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ARROWs for Change. 2003; 9(3):12.The World Bank is financing health sector reforms in low-income and middle-income countries of Asia. A review of community participation and accountability strategies within nine World Bank-financed projects (see table) spanning nine Asian countries reveals that most of them envisage some form of community and NGO participation and accountability. Women constitute an important target group of all the nine projects, with maternal and child health services being a priority in eight and improving access to contraception in five. However, few projects envisage community participation in design and policy formulation, provision of comprehensive sexual and reproductive health (SRH) services, and services for adolescents, men and sex workers. (excerpt)
New York, New York, UNDP, . 16 p.The 22 country offices where the We Care programme has been rolled out are taking great strides in making their workplaces truly AIDS competent. We are beginning to understand that HIV/AIDS is not 'out there' but among us -- and that if we are to make a difference in the way the world responds to it, WE MUST BEGIN WITH OURSELVES. Today, the We Care initiative is a global programme aiming at creating HIV/AIDS competence in all country offices, regional offices and headquarters by end of 2005. We Care is promoted together with initiatives spearheaded by other UN agencies, including 'Caring for Us' by UNICEF, the joint Access to Treatment and Inter-Organisational Needs (ACTION) programme facilitated by the UN Secretariat and the 'HIV/AIDS in the Workplace' initiative by WFP and ILO. (excerpt)
New York, New York, UNDP, . 16 p.We often assume that as UN employees, especially at Headquarters, we are somehow immune. Immune to being infected or affected by HIV/AIDS, immune from stigma and discrimination, immune from needing care, counselling, testing or treatment. But the truth is, we are as vulnerable as everyone else in society, and just like everyone else, we need to make informed decisions when it comes to HIV and AIDS. We need to be educated, we need to know how we can protect ourselves and how we can have a better quality of life if we happen to be living with HIV. We need to know that we have access to care and treatment and the right to confidentiality and non-discrimination in the workplace. In addition, as UN employees we have a special role to play. Before we can share with the world how HIV/AIDS should be addressed, we need to look into ourselves. Are we really that well informed, that sensitive? Can we talk openly to our co-workers about HIV/AIDS? Are we really sure that we will not be stigmatized if we happen to be living with HIV? Are we afraid of working closely with someone living with HIV? Do we discuss our anxieties and concerns within our families, with our partners, friends and co-workers? The We Care initiative addresses these issues. It helps us recognize that HIV/AIDS is not only 'out there' but also among us. And that if we are to create an environment that is empowering and respectful of the rights and responsibilities of every individual, we must first begin with ourselves. (excerpt)
Significance of foreign funding in developing health programmes in India - the case study of RNTCP in the overall context of North-South co-operation.
Health Administrator. 2003; 15(1-2):52-60.External assistance on disease containment and health policy has been a global phenomenon ever since the advent of modern medicine. The technically and resource advanced countries have been contributing to health programs of the resource constrained nations particularly with an objective of disease containment and eradication. India has its own history of receiving external assistance for its health programs since 1950s. Eradication of Small Pox, control of Malaria in 1970s, Family Planning Program, Universal Immunization Program (UIP), Pulse Polio and more recently campaigns against Human Immune-deficiency Virus (HIV) and Tuberculosis Programme had been supported by bilateral or multilateral aids. External assistance in India is small in terms of its proportion to the Gross Domestic Product (GDP). In health, it has never been more than 1-3 % of the total public health spending in any given year. Yet external assistance has had a profound impact on health, as technical support obtained from such assistance has made a significant contribution to hastening India’s demographic and epidemiological transition. The present paper reviews the issue of foreign funding in health programmes and specifically highlights its impact of TB Programme development in India. (excerpt)
Population 2005. 2003 Jun; 5(2):16.The founders of the grassroots campaign “34 Million Friends of UNFPA” announced May 1 that it had raised $1 million to support the United Nations Population Fund, mostly in small donations. More than 100,000 Americans have contributed to the campaign to help replace funds withheld by the United States Administration last July. “This campaign highlights the power of individuals to make a difference,” said Thoraya Ahmed Obaid, UNFPA executive director. “It also shows that the American people support the right of all women to have quality health care and to be able to plan their families.” UNFPA will use the campaign’s first million dollars to make pregnancy and childbirth safer for women; reduce the spread of HIV/AIDS; equip hospitals with essential supplies; support adolescents and youth; and prevent and treat obstetric fistula, a debilitating condition that results from obstructed labor. (excerpt)
