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Measuring postnatal care contacts for mothers and newborns: An analysis of data from the MICS and DHS surveys.
Journal of Global Health. 2017 Dec; 7(2):020502.Background: The postnatal period represents a vulnerable phase for mothers and newborns where both face increased risk of morbidity and death. WHO recommends postnatal care (PNC) for mothers and newborns to include a first contact within 24 hours following the birth of the child. However, measuring coverage of PNC in household surveys has been variable over time. The two largest household survey programs in low and middle-income countries, the UNICEF-supported Multiple Indicator Cluster Surveys (MICS) and USAID-funded Demographic and Health Surveys (DHS), now include modules that capture these measures. However, the measurement approach is slightly different between the two programs. We attempt to assess the possible measurement differences that might affect comparability of coverage measures. Methods: We first review the standard questionnaires of the two survey programs to compare approaches to collecting data on postnatal contacts for mothers and newborns. We then illustrate how the approaches used can affect PNC coverage estimates by analysing data from four countries; Bangladesh, Ghana, Kygyz Republic, and Nepal, with both MICS and DHS between 2010-2015. Results: We found that tools implemented todate by MICS and DHS (up to MICS round 5 and up to DHS phase 6) have collected PNC information in different ways. While MICS dedicated a full module to PNC and distinguishes immediate vs later PNC, DHS implemented a more blended module of pregnancy and postnatal and did not systematically distinguish those phases. The two survey programs differred in the way questions on postnatal care for mothers and newbors were framed. Subsequently, MICS and DHS surveys followed different methodological approach to compute the global indicator of postnatal contacts for mothers and newborns within two days following delivery. Regardless of the place of delivery, MICS estimates for postnatal contacts for mothers and newbors appeared consistently higher than those reported in DHS. The difference was however, far more pronounced in case of newborns. Conclusions: Difference in questionnaires and the methodology adopted to measure PNC have created comparability issues in the coverage levels. Harmonization of survey instruments on postnatal contacts will allow comparable and better assessment of coverage levels and trends.
Washington, D.C., Center for Global Development, 2016 Mar. 36 p. (CGD Policy Paper 077)This paper seeks to determine the degree to which a gender lens has been incorporated into World Bank projects and the success of individual projects according to gender equality-related indicators. We first examine the World Bank’s internal scoring of projects based on whether they encompass gender analysis, action, and monitoring and evaluation (M&E) components, as well as project development objective indicators and outcomes according to these indicators. We conclude that when indicators are defined, targets are specified, and outcomes are published, gender equality-related results appear largely positive. However, many projects (even those possessing a gender “theme” and perfect scores for the inclusion of gender analysis, action, and M&E components) lack gender-related indicators, and when such indicators are present, they often lack specified target goals. The paper concludes with a recommendation for increased transparency in gender-related project data (including data on the funding of gender equality-related components of projects) from donor institutions and a call for an increased number of gender-related indicators and targets in donor projects.
Washington, D.C., International Bank for Reconstruction and Development / The World Bank, 2017 Apr. 302 p.Gender equality is a core development objective in its own right and also smart development policy and business practice. No society can develop sustainably without giving men and women equal power to shape their own lives and contribute to their families, communities, and countries. And yet, critical gender gaps continue to exist in all countries and across multiple dimensions. The gender module of the World Bank’s ADePT software platform produces a comprehensive set of tables and graphs using household surveys to help diagnose and analyze the prevailing gender inequalities at the country level and over time. This book provides a step-by-step guide to the use of the ADePT software and an introduction to its basic economic concepts and econometric methods. The module is organized around the framework proposed by the World Development Report 2012: Gender Equality and Development. It covers gender differences in outcomes in three primary dimensions of gender equality: human capital (or endowments), economic opportunities, and voice and agency. Particular focus is given to the analysis and decomposition techniques that allow for further exploring of gender gaps in economic opportunities.
The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight.
