Your search found 368 Results

  1. 1
    Peer Reviewed

    Delivering HIV services in partnership: factors affecting collaborative working in a South African HIV programme.

    Jobson GA; Grobbelaar CJ; Mabitsi M; Railton J; Peters RP; McIntyre JA; Struthers HE

    Globalization and Health. 2017 Jan 13; 13(1):3.

    BACKGROUND: The involvement of Global Health Initiatives (GHIs) in delivering health services in low and middle income countries (LMICs) depends on effective collaborative working at scales from the local to the international, and a single GHI is effectively constructed of multiple collaborations. Research is needed focusing on how collaboration functions in GHIs at the level of health service management. Here, collaboration between local implementing agencies and departments of health involves distinct power dynamics and tensions. Using qualitative data from an evaluation of a health partnership in South Africa, this article examines how organisational power dynamics affected the operation of the partnership across five dimensions of collaboration: governance, administration, organisational autonomy, mutuality, and norms of trust and reciprocity. RESULTS: Managing the tension between the power to provide resources held by the implementing agency and the local Departments' of Health power to access the populations in need of these resources proved critical to ensuring that the collaboration achieved its aims and shaped the way that each domain of collaboration functioned in the partnership. CONCLUSIONS: These findings suggest that it is important for public health practitioners to critically examine the ways in which collaboration functions across the scales in which they work and to pay particular attention to how local power dynamics between partner organisations affect programme implementation.
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  2. 2

    [Organizational change: the implementation of children-friendly hospitals] Mudanca organizacional: implantacao da Iniciativa Hospital Amigo da Crianca.

    Sekyia SR; Luz TR

    Ciencia and Saude Coletiva. 2010 Jun; 15 Suppl 1:1263-73.

    Empirical evidences have pointed out the relevant role of breastfeeding to diminish infantile mortality. Children-friendly Hospitals (IHAC) is a worldwide action developed by the United Nations Children's Fund - UNICEF and by the World Health Organization, aiming to promote, protect and support breastfeeding and also prevent precocious weaning. The aim of the present study is to identify the main organizational changes which occurred in two hospitals, located in the State of Minas Gerais, Brazil that implemented IHAC. The organizational analysis carried out was based upon six perspectives, according to Motta's analytical chart that includes: strategic, structural, cultural, human, technological and political perspectives. A qualitative research was carried out, by using as a data gathering method the semi-structured interview, applied in all hierarchical levels. In order to interpret data, it was adopted the content analysis. In both cases, it could be concluded that the implementation of IHAC resulted in changes and improvement in the management of the organizations, due to the establishment of procedural patterns and staff training. It was verified that the cultural and technological changes occurred in a more intense manner and that the least perceived were the political and strategic changes.
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  3. 3
    Peer Reviewed

    Synthetic evaluation of the effect of health promotion: impact of a UNICEF project in 40 poor western counties of China.

    Bi Y; Lai D; Yan H

    Public Health. 2010 Jul; 124(7):376-91.

    OBJECTIVE: To synthetically evaluate the effects of a health promotion project launched by the Ministry of Health of China and the United Nations Children's Fund (UNICEF) in 40 poor western counties of China. STUDY DESIGN: The two surveys were cross-sectional studies. Stratified multistage random sampling was used to recruit subjects. METHODS: Data were collected through two surveys conducted in the 40 'UNICEF project counties' in 1999 and 2000. After categorizing the 27 evaluation indicators into four aspects, a hybrid of the Analytic Hierarchy Process, the Technique for Order Preference by Similarity to Ideal Solution, and linear weighting were used to analyse the changes. The 40 counties were classified into three different levels according to differences in the synthetic indicator derived. Comparing the synthetic evaluation indicators of these two surveys, issues for implementation of the project were identified and discussed. RESULTS: The values of the synthetic indicators were significantly higher in 2000 than in 1999 (P=0.02); this indicated that the projects were effective. Among the 40 counties, 11 counties were at a higher level in 2000, 10 counties were at a lower level, and others were in the middle level. Comparative analysis showed that 36% of village clinics were not licensed to practice medicine, nearly 50% of village clinics had no records of medicine purchases, nearly 20% of village clinics had no pressure cooker for disinfection, and 20% of pregnant women did not receive any prenatal care. CONCLUSIONS: The health promotion projects in the 40 counties were effective. Health management, medical treatment conditions, maternal health and child health care have improved to some extent. However, much remains to be done to improve health care in these 40 poor counties. The findings of this study can help decision makers to improve the implementation of such improvements. Copyright 2010 The Royal Society for Public Health. All rights reserved.
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  4. 4