[Geneva, Switzerland], International AIDS Economics Network [IAEN], 2003 Apr 17. 4 p.Of all the profound changes wrought by the AIDS pandemic, one of the most interesting has been the revolution in thinking about the responsibilities of rich countries toward poor ones. This is easiest to see by looking at the dispute between traditional international health economists and the AIDS advocacy community – a dispute that is quietly played out in academic journals and e-mail exchanges, and loudly reflected in such bold statements as President Bush’s commitment in the State of the Union Address to seek funding for a $15 billion Emergency Plan for AIDS Relief. For many years, a large share of health economists working in the field of international health focused in a somewhat single- minded fashion on the following problem: How can limited dollars be allocated to obtain the greatest impact on health in developing countries? Primarily using the tools of cost-effectiveness analysis, combined with epidemiologic data about the leading causes of death and disease in developing countries, recommendations flowed forth from development agencies. With the World Bank leading the charge, Ministries of Health in poor countries were advised to concentrate domestic and external funding on preventive and basic curative services – an “essential package of health services.” They were told to move funding away from high-cost curative, hospital-based services that benefit few to low-cost public health measures that benefit many – and that have the potential to prevent or control many of the leading causes of death in developing countries. Thus, basic childhood vaccinations, prenatal care, TB treatment, home treatment of diarrheal disease to prevent dehydration all were promoted as “best buys,” and eagerly funded by donor agencies. (excerpt)
Manila, Philippines, WHO, Regional Office for the Western Pacific, 2003.  p.This educational package is designed for the use of individuals, groups, and organizations involved in promoting adolescent health and development among a variety of audiences. The main target users are primary health care givers - doctors, nurses and midwives - who deal with adolescents in various settings, and who wish to involve their colleagues in advocacy work for and with adolescents. This package can also be useful for programme managers and policy-makers advocating adolescent health and development programmes and policies. In whole or in part, this package can be used to structure workshops and discussions on adolescent health and development issues. Ideally, adolescents should be invited to participate in these activities in order to achieve heightened understanding of their needs and concerns. The image of a butterfly emerging from its cocoon is depicted many times in this package. This symbolizes the metamorphosis that takes place as adolescents go through development. This image serves to remind us of the need to nurture adolescents as they go through this challenging phase. The image also foretells what adolescents can be, as they transform into the future of their countries. (excerpt)
Geneva, Switzerland, WHO, 2003.  p.The changing face of the HIV/AIDS epidemic has resulted in new opportunities, as well as new imperatives, to increase access to HIV testing and counselling and to knowledge of HIV status. Increased access to care and treatment, and decreased stigma and discrimination in many settings present important new opportunities associated with taking an HIV test. The fact that more and more of those infected with HIV need care and treatment based on knowledge of HIV status indicates new imperatives. HIV testing and counselling services must keep pace with the new opportunities if the increasing benefits of knowing your HIV status are to be accessed (see Box One). New approaches to HIV testing and counselling must now be implemented in more settings, and on a much larger scale than has so far been the case. WHO is advocating that health-care workers should offer testing and counselling to all those who might benefit from knowing their HIV status, and then benefit from advances in the treatment and prevention of HIV infection and HIV related diseases. As such benefits increase, there is an onus on national governments to provide good-quality testing and counselling services. The time has now come to implement HIV testing and counselling more widely using existing health-care settings, moving beyond the model of provision that relies entirely upon concerned individuals seeking out help for themselves to permit broader access for all. In this new approach, such services will become a routine part of health care, for example during attendance at antenatal clinics, or at diagnosis and treatment centres for tuberculosis and sexually transmitted infections (STIs). (excerpt)
