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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[Unpublished] 1980. 39 p. (EPI/GEN/80/1)This report of the Expanded Program on Immunization (EPI) Global Advisory Group Meeting, held during October 1980 in Geneva,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. 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.
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.
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.
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.
[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.
[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.
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.
International Journal of Health Services. 1986; 16(1):121-39.This article analyzes the patterns of health sector aid to India since 1947, summarizing criticisms such as the extension of dependency relationships, inappropriate use of techniques and models (maintenance costs of large projects are often too high for poor undeveloped countries), and Malthusianism in population programs. The major source of foreign assistance has been the US, amounting to US$107 million from 1950-1973; this figure is broken down to detail which foundations and agencies provided assistance, and how much, over this time period. Foreign assistance for family planning is also discussed. Most health policies adopted in India today predate independence and were present in plans established by the British. New patterns in health aid are described, such as funding made available in local currency to be spent on primary care and especially maternal and child health. The focus of foreign aid has been preventive in emphasis and oriented towards the primary care sector. In some periods it has contributed a substantial share of total public sector expenditures, and in some spheres, it has played a major role, particularly the control of communicable diseases. However, the impact of less substantial sums going to prestige medical colleges or to population control programs should not be ignored. Several aid categories have been of dubious origin (PL-480 counterpart funds and US food surpluses as the prime examples). However, the new health aid programs do not deserve the ready dismissal they have received in some quarters.
New York, New York, United Nations, 1985. v, 58 p. (Economic and Social Council Official Records, 1985. Supplement No. 10; E/1985/31; E/ICEF/1985/12)The major decisions of the UN Children's Fund Executive Board in their 1985 session were to: approve several new program recommendations and endores a major emergency assistance program for several African countries; approve initiatives to accelerate the implementation of child survival and development actions, particularly towards the goal of achieving universal immunization of children against 6 major childhood diseases by 1990; adopt a comprehensive policy framework for UN International Children's Emergency Fund (UNICEF) programs concerning women; approve UNICEF revised budget estimates for 1984-85 and budget estimates for 1986-87; and make a number of decisions on ways to improve the administration and the role of the Board. The Board members both reported on and heard evidence of the encouraging results of recent efforts to implement national child survival and development programs. Reports of the successful immunization campaigns in Burkina Faso, Colombia, El Salvador, and Nigeria were welcomed, along with the news that half a million children were saved during the year through the use of oral rehydration therapy. Stronger efforts were encouraged to improve results in the areas of breastfeeding and growth monitoring. Implementation issues in connection with child survival and development actions were a continuing focus of Board attention during the session. The accelerated implementation of child survival and development actions was accorded the highest priority in approving the medium-term plan for 1984-88. The Board also adopted a resolution that sought to draw the attention of world leaders, during their observance of the 40th anniversary of the UN, to the importance of reaffirming their commitment to accelerate the implementation of the child survival and development resolution and realizing universal immunization by 1990. Delegations commended the results of the World Health Organization/UNICEF joint nutrition support program but noted that malnutrition among women and children appeared to be increasing. Water supply and sanitation activities were encouraged, and the Board stressed that those actions should be linked with health and hygiene education. The Board endorsed the report on recent UNICEF activities in Africa. Many delegations spoke in support of the increased aid to Africa. Major emphasis was given to linking emergency responses with ongoing UNICEF programs. The Board approved new multi-year commitments from general resources totalling $303,053,422 for 28 country and interregional programs and noted 32 projects totaling $223,215,000 to be funded from specific-purpose contributions. The Board stressed the importance of ensuring that child survival and development actions were integrated with continuing efforts in other of UNICEF action. The Board approved a commitment of $252,550,443 for the budget for the biennium 1986-87.
The World Health Organization's Expanded Programme on Immunization: a global overview. Le Programme Elargi de Vaccination de L'Organization Mondiale de la Sante: apercu mondial.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(2):232-52.In recognition that immunization is an essential element of primary health care, the World Health Organization (WHO), with other agencies, is sponsoring the Global Program on Immunization whose goal is to reduce morbidity and mortality from vaccine-preventable diseases by providing immunization for all children of the world by 1990. A global advisory group of experts meets yearly to review the program. This paper summarizes the most salient features of the 1984 meeting. The major event for the Expanded Program on Immunization (EPI) in 1984 was the Bellagio Conference on protecting the world's children. Activities undertaken as a result of this conference are discussed. 1 outcome was the formation of the Task Force for Child Survival whose main objective is to promote the reduction of childhood morbidity and mortality through acceleration of key primary health care activities. Focus is on supporting Colombia, India and Senegal in accelerating the expansion of their immunization programs and strengthening other elements of primary health care, such as diarrheal diseases control, family planning and improved nutrition. The 5-point action program consists of the following components: promoting EPI within the context of primary health care; investing adequate human resources in EPI; ensuring that programs are continuously evaluated and adapted so as to achieve high immunization coverage and maximum reduction in target-disease deaths and cases; and pursuing research efforts as part of program operations. EPI has continued to collaborate with other programs to help assure that immunization services are provided to support delivery of other services. Integration of EPI in Africa, the Americas, the Eastern Mediterranean Region, Europe, the South-East Asia Region, and the Western Pacific Region is examined.