PloS Medicine. 2017 Jan; 14(1):e1002220.BACKGROUND: Perinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common noncommunicable diseases in adulthood. Against this background, WHO made it a high priority to provide the present fetal growth charts for estimated fetal weight (EFW) and common ultrasound biometric measurements intended for worldwide use. METHODS AND FINDINGS: We conducted a multinational prospective observational longitudinal study of fetal growth in low-risk singleton pregnancies of women of high or middle socioeconomic status and without known environmental constraints on fetal growth. Centers in ten countries (Argentina, Brazil, Democratic Republic of the Congo, Denmark, Egypt, France, Germany, India, Norway, and Thailand) recruited participants who had reliable information on last menstrual period and gestational age confirmed by crown-rump length measured at 8-13 wk of gestation. Participants had anthropometric and nutritional assessments and seven scheduled ultrasound examinations during pregnancy. Fifty-two participants withdrew consent, and 1,387 participated in the study. At study entry, median maternal age was 28 y (interquartile range [IQR] 25-31), median height was 162 cm (IQR 157-168), median weight was 61 kg (IQR 55-68), 58% of the women were nulliparous, and median daily caloric intake was 1,840 cal (IQR 1,487-2,222). The median pregnancy duration was 39 wk (IQR 38-40) although there were significant differences between countries, the largest difference being 12 d (95% CI 8-16). The median birthweight was 3,300 g (IQR 2,980-3,615). There were differences in birthweight between countries, e.g., India had significantly smaller neonates than the other countries, even after adjusting for gestational age. Thirty-one women had a miscarriage, and three fetuses had intrauterine death. The 8,203 sets of ultrasound measurements were scrutinized for outliers and leverage points, and those measurements taken at 14 to 40 wk were selected for analysis. A total of 7,924 sets of ultrasound measurements were analyzed by quantile regression to establish longitudinal reference intervals for fetal head circumference, biparietal diameter, humerus length, abdominal circumference, femur length and its ratio with head circumference and with biparietal diameter, and EFW. There was asymmetric distribution of growth of EFW: a slightly wider distribution among the lower percentiles during early weeks shifted to a notably expanded distribution of the higher percentiles in late pregnancy. Male fetuses were larger than female fetuses as measured by EFW, but the disparity was smaller in the lower quantiles of the distribution (3.5%) and larger in the upper quantiles (4.5%). Maternal age and maternal height were associated with a positive effect on EFW, particularly in the lower tail of the distribution, of the order of 2% to 3% for each additional 10 y of age of the mother and 1% to 2% for each additional 10 cm of height. Maternal weight was associated with a small positive effect on EFW, especially in the higher tail of the distribution, of the order of 1.0% to 1.5% for each additional 10 kg of bodyweight of the mother. Parous women had heavier fetuses than nulliparous women, with the disparity being greater in the lower quantiles of the distribution, of the order of 1% to 1.5%, and diminishing in the upper quantiles. There were also significant differences in growth of EFW between countries. In spite of the multinational nature of the study, sample size is a limiting factor for generalization of the charts. CONCLUSIONS: This study provides WHO fetal growth charts for EFW and common ultrasound biometric measurements, and shows variation between different parts of the world.
Performance of Risk Charts to Guide Targeted HIV Viral Load Monitoring of ART: Applying the Method on the Data From a Multicenter Study in Rural Lesotho.
Journal of Acquired Immune Deficiency Syndromes. 2016 May 1; 72(1):e22-5.Add to my documents.
World Development Indicators 2016. Highlights: Featuring the Sustainable Development Goals. Extracted from the full version of WDI 2016.
Washington, D.C., World Bank, 2016.  p.These WDI Highlights are drawn from World Development Indicators (WDI) 2016 - the World Bank’s compilation of internationally comparable statistics about global development and the quality of people’s lives. WDI is regularly updated and new data are added in response to the needs of the development community; the 2016 edition includes new indicators to help measure the Sustainable Development Goals. World Development Indicators is the result of a collaborative partnership of international agencies, statistical offices of more than 200 economies, and many more.
Washington, D.C., World Bank, 2016.  p.This annual release of a new edition is an opportunity to review the trends we’re seeing in global development and discuss updates we’ve made to our data and methods. The WDI team aims to produce a curated set of indicators relevant to the changing needs of the development community. The new edition includes indicators to help measure the 169 targets of the 17 Sustainable Development Goals (SDGs) -- these build on the 8 goals and 18 targets of the Millennium Development Goals we focused on in previous editions, but are far wider in scope and far more ambitious. A complementary Sustainable Development Goals data dashboard provides an interactive presentation of the indicators we have in the WDI database that are related to each goal. For each of the 17 SDGs the World View section of the publication includes recent trends and baselines against key targets. Data experts in the World Bank’s Data Group and subject specialists in the Bank’s Global Practices and Cross Cutting Solution Areas teamed up to identify new and existing indicators and assess key trends for each goal and for three cross-cutting areas: statistical capacity; fragility, conflict and violence; and financial inclusion.
