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[Johannesburg, South Africa], University of the Witwatersrand, Centre for Health Policy, Health Systems Knowledge Network, 2007 Jul.  p.In this paper I discuss gender issues manifested within health occupations and across them. In particular, I examine gender dynamics in medicine, nursing, community health workers and home carers. I also explore from a gender perspective issues concerning delegation, migration and violence, which cut across these categories of health workers. These occupational categories and themes reflect priorities identified by the terms of reference for this review paper and also the themes that emerged from the accessed literature. This paper is based on a desk review of literature accessed through the internet, search engines, correspondence with other experts and reviewing bibliographies of existing material. These efforts resulted in a list of 534 articles, chapters, books and reports. Although most of the literature reviewed was in English, some of it was also in Spanish and Portuguese. Material related to training and interpersonal patient-provider relations that highlights how occupational inequalities affect the availability and quality of health care is covered by other review papers commissioned by the Women and Gender Equity Knowledge Network. (Excerpt)
[Baltimore, Maryland], Catholic Relief Services, 2006 Jul. 53 p. (USAID Development Experience Clearinghouse DocID / Order No. PN-ADJ-423)In Zambia, HIV&AIDS is still approached primarily as a health issue, and therefore, interventions focus mainly on prevention and treatment. The provision of affordable, accessible and reliable public services is essential in supporting health maintenance and reducing stress for people infected and affected with HIV&AIDS. Reliable delivery of good quality water and sound basic sanitation are critical in reducing exposure to pathogens to which HIV-positive people are particularly vulnerable. Where water services are inadequate or inaccessible, time and monetary costs of access to good quality water in sufficient quantities are high, particularly for HIV-infected people and their caregivers. CRS responded to an announcement by WHO to conduct an assessment on the adequacy of water, sanitation and hygiene in relation to home-based care strategies for people living with HIV&AIDS in Zambia. The assessment was commissioned by the WHO with the goal of producing evidence-based guidance on water and sanitation needs in home-based care strategies, particularly in resource-poor situations. In addition, WHO desired the assessments to lead to both practical and strategic recommendations to be made at the programme and policy levels, while also identifying the most critical measures to be taken by the health sector and the water and sanitation sector to provide short- and medium-term solutions in the area of water, sanitation and hygiene support to home-based care. (excerpt)
Journal of Health, Population and Nutrition. 2006 Dec; 24(4):377-379.A new target-universal access to reproductive health by 2015-was endorsed in October 2006 under Millennium Development Goal 5 (MDG 5) to improve maternal health. And while the international reproductive health community could finally celebrate this official recognition of reproductive health on "centre stage of international efforts to defeat poverty and preventable illness" (1), the field reality is far from the target. What does it take to improve sexual and reproductive healthcare practices, including self-care practices at the home and use of services? Generated by a call for papers on these topics, this issue of the Journal contains selected papers describing current practices, examining specific barriers to improved practices, and providing results of interventions aimed at improving self-care practices or use of services. Most practices described relate to improving maternal and newborn* health or care; only two articles provide information on practices in other sexual and reproductive health areas-one on male sexuality and another on women with HIV/AIDS. No papers were received concerning care-seeking for family planning, menstrual regulation, or abortion care-a red flag perhaps signaling the marginalization of these topics in the current day. (excerpt)