Geneva, Switzerland, World Health Organization [WHO], Department of Gender and Women's Health, 2003. 53 p.The challenge of integrating existing knowledge about the impact of gender norms and inequality on HIV/AIDS into interventions, while formidable, can be met. There are several examples of programmes from around the world that have adopted different approaches to integrate gender considerations in their work. It is important to draw upon the lessons learned from these implementation experiences to develop concrete and practical guidelines for national HIV/AIDS programme managers so as to help them integrate gender issues into HIV/AIDS programmes. The need for such guidelines is underscored by a single fact: the effectiveness of HIV/AIDS programmes and policies is greatly enhanced when gender differences are acknowledged, the gender-specific concerns and needs of women and men are addressed, and gender inequalities are reduced. (excerpt)
AIDScience. 2003; 3(10): p..The belief that sex is the primary mode of human immunodeficiency virus (HIV) transmission in sub-Saharan Africa is an assertion so widely accepted and has remained unquestioned for so long that it has taken on the status of a received truth. The World Health Organization (WHO) and the Joint U.N. Programme on HIV/AIDS (UNAIDS) recently convened an expert consultation to review issues raised in a series of papers published in the International Journal of STD & AIDS (1-4) that questioned the validity of that assertion. After examining the papers, WHO and UNAIDS issued a press release announcing that "the vast majority of evidence [supports the view] that unsafe sexual practices continue to be responsible for the overwhelming majority of infections". As co-authors of the controversial articles, and as participants in the Geneva meeting (three of us), we state that WHO's conclusion is premature. It is neither based on those discussions, nor on a more considered review of the relevant literature. (excerpt)
Global HealthLink. 2003 May-Jun; (121):14-15.In 2000, roughly 11 million children died before their fifth birthday, almost all of them in the developing world. An estimated 140 million children under the age of five were underweight, almost half of them living in South Asia. In 1995, 515,000 women died during pregnancy or childbirth, only 1,000 of whom died in the industrialized world. Tuberculosis claimed another 2 million lives. As these numbers might well suggest, death and illness act as a brake on economic growth, and contribute to income poverty: health and demographic variables account for as much as half of the difference in growth rates between Africa and the rest of the world over the period 1965-1990. Nearly half of the Millennium Development Goals (MDGs) concern, directly or indirectly, health, nutrition and population issues. But based on present trends, relatively few low-income countries will achieve these goals. Only 17 percent of countries are on target for the under-five mortality goal (a two-thirds reduction between 1990 and 2015). Also, on present trends, sub-Saharan African as a whole will take 100 years to achieve the under-five mortality MDG. In all regions other than the Europe and Central Asia region, the under-five mortality rate declined faster during the 1980s than it did during the 1990s. The slowdown was particularly pronounced in Africa and the Middle East. In many countries, improvements in child mortality and malnutrition have been smallest among the poor. (excerpt)
The role of the health sector in supporting adolescent health and development. Materials prepared for the technical briefing at the World Health Assembly, 22 May 2003.
Geneva, Switzerland, World Health Organization [WHO], 2003. 15 p.I am very pleased to be here, and to be part of the discussion on Young Peoples Health at the World Health Assembly, for two reasons: because of the work we have been doing in adolescent health over the past years together with the Member States of the European Region of WHO, the work in cooperation with other UN agencies, especially UNICEF, UNFPA, and UNAIDS on adolescent health and development. Secondly, because Youth is a priority area of work of German Development Cooperation, and of the German Agency for Technical Cooperation, where I am working presently. Indeed, we have devoted this years GTZ´s open house day on development cooperation to youth I would also like to take this opportunity to remember the work of the late Dr. Herbert Friedman, former Chief of Adolescent Health in WHO, whose vision of the importance of working for and with young people has inspired many of the national plans and initiatives which we will hear about today. In many countries of the world, young people form the majority of populations, and yet their needs are being insufficiently met through existing health and social services. The health of young people was long denied the public, and public health attention it deserves. Adolescence is a driving force of personal, but also social development, as young people gradually discover, and question and challenge the adult world they are growing into. (excerpt)
Geneva, Switzerland, WHO, 2003.  p. (WHO/HIV/2003.21)The AMDS is a mechanism created to expand access to quality, effective treatment for HIV/AIDS by facilitating the increased supply of antiretrovirals (ARVs) and diagnostics in developing countries. The AMDS is the access and supply arm of UNAIDS/WHO 3 by 5 initiative, which aims to multiply eight-fold the number of people in poor countries receiving antiretroviral therapy by 2005. The AMDS builds on years of work by UNAIDS, WHO, UNICEF, the World Bank, and the global health community, as well as on some more recent initiatives, such as that by the Global Fund for AIDS, TB and Malaria, to address the AIDS treatment gap in developing countries. It brings together stakeholders and partners, pooling their capacities, in order to maximize impact towards meeting the 3 by 5 goal as rapidly as possible. The AMDS will be one of a trio of mechanisms, with secretariats housed at WHO, to improve access to treatment for HIV/AIDS, TB and malaria. (excerpt)
