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Washington, D.C., World Bank, 2004 May.  p. (Health, Nutrition and Population (HNP) Discussion Paper; World Bank Report No. 69106)This paper argues for more nuance in the interpretation of progress towards the Nutrition Millennium Development Goal indicator (halving the prevalence of underweight children, under 5 years old, by 2015). Interpretation of a country's performance based on trends alone is ambiguous, and can lead to erroneous prioritization of countries in need of donor assistance. For instance, a country may halve the prevalence by 2015, but will still have unacceptable high malnutrition rates. This paper analyses which countries are showing satisfactory and unsatisfactory progress using the Annual Rate of Change (ARC), and then introduces the World Health Organization-classification of severity of malnutrition in the analysis to provide more nuance. It highlights that a little less than half of the Bank's client population is likely to halve underweight by 2015. Although the paper uses national data only, it flags the risks and recommends that countries take regional disparities into their needs-analysis. The paper also argues for more attention to the other important nutrition indicators, stunting and micronutrient deficiencies, which remain enormous problems, and briefly discusses solutions to reducing underweight malnutrition.
A review of population, reproductive health, and adolescent health and development in poverty reduction strategies.
Washington, D.C., World Bank, Health, Nutrition and Population Central Unit, Population and Reproductive Health Cluster, 2004 Aug.  p.This review examines how poverty reduction strategies are addressing population (Pop), reproductive health (RH), and adolescent health and development (AHD) issues. We analyzed twenty-one Poverty Reduction Strategy Papers (PRSPs) and associated documents, and conducted interviews with Health, Nutrition, and Population (HNP) staff at the World Bank involved in the poverty reduction strategy process. Based on this review, we recommend actions that the Bank, other donors, government counterparts, and civil society groups can take to better support countries to address Pop/RH/AHD issues in their poverty reduction efforts. Population, reproductive health, and adolescent health and development issues are closely interrelated in cause, consequence and policy implications. To maintain a stronger focus on these three issues, we chose not to analyze related concerns such as gender, nutrition, and education -- all essential components of the multisectoral approach advocated by the Cairo Programme of Action (ICPD, 1994). Other reviews have examined these related issues in greater depth. This paper complements a growing body of work reviewing the application of the PRS framework to poverty alleviation in low-income countries. Compared to previous health and related sector reviews, it provides a more in-depth look at Pop/RH/AHD issues, examines documents related to the PRSP such as the JSA and CAS, and incorporates interviews of key actors with Pop/RH/AHD expertise involved in the PRS process. This review is meant to complement findings from other reviews of the PRS process that focus on broader issues of relevance to all sectors. Our analysis relied on several of these relevant internal and external reviews, including in-depth reviews of gender, the health sector, nutrition, and population and development issues. (Excerpt)
Integration of the human rights of women and a gender perspective: Violence against women. Report of the Special Rapporteur on violence against women, its causes and consequences, Yakin Erturk. Addendum. Mission to El Salvador (2-8 February 2004).
[Geneva, Switzerland], United Nations, Commission on Human Rights, 2004 Dec 20. 29 p. (E/CN.4/2005/72/Add.2)This report contains my findings as the Special Rapporteur on violence against women, its causes and consequences, following my visit to El Salvador on official mission, from 2 to 8 February 2004. It addresses the diverse forms of violence against women in the country and identifies key measures and initiatives needed to ensure the protection and promotion of the rights of women and the elimination of violence against women. Although women's rights were not central to the civil war that ravaged El Salvador between 1980 and 1992 or to the peace negotiations thereafter, women's high level of participation in the opposition forces gave them experience and political consciousness that enabled them to challenge discriminatory practices in the society. As a result, in the post-conflict era notable progress related to gender equality, particularly at the legislative level, was achieved. Other encouraging developments include the establishment of the Salvadoran Institute for the Advancement of Women (ISDEMU), a human rights programme within the National Civil Police (PNC) and other institutional initiatives designed to protect women against violence. Despite the achievements, the failure of authorities to investigate, prosecute and punish those responsible for gender-based violence has contributed to an environment of impunity that has resulted in little confidence in the justice system. Impunity for crimes, the socio-economic disparities and the machista culture foster a generalized state of violence, subjecting women to a continuum of multiple violent acts, including murder, rape, domestic violence, sexual harassment and commercial sexual exploitation. (excerpt)
London, England, ActionAid International, . 27 p. (P1625/01/04)UNAIDS estimated that in Africa in 2003, more than 2.3 million people died from AIDS, 3 million were newly infected and a total of 12 million children were orphaned. Antiretroviral drugs are reaching a mere 50,000 of those with AIDS in developing countries. The HIV/AIDS pandemic is clearly a human and developmental disaster. This paper looks at the response to the HIV/AIDS crisis by the World Bank as a key member of the international donor/lending community, a leader in the international health community, and as Africa's principal development partner. In its seminal document, Intensifying Action Against HIV/AIDS, the World Bank acknowledges both its special leadership role in fighting HIV/AIDS and the need that it be held accountable for its stewardship. (excerpt)
Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference.