Geneva, Switzerland, WHO, Programme for the Control of Diarrhoeal Diseases, 1994. 13 p. (CDD/93.2)Why was Advising Mothers produced? Every child that is seen at a health facility with mild diarrhoea, and every dehydrated child that has been successfully treated at the facility, will be sent home to follow Plan A of the WHO/CDD Diarrhoea Management Chart, Case Management in the Home (give increased fluids, continue feeding, and seek medical care when needed). Unlike many other treatments, which are provided by the health worker, case management in the home is entirely the responsibility of the mother or other child caretaker. If correctly carried out, it can have a significant impact on the health of the child. How well the mother carries it out depends partly on how well the health worker advises her. Advising a mother on home case management is often the last activity carried out during a consultation, and often the least well done. The advice and the manner in which it is given are often not sufficient to enable the mother to understand and have confidence in her ability to care for her child's diarrhoea. There are many reasons for this: the health facility may be crowded, a health worker may have little time, and it is not always clear just how to advise the mother. When assessing and treating a child with diarrhoea at a health facility, the health worker should follow the same, systematic approach with every child: "Look, Ask, Feel, Decide, Treat." (excerpt)
Geneva, Switzerland, WHO, Programme for the Control of Diarrhoeal Diseases, 1994. 21 p. (WHO/CDD/94.49; CDD/93.1)Advising a mother on home case management is often the last activity carried out during a consultation, and often the least well done. The advice and the manner in which it is given are often not sufficient to enable the mother to understand and have confidence in her ability to care for her child's diarrhoea. There are many reasons for this: the health facility may be crowded, a health worker may have little time, and it is not always clear just how to advise the mother. When you assess and treat a child with diarrhoea at a health facility, there is a systematic approach which allows you to follow the same process each time: "Look, Ask, Feel, Decide, Treat." Advising a mother on how to care for the child at home may seem like a less structured activity; it is definitely one which calls for good judgement and understanding on your part. The purpose of this guide is to help you to improve this activity, by teaching a process which will allow you correctly and effectively to advise mothers on home case management. The process should also make it easier for mothers to remember the advice you give. The guide is to be used during a case management training course, or by health workers already trained in case management. (excerpt)
Geneva, Switzerland, WHO, . 47 p.The Caregiver Booklet is designed to help patients, family members, and community caregivers in the home-based care of serious long term illness. Home care is best for many people with long term illnesses, including those who are close to the end of life. All patients being cared for at home should be first assessed and treated by a health worker, who will help caregivers provide high quality home care and ensure that medicines are taken correctly. This booklet explains how to: 1. Deal with specific symptoms. 2. Provide care for terminal and bedridden patients at home. 3. Decide when to seek help from a health facility. The booklet should be given to the patient or caregiver and its contents explained by a nurse or community worker. The first section of the booklet covers ways to prevent problems from occuring and should be followed in all patients. The second section explains how to treat specific symptoms that may occur. (excerpt)
Palliative care: symptom management and end-of-life care. Interim guidelines for first-level facility health workers.
Geneva, Switzerland, WHO, 2003 Dec. 50 p. (Integrated Management of Adolescent and Adult Illness [IMAI] No. 4; WHO/CDS/IMAI/2004.4)Palliative care includes symptom management during both acute and chronic illness and end-of-life (terminal) care. This module provides guidelines to prepare health workers to provide palliative care treatment and advice in clinic and to back up community caregivers and family members who need to provide home-based palliative care. For each symptom, the guidelines for the health worker include both a summary of non-pharmaceutical recommendations for home care and the clinical management and medications which the health worker might also provide, based on a limited essential drug list on the last page of this module. Alternative or additional drugs can be added during country adaptation. (excerpt)
Geneva, Switzerland, UNAIDS, 2000 Sep. 111 p. (UNAIDS Best Practice Collection; Summary Booklet of Best Practices Series No. 2; UNAIDS/00.34E)AIDS is now the leading killer in sub-Saharan Africa. Whereas 200,000 people died as a result of conflict or war in Africa in 1998, AIDS killed 2.2 million. The progression of the disease has outpaced all projections. In 1991, WHO projected that in 1999 there would be 9 million infected individuals and nearly 5 million cumulative deaths in Africa. The reality in 2000 is two to three times higher, with 34.3 million infected individuals and 18.8 cumulative deaths. Nearly 70 per cent of the world’s HIV infection and 90 per cent of deaths from AIDS are to be found in a region that is home to just 10 per cent of the world’s population. In the sub-Saharan region, infection levels are highest, access to care is lowest, and social and economic safety nets that might help families cope with the impact of the epidemic are badly frayed. Resources are not keeping pace with the challenge. Incidence of the disease is increasing three times faster than the money to control it. Current national AIDS activities in Africa must be expanded dramatically to make an impact on the epidemic. African leaders are demonstrating unprecedented leadership in fighting HIV/AIDS; the time is ripe for an extraordinary effort. The International Partnership against AIDS in Africa (IPAA) is such a mobilization. At the same time, the Best Practice process – accumulating and applying knowledge about what is working and not working in different situations and contexts – is crucial within the framework of the Partnership. (excerpt)
