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BMJ. British Medical Journal. 2008 Sep 15; 337:958-960.In sub-Saharan Africa, 3% of the world's health workforce cares for 10% of the world's population bearing 24% of the global disease burden. Developing countries need an extra 4.3 million health workers, and urgent action is required to scale up education and training. Last month the World Health Organization's Commission on Social Determinants of Health emphasised the importance of building and strengthening the health workforce if the goal of achieving health equity within a generation is to be realised. International cooperation will be essential to strengthen health systems and to manage the migration of health workers from developing to developed countries. But these measures will take time. What can African and Asian health systems do to recruit and retain health workers now? How can health workers be persuaded to practise in rural areas? Guidelines, commissioned by the Global Health Workforce Alliance, aim to help countries make the best use of incentives to attract and retain health professionals. (excerpt)
SCN News. 2002 Dec; (25):61-63.The Report of the CMH (Commission on Macroeconomics and Health) is likely to be influential given the high profile of the Commissioners, the weighty composition of its Working Groups and its endorsement by WHO. Its description of the global health situation and of health systems in poor countries, as well as its key recommendations are strongly reminiscent of the central thrust of the World Bank's influential 1993 Report, "Investing in Health", which also emphasized the point that health is a major input to economic growth, but also studiously avoided any critical engagement with the global macroeconomic architecture that continues to generate economic growth accompanied by deepening inequalities. A decade has elapsed since that influential global health policy document was published and promoted. Yet in poor countries, particularly Africa, poverty has deepened and the health situation has further deteriorated, and health systems and their capacity have declined. It is difficult to avoid asking the question: "Why should things be different this time?" (excerpt)
New York, New York, Oxford University Press, 1990. xvii, 423 p.This text on international health covers historical and contemporary health issues ranging from water distribution systems of the ancient Aztecs to the worldwide endemic of AIDS. The author has also included areas not in the 1979 version: the 1978 Alma Ata conference on primary health care, infant and maternal mortality, health planning, and the role of science and technology. The 1st chapter discusses how each population movement, political change, war, and technological development has changed the world's or a region's state of health. Next the book highlights health statistics and how they can be applied to determine the health status of a population. A text on international health would be incomplete without a chapter on understanding sickness within each culture, including a society's attitude towards the sick and individual behavior which causes disease, e.g. smoking and lung cancer. 1 chapter features risk factors of a disease that are found in the environment in which individuals live. For example, in areas where iodine is not present in the soil, such as the Himalayas, the population exhibits a high degree of goiter and cretinism. Others present the relationship between socioeconomic development and health, e.g., countries at the low socioeconomic development spectrum have low life expectancies compared to those at the high socioeconomic end. An important chapter compares national health care systems and identifies common factors among them. An entire chapter is dedicated to organizations that provide health services internationally, e.g., private voluntary organizations. 1 chapter covers 3 diseases exclusively which are smallpox, malaria, and AIDS. The appendix presents various ethical codes.
Washington, D.C., Centre for Development and Population Activities, 1986 Apr. 14 p. (CEDPA Tenth Anniversary Lecture Series)This discussion of the role of women managers in family planning and population programs begins with an overview of the participation of women in development and population. It then directs attention to the need for women in management, increasing women's role in development programs, and changing attitudes about women's roles. 1 of the major achievements of the Decade for Women has been the recognition by most governments of the need to integrate women more fully into the process of national socioeconomic development. More and more governments are making a concerted effort to increase the participation of women and to integrate them into development. An area in which opportunities for women have not increased as much as they could is in management. The role and involvement of women in population and family planning are particularly important. Family planning programs in many areas of the world are directed to women, involve women, and are utilized by women, yet women are not in the policy-making or management position, deciding what should be done for them. In management, the 5 basic concerns are authority to make decisions, communication within organizations, the opportunity to introduce change, the productivity of the operation, and staff morale. The most important positions for women managers are at the policy-making and decision-making levels, but few women are at those levels in most developing country programs. Women's knowledge of local customs, norms, and needs can be used in designing programs and in selecting methods and services. Many programs now are designed, and family planning methods selected, without a clear understanding of the local situations or local customs. Women managers have the responsibility to educate others about how to design, implement, and evaluate programs and projects that are sensitive to the needs of women. Thus, the family planning sector in particular must involve women in all stages and levels of program design and implementation. The UN Fund for Population Activities (UNFPA) developed some guidelines on women, population, and development following the 1975 conference in Mexico inaugrating International Women's Year. The guidelines call for special attention to the needs and concerns of women and for participation of women in all stages and aspects of the UNFPA program. Since 1984, UNFPA has been examining how it can address the involvement of women in population programs and ways to improve the role and status of women. It tires to suppport projects in 2 major categories: projects aimed directly at improving the role and status of women by increasing their access to educational training and skills development and their participation in the community; and activities aimed at increasing the participation of women in all UNFPA-supported projects, which must be designed with consideration to the needs and concerns of women.
Doctors--barefoot and otherwise. The World Health Organization, the United States, and global primary medical care.
