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[Unpublished] 1992. Presented at the 120th Annual Meeting of the American Public Health Association [APHA], Washington, D.C., November 8-12, 1992. 27,  p.In the mid 1980s, USAID started nonproject assistance, mainly in the economic sectors, to African countries. The countries received nonproject assistance after they fulfilled conditions which influence institutional and/or policy reforms. The longest running health sector reform program in Africa was in Niger and was slated to receive portions of the funds after fulfilling 6 specific predetermined reform activities. Yet, between 1986 and 1991, Niger had implemented only 2 of them. It did accomplish the population/family planning reforms: expansion of family planning services, a national population policy, analyses and implementation of improvements in the pricing and distribution of contraceptives, and legalization of use and distribution of contraceptives. Continuing economic deterioration during the 1980s and political upheavals after 1989 somewhat explained why the other reform activities were not implemented. Other equally important factors were a very complex sector grant design (more than 20 reforms in 6 policy/institutional areas) with little incentive to realize the reforms, insufficient number of staff (limited to senior personnel) to implement the reforms, and just 1 USAID staff to monitor and facilitate activities. The nonproject assistance for the primary health care (PHC) system in Nigeria had a simpler design than that in Niger. The reform goals were shifting responsibility for PHC from curative care to preventive health services. After USAID and the Nigerian government signed an agreement, they included policy reforms promoting privatization of health services. Only 1 reform was implemented. Factors which could lead to success of nonproject assistance include host government needs to perceive it owns the objectives and building financial and institutional sustainability. In conclusion, nonproject assistance can be effective when implementing policy reforms that the host government has already adopted.
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.
[Health costs and financing and the work of WHO] Cout et financement de la sante et activities de l'OMS.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1984; 37(4):339-50.This discussion examines the international responses to issues and problems in the cost and financing of the health sector, focusing on the work of the World Health Organization (WHO). It describes the growth of attention to these concerns beginning in the 1970s, reviews methods and applications of financial analysis in greater detail, and summarizes progress to date and the agenda for work. Emphasis is on the developing countries, for they face the most urgent problems regarding costs and financing, and more attention is directed to their needs for support in this area. By the early 1970s it was clear that progress in health development particularly in the most underprivileged countries was unsatisfactory and that changes were needed if services were to have an appreciable impact on the health problems of developing populations. A major study conducted jointly by the UN Children's Fund (UNICEF) and WHO identified several of the critical problems associated with resources. The essential financial concerns requiring attention in connection with primary health service coverage, the need for more equitable distribution of existing resources for health and the priority of resources allocation to peripheral health services were examined in detail by a WHO Study Group on Financing Health Services which met in 1977. Among the problems of health finance, those of the overall lack of funds, the maldistribution of health resources, rising health care costs, and the lack of coordination were found to be particularly important. The Study Group concluded that, despite difficulties, it was possible to collect information of sufficient reliability for planners' needs and at a modest cost, even for the private sector. To help bring this about, it recommended that research centers and universities, in collaboration with national health authorities of their country, devote considerable attention to data collection methods. The reports, studies, and papers prepared at various meetings deal in general with specific aspects of health cost and financing. A major element, and evolving product, of the meetings and studies related to developing countries was a manual on financing health services, originally based on the recommendations of the 1st Study Group meeting. This draft document served as background material for a series of further meetings and was used to guide many of the country financing studies. A number of other health financing manuals were also developed between 1979-81. In its final published form the WHO manual attempts to be relevant to all developing countries. The manual describes health policies and their financial aspects and outlines techniques for data collection. If the recommendations of the 1st Study Group are compared with the achievements recorded thus far, the following facts come to light: many countries have undertaken surveys of health sector financing and resource allocation; increased interest in this subject has been shown by other international organizations; much progress has been made in the development and refinement of methodologies for collecting and using financial data; international activities and country studies have made it possible to provide reports for country leadership; and issues of financial planning and management often appear in medium and longterm plans.
Bangkok, Thailand, ESCAP, 1984 Apr. 175 p. (ESCAP Programme on Health and Development Technical Paper No. 65/BCS 12; ST/ESCAP/291)The recognition of the necessity of involving the community in development efforts has been a turning point in the evolution of development thinking in recent years. Since 1978, the UNICEF Regional Office for East Asia and Pakistan and ESCAP have been conducting a series of training seminars where local development, basic services and primary health care are discussed as part of village reality. This volume reviews this experience, generalizing it to enhance adaptation. The seminars are a learning by doing and experience-sharing process. Group discussion and reflection on relevant issues are focused on. The seminars are oriented to community life as a whole, considering primary heatlh care as an entry point for coummunity development which involves generation of services within the community, supplemented by delivery of services from other institutional levels. This report describes the overall framework, including the organization of the 1983 seminar and the training approach, and the syllabus and evaluates the seminars. The goal of the seminar is the promotion of basic community health care in the countries of the region to improve the quality of life of the poor. Each participant discusses his/her work experience. Basic needs, basic services and primary health care are examined and a field-study phase at village-level is organized. Planning capabilities are developed by a phase of planning for basic and community services and primary health care. A module on national development, basic needs approach and production-oriented development is introduced. Finally, each participant prepares a draft project proposal for training for his/her own country situation. The evaluation of a program includes both its delivery system component and its eventual impact. The seminars used questionnaires, special group discussions and interviewing of the participants. The aim was to scrutinize the relevance and potential for modification of knowledge, attitudes and practice (KAP) rather that the actual impact actual impact achieved. Behavioral change should be evaluated on at least 2 levels: the individual and the collective. The structure, clustering and frequency of response to a given question in an evaluation questionnaire and the average level of awareness about a particular issue are 2 important measures to analyze. Seminar participants were mainly middle level personnel, but included some junior and senior officials from ministries of health, interior or home affairs and agriculture; training institutes; rural development institutes; planning commissions and universities.