Report on Ending Preventable Maternal Mortality (EPMM) Metrics Technical Meeting. Phase I: Developing a core set of maternal health indicators for GLOBAL monitoring and reporting.
[Unpublished] 2015 Sep 22.  p.In total, forty-five people participated in one or more stages of the process undertaken to reach consensus on a core set of priority, methodologically robust maternal health (MH) indicators with direct relevance for reducing preventable mortality (proximal to causes of death) for global monitoring and reporting by all countries. Consensus was reached on twelve maternal health indicators, with advancement on definitions that include the numerator, denominator, disaggregators, and data sources, which can contribute to a global monitoring framework for Ending Preventable Maternal Mortality (included as an Appendix to this meeting report). The definitions and data sources to accompany the Core Maternal Health Indicators for Global Monitoring and Reporting require further refinement, as per the outcomes of the meeting, and will be subject to ongoing review before finalization. There was consensus that it would be appropriate for WHO to put forward this core set of maternal health indicators in further member state consultation and deliberation through global processes, including integration and harmonization with core metrics from the Every Newborn Action Plan (ENAP) as part of a combined monitoring framework for maternal and newborn health. All participants pledged their support for these processes. Furthermore, agreement was reached on four priority areas in which immediate work is required to develop much needed indicators for global monitoring and reporting by all countries, through further refinement of definitions, further development of data sources, and further measure testing and validation. Such efforts should be undertaken in collaboration and coordination with other ongoing indicator development initiatives. Finally, a “parking lot” list of additional indicators of interest was generated. These represent indicators that are either desirable for use at different levels of the health system but not appropriate for global monitoring, or desirable for further research and development to enhance their validity or feasibility for future use in a global monitoring framework. (Excerpt)
Medicine (United States). 2015 Sep; 94(37):e1453.A public health approach to combination HIV prevention is advocated to contain the epidemic in sub-Saharan Africa. We explore the implications of universal access to treatment along with HIV education scale-up in the region. We develop an HIV transmission model to investigate the impacts of universal access to treatment, as well as an analytical framework to estimate the effects of HIV education scale-up on the epidemic. We calibrate the model with data from South Africa and simulate the impacts of universal access to treatment along with HIV education scale-up on prevalence, incidence, and HIV-related deaths over a course of 15 years. Our results show that the impact of combined interventions is significantly larger than the summation of individual intervention impacts (super-additive property). The combined strategy of universal access to treatment and HIV education scaleup decreases the incidence rate by 74% over the course of 15 years, whereas universal access to treatment and HIV education scale up will separately decrease that by 43% and 8%, respectively. Combination HIV prevention could be notably effective in transforming HIV epidemic to a low-level endemicity. Our results suggest that in designing effective combination prevention in sub-Saharan Africa, priorities should be given to achieving universal access to treatment as quickly as possible and improving compliance to condom use.
[Washington, D,.C.], World Bank, 2015 Jun.  p.The Roadmap articulates a shared strategic approach to support effective measurement and accountability systems for a country’s health programs. The Roadmap outlines smart investments that countries can adopt to strengthen basic measurement systems and to align partners and donors around common priorities. It offers a platform for development partners, technical experts, implementers, civil society organizations, and decision makers to work together for health measurement in the post-2015 era. Using inputs and technical papers developed by experts from international and national institutions, the Roadmap was completed following a public consultation that received extensive contributions from a wide number of agencies and individuals from across the globe. (Excerpt)
Geneva, Switzerland, WHO, 2014.  p.The action plan sets out a vision of a world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and children survive, thrive and reach their full potential. Nearly 3 million lives could be saved each year if the actions in the plan are implemented and its goals and targets achieved. Based on evidence of what works, and developed within the framework for Every Woman Every Child, the plan enhances and supports coordinated, comprehensive planning and implementation of newborn-specific actions within the context of national reproductive, maternal, newborn, child and adolescent health strategies and action plans, and in collaboration with stakeholders from the private sector, civil society, professional associations and others. The goal is to achieve equitable and high-quality coverage of care for all women and newborns through links with other global and national plans, measurement and accountability.
UNAIDS ‘multiple sexual partners’ core indicator: Promoting sexual networks to reduce potential biases.