Bulletin of the World Health Organization. 2003 Nov; 81(11):777.During the last quarter-century or so there has been a revolution in both health and information technology. For the globe as a whole we have seen tremendous strides made in life expectancy and disease control, together with an explosion of information technology and techniques. Humanity now has the potential to make all existing health knowledge available simultaneously to the entire population of the planet. By no means everyone has benefited from the overall trend of increased life expectancy, however, or from that of increased knowledge and its communicability. This gap goes beyond the notion of the “digital divide”. It is a “knowledge divide”, in which large sections of humanity are cut off not just from the information that could help them but from any learning system or community that fosters problem-solving. (excerpt)
Lancet Infectious Diseases. 2003 Sep 1; 3(9):530.According to Raviglione the antituberculosis drugs used with the directly observed therapy short-couse (DOTS) made it possible to cure tuberculosis in over 80 000 Africans living with HIV last year. However more than 200 000 Africans with HIV died from tuberculsosis because they had no access to anti-tuberculosis drugs and DOTS. Tuberculosis was notably absent from the scientific programme at the HIV meeting. “In Africa it strikes us as peculiar how politicians and academics can speak of their ‘AIDS initative’ or ‘their tuberculosis programme’ as if the two diseases are not related,” said Winstone Zulu, a Zambian man infected with HIV, who had been recently cured of tuberculosis. “We see them together conspiring and collaborating to steal away our health.” (excerpt)
POPLINE. 2003 Sep-Oct; 25:4.A $59.6 million grant to improve the health of Afghan women and children in a country where a quarter of all children do not survive beyond their fifth birthday has been approved by the World Bank. The project to develop basic health services and ensure that women and children have access to them will be implemented by Afghanistan’s health ministry. (excerpt)
Washington, D.C., National Academies Press, 2003. xii, 57 p.The present monograph--on rebuilding the health sector in East Timor following the nation's struggle for independence--is the second in this series. It provides an overview of the state of the health system before, during, and after reconstruction and discusses achievements and failures in the rebuilding process, using an informative case study to draw conclusions for potential improvements to the process in other post-conflict settings. Other topics under consideration in the series include reviews of current knowledge on psychosocial issues, reproductive health, malnutrition, and diarrheal diseases, as well as other case studies. (excerpt)
Social Science and Medicine. 2003 Nov; 57(9):1547-1557.Spurred on by donors, a number of developing countries are in the midst of fundamental health and population sector reform. Focused on the performance-oriented norms of efficiency and effectiveness, reformers have paid insufficient attention to the process-oriented norms of sovereignty and democracy. As a result, citizens of sovereign states have been largely excluded from the deliberative process. This paper draws on political science and public administration theory to evaluate the Bangladeshi reform experience. It does so with reference to the norms of efficiency, effectiveness, sovereignty and democracy as a means of making explicit the values that need to be considered in order to make health and population sector reform a fair process. (author's)
Guttmacher Report on Public Policy. 2003 Aug; 6(3):4-5, 14.In the United States and other developed countries, where Pap tests are widely available and easily accessible, deaths from cervical cancer have plunged in recent decades, even in the presence of high HPV rates. Death rates remain high in developing countries because women lack access to Pap tests or other effective screening programs. The evidence strongly suggests, then, that while keeping the focus on HPV and its sexual transmission may be politically useful in advancing a morality-based, abstinence-until- marriage agenda, a more realistic campaign against cervical cancer deaths would focus on increasing access to cervical cancer screening among women around the world. (excerpt)
New York, New York, Ford Foundation, 2003.  p.The connections between globalization and women’s reproductive health and rights are not straightforward, and as yet, there is little systematic evidence exploring these linkages. The following paper will examine more closely what is meant by globalization and attempt to analyze its broad implications for women’s health and well-being, albeit largely from first principles. (excerpt)
The new lepers. HIV-positive people are treated as social outcasts while the government fails to cope.
