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Estimating the value of point-of-care HPV testing in three low- and middle-income countries: a modeling study.
BMC Cancer. 2017 Nov 25; 17(1):791.BACKGROUND: Where resources are available, the World Health Organization recommends cervical cancer screening with human papillomavirus (HPV) DNA testing and subsequent treatment of HPV-positive women with timely cryotherapy. Newer technologies may facilitate a same-day screen-and-treat approach, but these testing systems are generally too expensive for widespread use in low-resource settings. METHODS: To assess the value of a hypothetical point-of-care HPV test, we used a mathematical simulation model of the natural history of HPV and data from the START-UP multi-site demonstration project to estimate the health benefits and costs associated with a shift from a 2-visit approach (requiring a return visit for treatment) to 1-visit HPV testing (i.e., screen-and-treat). We estimated the incremental net monetary benefit (INMB), which represents the maximum additional lifetime cost per woman that could be incurred for a new point-of-care HPV test to be cost-effective, depending on expected loss to follow-up between visits (LTFU) in a given setting. RESULTS: For screening three times in a lifetime at 100% coverage of the target population, when LTFU was 10%, the INMB of the 1-visit relative to the 2-visit approach was I$13 in India, I$36 in Nicaragua, and I$17 in Uganda. If LTFU was 30% or greater, the INMB values for the 1-visit approach in all countries was equivalent to or exceeded total lifetime costs associated with screening three times in a lifetime. At a LTFU level of 70%, the INMB of the 1-visit approach was I$127 in India, I$399 in Nicaragua, and I$121 in Uganda. CONCLUSIONS: These findings indicate that point-of-care technology for cervical cancer screening may be worthy of high investment if linkage to treatment can be assured, particularly in settings where LTFU is high.
Journal of Human Lactation. 2012 Aug; 28(3):272-5.The BFHI provides a framework for addressing the major factors that have contributed to the erosion of breastfeeding, that is, maternity care practices that interfere with breastfeeding. Until practices improve, attempts to promote breastfeeding outside the health service will be impeded. Although inappropriate maternity care cannot be held solely responsible for low exclusive breastfeeding rates and short breastfeeding duration, appropriate care may be a prerequisite for raising them. In many industrialized countries, BFHI activities were slow to start. Over the past 10 years and as the evidence was becoming increasingly solid and the commitment of health workers and decision makers has become stronger, considerable efforts are being made in most industrialized countries to implement the BFHI. However, coordinators of the BFHI in industrialized countries face obstacles to successful implementation that appear unique to these countries. Problems reported include opposition from the health care establishment, lack of support from national authorities, and lack of awareness or acceptance of the need for the initiative among government departments, the health care system, and parents. It is worth highlighting these facts to enable the BFHI coordinators in these countries to make well-designed and targeted plans with achievable objectives. Strengthening and scaling up the BFHI is an undisputed way to reduce infant mortality and improve quality of care for mothers and children. The BFHI has had great impact on breastfeeding practices. Reflecting new infant feeding research findings and recommendations, the tools and courses used to change hospital practices in line with Baby-Friendly criteria are available and ready to be used and implemented. Governments should ensure that all personnel who are involved in health, nutrition, child survival, or maternal health are fully informed and energized to take advantage of an environment that is conducive to revitalizing the BFHI; incorporate the basic competencies for protection, promotion, and support of optimal infant and young child feeding, including the BFHI, into all health-worker curricula, whether facility- or community-based health workers; and recognize that the BFHI has a major role to play in child survival and more so in the context of HIV/AIDS. The World Health Organization and UNICEF strongly recommend using this new set of materials to ensure solid and full implementation of the BFHI global criteria and sustain progress already made. It is one way of improving child health and survival, and it is moving ahead to put the Global Strategy for Infant and Young Child Feeding in place, thus moving steadily to achieving the Millennium Development Goals.
