Your search found 137 Results

  1. 1
    393503
    Peer Reviewed

    The impact of "Option B" on HIV transmission from mother to child in Rwanda: An interrupted time series analysis.

    Abimpaye M; Kirk CM; Iyer HS; Gupta N; Remera E; Mugwaneza P; Law MR

    PloS One. 2018; 13(2):e0192910.

    BACKGROUND: Nearly a quarter of a million children have acquired HIV, prompting the implementation of new protocols-Option B and B+-for treating HIV+ pregnant women. While efficacy has been demonstrated in randomized trials, there is limited real-world evidence on the impact of these changes. Using longitudinal, routinely collected data we assessed the impact of the adoption of WHO Option B in Rwanda on mother to infant transmission. METHODS: We used interrupted time series analysis to evaluate the impact of Option B on mother-to-child HIV transmission in Rwanda. Our primary outcome was the proportion of HIV tests in infants with positive results at six weeks of age. We included data for 20 months before and 22 months after the 2010 policy change. RESULTS: Of the 15,830 HIV tests conducted during our study period, 392 tested positive. We found a significant decrease in both the level (-2.08 positive tests per 100 tests conducted, 95% CI: -2.71 to -1.45, p < 0.001) and trend (-0.11 positive tests per 100 tests conducted per month, 95% CI: -0.16 to -0.07, p < 0.001) of test positivity. This represents an estimated 297 fewer children born without HIV in the post-policy period or a 46% reduction in HIV transmission from mother to child. CONCLUSIONS: The adoption of Option B in Rwanda contributed to an immediate decrease in the rate of HIV transmission from mother to child. This suggests other countries may benefit from adopting these WHO guidelines.
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  2. 2
    391438
    Peer Reviewed

    Effectiveness of the WHO Safe Childbirth Checklist program in reducing severe maternal, fetal, and newborn harm in Uttar Pradesh, India: study protocol for a matched-pair, cluster-randomized controlled trial.

    Semrau KE; Hirschhorn LR; Kodkany B; Spector JM; Tuller DE; King G; Lipsitz S; Sharma N; Singh VP; Kumar B; Dhingra-Kumar N; Firestone R; Kumar V; Gawande AA

    Trials. 2016 Dec 7; 17(1):576.

    BACKGROUND: Effective, scalable strategies to improve maternal, fetal, and newborn health and reduce preventable morbidity and mortality are urgently needed in low- and middle-income countries. Building on the successes of previous checklist-based programs, the World Health Organization (WHO) and partners led the development of the Safe Childbirth Checklist (SCC), a 28-item list of evidence-based practices linked with improved maternal and newborn outcomes. Pilot-testing of the Checklist in Southern India demonstrated dramatic improvements in adherence by health workers to essential childbirth-related practices (EBPs). The BetterBirth Trial seeks to measure the effectiveness of SCC impact on EBPs, deaths, and complications at a larger scale. METHODS/DESIGN: This matched-pair, cluster-randomized controlled, adaptive trial will be conducted in 120 facilities across 24 districts in Uttar Pradesh, India. Study sites, identified according to predefined eligibility criteria, were matched by measured covariates before randomization. The intervention, the SCC embedded in a quality improvement program, consists of leadership engagement, a 2-day educational launch of the SCC, and support through placement of a trained peer "coach" to provide supportive supervision and real-time data feedback over an 8-month period with decreasing intensity. A facility-based childbirth quality coordinator is trained and supported to drive sustained behavior change after the BetterBirth team leaves the facility. Study participants are birth attendants and women and their newborns who present to the study facilities for childbirth at 60 intervention and 60 control sites. The primary outcome is a composite measure including maternal death, maternal severe morbidity, stillbirth, and newborn death, occurring within 7 days after birth. The sample size (n = 171,964) was calculated to detect a 15% reduction in the primary outcome. Adherence by health workers to EBPs will be measured in a subset of births (n = 6000). The trial will be conducted in close collaboration with key partners including the Governments of India and Uttar Pradesh, the World Health Organization, an expert Scientific Advisory Committee, an experienced local implementing organization (Population Services International, PSI), and frontline facility leaders and workers. DISCUSSION: If effective, the WHO Safe Childbirth Checklist program could be a powerful health facility-strengthening intervention to improve quality of care and reduce preventable harm to women and newborns, with millions of potential beneficiaries. TRIAL REGISTRATION: BetterBirth Study Protocol dated: 13 February 2014; ClinicalTrials.gov: NCT02148952 ; Universal Trial Number: U1111-1131-5647.
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  3. 3
    391434