    Systems thinking for health systems strengthening.

    de Savigny D; Adam T

    Geneva, Switzerland, World Health Organization [WHO], Alliance for Health Policy and Systems Research, 2009. [112] p.

    Over 2008, wide global consultation revealed considerable interest and frustration among researchers, funders and policy-makers around our limited understanding of what works in health systems strengthening. In this current Flagship Report we introduce and discuss the merits of employing a systems thinking approach in order to catalyze conceptual thinking regarding health systems, system-level interventions, and evaluations of health system strengthening. The Report sets out to answer the following broad questions: What is systems thinking and how can researchers and policy-makers apply it? How can we use this perspective to better understand and exploit the synergies among interventions to strengthen health systems? How can systems thinking contribute to better evaluations of these system-level interventions? This Report argues that a stronger systems perspective among designers, implementers, stewards and funders is a critical component in strengthening overall health-sector development in low- and middle-income countries. (Excerpt)
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  5. 5

    Achieving the millennium development goals in Bangladesh [editorial]

    Sack DA

    Journal of Health, Population, and Nutrition. 2008 Sep; 26(3):251-2.

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  6. 6

    The state of Africa's children 2008. Child survival.


    New York, New York, UNICEF, 2008 May. 54 p.

    Every year, the United Nations Children's Fund (UNICEF) publishes The State of the World's Children, the most comprehensive and authoritative report on the world's youngest citizens. The State of the World's Children 2008, published in January 2008, examines the global realities of maternal and child survival and the prospects for meeting the health-related Millennium Development Goals (MDGs) - the targets set by the world community in 2000 for eradicating poverty, reducing child and maternal mortality, combating disease, ensuring environmental sustainability and providing access to affordable medicines in developing countries. This year, UNICEF is also publishing the inaugural edition of The State of Africa's Children. This volume and other forthcoming regional editions complement The State of the World's Children 2008, sharpening from a worldwide to a regional perspective the global report's focus on trends in child survival and health, and outlining possible solutions - by means of programmes, policies and partnerships - to accelerate progress in meeting the Millennium Development Goals. (excerpt)
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  7. 7
    Peer Reviewed

    Responding to the global HIV / AIDS crisis: A peace corps for health.

    Mullan F

    JAMA. 2007 Feb 21; 29(7):744-746.

    HIV disease is essentially the black death of the 21st century, killing on a massive scale and threatening to cripple economies and topple governments. However, the continued spread of the HIV epidemic and the new availability of lifesaving antiretroviral drugs have triggered an extraordinary response by governments, international organizations, philanthropies, pharmaceutical companies, religious organizations, and individuals. Campaigning against HIV/AIDS has no precedent in the history of medicine. Smallpox was eliminated by a globally coordinated strategy that required a single patient encounter to deliver the vaccine. In contrast, the directly observed therapy strategy at the core of modern tuberculosis treatment necessitates daily patient contact over much of the treatment course and, therefore, a much larger health workforce. Treating AIDS requires the daily delivery of medications as well as the clinical management of patients-- for the rest of their lives. Antiretroviral medications can help control disease, but do not cure it. More problematic yet, stopping treatment once started promotes the emergence of resistant strains of the virus, making halfway programs hazardous to public health. The sheer volume of health workers needed to tackle HIV disease--and the health systems to support their work--is off the scale of any previous public health campaign. (excerpt)
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  8. 8
    Peer Reviewed

    South Africa's "rollout" of highly active antiretroviral therapy: A critical assessment.

    Nattrass N

    Journal of Acquired Immune Deficiency Syndromes. 2006 Dec; 43(5):618-623.