Geneva, Switzerland, World Federation of Public Health Associations [WFPHA], 1984 Aug. vii, 78 p. (Information for Action)This bibliograph contains 4 parts. Part 1 is anannotated bibiography covering the following topics: an overview of health care in developing countries; planning and management of primary health care (PHC): manpower training and utilization; community participation and health education; delivery of health services, including nutrition, maternal and child health, family planning, medical and dental care; disease control, water and sanitation, and pharmaceutical; and auxiliary services, Part 2 is a reference directory covering periodicals directories, handbooks and catalogs, in PHC, as well as computerized information services, educational aids and training programs, (including audiovisual and other teaching aids), and procurement of supplies and pharmaceuticals. Also given are lists of international and private donor agencies, including development cooperation agencies, and directories of foundations and proposal writing. Parts 3 and 4 are the August 1984 updates of the original May 1982 edition of the bibliography.
Who Chronicle. 1984; 38(3):109-15.The theme of the 1984 World Health Day--children's health, tomorrow's wealth--provides an occasion to convey to a worldwide audience the message that children are a priceless resource, and that any nation which neglects them does so at its peril. World Health Day 1984 spotlights the basic truth that the healthy minds and bodies of the world's children must be safeguard, not only as a key factor in attaining health for all by 2000, but also as a major part of each nation's health in the 21st century. An investment in child health is a direct entry point to improved social development, productivity, and quality of life. Care of child health starts before conception, through postponement of the 1st pregnancy until the mother herself has reached full physical maturity, and through spacing of births. It continues from conception on, through suitable care during pregnancy, childbirth, and childhood. In the developing countries the child must be protected by all available means, particularly from the killer diseases. What happens in the immediate family and community around the mother and child, and even far away in the world, can have a direct impact on the health and security of both of them. The mother and child need to be placed in an environment that will ensure their health by protecting the overall setting in which they live. This means providing clean water, disposing of waste, and helping to improve shelter. Nothing can diminish the importance of good food, enough food, and proper nutrition for children and their mothers. Beyond the immediate physical needs are the equally important needs for love and understanding which stimulate the healthy development of the child. The emergence of new health problems of mothers and children in developing and developed countries should be kept in mind. Better health services must be made available to all who need them. The World Health Organization (WHO) provided resource material on World Health Day issues for dissemination throughout the world. Extracts from 4 articles on this year's theme are reproduced. The articles report on the success of the Rural Health Center in Ballabhgarh (India) in reducing maternal and infant mortality, the value of breastfeeding as 1 of the simplest and safest ways of ensuring adequate spacing of births, Tunisia's integration of a program of immunization into the routine activities of the health care system, and the needs of the healthy child.
Who Chronicle. 1984; 38(2):47-59.The 73rd session of the World Health Organization's (WHO) Executive Board met in January 1984 to review progress in implementing strategies for health for all by the year 2000, based on information emanating from the countries themselves. This monitoring function was assigned to the Board by the World Health Assembly in 1981 and calls for the Board to evaluate progress towards health for all at regular intervals and to report back to the Health Assembly. The 1st country reports together with comments of the regional committees and relevant information provided by theSecretariat were examined in November 1983 by the Board's Program Committee. Emphasis at this stage was placed on reviewing the relevance of national health policies to the attainment of health for all and the progress being made in implementing national strategies. Actual evaluation of the strategies will begin in 1985. As many of the country reports submitted were not as complete or as accurate as they could have been, the overall progress report submitted were not as complete or as accurate as they could have been, the overall progress report suffered from a lack of detailed and precise informattion on many important aspects that were crucial to national health for all strategies. Dr. Brandt, presenting the Program Committee's views, told the board that the report did indicate that a high level of political sensitization had occurred and that the political will to attain the goal of health for all existed in a large majorithy of the countries that had reported. The report indicated that to a large extent the Secretariat had met its responsibilities. It was the Member States that had to shoulder the responsibility and reaffirm their commitment by action. The Program Committee's progress report points to the existence of specific technical needs, particularly in national capability to carry out health policies. Among the areas requiring strengthening are information analysis and management, financial analysis, assessment of status of public information, competence in planning and management, effective involvement of relevant sectors in health, and measurement of intersectoral action for health. The Board urged Member States to give highest priority to the continuing monitoring and evaluation of their health for all strategies and to assume full responsibility for this process. In regard to the action program on essential drugs and vaccines, priority in the last 2 years has gone to training and manpower development, the dissemination of experience and information, cooperation in the procurement and production of essential drugs, technical cooperation among developing countries, and contracts with nongovernmental organizations and the pharmaceutical industry. During the far ranging discussion that ensued in the Executive Board, members addressed themselves in considerable detail to numerous aspects of the action program. The Board approved a new and carefully phased procedure for the review of substances to be recommended for international drug control.