Bulletin of the World Health Organization. 2011 Apr 1; 89(4):267-77.OBJECTIVE: To cross-validate the global cost of scaling up child survival interventions to achieve the fourth Millennium Development Goal (MDG4) as estimated by the World Health Organization (WHO) in 2007 by using the latest country-provided data and new assumptions. METHODS: After the main cost categories for each country were identified, validation questionnaires were sent to 32 countries with high child mortality. Publicly available estimates for disease incidence, intervention coverage, prices and resources for individual-level and programme-level activities were validated against local data. Nine updates to the 2007 WHO model were generated using revised assumptions. Finally, estimates were extrapolated to 75 countries and combined with cost estimates for immunization and malaria programmes and for programmes for the prevention of mother-to-child transmission of the human immunodeficiency virus (HIV). FINDINGS: Twenty-six countries responded. Adjustments were largest for system- and programme-level data and smallest for patient data. Country-level validation caused a 53% increase in original cost estimates (i.e. 9 billion 2004 United States dollars [US$]) for 26 countries owing to revised system and programme assumptions, especially surrounding community health worker costs. The additional effect of updated population figures was small; updated epidemiologic figures increased costs by US$ 4 billion (+15%). New unit prices in the 26 countries that provided data increased estimates by US$ 4.3 billion (+16%). Extrapolation to 75 countries increased the original price estimate by US$ 33 billion (+80%) for 2010-2015. CONCLUSION: Country-level validation had a significant effect on the cost estimate. Price adaptations and programme-related assumptions contributed substantially. An additional 74 billion US$ 2005 (representing a 12% increase in total health expenditure) would be needed between 2010 and 2015. Given resource constraints, countries will need to prioritize health activities within their national resource envelope.
Southern Med Review. 2011 Dec; 4(2):15-21.Objectives: Although poor reproductive health constitutes a significant proportion of the disease burden in developing countries, essential medicines for reproductive health are often not available to the population. The objective was to analyze the guiding principles for developing national Essential Medicines Lists (EML). The second objective was to compare the reproductive health medicines included on these EMLs to the 2002 WHO/UNFPA list of essential drugs and commodities for reproductive health. Another objective was to compare the medicines included in existing international lists of medicines for reproductive health. Methods: The authors calculated the average number of medicines per clinical groups included in 112 national EMLs and compared these average numbers with the number of medicines per clinical group included on the WHO/UNFPA List. Additionally, they compared the content of the lists of medicines for reproductive health developed by various international agencies. Results: In 2003, the review of the 112 EMLs highlighted that medicines for reproductive health were not consistently included. The review of the international lists identified inconsistencies in their recommendations. The reviews' outcomes became the catalyst for collaboration among international agencies in the development of the first harmonized Interagency List of Essential Medicines for Reproductive Health. Additionally, WHO, UNFPA and PATH published guidelines to support the inclusion of essential medicines for reproductive health in national medicine policies and EMLs. The Interagency List became a key advocacy tool for countries to review their EMLs. In 2009, a UNFPA/WHO assessment on access to reproductive health medicines in six countries demonstrated that the major challenge was that the Interagency List had not been updated recently and was inconsistently used. Conclusion: The addition of cost-effective medicines for reproductive health to EMLs can result in enhanced equity in access to and cost containment of these medicines, and improve quality of care. Action is required to ensure their inclusion in national budget lines, supply chains, policies and programmatic guidance.
Coordination, management and utilization of foreign assistance for HIV / AIDS prevention in Vietnam. Assessment report.
Ha Noi, Vietnam, CCRD, 2006 Oct. 82 p. (CCRD Assesssment Report)International assistance for HIV / AIDS prevention and control in Vietnam has significantly contributed to combating this epidemic. However, while current resources have not yet fully met the needs, the management and utilization of resources still had many limitations which affect the effectiveness of foreign assistance and investments. The independent assessment was prepared for the Conference on “the Coordination of Foreign Assistance for HIV / AIDS Prevention and Control”. Analytical assessment and comments on the management and coordination of foreign aid were made on the basis of Government’s official procedures and regulations on those issues. This research was carried out in October, 2006.