    Quality of care in women's, children's, and adolescent health. Methods for assessing evaluation and implementation in West Africa. Experience in the Cote d'Ivoire. Qualite des soins en SMNI. Methodologie de l'evaluation et mise en pratique en Afrique de l'Ouest. A propos de l'experience de la Cote d'Ivoire.

    Guie YP; Cisse L; Saki-Nekouressi G; Bucagu M; Landrivon G; Agbodjan-Prince O

    Medecine et Sante Tropicales. 2016 Nov 1; 26(4):357-362.

    A tool developed by WHO was used to assess the quality of care for mothers, newborns, and children in some healthcare facilities in French-speaking Africa; this study led to the development of recommendations for the implementation of actions intended to resolve the problems observed and to optimize patient management. We report here the experience of the maternity units of the university hospital center of Treichville, in Abidjan, discuss the presentation of the results of the assessment, and make some recommendations as part of an action program. The experience of the monthly review of referred cases is also reported.
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  4. 4
    389408
    Peer Reviewed

    An assessment of staffing needs at a HIV clinic in a Western Kenya using the WHO workload indicators of staffing need WISN, 2011.

    Burmen B; Owuor N; Mitei P

    Human Resources For Health. 2017 Jan 26; 15(1):9.

    BACKGROUND: An optimal number of health workers, who are appropriately allocated across different occupations and geographical regions, are required to ensure population coverage of health interventions. Health worker shortages in HIV care provision are highest in areas that are worst hit by the HIV epidemic. Kenya is listed among countries that experience health worker shortages (<2.5 health workers per 1000 population) and have a high HIV burden (HIV prevalence 5.6 with 15.2% in Nyanza province). We set out to determine the optimum number of clinicians required to provide quality consultancy HIV care services at the Jaramogi Oginga Odinga Teaching and Referral Hospital, JOOTRH, HIV Clinic, the premier HIV clinic in Nyanza province with a cumulative client enrolment of PLHIV of over 20,000 persons. CASE PRESENTATION: The World Health's Organization's Workload Indicators of Staffing Needs (WISN) was used to compute the staffing needs and sufficiency of staffing needs at the JOOTRH HIV clinic in Kisumu, Kenya, between January and December 2011. All people living with HIV (PLHIV) who received HIV care services at the HIV clinic at JOOTRH and all the clinicians attending to them were included in this analysis. The actual staffing was divided by the optimal staff requirement to give ratios of staffing excesses or shortages. A ratio of 1.0 indicated optimal staffing, less than 1.0 indicated suboptimal staffing, and more than 1 indicated supra optimal staffing. The HIV clinic is served by 56 staff of various cadres. Clinicians (doctors and clinical officers) comprise approximately one fifth of this population (n = 12). All clinicians (excluding the clinic manager, who is engaged in administrative duties and supervisory roles that consumes approximately one third of his time) provide full-time consultancy services. To operate at maximum efficiency, the clinic therefore requires 19 clinicians. The clinic therefore operates with only 60% of its staffing requirements. CONCLUSIONS: Our assessment revealed a severe shortage of clinicians providing consultation services at the HIV clinic. Human resources managers should oversee the rational planning, training, retention, and management of human resources for health using the WISN which is an objective and reliable means of estimating staffing needs.
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  5. 5
    376132
    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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  6. 6
    367020
    Peer Reviewed

    Implementation of the WHO safe childbirth checklist program at a tertiary care setting in Sri Lanka: a developing country experience.