    The number of people on highly active antiretroviral therapy (HAART) in South Africa has risen from < 2000 in October 2003, to almost 200,000 by the end of 2005. Yet South Africa's performance in terms of HAART coverage is poor both in comparison with other countries and the targets set by the government's own Operational Plan. The public-sector HAART ''rollout'' has been uneven across South Africa's nine provinces and the role of external assistance from NGOs and funding agencies such as the Global Fund and PEPFAR has been substantial. The National Treasury seems to have allocated sufficient funding to the Department of Health for a larger HAART rollout, but the Health Minister has not mobilized it accordingly. Failure to invest sufficiently in human resources-- especially nurses--is likely to constrain the growth of HAART coverage. (author's)
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  9. 9

    Strengthening country responses to HIV and AIDS.

    SAfAIDS News. 2005 Sep; 11(3):11-12.

    The AIDS epidemic has become a genuine global emergency with rising numbers of new infections, increasing numbers of deaths and the impact of the epidemic increasingly being felt particularly by the rising numbers of children made orphans or vulnerable by AIDS. The scale of the emergency has resulted in an unprecedented response by African countries, civil society and the international community. Today, there are more resources for HIV prevention, care, support and treatment than ever before. This increase in resources is coupled with an increasing number of actors becoming involved in the AIDS response, often leading to unclear roles and leadership and dispersed authority that may undermine national plans and priorities. Furthermore, resources are often dissipated and scattered, transaction costs have increased, capacities are distracted and weakened while monitoring and evaluation remains fragmented. The result has been that a substantial amount of available resources are not being used effectively and not getting to the people that need them most. (excerpt)
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  10. 10
    Peer Reviewed

    The key role of vaccine vial monitors in routine and mass immunisation.

    Martin JP; Lloyd J

    Journal of the Indian Medical Association. 2005 Dec; 103(12):[4] p..

    In the late 1970s the global network of developing countries immunisation programmes known as Expanded Programme on Immunisation (EPI) faced the challenge of having the risk of vaccines being damaged by heat due to exposure to the harshest of climatic conditions in some developing countries where the access is problematic from the last intermediate store to the final vaccination point. Because it was not possible to precisely monitor each vial, health workers would often have to destroy vaccines when the integrity of the cold-chain had been compromised. The EPI, not having a reliable technology to ensure that the vaccine was not heat damaged, established a rigid set of parameters for handling and storage of vaccines. These rigid parameters, necessary to ensure that the children of the world were not receiving heat-damaged vaccine, led to high vaccine wastage, less frequent and smaller vaccinations campaigns and fewer children being vaccinated. (excerpt)
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  11. 11

    WHO training course for TB consultants: RPM Plus drug management sessions in Sondalo, Italy. Trip report: May 17-20, 2006.

    Barillas E

    Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2006 May 29. 33 p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-499; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)

    WHO, Stop-TB Partners, and NGOs that support country programs for DOTS implementation and expansion require capable consultants in assessing the capacity of countries to manage TB pharmaceuticals in their programs, developing interventions, and providing direct technical assistance to improve availability and accessibility of quality TB medicines. Beginning in 2001, RPM Plus, in addition to its own formal courses on pharmaceutical management for tuberculosis, has contributed modules and facilitated sessions on specific aspects of pharmaceutical management to the WHO Courses for TB Consultants in Sondalo. The WHO TB Course for TB Consultants was developed and initiated in 2001 by the WHO-Collaborating Centre for Tuberculosis and Lung Diseases, the S. Maugeri Foundation, the Morelli Hospital, and TB CTA. The main goal of the course is to increase the pool of international level TB consultants. As of December 2005, over 150 international TB consultants have participated in the training, a majority of whom have already been employed in consultancy activities by the WHO and international donors. In 2006 fiscal year RPM Plus received funds from USAID to continue supporting the Sondalo Course, which will allow RPM Plus to facilitate sessions on pharmaceutical management for TB at four courses in May, June, July, and October of 2006. (excerpt)
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  12. 12
    Peer Reviewed

    A report on syphilis control in Turkey.

    Christiansen S

    Bulletin of the World Health Organization. 1954; 10:627-690.