Global Health Action. 2014; 7:23103.UNAIDS proposed a set of core indicators for monitoring changes in the worldwide AIDS epidemic. This paper explores the validity and effectiveness of the ‘multiple sexual partners’ core indicator, which is only partially captured with current available data. The paper also suggests an innovative approach for collecting more informative data that can be used to provide an accurate measure of the UNAIDS’s ‘multiple sexual partners’ core indicator. Specifically, the paper addresses three major limitations associated with the indicator when it is measured with respondents’ sexual behaviors. First, the indicator assumes that a person’s risk of contracting HIV / AIDS / STIs is merely a function of his / her own sexual behavior. Second, the indicator does not account for a partner’s sexual history, which is very important in assessing an individual’s risk level. Finally, the 12-month period used to define a person’s risks can be misleading, especially because HIV / AIDS theoretically has a period of latency longer than a year. The paper concludes that, programmatically, improvements in data collection are a top priority for reducing the observed bias in the ‘multiple sexual partners’ core indicator.
Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division.
Geneva, Switzerland, WHO, 2014.  p.Millennium Development Goal (MDG) 5 Target 5A calls for the reduction of maternal mortality ratio by three quarters between 1990 and 2015. It has been a challenge to assess the extent of progress due to the lack of reliable and accurate maternal mortality data -- particularly in developing-country settings where maternal mortality is high. As part on going efforts, the WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division updated estimates of maternal mortality for the years 1990, 1995, 2000, 2005 and 2013.
Bulletin of the World Health Organization. 2014; 92:155.Unsafe abortion is defined by the World Health Organization (WHO) as a procedure for terminating a pregnancy as performed by persons lacking the necessary skills or in an inappropriate environment that fails to meet minimal medical standards, or both. Concepts first outlined in a 1992 WHO Technical Consultation are embodied in this definition. However, although this definition is widely used, it is inconsistently interpreted. In this editorial, we discuss its correct interpretation and operationalization. (excerpt)
The structural determinants of child well-being: an expert consultation hosted by the UNICEF Office of Research, 22-23 June 2012.
Florence, Italy, UNICEF, Office of Research, 2012.  p.This paper describes the outcomes of an expert consultation on “The Structural Determinants of Child Well-being” hosted by the UNICEF Office of Research. The two-day meeting brought together twelve participants to discuss the underlying causes of child well-being and develop an initial framework to consider the impact of structural factors on children’s lives and the inequalities that too often shape (and limit) their futures. Seven major conclusions emerged from the debate. There is a large and still to be exploited potential for structural interventions to improve the lives of children in low and middle-income countries. Some sectors, notably health, have moved ahead in defining a structural determinants approach to programming and have a growing evidence base to draw upon. Other sectors have begun to follow but still have to make their case with the policy community. Until now, there has been very little work that brings together insights from analysing structural determinants of child wellbeing across all its dimensions in a consistent and rigorous way. Definitions of terms relating to structural and social determinants, and what we understand by social norms vary, and are sometimes at odds with each other or confusing. An agreement on key principles and concepts is an important basis for defining structural interventions that can make a difference at national and local levels. An integrated view of child well-being requires inter-sectoral and comprehensive approaches which both recognize the interplay of structural factors that influences children’s lives and seek to build synergies across programme areas. A pathway analysis can be helpful, together with the recognition of the vital importance of the early years, and other key periods of emotional and cognitive development such as adolescence. Such a ‘life-course’ approach offers the possibility to better understand the interaction of determinants at different stages of a child’s life and intergenerational drivers of inequity, gender inequality and disadvantage. A life-course approach has a strong evidence base primarily in OECD countries, and is still to be extended to low- and middle-income countries. Structural determinants are by their nature complex. That complexity does not imply that appropriate interventions cannot be launched, rather that new ways of planning and organizing inter-sectoral approaches are required especially in settings where administrative capacities are are still weak. A number of such innovations are beginning to show promise and need both support and expansion. New thinking related to ‘Governance’ as a domain of analysis and policy action for children provides directions of fresh research. Applied to systemic issues such as de-centralisation or social exclusion, such approaches point back to the insights developed from human rights thinking, including the obligations of the state to put in place and monitor the effectiveness of institutions and structures that address underlying causes of inequity and ensure that excluded groups, including all children, girls and boys, have a voice and are heard both in policy making and in resource allocation. A number of tools to strengthen analysis and action under a structural determinants approach are available but need to be expanded and tested in different settings. Finally, measurement challenges also need to be overcome to build a strong data base for action.