    Patabendige M; Senanayake H

    BMC Pregnancy and Childbirth. 2015; 15:12.

    BACKGROUND: To study institutionalization of the World Health Organization's Safe Childbirth Checklist (SCC) in a tertiary care center in Sri Lanka. METHOD: A hospital-based, prospective observational study was conducted in the De Soysa Hospital for Women, Colombo, Sri Lanka. Healthcare workers were educated regarding the SCC, which was to be used for each woman admitted to the labor room during the study period. A qualitatively pretested, self-administered questionnaire was given to all nursing and midwifery staff to assess knowledge and attitudes towards the checklist. Each item of the SCC was reviewed for adherence. RESULTS: A total of 824 births in which the checklist used were studied. There were a total of births 1800 during the period, giving an adoption rate of 45.8%. Out of the 170 health workers in the hospital (nurses, midwives and nurse midwives) 98 answered the questionnaire (response rate = 57.6%). The average number of childbirth practices checked in the checklist was 21 out of 29 (95% CI 20.2, 21.3). Educating the mother to seek help during labor, after delivery and after discharge from hospital, seeking an assistant during labor, early breast-feeding, maternal HIV infection and discussing contraceptive options were checked least often. The mean level of knowledge on the checklist among health workers was 60.1% (95% CI 57.2, 63.1). Attitudes for acceptance of using the checklist were satisfactory. Average adherence to checklist practices was 71.3%. Sixty eight (69.4%) agreed that the Checklist stimulates inter-personal communication and teamwork. Increased workload, poor enthusiasm of health workers towards new additions to their routine schedule and level of user-friendliness of Checklist were limitations to its greater use. CONCLUSIONS: Amongst users, the attitude towards the checklist was satisfactory. Adoption rate amongst all workers was 45.8% and knowledge regarding the checklist was 60.1%. These two factors are probably linked. Therefore prior to introducing it to a facility awareness about the value and correct use of the SCC needs to be increased, while giving attention to satisfactory staffing levels.
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  7. 7
    331349

    Blind optimism: Challenging the myths about private health care in poor countries.

    Marriott A

    Oxford, United Kingdom, Oxfam International, 2009 Feb. 55 p. (Oxfam Briefing Paper No. 125)

    'The realization of the right to health for millions of people in poor countries depends upon a massive increase in health services to achieve universal and equitable access. A growing number of international donors are promoting an expansion of private-sector health-care delivery to fulfil this goal. The private sector can play a role in health care. But this paper shows there is an urgent need to reassess the arguments used in favor of scaling-up private-sector provision in poor countries. The evidence shows that prioritizing this approach is extremely unlikely to deliver health for poor people. Governments and rich country donors must strengthen state capacities to regulate and focus on the rapid expansion of free publicly provided health care, a proven way to save millions of lives worldwide. (Excerpt)
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  8. 8
    308729

    Indicators for monitoring and evaluation of AIDS programs.

    University of North Carolina at Chapel Hill. Carolina Population Center. MEASURE Evaluation

    MEASURE Evaluation Bulletin. 2001; (2):1-27.

    This issue of the MEASURE Evaluation Bulletin includes articles in a number of areas of monitoring and evaluation of AIDS programs. The first four articles are based on a field test of indicators on knowledge, sexual behavior and stigma that was carried out as part of a large international effort to improve monitoring and evaluation of national programs. The field test resulted in revisions of standard indicators for AIDS programs, which were eventually published by UNAIDS, and revisions of the survey tools that are now used to collect AIDS information in many countries. Three subsequent articles deal with different aspects of monitoring and evaluation. The first of these explores estimation of the size of core groups, such as commercial sex workers or bar workers, which is essential but difficult. Capture-recapture techniques can be used to make such estimates, although there are multiple pitfalls. The next article focuses on monitoring trends in HIV prevalence among young antenatal women, which is the most feasible method of monitoring HIV incidence. Modelling shows that using prevalence trends to extrapolate incidence trends has to be done very carefully, but can be done if one takes measures to minimize the various biases. The last article of the Bulletin discusses the use of newspaper clippings as a source of indicators on political will and commitment and stigma. Although newspaper clippings have been cited as an easily accessible source for these indicators, the analysis suggests that an analysis of newspaper clippings may be more suitable for a cross-sectional situation analysis or in-depth qualitative research than for monitoring purposes. (excerpt)
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  9. 9
    319050
    Peer Reviewed

    Resistance and renewal: Health sector reform and Cambodia's national tuberculosis programme.