Public Health Reviews. 1982 Jul-Dec; 10(3-4):223-7.Throughout the world and particularly in the developing and underdeveloping countries the health situation is less than satisfactory. In their report O'Mahoney and Dahlqvist listed 31 countries as being the least developed and with an average life expectancy of 45 years and 200/1000 children born dying within a year. With a world population of 4 billion people, 10 countries in the World Health Organization (WHO) South East Asian region alone have a population of about 1 billion. The common enemies of the population of this region are hunger, poverty, and ignorance. The health problems which are responsible for high morbidity and mortality are protein energy malnutrition, which aggravates the already prevalent common infectious diseases, and gastrointestinal infections due to bacteria and parasites. Tuberculosis, malaria, and acute hemorrhagic fever also require attention. The situation is worsened by very high birthrates (30-40/1000), resulting in high population growth rates (1.8-3.0%) in many countries in this region. The impact of medical care on health, not to mention health coverage, is only temporary. Health depends on a simple effective system within a community whose members are alert to their own health, since the number of professional medical personnnel will never suffice. Health is as much everyone's right as everyone's responsibility. It is essential to gear the education of the health professionals to the true needs of the people. The public requires a new kind of physician who is willing to attack the health needs of a total population and is committed to preventing, promoting, and rehabilitating as well as curing. Physicians need to be concerned with socioeconomic and health problems, and students must be trained to function as members of a larger group of health personnel, i.e., of a health care team. At the 30th World Health Assembly, held in May 1977, it was resolved that primary social target of WHO and its member states should be the attainment by the year 2000 of a level of health that will allow all the worlds' citizens to lead socially and economically productive lives. Essential elements for health as suggested by the Director General of WHO include: adequate food and housing; adequate supply of safe drinking water; suitable waste disposal; maternal and child health and family planning; immunization against major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; health education; and the provision of essential drugs. These are guidelines; each individual country has to work out its own strategies.
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):546-53.Control of measles in tropical Africa has been attempted since 1966 in 2 large programs; recent evaluation studies have pinpointed obstacles specific to this area. Measles epidemics occur cyclically with annual peaks in dry season, killing 3-5% of children, contributing to 10% of childhood mortality, or more in malnourished populations. The 1st large control effort was the 20-country program begun in 1966. This effort eradicated measles in The Gambia, but measles recurred to previous levels within months in other areas. The Expanded Programme on Immunization initiated by WHO in 1978 also included operational research, technical assistance, cooperation with other groups such as USAID, and development of permanent national programs. Cooperative research has shown that the optimum age of immunization is 9 months, and that health centers are more efficient at immunization, but mobile teams are more cost-effective as coverage approaches 100%. 53 evaluation surveys have been done in 17 African countries on measles immunization programs. Some of the obstacles found were: rural population, underdevelopment of infrastructure, and exposure of unprotected infants contributing to the spread of measles. Measles surveillance is so poor that less than 10% of expected cases are reported. People are apathetic or unaware of the importance of immunization against this universal childhood disease. Vaccine quality is a serious problem, both from the lack of an adequate cold chain, and lack of facilities for testing vaccine. The future impact of measles control from the viewpoint of population growth and health of children offers many fine points for discussion.
[Geneva, Switzerland], WHO, 1982. 17 p. (HRG/CRU.1/Rev.1/Mtg.1)In 1979, a WHO team collaborated with national personnel in The Gambia in developing a comprehensive primary health care (PHC) plan of action for the period 1980/81 - 1985/86. In his address to the legislature in August, 1980, the president declared that the plan involved the active participation of local communities and emphasized programs for health promotion and disease prevention. This monograph reports on a meeting of the Gambian Ministries of Economic Planning and Industrial Development and of Health, Labor and Social Welfare in June 1982. Improvements in rural health are a basic need. In order to provide PHC, it was fully realized that a strong supportive infrastructure was essential. The village sensitization program was considered as vital for success. Not 1 village has rejected PHC or its responsibilities. The training program for community health nurses, village health workers and traditional birth attendants was proceeding according to plan for the various levels. Recognizaing that an efficient drug supply was essential, concomitant action had been taken to reorganize the central store. Another essential element without which success could not be achieved related to provision of transport and facilities for their maintenance, so that communications could be assured with rural areas. The need for a radio network to link 6 staions and 26 sub-stations was stresses. The list of participants and the agenda are attached as are the requirements for external support for the planned provision of PHC which were considered by the participants of the meeting.