Geneva, Switzerland, World Health Organization [WHO], 2012.  p.Millennium Development Goal (MDG) 5 Target 5A calls for the reduction of maternal mortality ratio by three quarters between 1990 and 2015. It has been a challenge to assess the extent of progress due to the lack of reliable and accurate maternal mortality data -- particularly in developing-country settings where maternal mortality is high. As part of ongoing efforts, the WHO, UNICEF, UNFPA and The World Bank updated estimates of maternal mortality for the years 1990, 1995, 2000, 2005 and 2010.
Bulletin of the World Health Organization. 2011 Nov 1; 89(11):779-779A.This editorial, focused on maternal death surveillance and response, states that a system which includes maternal death identification, reporting, review, and response can provide the essential information to stimulate and guide actions to prevent future maternal deaths and improve the measurement of maternal mortality. It finds that the current convergence of factors including political will, technical innovations and financial resources provides an ideal opportunity to make such systems a reality for low-income countries.
Reproductive Health Matters. 2011 Nov; 19(38):35-41.This paper explores the actors who replaced the agreements about the global development agenda made in the International Conference on Population and Development (ICPD) in Cairo 1994 and the 4th UN World Women's Conference in Beijing in 1995 with the Millennium Development Goals (MDGs). It also surveys the processes which shape and affect the exercise of power, which can lead to radical changes.
Measuring and responding to gender-based violence in the Pacific: Action on gender inequality as a social determinant of health. Republic of Kiribati. Draft background paper.
[Unpublished] 2011. Draft background paper commissioned by the World Health Organization for the World Conference on Social Determinants of Health, Rio de Janeiro, Brazil, 19-21 October 2011.  p. (WCSDH/BCKGRT/4B/2011; Draft Background Paper 4B)The successful implementation of the FHSS with the subsequent development of responsive policies to tackle the problem of GBV in Kiribati demonstrate several key lessons for other problems to be addressed, perhaps in other contexts. First, data collection is a time-consuming and expensive process, but it is necessary to assess and understand health issues in order to develop responsive policies. Communities and municipalities / provinces should be informed of the study (with a safe name, if deemed necessary) prior to its initiation, so as to facilitate collaboration. If staff capacity and/or expertise is lacking, appropriate sources of support should be identified and utilized, not only to ensure a successful research project, but in order to build national capacity. It was important in Kiribati that government officials carried out the study and follow-up activities -- and that they were publicly perceived to do so. Consistent (and appropriate) stakeholder engagement throughout the intervention was critical for credibility, successful implementation and acceptance of results. The selection of the research methodology must also be considered and goal-oriented: the indicators included in an investigation (or not) will determine, in large part, the information collected and its potential uses. The WHO multi-country study offers a validated methodology for measuring GBV, which has proved to be replicable in the Pacific. The Kiribati FHSS was able to inspire policy responses to both GBV and its key determinant, gender inequality, because it included gender-sensitive indicators and metrics of gender inequality itself (qualitative in this instance). Additionally, the qualitative research sufficiently focused on men, validating while attempting to understand their perspectives so that men and boys may be involved as agents of social change. Given the apparent recognition in Kiribati that gender inequality fuels its epidemic of GBV, monitoring and evaluation of its policies on EVAW and gender equality should include an assessment of gender inequality. The FHSS included some metrics of gender inequality, but as mentioned above, the NAP on EVAW will need to be supplemented by additional monitoring to adequately measure changes in gender inequality. As challenging as it was to accumulate sufficient political will and attention to GBV for completion of the FHSS, a more thorough assessment of gender equality should be conducted so as to provide a baseline against which the effects of the National Policies on Gender Equality and EVAW can be measured. While the determinants of GBV itself -- largely gender equality, are more challenging to quantify than its incidence or prevalence, WHO’s Regional Office for the Western Pacific has identified some indicators of gender equity and repeat focus groups could provide quantitative data. (Excerpt)
Gender-based violence in Solomon Islands: Translating research into action on the social determinants of health. Draft background paper.