    Hill PS; Mao Tan Eang

    Bulletin of the World Health Organization. 2007 Aug; 85(8):631-636.

    Following the destruction of Cambodia's health infrastructure during the Khmer Rouge period (1975-1979) and the subsequent decade of United Nations sanctions, international development assistance has focused on reconstructing the country's health system. The recognition of Cambodia's heavy burden of tuberculosis (TB) and the lapse of TB control strategies during the transition to democracy prompted the national tuberculosis programme's relaunch in the mid-1990s as WHO-backed health sector reforms were introduced. This paper examines the conflicts that arose between health reforms and TB control programmes due to their different operating paradigms. It also discusses how these tensions were resolved during introduction of the DOTS strategy for TB treatment. (author's)
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  10. 10
    319047
    Peer Reviewed

    Evaluating the potential impact of the new Global Plan to Stop TB: Thailand, 2004 -- 2005.

    Varma JK; Wiriyakitjar D; Nateniyom S; Anuwatnonthakate A; Monkongdee P

    Bulletin of the World Health Organization. 2007 Aug; 85(8):586-592.

    WHO's new Global Plan to Stop TB 2006-2015 advises countries with a high burden of tuberculosis (TB) to expand case-finding in the private sector as well as services for patients with HIV and multidrug-resistant TB (MDR-TB). The objective of this study was to evaluate these strategies in Thailand using data from the Thailand TB Active Surveillance Network, a demonstration project begun in 2004. In October 2004, we began contacting public and private health-care facilities monthly to record data about people diagnosed with TB, assist with patient care, provide HIV counselling and testing, and obtain sputum samples for culture and susceptibility testing. The catchment area included 3.6 million people in four provinces. We compared results from October 2004-September 2005 (referred to as 2005) to baseline data from October 2002-September 2003 (referred to as 2003). In 2005, we ascertained 5841 TB cases (164/100 000), including 2320 new smear-positive cases (65/100 000). Compared with routine passive surveillance in 2003, active surveillance increased reporting of all TB cases by 19% and of new smear-positive cases by 13%. Private facilities diagnosed 634 (11%) of all TB cases. In 2005, 1392 (24%) cases were known to be HIV positive. The proportion of cases with an unknown HIV status decreased from 66% (3226/4904) in 2003 to 23% (1329/5841) in 2005 (P< 0.01). Of 4656 pulmonary cases, mycobacterial culture was performed in 3024 (65%) and MDR-TB diagnosed in 60 (1%). In Thailand, piloting the new WHO strategy increased case-finding and collaboration with the private sector, and improved HIV services for TB patients and the diagnosis of MDR-TB. Further analysis of treatment outcomes and costs is needed to assess this programme's impact and cost effectiveness. (author's)
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  11. 11
    316238
    Peer Reviewed

    The Global Drug Facility: a unique, holistic and pioneering approach to drug procurement and management.

    Matiru R; Ryan T

    Bulletin of the World Health Organization. 2007 May; 85(5):325-420.