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S27-S36.Thorough training, continuous standardization, and close monitoring of the adherence to measurement procedures during data collection are essential for minimizing random error and bias in multicenter studies. Rigorous anthropometry and data collection protocols were used in the WHO Multicentre Growth Reference Study to ensure high data quality. After the initial training and standardization, study teams participated in standardization sessions every two months for a continuous assessment of the precision and accuracy of their measurements. Once a year the teams were restandardized against the WHO lead anthropometrist, who observed their measurement techniques and retrained any deviating observers. Robust and precise equipment was selected and adapted for field use. The anthropometrists worked in pairs, taking measurements independently, and repeating measurements that exceeded preset maximum allowable differences. Ongoing central and local monitoring identified anthropometrists deviating from standard procedures, and immediate corrective action was taken. The procedures described in this paper are a model for research settings. (author's)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S37-S45.The objective of the Motor Development Study was to describe the acquisition of selected gross motor milestones among affluent children growing up in different cultural settings. This study was conducted in Ghana, India, Norway, Oman, and the United States as part of the longitudinal component of the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS). Infants were followed from the age of four months until they could walk independently. Six milestones that are fundamental to acquiring self-sufficient erect locomotion and are simple to evaluate were assessed: sitting without support, hands-and-knees crawling, standing with assistance, walking with assistance, standing alone, and walking alone. The information was collected by both the children's caregivers and trained MGRS fieldworkers. The caregivers assessed and recorded the dates when the milestones were achieved for the first time according to established criteria. Using standardized procedures, the fieldworkers independently assessed the motor performance of the children and checked parental recording at home visits. To ensure standardized data collection, the sites conducted regular standardization sessions. Data collection and data quality control took place simultaneously. Data verification and cleaning were performed until all queries had been satisfactorily resolved. (author's)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S5-S14.The rationale for developing a new international growth reference derived principally from a Working Group on infant growth established by the World Health Organization (WHO) in 1990. It recommended an approach that described how children should grow rather than describing how children grow; that an international sampling frame be used to highlight the similarity in early childhood growth among diverse ethnic groups; that modern analytical methods be exploited; and that links among anthropometric assessments and functional outcomes be included to the fullest possible extent. Upgrading international growth references to resemble standards more closely will assist in monitoring and attaining a wide variety of international goals related to health and other aspects of social equity. In addition to providing scientifically robust tools, a new reference based on a global sample of children whose health needs are met will provide a useful advocacy tool to health-care providers and others with interests in promoting child health. (author's)
New York, New York, UNICEF, 2004 Aug. 33 p.In September 2000, 189 UN Member States adopted the Millennium Development Goals (MDGs), setting clear, time-bound targets for making real progress on the most pressing development issues we face. Achieving these targets will directly affect the lives and future prospects of billions of people around the globe. It will also set the world on a positive course at the start of the 21st century. Goal 7 is to ensure environmental sustainability. One of its targets is the subject of this report: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. Although the MDGs were formulated in 2000, the baseline for most of the MDG targets, including that on water and sanitation, has been set as 1990. Therefore 2002, the last year for which comprehensive data are available, can be considered the halfway mark towards achieving the 2015 MDG deadline. This report, prepared by the WHO/UNICEF Joint Monitoring Programme (JMP), provides coverage data for 1990 and 2002 at national, regional and global levels and an analysis of trends towards 2015. It also marks a new cycle of more frequent reporting, which can be effectively used for sector capacity-building efforts at the national and subnational levels. The report is intended as a ‘reality check’ for individual countries and the international community on how far we have come, and where we need to focus next, in order to fulfill our commitment. (excerpt)