International Journal of Health Planning and Management. 2006 Oct-Dec; 21(4):297-312.After the break-up of the Soviet Union, the country of Georgia suffered from intense civil unrest and socio-economic deterioration, which particularly affected the health sector. To remedy the situation, the government initiated health sector reform, which introduced major changes in healthcare financing in Georgia: the previously free healthcare model was replaced by social insurance, and patients were required to pay out-of-pocket for services not covered by insurance. This paper is an attempt to determine if the health system of Georgia is reaching the WHO health system goals of improved health status, responsiveness to patients' needs (consumer satisfaction), and financial risk protection as a result of health reforms. (author's)
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1987; (749):1-86.This report makes a special effort to present practical information on the control of intestinal parasitic infections. It covers the following: public health significance of intestinal parasitic infections (methods of assessment, helminthic infections, and protozoan infections); the costs of not having a control program (nutrition, growth, and development; work and productivity; and medical care); prevention and control strategies (epidemiological foundation, objectives and general approaches, implementation strategies, costs and financing, methodologies and tools, and strategy for prevention and control); national programs (justification; objectives and strategies; planning; program and implementation; training, education, and dissemination of information; program monitoring and evaluation; and technical guidance); and program support (the role of the World Health Organization, technical and research organizations, funding agencies, industry, and information flow). Current experience suggests that intestinal parasite control programs are appropriate and socially advantageous because people can actually see the effects of primary health care intervention and start to learn some simple facts about health care by watching their village or community become healthier as a result of the control measures. There are 3 major areas in which the lack of control program is responsible for significant losses: nutrition, growth, and development; work and productivity; and medical care costs. Countries in which intestinal parasitic infections and diseases constitute a significant health problem need to consider adopting a national policy for their prevention and control. Recent experience in various countries has demonstrated the effectiveness of periodic deworming and standard case management at the primary health care level in reducing most of the problems associated with intestinal parasitic infections. Support can come from outside the country as well as from national authorities. Support from the outside may be available in the areas of management, technical expertise (which includes research), funding, and exchange of relevant information. The World Health Organization can provide both technical and managerial expertise in the design of programs.
WHO Programme in Maternal and Child Health and Family Planning. Report of the second meeting of the WHO Programme Advisory Committee in Maternal and Child Health, Geneva, 21-25 November 1983.
[Unpublished] 1984. 95 p. (MCH/84.5)The objectives of the 2nd meeting of the Program Advisory Committee (PAC) for the World Health Organization's (WHO's) Program in Maternal and Child Health, including Family Planning (MCH/FP) were to 1) assess the MCH/FP program's achievements since the 1st PAC meeting in June, 1982, 2) determine the level of scientific and financial resources available for the program, and 3) to examine the role of traditional birth attendants (TBAs) in the delivery of MCH/FP services. The committee reviewed the activities and targets of the program's 4 major areas (pregnancy and perinatal care, child health, growth, and development, adolescent health, and family planning and infertility), and developed a series of recommendations for each of these areas. Specific recommendations were also made for each of the major program areas in reference to the analysis and dessimination of information and to the development and use of appropriate health technologies. Upon reviewing the role of TBAs in the delivery of MCH/FP services, PAC recommended that all barriers to TBA utilization be removed and that training for TBAs should be improved and expanded. PAC's examination of financial support for MCH/FP activities revealed that for a sample of 26 countries, the average annual amount allocated to MCH activities was less than US$3/child or woman. This low level of funding must be taken into account when setting program targets. International funding agencies did indicate their willingness to increase funding levels for MCH programs. The appendices included 1) a list of participants, 2) an annotated agenda, 3) detailed information on the proposed activities of the program's headquarters for 1986-87, and 4) a description of the the function, organizational structure, and technical management of the MCH/FP program. Also included in the appendices was an overview of the current status of MCH and a series of tables providing information on infant, child, and maternal health indicators. Specifically, the tables provided information by region and by country on maternal, child, and infant mortality; causes of child deaths; maternal health care coverage; contraceptive prevalence; infant and child malnutrition; the number of low weight births; adolescent health; teenage births; breast feeding prevalence and duration; and the proportion of women and children in the population.
[Unpublished] 1984. 27 p.The current status of the Control of Diarrhoeal Diseases (CDD) Program was reviewed, and activities related to the evaluation of country control programs, the assessment of potential diarrheal disease control interventions, and the program's operational research activities were examined. In the health services component, ciontinued efforts to promote the preparation of plans of operation for national CDD programs is recommended, as is continued use of the national CDD program managers training course. Concern was expressed that the level of use of oral rehydration therapy (ORT) appeared to be modest. Case management was endorsed as the major program strategy. The series of studies on interventions for reducing diarrhea's mortality and morbidity were welcomed. For evaluation purposes, it is recommended that the program develop additional criteria for monitoring increased access to and usage of oral rehydration salts (ORS) and the reduction of diarrheal mortality. Continued accumulaton and publication of information yielded by the program's survey of the impact of ORT in hospitals was recommended. In the research component, the growth of research activities is satisfying. While biomedical aspects have developed well, it might be necessary to relate them gradually to specific control interventions in the future. Further studies of improved ORS formulatons were recommended. High priority should also be given to the promotion of breast feeding, immunization, and water supply and sanitation. The underlying mechanisms that cause the intervention to reduce diarrheal morbidity or mortality should be clarified. Research is recommended on the promotion of personal and domestic hygiene, food hygiene, and improved weaning practices. Emphasis on the development and evaluation of vaccines against the causes of diarrhea is supported. Some changes in the balance of research activities should be made. Epidemiological weak.