    In January 2006, the Stop TB Partnership launched the Global Plan to Stop TB 2006-2015, which describes the actions and resources needed to reduce tuberculosis (TB) incidence, prevalence and deaths. A fundamental aim of the Global Plan is to expand equitable access to affordable high-quality anti-tuberculous drugs and diagnostics. A principal tool developed by the Stop TB Partnership to achieve this is the Global Drug Facility (GDF). This paper demonstrates the GDF's unique, holistic and pioneering approach to drug procurement and management by analysing its key achievements. One of these has been to provide 9 million patient-treatments to 78 countries in its first 6 years of operation. The GDF recognized that the incentives provided by free or affordable anti-tuberculosis drugs are not sufficient to induce governments to improve their programmes' standards and coverage, nor does the provision of free or affordable drugs guarantee that there is broad access to, and use of, drug treatment in cases where procurement systems are weak, regulatory hurdles exist or there are unreliable distribution and storage systems. Thus, the paper also illustrates how the GDF has contributed towards making sustained improvements in the capacity of countries worldwide to properly manage their anti-TB drugs. This paper also assesses some of the limitations, shortcomings and risks associated with the model. The paper concludes by examining the GDF's key plans and strategies for the future, and the challenges associated with implementation. (author's)
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  12. 12
    311318

    Addressing Africa [editorial]

    Lancet. 2006 Nov 25; 368(9550)

    The first African Regional Health Report, finally released this week more than a year after its initial launch target, is one of the first products to emerge from Luis Sambo's Directorship of WHO's African Regional Office. In his inaugural speech on Feb 1, 2005, Sambo urged his colleagues, in country offices and regional headquarters, to "intensify efforts at identifying the best practices in health" and "document and disseminate" them so they can be replicated. This regional health report is, he believes, a key step in upgrading WHO AFRO's stewardship role in the region. It is a disappointing effort, one that reveals WHO's weaknesses rather than its strengths. It is clearly intended as an overview rather than as a detailed analysis, but even so it still suffers from being light on facts and heavy on well-rehearsed rhetoric. Much is simply lifted from past World Health Reports that have emerged from Geneva headquarters, supplemented by data from the World Bank and other institutions. There are some useful asides: briefly reported successes, such as a remarkable reduction in road traffic deaths in Rwanda and improvements to health-service access in South Africa's rural areas. However, it will take much more than an assemblage of isolated anecdotes to create a strategy for Africa's renaissance. (excerpt)
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  13. 13
    302116
    Peer Reviewed

    Effect of an armed conflict on human resources and health systems in Cote d'Ivoire: Prevention of and care for people with HIV/AIDS.

    Betsi NA; Koudou BG; Cisse G; Tschannen AB; Pignol AM

    AIDS Care. 2006 May; 18(4):356-365.

    In September 2002, an armed conflict erupted in Cote d'Ivoire which has since divided the country in the government-held south and the remaining territory controlled by the 'Forces Armees des Forces Nouvelles' (FAFN). There is concern that conflict-related population movements, breakdown of health systems and food insecurity could significantly increase the incidence of HIV infections and other sexually-transmitted infections, and hence jeopardize the country's ability to cope with the HIV/AIDS epidemic. Our objective was to assess and quantify the effect this conflict had on human resources and health systems that provide the backbone for prevention, treatment and care associated with HIV/AIDS. We obtained data through a questionnaire survey targeted at key informants in 24 urban settings in central, north and west Cote d'Ivoire and reviewed relevant Ministry of Health (MoH) records. We found significant reductions of health staff in the public and private sector along with a collapse of the health system and other public infrastructures, interruption of condom distribution and lack of antiretrovirals. On the other hand, there was a significant increase of non-governmental organizations (NGOs), some of which claim a partial involvement in the combat with HIV/AIDS. The analysis shows the need that these NGOs, in concert with regional and international organizations and United Nations agencies, carry forward HIV/AIDS prevention and care efforts, which ought to be continued through the post-conflict stage and then expanded to comprehensive preventive care, particularly antiretroviral treatment. (author's)
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  14. 14
    293114

    [Improvement of reproductive health services in rural China: approaches and entry points]

    Zhang K; Liu Y

    Chinese Primary Health Care. 2000; 14(9):11-14.