Jama. 1984 Dec 14; 252(22):3146-8.The international effort to provide primary health care (PHC) services for all by the year 2000 requires the development of appropriate manpower resources in the developing countries. Given the limited health budgets of developing countries, research on manpower development is necessary to ensure that funds for manpower development are used in the most efficient manner. In recognition of this need, the World Health Organization (WHO) and the International Organization for Medical Sciences convened a workshop, entitled "Health for All - A Challenge to Health Manpower Development Research" in Ibadan, Nigeria in 1982. The participants at the workshop agreed that manpower development strategies must be developed in the context of PHC, and that the current manpower development strategies in most developing countries do not provide the type of manpower required in PHC systems. Specifically, the workshop recommended that health manpower development strategies must 1) take into account the fact that health improvement is dependent not just on health services but on improvements in sanitation, water, housing, and nutrition; 2) recognize that PHC systems require an extensive cadre of health workers, paramedics, and auxiliary personnel, and that PHC systems are not highly physician dependent; and 3) recognize that medical schools must train physicians capable of serving the needs of the entire population rather than just the needs of the elite few. Participants also recognized that the development of effective strategies may be hindered by various professional, technical, financial, and bureaucratic factors. Given the pressing needs and scarce resources of developing countries, manpower development research must be highly policy oriented. The recommendations of the workshop were endorsed by WHO's Advisory Committee on Medical Research in 1983 and then distributed to WHO's 6 regional offices. The regional offices are currently discussing the recommendations with individual countries in an effort to determine how each country can implement the recommendations. The success of the effort to train appropriate manpower will require the assistance of developed countries and especially the US. The US can assist by providing training in US institutions for individuals from developing countries. Training programs, however, must be reoriented in such a way as to equip students to work in PHC settings. Medical personnel from the US can provide technical assistance in the developing countries, but efforts must made to ensure that this assistance is directed toward the development of PHC prsonnel and services.
Development: Seeds of Change. 1984; 2:66-7.UN International Children's Emergency Fund (UNICEF) experience over the last 20 years suggests that successful development for poor people is not possible without substantial grassroots involvement. This is the experience both in the developing and in industrialized countries. In the 1960s it became increasingly clear to UNICEF that if programs were to succeed with the small and landless farmers and the urban slum dwellers, there was no possibility of finding enough money to meet needs of these people through governmental channels. It was equally clear that in most places the existing patterns of development andeconomic growth would not reach these people until the year 2000 or thereabots. It was this that led UNICEF to adopt its basic services approach in the late 1960s and early 1970s, which implied that the cost of the most needed basic health services, education, and water had to be reduced to manageable limits. At this stage UNICEF began to articulate the imperative of using paraprofessionals, the need for much greater use of technology that was appropriate to rural and slum areas, and the importance of involving the people in this effort. Looking at those low income countries which have managed to achieve longer life expectancy and higher literacy rates, they are all societies which have practiced much more people's participation in economic and social activities than most other countries. These 3 very different societies -- China, South Korea, and Sri Lanka -- all have had a rather unique degree of people's participation in the development process. Grassroots participation in development is a very important element in developing and in industrial countries. 1 example concerns the whole question of proper nutrition practices, the promotion of breastfeeding, and the problem of the infant formula code. It was the people's groups which picked up the research results in the 1960s, which showed that breastfeeding was a better and more nutritious way of feeding children. The 2nd example pertains to the US government recommendation of significant cuts in UNDP and UNICEF, and the refusal of Congress to give in to those cuts. In regard to the developing countries, over the last year it has increasingly become the consensus of international experts that a childrens' health revolutioon is possible. The conclusion was based upon the fact that there were 2 new sets of developments coming together that created this new opportunity: some new technological advances in the development of rural rehydration therapy; and the capacity to communicate with poor people. With the whole emphasis on the basic human needs of the last 10 years, and on primary health care in the last 5 years, literally millions of health auxiliaries and community workers have been trained, a group of people who, if a country can mobilize them, can provide a new form of access.
Regional Course on Social Communication for Women Professionals in Population Programmes, Shanghai, China, 23 August to 3 September 1982, course report.
[Bangkok], Unesco, 1983. 34 p.This pamphlet summarizes the proceedings of the regional course on Social Communication for Women Professionals in Population/Development Programs held in Shanghai, China, in 1982. The gathering, attended by 12 participants from 10 countries, was organized by the United Nations Educational, Scienticfic and Cultural Organization (UNESCO) in cooperation with all All-China Women's Federation and the Asia-Pacific Institute for Broadcasting Development. The objectives of the course were: to study communication techniques ans strategies in support of national development with special reference to population programs; to study the role of women in the national development process, especially in terms of information, education, and communication activities; to delineate specific aspects of population and development programs in which women can play significant roles; and to exchange experiences. It was suggested that women's organizations can provide governments with an accurate picture of women's participation in national development. However, this requires adoption of health, education, legal, and labor force indicators to measure the degree of female participation. There is also a need to involve educated professional women in the effort to raise the status of the masses of women. Each country needs to take an inventory of all groups and organizations interested in women's developemnt and seek to involve them in mass publicity campaigns to explain the importance of mobilizing women in the developing effort. Women's groups can act as liaisons between the government and local women. The development of national communication strategies should involve identification of prevalent social issues, establishment of linkages between these issues and development, and identification of the role that the mass media can play to project women in a nonsexist fashion. Finally, it was recommended that governments of the Asian-Pacific Region should aim to improve coordination between government and nongovernmental organizations.