New York, New York, UNFPA, 2004. 6 p.In order to achieve internationally agreed development goals, it is vital that the linkages between reproductive health and HIV/AIDS prevention and care be addressed. To date, the benefits of the linkages have not been fully realized. United Nations agencies have initiated consultations with a wide range of stakeholders to identify opportunities for strengthening potential synergies between reproductive health and HIV/AIDS efforts. This Glion Call to Action reflects the consensus of one such consultation, which focused on the linkage between family planning (a key component of reproductive health) and prevention of mother-to-child HIV transmission (PMTCT) (a key component of HIV/AIDS programmes). The focus of the Glion Call to Action on preventing HIV among women and children is fully consistent with the parallel need for increased commitment to the health and wellbeing of women themselves. Therefore, the Glion Call to Action rests on the consensus achieved at the International Conference on Population and Development (ICPD) in Cairo and acknowledges the rights of women to decide freely on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence, and the need to improve access to services so that couples and individuals can decide freely the number, spacing and timing of their children. In order to ensure that these rights are respected, policies, programmes and interventions must promote gender equality, and give priority to the poor and underserved populations. (excerpt)
Issue paper: Review of the human rights content of frameworks to assess the effectiveness of HIV / AIDS programming.
Geneva, Switzerland, UNAIDS, 2004. Prepared for the 4th Meeting of the UNAIDS Global Reference Group on HIV / AIDS and Human Rights, August 23-25, 2004. 7 p.This paper examines approaches used by some of the primary intergovernmental and governmental agencies in assessing the effectiveness of HIV/AIDS programmes, as they have been reviewed by the UNAIDS Monitoring and Evaluation Reference Group (MERG). This is to attempt to begin to shed light on how the effectiveness of HIV/AIDS programs are currently assessed by UNAIDS, its partners, and other major organizations, and to understand the extent and ways in which human rights considerations form parts of these assessments. (excerpt)
Geneva, Switzerland, UNAIDS, 2004. Prepared for the 4th Meeting of the UNAIDS Global Reference Group on HIV / AIDS and Human Rights, August 23-25, 2004. 7 p.This paper explores issues and approaches relevant to the assessment of the application of a rights based approach to the planning and implementation of HIV/AIDS strategies. It builds on the premise that the Reference Group may wish to recommend to UNAIDS a set of practical steps towards integrating human rights in HIV/AIDS policies and programs and monitoring the compliance of HIV/AIDS policies and programs with international human rights principles and guidelines, in particular those that have been explicitly promoted by UNAIDS in its publications and other work. Some suggested key issues are highlighted and, HIV testing strategies will be used as an example to the extent necessary to clarify concepts. (excerpt)
Emerging Infectious Diseases. 2004 Nov; 10(11):1979-1983.The mechanisms, techniques, and data sources used to monitor and evaluate global AIDS prevention and treatment services may vary according to gender. The Joint United Nations Programme on HIV/AIDS has been charged with tracking the response to the pandemic by using a set of indicators developed as part of the Declaration of Commitment endorsed at the U.N. General Assembly Special Session on AIDS in 2001. Statistics on prevalence and incidence indicate that the pandemic has increasingly affected women during the past decade. Women’s biologic, cultural, economic, and social status can increase their likelihood of becoming infected with HIV. Since 2000, global financial resources have increased to allow expansion of both prevention and treatment services through a number of new initiatives, such as the Global Fund to Fight AIDS, TB and Malaria; the U.S. President’s Emergency Plan for AIDS Relief; and the World Bank MAP program. Programs should be monitored and evaluated to ensure these investments are used to maximum effect. Different types of data should be included when assessing the status of the HIV/AIDS epidemic and effectiveness of the response. Each of these “data streams” provides information to enhance program planning and implementation. (excerpt)
“Three Ones” key principles . “Coordination of National Responses to HIV / AIDS”. Guiding principles for national authorities and their partners.