    To set up the research priorities for the broader reproductive health programmes, the World Health Organization (WHO) has given a high priority to planning and programming for reproductive health, which aims at improvement of the delivery of reproductive health services. In 1998, with a financing support by Ford Foundation, the Foreign Loan Office of the China Ministry of Health (MoH) initiated a program in poor rural areas of China entitled reproductive health improvement project (RHIP) in 4 of the 71 World Bank/MoH of China "Health VIII Project" Counties. This paper reports the approaches and entry points of RHIP: (1) Participatory planning; (2) Operations research; and (3) Listening to women's voice at the rural communities. It is expected that these approaches and entry points will be useful for improvement of reproductive health services in other rural areas of China. (author's)
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  15. 15
    292351
    Peer Reviewed

    The WHO 'Roll Back Malaria Project': planning for adverse event monitoring in Africa.

    Simooya O

    Drug Safety. 2005; 28(4):277-286.

    Artemisinin combination therapies (ACTs) have been recommended for the treatment of malaria in countries where there is widespread resistance to commonly used antimalarial drugs. Several sub-Saharan African countries are, therefore, in the process of introducing ACTs in their malaria drug policies. However, there is limited information about the safety of ACTs outside South East Asia, where their use has been well documented. As with all other new medicinal compounds, the monitoring of a drug's safety or ’pharmacovigilance’ is important, especially in areas where co-morbid conditions, such as HIV/AIDS, malnutrition and tuberculosis, are common. Because in most malaria endemic countries, particularly Africa, there are no pharmacovigilance programmes in place, it has been suggested that the introduction of ACTs offers an opportunity for these countries to put drug safety monitoring systems in place. Backed by the WHO Roll Back Malaria department and other international cooperating partners, five African countries, which are in the process of introducing ACTs (Burundi, Democratic Republic of the Congo, Mozambique, Zambia and Zanzibar), have drawn up action plans to introduce pharmacovigilance in their health sector. It is planned that once the safety monitoring of antimalarials has been established, these activities can then be extended to cover medicinal compounds used in other public health programmes, such as HIV/ALDS, tuberculosis and the immunisation programmes. This article looks at the rationale for pharmacovigilance, the process of setting up monitoring centres and the challenges of implementing the project in the region. (author's)
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  16. 16
    290936

    Joint ILO / WHO guidelines on health services and HIV / AIDS. Tripartite Meeting of Experts to Develop Joint ILO / WHO Guidelines on Health Services and HIV / AIDS.

    International Labour Organisation [ILO]; World Health Organization [WHO]

    Geneva, Switzerland, ILO, 2005. [65] p. (TMEHS/2005/8)

    These guidelines are the product of collaboration between the International Labour Organization and the World Health Organization. In view of their complementary mandates, their long-standing and close cooperation in the area of occupational health, and their more recent partnership as co-sponsors of UNAIDS, the ILO and the WHO decided to join forces in order to assist health services in building their capacities to provide their workers with a safe, healthy and decent working environment, as the most effective way both to reduce transmission of HIV and other blood-borne pathogens and to improve the delivery of care to patients. This is essential when health service workers have not only to deliver normal health-care services but also to provide HIV/AIDS services and manage the long-term administration and monitoring of anti-retroviral treatments (ART) at a time when, in many countries, they are themselves decimated by the epidemic. (excerpt)
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  17. 17
    284310

    Cost of mother-child care in Morelos State, Mexico. Costo de la atención materno infantil en el estado de Morelos, México.

    Cahuana-Hurtado L; Sosa-Rubí S; Bertozzi S

    Salud Pública de México. 2004 Jul-Aug; 46(4):316-325.

    The objective was to compare the cost of maternal and child health care (current model) to that of the WHO Mother-Baby Package if it were implemented. A pilot cross-sectional case study was conducted in September 2001 in Sanitary District No. III, Morelos State, Mexico. Two rural health centers, an urban health center, and a general hospital, all managed by the Ministry of Health, were selected for the study. The Mother-Baby Package Costing Spreadsheet was used to estimate the total cost and cost per intervention for the current model and for the Mother-Baby Package model. The total cost of the Mother-Baby Package was twice the cost of the current model. Of the 18 interventions evaluated, the highest proportion of total costs corresponded to antenatal care and normal delivery. Personnel costs represented more than half of the total costs. The Mother-Baby Package Costing Spreadsheet is a practical tool to estimate and compare costs and is useful to guide the distribution of financial resources allocated to maternal and child healthcare. However, this model has limited application unless it is adapted to the structure of each healthcare system. (author's)
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  18. 18
    280675
    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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  19. 19
    276967

    From Bangkok to Mexico: towards a framework for turning knowledge into action to improve health systems [editorial]

    Pang T; Pablos-Mendez A; Ijsselmuiden C

    Bulletin of the World Health Organization. 2004 Oct; 82(10):720-721.