    This report presents the results of a six-month survey of the nature and extent of venereal diseases in Turkey which was undertaken by the author, on behalf of WHO, at the request of the Turkish Government. The first part of the report outlines the present venereal-diseases-control system and includes descriptions of the work undertaken by public authorities, hospitals and dispensaries, mobile venereal-disease-control teams, and laboratories; in the second part, the author enumerates certain recommendations for the intensification of the current control programme. These recommendations are particularly concerned with the control of syphilis (since the incidence of other venereal diseases in Turkey is of very secondary importance), and with the expansion, standardization, and co-ordination of serodiagnostic facilities and services. It is suggested that there might be a gradual intensification and reorientation of the present programme. A proposed plan of operations for an eight-year period is described. (author's)
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  13. 13
    Peer Reviewed

    Ukraine fights to re-instate loan for HIV/AIDS project.

    Ahmad K

    Lancet Infectious Diseases. 2006 Jun; 6(6):328.

    Ukraine plans to restructure a key HIV/ AIDS and tuberculosis control project to help ensure disbursement of a US$60 million loan recently suspended by the World Bank. Alla Shcherbinska (Ukrainian Centre to Combat HIV/AIDS) told journalists that it will take the government only a few weeks to "reconstruct" the project. However, Shiyan Chao, a senior health economist at the World Bank cautioned that: "resumption of the funds will hinge on the government's concrete actions to improve earlier shortcomings related to policy issues on tuberculosis control, procurement, fiduciary controls, and other important aspects of project management". The World Bank suspended the loan, complaining of poor implementation by the Ukrainian ministry of health. "At the time of suspension, which came after the first 3 years of implementation, only 2% of funds available for this project had been disbursed by the Ukrainian ministry of health", Merrell Tuck, a spokesperson of the Bank said. The Bank says "there is also concern about the government's full commitment to both condom use and harm reduction for injecting drug users [IDUs]". (excerpt)
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  14. 14

    Access to Clinical and Community Maternal, Neonatal and Women’s Health Services Program. ACCESS. Year one annual report, 1 October 2004 - 30 September 2005.

    JHPIEGO. Access to Clinical and Community Maternal, Neonatal and Women’s Health Services Program [ACCESS]

    [Baltimore, Maryland], JHPIEGO, ACCESS, 2005 Oct. [50] p. (USAID Cooperative Agreement No. GHS-A-00-04-00002-00)

    The Access to Clinical and Community Maternal, Neonatal and Women’s Health Services (ACCESS) Program launched its mission to improve maternal and newborn health and survival in developing countries worldwide in July 2004, with program implementation beginning October 1, 2004. In its first year, ACCESS had three field-supported country programs; now—one year later— the Program has nine country programs, four Malaria Action Coalition (MAC) countries, and ongoing activities in another 16 countries worldwide. This rapid expansion of field-based programming reflects countries’ growing confidence and interest in ACCESS as they seek to reduce continued high rates of maternal and newborn mortality. Over the past year, ACCESS has become increasingly recognized as a global leader for policy and advocacy, technical expertise, and implementing evidence-based interventions and approaches in maternal and newborn health. Because ACCESS is implemented through such a rich partnership, the Program has demonstrated the technical and programmatic expertise to both advocate for and support the full range of maternal and newborn health care interventions from the household to the referral level. (excerpt)
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  15. 15

    Rational Pharmaceutical Management Plus. Technical Advisory Group (TAG) -- 2nd Meeting on Tuberculosis: trip report.

    Zagorskiy A

    Arlington, Virginia, Management Sciences for Health [MSH], Center for Pharmaceutical Management, Rational Pharmaceutical Management Plus, 2005 Oct. 15 p. (USAID Cooperative Agreement No. HRN-A-00-00-00016-00)

    RPM Plus has been substantially involved in TB activities in the E&E region both at the country and regional level since 1998, providing technical leadership to StopTB partners and technical assistance to countries in streamlining TB drug management systems as part of overall WHO DOTS strategy. In recognition of the RPM Plus role as a leader in pharmaceutical management, RPM Plus Program Manager for TB Andrey Zagorskiy was elected a member of the WHO/Euro Technical Advisory Group (TAG), with the first meeting in 2004 in Sinaia, Romania. In 2005, RPM Plus continued to provide technical leadership in pharmaceutical management for TB to WHO/Euro TAG, and participated in the second meeting in September 2005, in Copenhagen, Denmark. (author's)
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  16. 16

    Responses to AIDS challenges in Brazil: limits and possibilities. [Respuestas a los desafíos del SIDA en Brasil: límites y posibilidades]

    Castro MG; da Silva LB

    Brasilia, Brazil, UNESCO, 2005 Jun. 680 p.