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2001 Nov.  p. (UNAIDS Best Practice Collection; UNAIDS Case Study; UNAIDS/01.72E; National Institute on Aging Grant No. AG15983)This study provides a qualitative analysis of the circumstances and consequences of parental caregiving to adult children with AIDS in Thailand based on open-ended interviews, primarily with parents of adult children who died of AIDS. The results reveal the circumstances that lead to parental caregiving, the tasks involved and the stress they created, how parents coped with this stress, and the consequences for their emotional, social and economic well-being. The results make clear that routine caregiving to those with AIDS often requires extensive time from the main caregiver. Caregiving assistance is especially needed in the final stage of illness when the AIDS-afflicted person often requires help with even basic bodily needs and functions. Financial demands can also accumulate to the point where the adult son/daughter’s and parents’ own resources are exhausted. Such a situation can be overwhelming for anyone, but it is particularly so for an older person. With varying degrees of success, Thai parents often solicit the help of other family members in caregiving, paying expenses and providing emotional support. In addition, viewing their role in terminal-stage caregiving as part of the responsibility that parents have for their children (regardless of age), refusing to view the child as a burden, and avoiding blaming their son/daughter for becoming infected, all help Thai parents cope with the emotional stress of caring for their terminally ill son or daughter. (excerpt)
Technical bases for the WHO recommendations on the management of pneumonia in children at first-level health facilities.
Geneva, Switzerland, WHO, Programme for the Control of Acute Respiratory Infections, 1991.  p. (WHO/ARI/91.20)About 13 million children under 5 years of age die every year in the world, 95% of them in developing countries. Pneumonia is one of the leading causes, accounting for about 4 million of these deaths. Despite this fact, for a combination of technical and operational reasons, pneumonia has been a neglected problem until very recently. Clinicians and epidemiologists thought that the control of respiratory infections did not deserve high priority because of the difficulties involved in preventing and managing these infections; it was said that antibiotics might not be an effective treatment against pneumonia because patients are often weakened by conditions such as chronic malnutrition and parasitic infections, and that a wide variety of viruses and bacteria are associated with pulmonary infections making it impossible to identify the specific etiological agent in each patient (1.) On the other hand, some public health experts felt that a programme aimed at preventing mortality from pneumonia could not succeed because it would be difficult to deliver the available technology (antibiotics) through peripheral health units and community-based health workers. At most, one quarter of the pneumonia cases in children can be prevented by the measles and pertussis vaccines included in the immunization schedule of the Expanded Programme on Immunization. There is a clear need for research to develop and test vaccines against the most frequent agents of pneumonia in children. Such research has been pursued by WHO, notably within the Programe for the Control of Acute Respiratory Infections (ARI) and the Vaccine Development Programme; however, WHO has simultaneously been utilizing current clinical knowledge to formulate a case management strategy to reduce the high mortality from pneumonia in children. The present document is not intended to provide detailed case management guidelines. These are to be found in the manual "Acute respiratory infections in children: Case management in small hospitals in developing countries. A manual for doctors and other senior health workers", document WHO/ARI/90.5 (1990). (excerpt)