Geneva, Switzerland, UNAIDS, 2004. 4 p.The HIV/AIDS pandemic is a genuine global emergency taking the lives of eight thousand people a day and threatening the lives of tens of millions more as the infection continues to spread around the world. New but still limited resources to respond to the needs of people living with HIV and AIDS and those at risk of infection will be utilized most efficiently if there is maximum coordination within the international community. To leverage resources and have the maximum impact on the global response to AIDS, all parties should strive to target their programmes on the priority needs of affected countries strive, seeking to avoid duplication of effort. (excerpt)
Geneva, Switzerland, UNAIDS, . 2 p.The AIDS epidemic is a complex global crisis, which continues to worsen. At the same time, the world is responding more effectively than ever before. National responses are broader and stronger, and have improved access to financial resources and commodities. We, bilateral and multilateral donor agencies meeting with national leaders combating the spread of AIDS, reaffirm our broad and sustained commitment to supporting national AIDS responses. We endorse the “Three Ones” or key principles for concerted AIDS action at country level, with a view toward achieving the most effective and efficient use of available resources and ensuring rapid action and result-based management. These principles – detailed in the conference papers – are: One agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners. One National AIDS Coordinating Authority, with a broad based multi-sectoral mandate. One agreed country level Monitoring and Evaluation System. (excerpt)
Geneva, Switzerland, UNAIDS, 2004 Jun.  p. (UNAIDS/04.35E)This progress report summarizes the achievements of CRD (Country and Regional Support Department) in 2003 and presents selected highlights in greater detail. The first section outlines the strategic framework for action, Directions for the Future, the status of its implementation, the associated capacity strengthening of UNAIDS at country level, and challenges for 2004 and the next biennium. Text boxes in this section highlight “UNAIDS corporate tools” employed to implement the strategic framework. The second section reviews CRD’s efforts to translate global initiatives into results at country level. UNAIDS is involved in numerous global initiatives, three, which required particular involvement of UNAIDS resources at country level, are highlighted here. The third section reviews regional progress towards implementing the strategic framework for action. The examples cited, whilst not being an exhaustive review of country work, illustrate how UNAIDS has worked as a catalyst for national AIDS response. This report concludes with a collection of two-page country situation and progress summaries from 70 of the 134 countries with the UN Theme Groups on HIV/AIDS. (excerpt)
Geneva, Switzerland, UNAIDS, 2004 Jul.  p.In monitoring resource flows for HIV and AIDS, it has proven easier to collect information on donor governments, multilateral agencies, foundations and nongovernmental organizations (NGOs) than to obtain reliable budget information on domestic outlays for HIV and AIDS in affected countries. As a result, UNAIDS has focused significant efforts on strengthening the capacity of countries to monitor and track expenditures for HIV and AIDS. This report summarizes the latest information available on HIV-related spending in 26 countries. Seventeen of the countries are from the Latin America and Caribbean (LAC) region. Resource tracking in the LAC region, as well as in Thailand, Burkina Faso and Ghana has benefited from the leadership of the Regional AIDS Initiative for Latin America and the Caribbean (SIDALAC), which helped implement the National AIDS Account (NAA) approach. Beginning with pilot projects in three countries in 1997–1998, NAA has now been extended throughout the region, in large part due to the provision of extensive technical assistance by countries involved in the early pilot projects. NAA uses a matrix system that describes the level and flow of health expenditures on AIDS. The NAA model: a) identifies key actors in HIV and AIDS activities; b) uses existing data or makes estimates for specific services or goods purchased; c) analyses domestic (public and private) and international budgets; d) determines out-of-pocket expenditures; and e) assesses the financial dimensions of the country’s response to AIDS. (excerpt)