    UNESCO and the National Program on STD/AIDS, of the Brazilian Ministry of Health, once again establish a partnership to carry out an activity, which records and cooperates towards implementing one of the most successful Brazilian public policies in health, worldwide acknowledged: those oriented to the fight against AIDS. This publication, basically addressed to tackle the dynamics of those agencies participating in AIDS-related governance in Brazil, lists and itemizes practices and representations of collective civil society units, at different territories. Furthermore, it records contemporaneous debates, assessments, criticisms and suggestions, aiming at adjusting the path. (excerpt)
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  17. 17
    Peer Reviewed

    Ethical and programmatic challenges in antiretroviral scaling-up in Malawi: challenges in meeting the World Health Organization's "Treating 3 Million by 2005" Initiative goals.

    Muula AS

    Croatian Medical Journal. 2004; 45(4):415-421.

    The Fifty-seventh World Health Assembly's (WHA's) resolution on the "scaling up of treatment and care within a coordinated and comprehensive response to HIV/AIDS" is welcomed globally, and even more so in Sub-Saharan Africa, where the majority of the people currently in need of antiretroviral therapy do not have access to it. The WHA identified, among others, the following areas which should be pursued by member states and the World Health Organization (WHO): trained human resources, equity in access to treatment, development of health systems, and the integration of nutrition into the comprehensive response to HIV/AIDS. The WHO Director-General was requested to "provide a progress report on the implementation of this resolution to the Fifty-eighth World Health Assembly." Much of what happens between now and that time depends on the actions of the WHO and the member states and also on the contribution of the international community to the fight against HIV/AIDS. Much of what is to be done will be based on what is available now in terms of practice, human resources, and programs. This paper explores the WHA's resolution, especially regarding the scaling up of antiretroviral therapy, taking Malawi as the case study, to identify the challenges that a Southern African country may be facing which will eventually influence whether the initiative to "Treat 3 Million by 2005" ("3 by 5") will be achieved or not. The challenges southern countries may be facing are presented in this paper not in order to undermine the initiative but to create an awareness of these factors and initiate the appropriate action which would surmount the challenges and achieve the goals set. (author's)
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  18. 18
    Peer Reviewed

    Jim Yong Kim -- WHO HIV / AIDS Director. Interview.

    Das P

    Lancet Infectious Diseases. 2005 Sep; 5(9):544-547.

    Jim Yong Kim completed his undergraduate studies at Brown University. He graduated in medicine from Harvard Medical School in 1991, and obtained a PhD in anthropology from Harvard University in 1993. In 1996, he became the codirector of Harvard’s Programme in Infectious Disease and Social Change, and in 2003 became the Chief of the Division of Social Medicine and Health Inequalities at Harvard Medical School. He is currently on leave at the WHO, where he heads the Department of HIV/AIDS, and is also responsible for coordinating HIV efforts with the tuberculosis department. TLID: What drew you into infectious diseases? Who were your mentors? JYK: My friend and colleague Paul Farmer was the person who was most influential in getting me interested in infectious diseases. But unlike Paul and others in the field who really love the bugs, what they are, and what they do, I’ve always been more interested in how some of these bugs—tuberculosis and HIV in particular—force us to confront the most profound problems of our time. In working on multidrug-resistant tuberculosis treatment in resource-poor settings and global HIV treatment scaleup, the groups I’ve worked with have been able to contribute to the science of infectious disease, develop new modalities for scaling-up complex health interventions in poor and difficult settings, and, I hope, advance social justice. (excerpt)
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  19. 19

    Impact of external assistance: review of the tuberculosis programme in Karnataka, India (1999-2001).


    Health Administrator. 2003 Jan-Jul; 15(1-2):102-105.