Geneva, Switzerland, UNAIDS, 2004. vii, 64 p.This report grows out of our shared belief that the world must respond to the HIV crisis confronting women. It highlights the work of the Global Coalition on Women and AIDS—a UNAIDS initiative that supports and energizes programmes that mitigate the impact of AIDS on girls and women worldwide. Through its advocacy and networking, the Coalition is drawing greater attention to the effects of HIV on women and stimulating concrete, effective action by an ever-increasing range of partners. We believe this report, with its straightforward analysis and practical responses, can be a valuable advocacy and policy tool for addressing this complex challenge. The call to empower women has never been more urgent. We must act now to strengthen their capacity, resilience and leadership. (excerpt)
Geneva, Switzerland, UNAIDS, 2004 Feb 2.  p.All over the world women are expected to take the lead in domestic work and in providing care to family members. HIV and AIDS have significantly increased the care burden for many women. Poverty and poor public services have also combined with AIDS to turn the care burden for women into a crisis with far-reaching social, health and economic consequences. The term 'care economy' is sometimes used to describe the many tasks carded out mostly by women and girls at home such as cooking, cleaning, fetching water and many other activities associated with caring for the young, sick and elderly in the household. The value of the time, energy and resources required to perform this unpaid work is hardly recognized and accounted for, despite its critical contribution to the overall economy and society in general. Women and girls pay an opportunity cost when undertaking unpaid care work for HIV and AIDS-related illnesses since their ability to participate in income generation, education, and skills building diminish. AIDS intensifies the feminization of poverty, particularly in hard-hit countries, and disempowers women. Entire families are also affected as vulnerability increases when women's time caring for the sick is taken away from other productive tasks within the household. (excerpt)
Lancet. 2003 Nov 29; 362(9398):1773.December 1 is the 16th World AIDS Day. The major theme of the past year has been on strengthening the campaign for cheap antiretroviral drugs. This thrust, some critics maintain, has been to the detriment of HIV prevention efforts. Perhaps the most ambitious HIV/AIDS development in the past year has been WHO’s focus on the “3 by 5” target—a commitment to provide antiretroviral drugs to 3 million people in developing countries by the end of 2005. For many the “3 by 5” initiative, if successfully implemented, will bring a longer life. But how useful is this and other antiretroviral-based initiatives to those people with AIDS in the developing world who will die today, tomorrow, or in the very near future? For these people, the stark reality is that it is too late for antiretroviral treatment; what they need, yet rarely receive, is palliative care. (excerpt)
AIDS Analysis Africa. 2003 Jun-Jul; 14(1):6-8.Given that Budget 2003/4 significantly steps up the amount of funds going to the provinces for HIV/AIDS, there are now two critical questions facing us. 1. Extra money for HIV/AIDS was put into the Equitable Share in Budget 2003/4. Will provinces use the additional funds in their equitable share grant to increase their provincial health budgets and boost funding to HIV/AIDS interventions? Or will those funds be diverted to other priorities as identified by individual provinces? 2. Will provinces be able to spend the added funds? Absorption is a real problem-provincial departments are already struggling with capacity in terms of lack of financial management and programme management skills, insufficient staff, or unfilled posts. This issue is not unique to HIV/AIDS but symptomatic of other social sector programmes. In essence, analysis of Budget 2003/4 suggests that--from a public finance perspective--the main challenge for government's response to HIV/AIDS in the foreseeable future is not going to be lack of financial resources, but the capacity to spend. (excerpt)
Comfort and hope. Six case studies on mobilizing family and community care for and by people with HIV / AIDS.
Geneva, Switzerland, UNAIDS, 1999 Jun. 94 p. (UNAIDS Best Practice Collection; UNAIDS/99.10E)This booklet presents six case studies on mobilizing family and community care for and by people with HIV/AIDS. The case studies included in this collection stem from the Joint UN Programme on HIV/AIDS (UNAIDS) presentation entitled, “Home and Community Care: It Works!," which documents the experiences and lessons learned by community-level projects in Africa, Asia, and Latin America. These six case studies include: 1) Project Hope--Projeto Esperanca de Sao Miguel Paulista, Brazil; 2) The Diocese of Kitui HIV/AIDS Programme, Kenya; 3) The Drug User Program, Ikhlas Community Centre, Pink Triangle, Malaysia; 4) The Tateni Home Care Services, South Africa; 5) Sanpatong Home-based Care Project, Thailand; and 6) The Chirumhanzu Home-based Care Project, Zimbabwe. It is noted that all these projects were chosen because they reflected most or all of what UNAIDS considers key elements of home and community care, as well as most of UNAIDS’ Best Practice criteria.