Paper presented at the Nineteenth Session of the UNICEF/WHO Joint Committee on Health Policy, Geneva, February 1-2, 1972. 40 pFamily planning is an integral part of the health care of the family and has a striking impact of the health of the mother and children. Many aspects of family planning care require the personnel, skills, techniques, and facilities of health services and is thus of concern to UNICEF and WHO. Once individual governments have determined basic matters of family planning policy and methods, UNICEF and WHO can respond to requests for assistance on a wide range of activities, with the primary goal being the promotion of health care of the family. Emphasis will be placed on achieving this by strengthening the basic health services that already have a solid foundation in the community. The past experience of UNICEF and WHO should provide valuable guidance for assistance to the health aspects of family planning, particularly as they relate to the planning and evaluation of programs; organization and administration; public education; the education and training of all medical personnel; and the coordination of family health activities both inside and outside the health sector. The review recommends that UNICEF and WHO first regard the capacity of the host country to absorb aid and maintain projects, and that specific family planning activities, such as the provision of supplies, equipment, and transport, be introduced only when the infrastructure is actually being expanded. Capital investment should be viewed in relation to the government's ability to meet budgetary and staff requirements the new facilities demand.
Project appraisal document on a proposed loan of US $10.0 million and a proposed credit of SDR 36.8 million to the People's Republic of China for a Health Nine project.
Washington, D.C., East Asia and Pacific Region, Human Development Sector Unit, 1999 Apr 14. , 63 p. (Report No. 19141-CHA)This project appraisal document of the World Bank details the proposed loan of US $10 million and a proposed credit of special drawing right for nine health projects in the People's Republic of China.
New York, New York, United Nations Population Fund [UNFPA], 1999. v, 68 p. (Evaluation Report No. 18)This thematic evaluation examines the relevance, efficiency, effectiveness and sustainability of support from the UN Population Fund (UNFPA) for projects and interventions related to the prevention of HIV infection and AIDS. The first chapter introduces the thematic evaluation, while chapter 2 discusses approaches that UNFPA adopted to integrate HIV/AIDS concerns into country programs. Specific strategies and modalities used by UNFPA to integrate content concerning HIV and AIDS into training or to implement specific HIV/AIDS training for health service providers and non-health personnel is described in chapter 3. Chapter 4 discusses the extent of UNFPA support for distributing and promoting condoms or ensuring the availability of and accessibility to condoms in support of HIV/AIDS prevention. Chapter 5 focuses on the relevance, efficiency, effectiveness and sustainability of information, education and communication (IEC) strategies and modalities, including IEC materials and channels in support of reproductive health, including STIs and HIV/AIDS; IEC interventions targeted to youth through in-school and out-of-school interventions; and advocacy. Finally, recommendations on program strategies program management, coordination and collaboration, training, condoms, IEC communication for behavior change; and advocacy is presented in chapter 6.
Washington, D.C., Population Reference Bureau, 1998 Nov. 32 p.This study is one of a number of case studies coordinated by the Population Reference Bureau (PRB), covering four countries (Morocco, Uganda, Brazil, and India). The objective of the case studies is to determine how central elements of the ICPD [International Conference on Population and Development] Programme of Action have been implemented and to identify achievements and obstacles. The present study on Morocco contains sections on demographic trends, the policy environment for reproductive health, the status of women, reproductive health programs and services, individuals' perceptions of services, and sources of financing for reproductive health care, 1991-1998. (EXCERPT)
Washington, D.C., Futures Group International, POLICY Project, 1998 Sep. vii, 69 p.This report presents case studies of reproductive health (RH) and family planning programs and policies in Bangladesh, India, Nepal, Ghana, Jordan, Senegal, Jamaica, and Peru. Data were obtained from in-depth interviews among 20-44 individuals in each country who were key representatives of population and RH government ministries, parliaments, academia, nongovernmental organizations, women's groups, donor agencies, and health care staff. Findings focus on the following topics: RH context; the policy process; participation, support, and opposition; policy implementation; financial resources; and general implementation. Progress is gauged based on improving knowledge of stakeholders; planning for integrated and decentralized services; developing human resources; improving quality of care; addressing legal, social, and regulatory issues; clarifying donors' role; and maintaining long-term aims. All countries made considerable, though limited, progress according to the mandates of the 1994 Cairo Plan of Action. Population size ranges from 2.6 million in Jamaica to nearly 1 billion in India. The countries vary in level of urbanization, literacy, fertility, contraceptive prevalence, infant mortality, maternal mortality, and prenatal care and delivery. Although the social, cultural, and economic contexts vary, all countries have a subordinate role for women. All countries struggled with setting priorities, financing, and implementation. Bangladesh made the greatest progress. Jordan still emphasizes mostly family planning. India, Nepal, Jordan, Senegal, and Peru will need donor funding to advance a broad constellation of services.