    RNTCP in Karnataka is a centrally sponsored project financed by the World Bank at a total cost of about 18 crores. Inspite of the fact that Karnataka has been a pioneer in initiating Tuberculosis Programme, the state stands listed with Assam, Bihar, J&K, Madhya Pradesh, Meghalaya, Mizoram, Punjab and Uttar Pradesh as the most difficult areas for implementation. Questions are raised as to the impact of external assistance in the control and implementation of the Tuberculosis Programme. (excerpt)
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  20. 20

    Advances in tuberculosis diagnostics.

    Kar A; Modi-Parekh K; Chakroborty AK

    Health Administrator. 2003 Jan-Jul; 15(1-2):118-123.

    A world wide effort is under way to develop new tools to diagnose tuberculosis, spearheaded by the World Health Organization (WHO) under its Tuberculosis Diagnostic Initiative (TBDI). This article discusses the advanced diagnostics being developed, and highlights the feasibility of use of these technologies in the public health facilities involved in tuberculosis control in India. (excerpt)
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  21. 21

    At ICPD+10 mark, UNFPA intensifies efforts to promote RH commodity security. [Approchant le dixième anniversaire de la CIPD, le FNUAP intensifie ses efforts pour promouvoir la sécurité de la santé de la reproduction]

    Abrams T

    Population 2005. 2004 Jun; 6(2):13.

    As the 10th anniversary of the Cairo International Conference on Population and Development (ICPD) approaches, there has been no letup in the UN Population Fund’s efforts to promote reproductive health commodity security around the world. Indeed, the Fund is actually intensifying its activities in this sector, leaving the distinct impression that it is all part of a coordinated and continuing response to the Program of Action of the September 1994 conference, and to the ICPD+5 update by the UN General Assembly in 1999. The impression would be neither casual nor accidental, because UNFPA is acting as the lead international agency that is trying to facilitate the creation and implementation of government strategies to meet the growing need for quality contraceptives, essential drugs and other reproductive health commodities. Special attention is also being devoted to assess future condom needs for HIV/AIDS prevention programs. Reproductive health commodity security (RHCS) is accepted as assured in those countries where the strategy has been successfully integrated into the national health program. (excerpt)
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  22. 22

    Putting knowledge to work: technical networks for effective responses to HIV / AIDS.

    Adeyi O; Bridger D; Deany P; Delate R; Hecht R

    Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2000 Dec. 22 p. (UNAIDS Best Practice Collection Key Material; UNAIDS/00.47E)

    This document provides guidance to practitioners who seek to improve their networking skills for effectiveness in HIV/AIDS programmes and to groups of practitioners who are trying to establish an AIDS technical network in some specific geographical or thematic area of specialization. The complexity and scale of the HIV/AIDS epidemic have spawned a number of programmes aimed at influencing the course of the epidemic. There are wide variations in the scope, technical quality and effectiveness of these programmes. Although relatively successful efforts have been documented in various forms (including collections of ‘best practices’) the adaptation of these success stories has been slow and patchy. Technical Resource Networks (TRNs) constitute a means of accelerating, in a professional and systematic fashion, the spread of effective responses to HIV/AIDS. They are groups of individuals, communities, institutions or governments that work together towards a shared objective in the fight against AIDS. Networks assist in building local technical capacity, expanding national and regional advocacy, sharing of information, building peer support and facilitating collective action. By improving knowledge, providing support, developing capacity and sharing approaches proven elsewhere, these networks can both strengthen HIV prevention efforts on the ground and influence policy development at the regional and national levels. UNAIDS supports these efforts though funding and technical collaboration to improve institutional capacity in cooperating countries and subregions. In the near term, UNAIDS will continue to support networking using the following mutually reinforcing strategies: development of resource materials, expansion of the knowledge base, initiation of new networks on priority themes, as well as improved communications for networking. (author's)
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  23. 23
    Peer Reviewed

    Barriers to sustainable tuberculosis control in the Russian Federation health system.

    Atun RA; Samyshkin YA; Drobniewski F; Skuratova NM; Gusarova G

    Bulletin of the World Health Organization. 2005; 83:217-223.