    As a follow-up to the International Conference on Health Research for Development that took place in Bangkok, Thailand, in 2000, WHO convened a Ministerial Summit on Health Research to be held in Mexico City in November 2004, to review progress to date and reflect on emerging opportunities in the global field of health research. In 1990, the Commission on Health Research for Development recommended that all countries should undertake essential national health research; it stipulated that international partnerships are the foundations for progress and that financing for these efforts should be mobilized from both international and national sources. In 1996, WHO'S Ad Hoc Committee on Health Research Relating to Future Intervention Options outlined a five-step priority-setting approach to decide how health research funds should be allocated. It identified "best buys" for the development of products and procedures in several key areas, including childhood infections, malnutrition, microbial threats, noncommunicable diseases and health systems. Overall, progress has been slow and there is much more to be done to deal with major health challenges. (excerpt)
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  20. 20
    276964
    Peer Reviewed

    Schistosomiasis control in China: the impact of a 10-year World Bank loan project (1992-2001).

    Chen X; Wang L; Cai J; Zhou X; Zheng J

    Bulletin of the World Health Organization. 2005; 83(1):43-48.

    China has been carrying out large-scale schistosomiasis control since the mid-1950s, but in the early 1990s, schistosomiasis was still endemic in eight provinces. A World Bank Loan Project enabled further significant progress to be made during the period 1992-2001. The control strategy was focused on the large-scale use of chemotherapy primarily -- to reinforce morbidity control -- while at the same time acting on transmission with the ultimate goal of interrupting it. Chemotherapy was complemented by health education, chemical control of snails and environmental modification where appropriate. A final evaluation in 2002 showed that infection rates in humans and livestock had decreased by 55% and 50%, respectively. The number of acute infections and of individuals and advanced disease had also significantly decreased. Although snail infection rates continued to fluctuate at a low level, the densities of infected snails had decreased by more than 75% in all endemic areas. The original objectives of the China World Bank Loan Project for schistosomiasis control had all been met. One province, Zhejiang, had already fulfilled the criteria for elimination of schistosomiasis by 1995. The project was therefore a success and has provided China with a sound basis for further control. (author's)
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  21. 21
    276518
    Peer Reviewed

    Use of research to inform public policymaking.

    Lavis JN; Posada FB; Haines A; Osei E

    Lancet. 2004 Oct 30; 364:1615-1621.

    To improve health and reduce health inequalities, public policymakers need to find the best solutions to the most burdensome health problems, the best ways to fit these solutions into complex and often overstretched and under-resourced health systems, and the best ways to bring about the desired changes in health systems. Systematic reviews can inform public policymaking by providing research-based answers to these questions. Public policymakers can encourage more informed policymaking by asking to see systematic reviews on priority issues, commissioning reviews when none exists, and placing more value on such work in their deliberations and in their interactions with stakeholders. Donors and international agencies can encourage more informed public policymaking by supporting national and regional efforts to undertake reviews and assess their local applicability, and by supporting regional or worldwide efforts to coordinate review and assessment processes. (author's)
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  22. 22
    191680

    Enhancing adolescents' reproductive health: strategies and challenges. Panel discussion.

    In: Towards adulthood: exploring the sexual and reproductive health of adolescents in South Asia, edited by Sarah Bott, Shireen Jejeebhoy, Iqbal Shah, Chander Puri. Geneva, Switzerland, World Health Organization [WHO], Department of Reproductive Health and Research, 2003. 223-226.