Lessons learned from experience in World Bank population, health and nutrition projects in Africa: a synthesis of implementation completion reports.
Washington, D.C., World Bank, Africa Region, Human Resources and Poverty Division, 1995 Dec. iv, 26 p. (AFTHR Technical Note No. 20)The lessons learned from 13 World Bank-supported projects that were begun in Africa during the 1980s and completed as of November 1994 are summarized. The projects were all related to population growth, health, or nutrition issues and were implemented in 11 African countries. The appendices contain a description of the projects and the main findings in annexes pertaining to basic data, an overview of project cost and financing, methods of and quality of assessments, and lessons learned by country. The results were viewed as positive but uneven in quality. The successful or satisfactory projects were located in Malawi, Senegal, Lesotho, Botswana, Rwanda, and Ghana. Mali and Guinea-Bissau had two unsatisfactory projects. Four projects in Comoros, Kenya, and Nigeria had mixed results. 45% of project aims were satisfactorily completed. Over 80% of aims were implemented and at least partially satisfactory. Most of the difficulties arose in management and management capacity. None of the projects attempted to achieve some cost recovery despite the stated project goal of cost recovery. The World Bank financed under 60% of projects. It is suggested that future projects examine institutional capacity within the project agency and the overall social and political environment in which projects operate. Attention must be directed to the issue of whether implementing organizations are able to cooperate. Design problems were found to increase during project implementation. These projects were considered successful in terms of strengthened capacity of health institutions and national health planning. Family planning and cost recovery issues were successfully introduced and accepted for the most part. The main failures are identified as the unrealistic assessment of the host country's capacity to implement the project, inadequate double-checking at the design stage for problems, and the lack of sustainability of programs.
WORLD HEALTH FORUM. 1993; 14(4):333-44.WHO evaluated the implementation of the health-for-all strategy using data from 151 countries. 110 countries still endorsed the strategy. 95 have either completely implemented or further developed community involvement. Just 33 countries had more equitable distribution of resources. The percentage of gross national product (GNP) that the government dedicated to health rose in the least developed countries. Developed countries spent a higher proportion of their GNP on health than did developing countries (3.3% vs. 0.9%, 1991). Maldistribution of health personnel continued to be a major problem. Between 1985 and 1990, the proportion of people in developing countries with access to safe water rose from 68 to 75%. Adequate sewage disposal coverage rose from 46 to 71% (1985-1991). Prenatal care coverage by trained personnel increased from 58 to 67%. Tetanus toxoid coverage of pregnant women only increased from 24 to 34%. Most maternal deaths were a result of inadequate prenatal care, inadequate care during childbirth, pregnancies spaced too closely, multiparity, and poor health and nutritional status before the first pregnancy. Immunization coverage rose considerably in every region (e.g., 47-83% for diphtheria). Nevertheless, substantial differences in coverage existed between countries. A substantial trend towards more integrated primary health care occurred. Child survival rates improved, but the gap in infant mortality rates between developed countries and the least developed countries widened. The gap in health status between the poor and the wealthy had become larger. Developing countries in the process of the epidemiological transition continued to be burdened with both infectious and degenerative diseases. GNP and adult literacy rose, but less so in the least developed countries. These findings suggested that governments must sustain the commitment to reduce inequities, realign health systems, improve health financing systems, improve coordination between health sectors, and improve linkage between health and development.