    The Russian Federation has the eleventh highest tuberculosis burden in the world in terms of the total estimated number of new cases that occur each year. In 2003, 26% of the population was covered by the internationally recommended control strategy known as directly observed treatment (DOT) compared to an overall average of 61% among the 22 countries with the highest burden of tuberculosis. The Director-General of WHO has identified two necessary starting points for the scaling-up of interventions to control emerging infectious diseases. These are a comprehensive engagement with the health system and a strengthening of the health system. The success of programmes aimed at controlling infectious diseases is often determined by constraints posed by the health system. We analyse and evaluate the impact of the arrangements for delivering tuberculosis services in the Russian Federation, drawing on detailed analyses of barriers and incentives created by the organizational structures, and financing and provider-payment systems. We demonstrate that the systems offer few incentives to improve the efficiency of services or the effectiveness of tuberculosis control. Instead, the system encourages prolonged supervision through specialized outpatient departments in hospitals (known as dispensaries), multiple admissions to hospital and lengthy hospitalization. The implementation, and expansion and sustainability of WHO-approved methods of tuberculosis control in Russian Federation are unlikely to be realized under the prevailing system of service delivery. This is because implementation does not take into account the wider context of the health system. In order for the control programme to be sustainable, the health system will need to be changed to enable services to be reconfigured so that incentives are created to reward improvements in efficiency and outcomes. (author's)
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  24. 24
    Peer Reviewed

    From research to practice: the example of antenatal care in Thailand.

    Lumbiganon P; Winiyakul N; Chongsomchai C; Chaisiri K

    Bulletin of the World Health Organization. 2004 Oct; 82(10):746-749.

    The rationale for providing antenatal care is to screen predominantly healthy pregnant women to detect early signs of, or risk factors for, abnormal conditions or diseases and to follow this detection with effective and timely intervention. The recommended antenatal care programme in most developing countries is often the same as the programmes used in developed countries. However, in developing countries there is wide variation in the proportion of women who receive antenatal care. The WHO randomized trial of antenatal care and the WHO systematic review indicated that a model of care that provided fewer antenatal visits could be introduced into clinical practice without causing adverse consequences to the woman or the fetus. This new model of antenatal care is being implemented in Thailand. Action has been required at all levels of the health-care systems from consumers through to health professionals, the Ministry of Public Health and international organizations. The Thai experience is a good example of moving research findings into practice, and it should be replicated elsewhere to effectively manage other health problems. (author's)
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  25. 25
    Peer Reviewed

    Costs of scaling up health interventions: a systematic review.

    Johns B; Torres TT

    Health Policy and Planning. 2005; 20(1):1-13.

    National governments and international agencies, including programmes like the Global Alliance for Vaccines and Immunizations and the Global Fund to Fight AIDS, Tuberculosis and Malaria, have committed to scaling up health interventions and to meeting the Millennium Development Goals (MDGs), and need information on costs of scaling up these interventions. However, there has been no systematic attempt across health interventions to determine the impact of scaling up on the costs of programmes. This paper presents a systematic review of the literature on the costs of scaling up health interventions. The objectives of this review are to identify factors affecting costs as coverage increases and to describe typical cost curves for different kinds of interventions. Thirty-seven studies were found, three containing cost data from programmes that had already been scaled up. The other studies provide either quantitative cost projections or qualitative descriptions of factors affecting costs when interventions are scaled up, and are used to determine important factors to consider when scaling up. Cost curves for the scaling up of different health interventions could not be derived with the available data. This review demonstrates that the costs of scaling up an intervention are specific to both the type of intervention and its particular setting. However, the literature indicates general principles that can guide the process: (1) calculate separate unit costs for urban and rural populations; (2) identify economies and diseconomies of scale, and separate the fixed and variable components of the costs; (3) assess availability and capacity of health human resources; and (4) include administrative costs, which can constitute a significant proportion of scale-up costs in the short run. This study is limited by the scarcity of real data reported in the public domain that address costs when scaling up health interventions. As coverage of health interventions increases in the process of meeting the MDGs and other health goals, it is recommended that costs of scaling up are reported alongside the impact on health of the scaled-up interventions. (author's)
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