World Health Forum. 1981; 2(4):463-4.The plans of Nepal, a member state of WHO, to meet the targets of "Health for All by the Year 2000" are presented. They include goals for basic needs such as food, fuel, drinking water, health care, education and communication. Several government groups have been involved in overall strategies and intersectoral plans. Health planning has been decentralized at the district level with health posts for primary care delivery being strengthened. Health related minimum needs programs such as the development of livestock, forestry, and the improvement of rural communication have been tied to primary care. Health research, education, and information systems are being improved. The overall monetary allocations to social services has been increased by 28%.
New policies for health education in primary health care. Background document for Technical Discussions Thirty-sixth World Health Assembly, 1983.
Geneva, Switzerland, WHO, 1983 Feb 25. 32 p. (A36/Technical Discussions/1)The 36th World Health Assembly Technical Discussions, which will focus on "New Policies for Health Education in Primary Health Care," seek to support efforts aimed at promoting community involvement and self-reliance, a greater diversity of objectives in policy making, harmonization of national and local plans, and facilitation of intersectoral action and the use of appropriate technology. As a basis for discussion, a 12-step model of the contribution of health education to primary health care strategy is proposed: 1) the movement starts with the people, 2) verification of whether felt needs reflect community issues is obtained, 3) priorities are dilineated, 4) central support comes into play in plan formulation, 5) implementation and coordination of resources begins, 6) action develops and the technology's appropriateness is evaluated, 7) program effectiveness is evaluated, 8) new needs emerge and unused resources are identified, 9) the cycle for increased involvement and self-reliance develops at another level, 10) the community develops new resources, 11) central and local activities are evaluated, and 12) greater involvement of all sectors fills existing gaps and self-reliance is realized. Health education must be supported by policies which: reflect a commitment to the equitable distribution of resources; provide for its integration at stages of the health care process where people's involvement and increased self-reliance requires additional understanding and skills; stress the need for coordination and an intersectoral approach; assign health education responsibilities to all health workers, teachers, and media personnel; provide an institutional framework and economic and legislative supports for increased individual, family, and community responsibility for health and welfare; and specify clearly the fundamental objective of health education and community involvement, i.e., to help each individual, family member, and community to acheive the harmonious development of their physical, mental, and social potential. Development of skilled manpower trained to introduce the educational dimension, linkages of the mass media to the development process, research on priority areas of input, and collaboration with nongovernmental agencies are essential to this process.
In: Bannerman RH, Burton J, Ch'en Wen-Chieh. Traditional medicine and health care coverage: a reader for health administrators and practitioners. Geneva, Switzerland, World Health Organization, 1983. 231-9.This article discusses the status and functioning of the major systems of traditional medicine in Southeast Asia with particular attention to the activities of WHO. Decision regarding traditional medicine taken by health and political authorities in congresses and conferences from 1977 to 1979 are outlined. Intercountry projects to promote traditional medicine including 1 begun by WHO in 1978 and another 1 founded by the United Nations Development Programme in 1982 are described. The major systems of traditional medicine practiced in the region can be classified as 1) formalized systems which include Ayurveda, Siddha, Unani-Tibbi, the chinese system of medicine, and 2) non-formalized, traditional systems of medicine practiced by herbalists, bonesetters, practitioners of thaad (element system), home remedies and spiritualists. In addition yoga, nature cure and homeopathy are being practiced in some countries including Bangladesh and India. Almost all the countries have recognized the traditional systems of medicine and are making efforts to utilize the practitioners in their health care delivery programs. There are at present 750,000 practitioners of traditional medicine in the region. Health programs in Bangladesh, Burma, India, Indonesia, Maldives, Nepal, and Sri Lanka are discussed. Future efforts of WHO in the region will be related 1st, to reorient traditional healers to meet the needs of primary health care; and 2nd to support research on the treatment of diseases for which modern medicine has no cure, such a peptic ulcer, bronchial asthma, rheumatoid arthritis, urolithiasis, viral hepatitis, and diabetes mellitus.
[The strategy of health for all in all its magnitude] Estrategia de salud para todos en toda su magnitud.
Boletin de la Oficina Sanitaria Panamericana. 1983 Oct; 95(4):361-6.Around 1970, interest in the concept of social justice began to be reflected in analyses of health systems in developing countries, and in the rapid acceptance and popularization of the goal of health for all by the year 2000, to be achieved through primary health care programs providing universal coverage. UN member states can maintain the impulse to provide universal health care by carrying out within their borders the health care policies collectively recommended by the UN General Assembly, aided by the World Health Organization (WHO) which has put aside the paternalistic policies of the past and which now seeks to assist nations in carrying out their own goals. 1 step in assuring that the goals will be met involves continual surveillance of the progress of implementation, which is to be reported in various meetings and conferences at regional levels and at the World Health Assembly in 1984. Identification of problems in implementation should not be interpreted as placing blame, but rather as signalling the need to search for common solutions to them. New principles in the use of WHO aid are that the member governments should assume responsibility for the application in their countries of the jointly agreed upon policies as well as the utilization of WHo resources reserved for that end, that WHO resources be used only for activities compatible with policies defined at the national and international levels; that WHO resources be used to achieve adequate planning and administration of the health infrastructure, with assistance from WHO; that individual countries participate in evaluation of WHO sponsored activities to assure the optimal use of resources; and that countries assume much greater responsibility for the use of WHO resources. Application of the new principles will require a new type of interaction with the various organs and personnel of WHO at different levels. External aid which requires excessive concentration on only 1 aspect of health care, such as immunization or control of some forms of diarrhea, is counterproductive and continues past tendencies to impose health goals and programs from outside.