste disposal, and health education. Also such a shift would increase the public resources available for simple curative care and referral for the poor who now only have limited access to low quality services of this nature. Government efforts to cover the full costs of health care for everyone from general public revenues have contributed to 3 sets of problems in the health systems of many countries: an allocation problem -- insufficient spending on cost-effective health activities; an internal efficiency problem -- inefficient public programs; and an equity problem -- inequitable distribution of benefits from health services. 4 policies for health financing are proposed to raise revenues for important health programs, increase the efficiency of public health services, and make the system better serve the poor. These are: charging users of public health facilities; providing insurance or other risk coverage; strengthening nongovernmental health activities; and decentralizing government health services. A table summarizes the effects of each of the 4 options for reform in alleviating health sector problems.
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.
Expanded Programme of Immunization Eastern Mediterranean Region. A report for the EPI Global Advisory Group Meeting, Alexandria, 21-25 October 1984.
[Unpublished] 1984. 10,  p. (EPI/GAG/84/WP.7.a)The strategy adopted by the Members States of the Eastern Mediterranean Region (EMR) to achieve the objective of the promotion of the Expanded Program of Immunization (EPI) through primary health care (PHC) concentrates on strengthening synergistic integration of EPI with other services. Activities have been planned and implemented or are being implemented at the Regional Office and at the country level. 21 countries of the Region now have either a full-time or part-time manager or an EPI focal point. This is a considerable development, for in 1982 there were EPI managers in 9 countries. Except for 3 countries, all national EPI managers/focal points have received senior level training in EPI. At delivery points, vaccination is performed to a large extent by multipurpose health workers, but full-time vaccinators are available in about 6 countries. All field workers have received training at their respective regional levels. Limited financial resources continue to be 1 of the primary constraints of the program in the Region. Plans to resolve this problem include: counteracting wastage factors; close collaboration with the UN International Children's Emergency Fund (UNICEF) and other international agencies at the country level to standardize approaches and avoid overlap; tapping regional and international voluntary agencies to increase their contributions; and increased use of associate experts, UN volunteers, and national technical staff. The overall information system is to some extent weak and suffers from irregularity and a lack of continuity. Regular reports are received from 9 countries which have World Health Organization staff. Repeated requests from other countries yield incomplete and at times contradicting data. Research efforts are directed towards operational areas, and research in strategies, integration, community, and surveillance areas is being encouraged.
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.
[Unpublished] 1978 Mar 31. Presented to the Thirty-first World Health Assembly provisional agenda item 2.6.10. 13 p. (A31/21)This report summarizes progress in 1977-78 in the planning and implementation of the Expanded Program on Immunization (EPI). The EPI's long-term objectives are: 1) to reduce morbidity and mortality from diphtheria, pertussis, measles, poliomyelitis, and tuberculosis by providing immunization against these diseases to every child in the world by 1990; 2) to promote countries' self-reliance in the delivery of immunization services within the context of comprehensive health services; and 3) to promote regional self-reliance in matters of vaccine quality control and production. The present EPI program strategy is to develop managerial competence at the senior and middle levels to serve as a foundation for solid, enduring program implementation. Regional and national authorities have been made a part of the global planning process. An EPI Global Advisory Group has been established to assist in operational implementation, develop prototype training curricula and educational materials, develop and transfer appropriate technologies, establish a 2-way information system to obtain global data on the target diseases, and attract and coordinate extrabudgetary resources. Recent training activities have included a course on EPI planning and management, middle management training at the national level, training in cold chain management, and preparation of an EPI field manual. Research and development efforts have focused on improving the equipment used in the cold chain. Work continues on the development of more stable, more potent, less reactogenic vaccines. 42 developing countries, in which a total of 57 million children are born every year, have been identified as expanding their immunization programs in active collaboration with the World Health Organization. As more countries actively expand their immunization coverage, a larger level of resource input will be required to sustain this expansion.
[Main objectives of the WHO Special Program on Human Reproduction] Osnovnye napravleniia Spetsialnoi Programmy VOZ po Reproduktsii Cheloveka.
AKUSHERSTVO I GINEKOLOGIIA. 1984 Jul; (7):3-6.The WHO Special Program on Human reproduction was established in 1972 to coordinate international research on birth control, family planning, development of effective methods of contraception, and treatments for disorders of the human reproductive system. The Program's main objectives are: implementation of family planning programs at primary health care facilities, evaluation of the safety and effectiveness of existing birth control methods, development of new birth control methods, and development of new methods of sterility treatment. In order to attain these goals, the Program forth 3 major tasks for international research: 1) psychosociological aspects of family planning, 2) birth control methods, and 3) studies on sterility. Since most of the participating nations belong to the 3rd World, the Program is focused on human reproduction in developing countries. The USSR plays an important role in the WHO Special Program on Human reproduction. A WHO Paticipating Center has been established at the All-Union Center for Maternal and Child Care in Moscow. Soviet research concentrates on 3 major areas: diagnosis and treatment of female sterility, endocrinological aspects of contraception, and birth control prostaglandins.
TROPICAL AND GEOGRAPHICAL MEDICINE. 1985 Sep; 37(3 Suppl):S78-80.In the Netherlands the program of international cooperation focuses on the improvement of the socioeconomic situation of the poorest groups in societies as one of the major aims. Health is considered to be an important component of that situation and emphasis is laid on the complexity of the many different factors that determine the health status of individuals, groups, and populations. The ministry strongly advocates a community-based or community-oriented approach, popular participation, and a multisectoral approach by integration of activities such as health care, drinking water supply, agriculture, education, and poverty-reducing measures in general. Considering the above identified policy and the positive experiences the government had gained through bilateral, multilateral, and nongovernmental organization channels, the Netherlands wholeheartedly welcomed the results of the World Health Organization (WHO) UN International Children's Emergency Fund Conference of Alma Ata in 1978, endorsing the declaration of the conference. It was stated that the actual health situation of the world population was intolerably poor, that the majority of humankind had to live without possibilities to benefit from modern health technology, and that primary health care (PHC) had to be considered the key strategy in order to obtain the aim of "Health for All at the Year 2000." In the years that followed, PHC became a popular concept worldwide. Within the Netherlands itself, the Royal Tropical Institute in Amsterdam created a multidisciplinary group linked with other institutions in order to process and analyze the experience gained in different PHC projects in various 3rd world countries. These studies already have contributed to basic knowledge in the PHC field and the group assisted through direct or indirect training. Additionally, about 200 Dutch medical doctors working in developing countries and doctors from those countries have participated in the annual international Courses in Health Development, organized in 1963. In the context of a multilateral approach to help solve global problems, the Netherlands has built up a certain tradition, one that supports WHO in its efforts to elaborate the concept of PHC as well as to develop and to supply the means to implement the strategy. Support also is given to WHO's initiative to establish the Health Resources Group, which participates in making an inventory of national health problems and of available resources from national and international sources. Returning to the theme of this symposium, vaccination can function as a starter for PHC when it is implemented in accordance with the overall PHC philosophy, i.e., it supports the general development process of societies and individuals.