[Unpublished] 2011. Draft background paper commissioned by the World Health Organization for the World Conference on Social Determinants of Health, Rio de Janeiro, Brazil, 19-21 October 2011.  p. (WCSDH/BCKGRT/4A/2011; Draft Background Paper 4A)The successful implementation of the SIFHSS with resultant policy development provides several key lessons for addressing other health inequities, perhaps in other contexts. First, data collection is a time-consuming and expensive process, but is necessary to effectively understand health issues for responsive policymaking. The selection of research methodology and indicators must be well-considered, comprehensive and goal-oriented: the indicators measured (or not) will significantly determine, the information collected and its potential uses. The WHO multi-country study provides a validated methodology for measuring GBV, replicable in all regions, including the Pacific.The SIFHSS was able to catalyze policy responses to both GBV and its key determinant -- gender inequality -- because, building on WHO methodology, it included gender-sensitive indicators and metrics of gender inequality itself (qualitative in this instance). Furthermore, the qualitative research sufficiently focused on men, at once validating and attempting to understand their perspectives so that men and boys may be meaningfully involved as agents of social change. Second, research implementation should be completed in a context-specific and respectful manner that allows for study rigor as well as the safety and well being of its research team. Recruitment, selection and training are important for the successful completion of the study, and applicants should be given detailed information of the work required and living situation during fieldwork, including time away from home. Positive attitudes and teamwork skills are invaluable. Communities should be informed of the study (with a safe name, if necessary) in advance so as to facilitate collaboration and reduce study team harassment. Travel logistics, accommodation and board in research sites should be anticipated and pre-organized. If staff capacity and/or expertise is lacking, external sources of support should be identified and utilized to ensure a successful project while building national capacity. (Excerpt)
Monitoring equity in access to AIDS treatment programmes: a review of concepts, models, methods and indicators.
Geneva, Switzerland, WHO, 2010.  p.The World Health Organization (WHO) and the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through REACH Trust Malawi and Training and Research Support Centre (TARSC) developed this review. It provides a practical resource for programme managers, health planning departments, evaluation experts and civil society organizations working on health systems and HIV / AIDS programmes at sub-national, national and regional levels in East and Southern Africa. Many of the orientations and tools in this document were developed through a wide consultation process, starting in 2003. We draw on the broader analysis of health equity advanced by EQUINET, as well as evidence from five background studies on equity and health systems impacts of ART programming in East and Southern Africa which were supported by EQUINET, TARSC and DFID (available at www. equinetafrica.org). (Excerpt)
Trends in maternal mortality: 1990 to 2008. Estimates developed by WHO, UNICEF, UNFPA and The World Bank.
Geneva, Switzerland, World Health Organization [WHO], 2010.  p.This report presents the global, regional, and country estimates of maternal mortality in 2008, and the findings of the assessment of trends of maternal mortality levels since 1990. It summarizes the challenges involved in measuring maternal mortality and the main approaches to measurement, and explains the methodology of the 2008 maternal mortality estimates. The final section discusses the use and limitations of the estimates, with an emphasis on the importance of improved data quality for estimating maternal mortality. The appendices present the sources of data for the country estimates as well as MMR estimates for the different regional groupings for WHO, UNICEF, UNFPA, The World Bank, and UNPD. (Excerpt)
Washington, D.C., World Bank, Urban Sector Board, 2008.  p.This paper provides an overview on what has been learned about urban poverty over the past decade with a focus on what is new and what the implications are for the World Bank going forward in an increasingly urbanized world. Coverage includes current information on the scope of urban poverty, identification of the key issues for the urban poor, a summary of regional characteristics of urban poverty, what has been learned from programs and policies aimed at the urban poor, and finally, the paper identifies priorities for urban poverty reduction within the context of an overall urban strategy.
Entre Nous. 2009; (68):8-9.The availability of effective sexual and reproductive health services (SRHS) has major implications on health in the European context. Low natural growth, epidemiological challenges generated often by sexually transmitted infections, increasing cross-border movement and inequalities in quality standards and safety requirements in health services all impact the SRH of populations in the Region. Integration of health system functions is critical to efficiently address the evolving issue of SRH at national level, and to ponder system’s capacity for delivery with the fluctuating clinical demand and public expectations. In the national context, the main challenge lies in the interventions of choice and in the degree to which these are prioritized, linked and disseminated, in terms of value, resources and policies.
Entre Nous. 2009; (68):4-5.The WHO European Ministerial Conference on “Health Systems, Health and Wealth” held in Tallinn in June 2008 was a watershed event that took stock of and consolidated the recent conceptual and methodological developments, as well as, practice-based innovations in the European health arena. The upshot of the conference was that not only does health matter - we knew that already because we in Europe value health in its own right - but also good health contributes to wealth generation. The conference also argued that health systems contribute to the generation of wealth, since in almost any society, albeit at varying degrees, the health sector constitutes one of the major spheres of economic activities, producing, consuming and trading goods and services, and contributing to knowledge and technology generation through research and development.