Arlington, Virginia, John Snow [JSI], Resources for Child Health [REACH], 1988 Sep. , 99,  p. (USAID Contract No. DPE-5927-C-00-5068-00)Building upon smallpox and measles immunization campaigns originally supported by USAID, the Centers for Disease Control, and the World Health Organization, the African region Combatting Childhood Communicable Diseases (CCCD) Project began providing immunizations, oral rehydration therapy for children with diarrhea, and malaria prophylaxis services in 1982. The project was approved in September, 1981, for spending of $47 million through fiscal 1988, and was designed to be implemented through existing publicly operated health service delivery systems with recipient CCCD project countries helping to finance recurrent costs and providing human resources for project implementation. Accordingly, almost all country project agreements were written to ensure that country governments would provide financial support for activities through direct budget allocations, user fees, or some combination of the 2. Regular analyses of service provision were also agreed upon. The development and implementation of user fees have taken place, but the overall theoretical financial strategy has yet to be met in any country project. This document discusses financing achievements and what more is needed to ensure longer term project financial sustainability. Sections review country-specific agreements to spell out original USAID/country terms on financing components; consider the capacity of CCCD project governments to finance recurrent costs in their respective macroeconomic contexts; present highlights of a review of CCCD project financing activities; summarize an evaluation of alternative health financing options; give conclusions of analyses on the financial sustainability of CCCD project activity; and make recommendations for future USAID CCCD project support with respect to financing and economics.
PUBLIC HEALTH REPORTS. 1980 Sep-Oct; 95(5):422-6.The implications of the eradication of smallpox in the context of epidemiology are presented. Eradication of disease has been conceived since the 1st smallpox vaccination was developed in the 18th century. Since then, attempts to eradicate yellow fever, malaria, yaws and smallpox have been instituted. Most public health professionals have been rightfully skeptical. Indeed, the success with smallpox was fortuitous and achieved only by a narrow margin. It is unlikely that any other disease will be eradicated, lacking the perfect epidemiological characteristics and affordable technology. The key to success with smallpox was the principle of surveillance. This concept has a vigorous developmental history in the discipline of epidemiology, derived from the work of Langmuir and Farr. It involves meticulous data collection, analysis, appropriate action and evaluation. In the case of smallpox, only these techniques permitted the key observations that smallpox vaccination was remarkably durable, and that effective reporting was fundamental for success. The currently popular goal of health for all, through horizontal programs, is contrary to the methods of epidemiology because its objective is vague and meaningless, no specific management structure is envisioned, and no system of surveillance and assessment is in place.
EPI in the Americas. Report to the Global Advisory Group Meeting, Alexandria, Egypt, 22-26 October 1984.
[Unpublished] 1984. 15 p.This discussion of the Expanded Program on Immunization (EPI) in the Americas covers training, the cold chain, the Pan American Health Organization's (PAHO) Revolving Fund for the purchase of vaccines and related supplies, evaluation, subregional meetings and setting of 1985 targets, progress to date and 1984-85 activities, and information dissemination. All countries in the Region of the Americas are committed to the implementation of the EPI as an essential strategy to achieve health for all by 2000. During 1983, over 2000 health workers were trained in program formulation, implementation, and evaluation through workshops held in Argentina, Brazil, Cuba, El Salvador, and Uruguay. From the time EPI training activities were launched in early 1979 through 3rd quarter 1984, it is estimated that at least 15,000 health workers have attended these workshops. Over 12,000 EPI modules have been distributed in the Region, either directly by the EPI or through the PAHO Textbooks Program. The Regional Focal Point for the EPI cold chain in Cali, Colombia, continues to provide testing services for the identification of suitable equipment for the storage and transport of vaccines. The evaluation of solar refrigeration equipment is being emphasized increasingly. PAHO's Revolving Fund for the purchase of vaccines and related supplies received strong support from the UN International Children's Emergency Fund (UNICEF), which contributed US $500,000, and the government of the US, which contributed $1,686,000 to the fund's capitalization. These contributions raise the capitalization level to US $4,531,112. Most countries are gearing their activities toward the increase of immunization coverage, particularly to the high-risk groups of children under 1 year of age and pregnant women. To evaluate these programs, PAHO has developed and tested a comprehensive multidisciplinary methodology for this purpose. Since November 1980, 18 countries have conducted comprehensive EPI evaluations. 6 countries also have had followup evaluations to assess the extent to which the recommendations from the 1st evaluation were implemented. At each subregional meeting, participants met in small discussion groups to review each other's work plans and discuss appropriate targets for the next 2 years. Immunization coverage has improved considerably in the Americas over the last several years. Figure 2 plots the incidence rates of polio, tetanus, diphtheria, whooping cough, and measles from 1970-83 in the 20 countries which make up the Latin American subregion. If all countries meet their 1985 targets, immunization coverages for DPT and polio will range from 60-100%, with most countries attaining coverages of over 80%. For measles, 1985 targets range from 50-95%, and from 70-99% for BCG. The main vehicle for dissemination of information is the "EPI Newsletter," which publishes information on program development and epidemiology of the EPI diseases.