London, England, Institute for War and Peace Reporting [IWPR], 2003 Aug 8. 3 p. (Belarus Reporting Service No. 28)More and more people in Belarus are finding themselves in her position – 50 or 60 new HIV cases are recorded every month. At the beginning of August, the number of people carrying the virus reached 5,150, and experts fear that the figure will be more than double that in 2005. More worryingly, some say the recorded figures should be multiplied by a factor of three or more since they fail to capture drug users who have not been seen by the health authorities. Although HIV and AIDS are advancing rapidly, neither the government nor society in general appear able to come to terms with it. A survey conducted jointly by the United Nations and the Centre for Sociological and Political Research in Minsk found that three quarters of the people polled thought people with HIV should not be allowed to care for their own children, and more than 40 per cent said they should not be allowed to travel around the country or choose where they want to live. (excerpt)
POPLINE. 2003 May-Jun; 25:3, 4.The president of the Population Institute contends that it would be "not only unacceptable but also morally reprehensible for the United States to back away" from commitments toward universal access to family planning and reproductive health. In testimony submitted to the foreign operations subcommittee of the House of Representatives Appropriations Committee, Werner Fornos, president of the Population Institute, was referring to apparent efforts by the Bush administration to reverse United States support of the Cairo Program of Action from the 1994 International Conference on Population and Development. (excerpt)
Lancet. 2003 Jul 19; 362(9379):249.These positive results from the new community-based therapeutic care (CTC) model of intervention call for a change in the way that we classify acute malnutrition. The WHO classification consists of moderate and severe categories, defined according to anthropometry and the presence of bilateral pitting oedema. This classification was appropriate and operationally relevant when the modes of treatment involved inpatient therapeutic feeding centres for severe acute malnutrition, and outpatient supplementary feeding for moderate acute malnutrition. This new era of community-based care, however, has three treatment modes. To be operationally relevant, a new system of classification must, therefore, include complicated malnutrition as well as severe and moderate malnutrition. (excerpt)
Population assistance and family planning programs: issues for Congress. Updated February 13, 2003. Programas de asistencia a la población y de planificación familiar: temas para el Congreso. Actualización al 13 de febrero de 2003.
Washington, D.C., Library of Congress, Congressional Research Service, 2003 Feb 13.  p. (Issue Brief for Congress)Since 1965, United States policy has supported international population planning based on principles of voluntarism and informed choice that gives participants access to information on all methods of birth control. This policy, however, has generated contentious debate for over two decades, resulting in frequent clarification and modification of U.S. international family planning programs. In the mid-1980s, U.S. population aid policy became especially controversial when the Reagan Administration introduced restrictions. Critics viewed this policy as a major and unwise departure from U.S. population efforts of the previous 20 years. The “Mexico City policy” further denied U.S. funds to foreign non-governmental organizations (NGOs) that perform or promote abortion as a method of family planning, regardless of whether the source of money was the U.S. government Presidents Reagan and Bush also banned grants to the U.N. Population Fund (UNFPA) because of its program in China, where coercion has been used. During the Bush Administration, a slight majority in Congress favored funding UNFPA and overturning the Mexico City policy but failed to alter policy because of presidential vetoes or the threat of a veto. President Clinton repealed Mexico City policy restrictions and resumed UNFPA funding, but these decisions were frequently challenged by some Members of Congress. On January 22, 2001, President Bush revoked the Clinton Administration population policy position and restored in full the terms of the Mexico City restrictions that were in effect on January 19, 1993. Foreign NGOs and international organizations, as a condition for receipt of U.S. funds, now must agree not to perform or actively promote abortions as a method of family planning in other countries. Subsequently, in January 2002, the White House placed a hold on the transfer of $34 million appropriated by Congress for UNFPA and launched a review of the organization’s program in China. Following the visit by a State Department assessment team in May, Secretary of State Powell announced on July 22 that UNFPA was in violation of the “Kemp-Kasten” amendment that bans U.S. assistance to organizations that support or participate in the management of coercive family planning programs. For FY2003, the President proposes no UNFPA funding, although there is a “reserve” of $25 million that could be used if the White House determines that UNFPA is eligible for U.S. support in FY2003. The Administration further requests $425 million for bilateral family planning programs, a reduction from the $446.5 million provided in FY2002. H.J.Res. 2, as passed by the Senate on January 23, 2003, includes the FY2003 Foreign Operations Appropriations. It provides $435 million for bilateral family planning aid and $35 million for UNFPA. Last year, the Senate Appropriations Committee (S. 2779) had recommended $450 million for bilateral activities and $50 million for UNFPA. The Senate bill further would have modified the Kemp-Kasten amendment and partially reversed the President’s Mexico City policy for some organizations. The House bill (H.R. 5410) last year provided $425 million for family planning and $25 million for UNFPA, but made no modifications to Kemp-Kasten or to the Mexico City policy. (excerpt)
Bulletin of the World Health Organization. 2003 Jul; 81(7):539-545.Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions’ work. Equity and human rights perspectives can contribute concretely to health institutions’ efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector. (author's)