    Representatives from governments, nongovernmental organizations (NGOs) and international agencies participated in a panel discussion entitled “Enhancing Adolescents’ Reproductive Health: Strategies and Challenges”, moderated by Dr Iqbal Shah. The objective of this discussion was to share information about adolescent sexual and reproductive health (ASRH) programmes from different sectors and different countries. Panellists were asked to draw from their personal and institutional experiences in discussing strategies and approaches used by ASRH programmes, as well as challenges and opportunities confronting those who work in this area. Panellists included government representatives from India, Nepal and Sri Lanka, as well as NGO representatives from Bangladesh and Pakistan, and representatives from international agencies with a wide regional presence, including UNAIDS (the Joint United Nations Programme on HIV/AIDS) and the World Health Organization Regional Office for South-East Asia (WHO/ SEARO). (excerpt)
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  23. 23
    186063

    Africa's newborns: the forgotten children.

    World Health Organization [WHO]. Regional Office for Africa

    Brazzaville, Congo, WHO, Regional Office for Africa, 2002. 4 p.

    Newborns hold every country's promise for the future, yet they are Africa's forgotten children. Many times newborn deaths even go unrecorded, unknown to all but the grieving families. In the African region, almost half of all deaths in the first year of life take place in the first month, most of them during the first week. For every baby who dies within the first four weeks (the neonatal period),another one is stillborn. The newborn death rate is a sensitive indicator of the quality of health services. Even though the unacceptably high neonatal mortality rate has changed little over the past 30 years, no major, global programme focuses on newborn health. This indicates neglect of the most vulnerable members of society and of their right to quality care and good health. (excerpt)
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  24. 24
    179568

    [Operations research: an essential element in the evaluation of the impact and systematization of the experience of the National Program of Traditional Midwives] Investigación operativa: elemento esencial en la evaluación del impacto y sistematización de la experiencia del Programa Nacional de Parteras Tradicionales.

    Moreno Castro M

    In: La partera tradicional en la atención materno infantil en México, [compiled by] Mexico. Secretaría de Salud. Programa Nacional de Parteras Tradicionales. Mexico City, Mexico, Secretaría de Salud, Programa Nacional de Parteras Tradicionales, 1994. 149-153.

    Linking operational research with general goals and achievements results in the scientific validation of the program's impact in terms of the modification of the situation of the population, the objective, and its environment. We can categorically state that without the evaluation process-understood in methodological terms as an operational investigation of all the strategies that make up an established program-it is not possible to establish scientifically valid correlations between the results and the impact of actions, nor to systematize the experience so that it can be replicated and disseminated. Within this framework, the Secretariat of Health, by way of the Board of Maternal-Infant Health, with the participation of the United Nations Children's Fund (UNICEF), decided to undertake an operational investigation to evaluate the impact of training for traditional midwives in the period 1989-1993 and to systematize this experience. (excerpt)
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  25. 25
    189167

    WHO antenatal care randomized trial: Manual for the implementation of the new model. [Estudio clínico aleatorizado de control prenatal de la OMS: Manual para la puesta en práctica del nuevo modelo]

    Villar J; Bergsjo P

    Geneva, Switzerland, World Health Organization [WHO], 2002. 33 p.

    This manual describes the basic component of the new WHO antenatal care model. It provides detailed instructions on how to conduct the four-visit schedule of the basic component of the new WHO model. It includes a classifying form for easy assessment of a woman’s eligibility for the basic component, and provides a checklist of activities that are to be performed throughout the four-visit schedule. It is important to emphasize that the basic component of the new WHO antenatal care model is intended only for the management of pregnant women who do not have evidence of pregnancy-related complications, medical conditions or major health-related risk factors. For the management of women who have such conditions, health providers are advised to follow the recommended established procedures of their clinic or hospital. The clinics or hospitals that do not have established procedures for women with such conditions, or that wish to update the ones they currently have, can use The WHO Reproductive Health Library to identify evidence-based interventions. (author's)
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