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. 8 p. (EPI/CCIS/85.2)This protocol provides a method for using Vaccine Cold Chain Monitors to make periodic reviews of a national cold chain. This protocol is based on experience that has been gained from information from 31 countries and from cold chain reviews in India and Tunisia. The purpose of a cold chain review is to make a nationwide or regionwide review of the effectiveness of the vaccine cold chain; and to find out how best to redirect cold chain development efforts into the areas that most need help. A review method is outlined and should be modified according to local conditions. A cold chain review should take about 7 months to complete and should be timed to precede or coincide with a wider EPI and primary health care review. A timetable is included. For the review: monitor cards are distributed with vaccine shipments from the manufacturers so that cards reach all cold chain stores; at each store in the cold chain and at each transport link, the cold chain monitor arriving with vaccines is checked, and any failures registered by the indicators are recorded on the monitor card; monitor cards are returned to a central office for sorting and analysis; and the results of this analysis then are used as a guide to identify and strengthen the weakest links in the cold chain. How many cold chain monitors are needed for a review depends on the size of the study area and the extent to which the monitors will be used. In general, each dispensary and outreach immunization session should receive at least 1 monitor card that has traveled through the cold chain from the central store during the study period. An extensive training program is needed before the review can begin. All health workers who will handle vaccines during the study must receive some training on how to fill in and interpret the readings on the monitors. Once the materials have been written, this training should be conducted in 3 steps for regional and district supervisors and maternal and child health staff and health assistants who work in health posts and outreach centers. The analysis of the results can be organized in many different ways. Each monitor that has been returned from a health center can have up to 23 items of information on it.
Evaluation of the USAID grant to the International Center for Diarrheal Disease Research, Bangladesh: Maternal and Child Health/Family Planning Extension Project.
Arlington, Virginia, International Science and Technology Institute, Population Technical Assistance Project, 1986 Sep 18. xi, 23,  p. (Report No. 85-68-039)This report evaluates a US Agency for International Development (AID) grant to the International Center for Diarrheal Disease Research, Bangladesh (ICDDR, B), which supports the Maternal and Child Health/Family Planning Extension Project (EP). The EP operations research effort was initially designed to replicate the Matlab model in 2 upazilas, but shifted to an effort to initiate new approaches. Of the 13 major experiment undertaken during the project's 4-year history, over half have adopted by the Ministry of Health and Population Control, including a plan to add 10,000 female welfare assistants to the existing cadres. Considering the accomplishments of the EP to date, there is strong justification for continued funding of the project, at least until 1990 when the government's 5-year Plan concludes. It is recommended that the project's emphasis should continue to be to test various alternative strategies for improved implementation of family planning/maternal-child health programs within the overall framework of a limited number of clearly defined project objectives. The task of analyzing incremental costs should be given higher priority in the next 5 years and project documentation should be refined. The decision as to whether the project should be funded after 1990 or phased out should be deferred until a later date. Also presented in this report are specific recommendations regarding the selection of research topics, research procedures, dissemination of research results, addition of new staff, filling of staff vacancies, and Population Council involvement.
[Unpublished] . iv, 70,  p.To strengthen project development and reinforce the links between the United Nations Family Planning Association (UNFPA) and specialized agencies, it has been proposed to convene a series of meetings between UNFPA Policy and Technical Division/Program Division staff and staff working in the area of population communication. These meetings are further intended to improve ongoing monitoring of UNFPA communication activities, improve the flow of data on new developments in the field, and upgrade the quality of technical project documents. The background documentation and papers in this manual were prepared to serve as a basis for discussion at the meetings. Material is presented in 5 categories: review of trends and changes in population communication, examples of population communication programs assisted by UNFPA, UNFPA policy guidelines, project formulation and evaluation, and UNFPA basic need assessment guidelines. Supplementary papers focus on changes in development models, population communication research, preproject research, and ongoing projects in population communication and education. The documents stress that many IEC activities in developing countries have been based on research models derived from western mass communications research. It is essential that new models of communication research be developed for use in population programs that reinforce the role of community participation in development. UNFPA's main consideration in providing assistance for population education is to develop and strengthen national resources and programs and to improve local capacity for sustained action.
Geneva, Switzerland, WHO, 1985. 110 p.3 World Health Organization (WHO) Scientific Groups have examined different technical aspects of the problem of sexually transmitted diseases and their reports have been published in the Technical Report Series. This book has been prepared following the meeting of a scientific working group that was held in Washington in April 1982 to discuss the formulation of appropriate strategies and programs for the control of this group of diseases. This book emphasizes the need for such programs to be integrated into general programs for the control of communicable diseases and for the gynecologcal, obstetric, pediatric, and urological services to play an active and dynamic part. A control activity for sexually transmitted diseases is any activity which minimizes the adverse health effects of this group of diseases. Control activities may reduce the incidence of the disease; the duration of the disease; the effects of each case, including both the physical complications and psychosocial consequences; or the cost of achieving certain outcomes, i.e., increase the efficiency of services. Many different control activities, for example, clinical services, screening, and contact tracing, can reduce the effects of sexually transmitted diseases. A control program is composed of various control activities. Priorities are established, various options for control are examined, and appropriate methods are adopted. Control programs for sexually transmitted diseases define the population to be covered and specify the control activities related to that group. The 1st section of this book covers initial planning steps, focusing on estimating the public health importance of sexually transmitted diseases, priority groups, and sociological aspects of control. The section devoted to intervention strategies deals with health promotion, disease detection, national treatment programs, contact tracing and patient counseling, and clinical services. The 4 chapters that make up the support components section discuss centers for prevention of sexually transmitted diseases, information systems, professional training, and laboratory services. The 2 chapters devoted to implementation examine program management and evaluation of control programs. This book may appear to suggest that the disease control process should be highly systematic, comprehensive, and compartmentalized. Yet, in practice, many activities take place simultaneously and in a manner that is far from systematic, sequential, and ordered.
Report on the evaluation of various family life education projects with particular emphasis on youth in the English-speaking Caribbean: general conclusions and recommendations.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Nov. xii, 39,  p.Most family life education (FLE) projects included in this evaluation have the longterm objectives of reducing the incidence of teenage prognancy, and promotion of self-reliance and positive, responsible behavior among youth. The immediate objectives and project strategies are also very similar across projects, e.g., in-school and out-of-school FLE, comprehensive youth services, including family planning (FP) and training. The evaluation shows that project design has improved over the years (clearer and measurable formulation of objectives, more comprehensive workplans and better explanation of budgetary items) and projects have moved from addressing a wide variety of broad issues to a more focused consideration of adolescent fertility. However, the Evaluation Mission in concerned that due to the similarities in project design, country-and-time-specific factors have not always been adequately taken into consideration. Other concerns include the lack of systematic needs assessment and use of baseline data to guide implementation. All the projects evaluated have contributed to the training in FLE/FP of a large number of family life educators, teachers and nurses and have thus significantly strengthened professional national capability. Nevertheless, training needs still exist in motivational/attitudinal variables, sex roles, teaching/learning technics. The projects have made a significant contribution to the introduction of FLE into schools and teacher training institutions. The focus at present should be the institutionalization of FLE within the in-school sector, including the development of a policy approving FLE in schools. The development of community-based health centers was often the central activity of the out-of-school FLE component of the projects. These centers have contributed to shaping the countries' attitudes by creating an awareness of teenage pregnancy, by developing an acceptable strategy, by providing a focal point for discussing sensitive issues, and by becoming a mechanism for community mobilization. The projects have also contributed to making FP services available and specialized services for adolescents are being established. The emphasis has been more on education and awareness creation than on contraceptive distribution to adolescents. At present the need is to strengthen the service delivery components. The limited availability of data suggests that adolescent pregnancy remains an urgent problem in the region. Sustained and more focused FLE/FP program efforts directed to adolescents continue to be needed in the region. The most important general lesson learnt from the programs is that programs in adolescent fertility can be started and implemented in countries even prior to declaration of policy by governments. However, at a certain stage of implementation the programs cannot be carried further without explicit government policies and control.