Geneva, Switzerland, UNAIDS, 2004 Jul.  p. (UNAIDS/04.39E)As the AIDS epidemic has spread, funding for sexually transmitted diseases (STDs) and HIV and AIDS activities has also increased sharply over the last few years. Based on the best available information, UNAIDS estimates that spending on AIDS in low and middle-income countries amounted to nearly US$ 4.7 billion in 2003 – a 20% increase over 2002 (US$ 3.9 billion) and an almost 15 fold increase over 1996 expenditures. Along with the spread of the epidemic, political commitment to reverse the spread of AIDS has grown stronger, triggering greater international action to mobilize critical financial resources. At the Millennium Summit in 2000, world leaders pledged to halt and begin to reverse the spread of AIDS by 2015. In 2001, the United Nations General Assembly Special Session on HIV/AIDS unanimously adopted the Declaration of Commitment on HIV/AIDS, which provides a comprehensive framework for achieving the HIV-related vision of the Millennium Development Goals. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) was launched in 2002 to increase resources to fight three of the world’s most devastating diseases. Resolving to address the challenges of financing for development, world leaders adopted the Monterrey Consensus in 2002, pledging to mobilize and increase the effective use of financial resources to achieve internationally agreed development goals. On World AIDS Day 2003 WHO and UNAIDS released a detailed plan to reach the 3 by 5 target of providing antiretroviral treatment to three million people living with AIDS in developing countries and those in transition by the end of 2005. This is a vital step towards the ultimate goal of providing universal access to AIDS treatment to all those who need it. In 2003, the United States government launched the United States President's ‘Emergency Plan for AIDS Relief’ (PEPFAR). Just this year, the Copenhagen Consensus stated that AIDS is the leading priority for the international community. As a result of increased advocacy and mobilization efforts, spending on AIDS activities increased from US$ 998 million in 2000, to US$ 3.9 billion in 2002. It is estimated that global spending from all sources will reach US$ 6.1 billion on AIDS activities in 2004. (excerpt)
AIDS. 2004; 18 Suppl 3:S49-S53.The widespread use of any antimicrobial agent, including antiretroviral agents, has the potential to select drug-resistant populations of microorganisms. HIV drug-resistant strains have been recognized as a serious threat to the efficacy of current antiretroviral treatments and could jeopardize efforts to increase access to treatment in countries most affected by the HIV epidemic. The WHO Global HIV Drug Resistance Surveillance Programme aims at enhancing and enabling the response to the threat of antiretroviral drug resistance by assessing the geographical and temporal trends in HIV drug resistance, increasing our understanding of the determinants of HIV drug resistance, and identifying ways to minimize its appearance, evolution and spread. Based on a global network of experts and collaborating institutions, the programme is developing and field-testing tools and guidelines for the regular monitoring of the level and spread of HIV resistance, particularly in treatment-naive patients. Although relevant progress has been made, several important challenges still exist to the implementation of this essential and innovative programme. (author's)
Geneva, Switzerland, WHO, 2004. 28 p.The “3 by 5” target builds upon the years of work of governments and civil society in many countries, supported by their bilateral and multilateral partners, to expand access to HIV treatment. People living with HIV in low and middle income countries have been pressing their demands for antiretroviral treatment since the mid 1990s, when it became clear that treatment was dramatically reducing AIDS mortality and morbidity in the high income countries where it was accessible. As early as 1997, UNAIDS and WHO launched the Drug Access Initiative in Cote d’Ivoire and Uganda, the first public sector pilot projects demonstrating that antiretrovirals could be delivered safely and effectively in resource-limited settings. Despite the subsequent successes of one after another small-scale pilot project, few countries have managed to deliver HIV treatment to all, or even the majority, of those in need. In the late 1990s and in 2000-2001, additional initiatives such as the International Therapeutic Solidarity Fund, the African Comprehensive HIV/AIDS Partnerships (ACHAP) in Botswana, and the work of Médecins Sans Frontières, U.S. Centers for Disease Control and Prevention, and many donor funded efforts, to name a few, added much knowledge to implementing HIV/AIDS treatment programs. (excerpt)
Program note: using UN process indicators to assess needs in emergency obstetric services: Benin and Chad.
International Journal of Gynecology and Obstetrics. 2004 Jul; 86(1):110-120.The major obstetric complications that are taken into consideration for the calculation of the process indicators are hemorrhage, sepsis, prolonged or obstructed labor, eclampsiaysevere pre-eclampsia, complications from abortion, ruptured uterus and ectopic pregnancy. The following brief reports present data from needs assessments conducted with the UN Process Indicators in Benin and Chad in 2003. In each case, they reflect 12 months of facility data. (excerpt)
Development in Practice. 2004 Jun; 14(4):569-573.Monitoring and evaluation (M&E) are needed by all development interventions in order to document their output and outcomes. Once a set of goals has been established in response to a development ‘problem’, a corresponding set of indicators (i.e. variables or information) will also be identified in order to review progress towards those goals. In Africa, the so-called ‘expert’ evaluators—those who see M&E as their professional calling—have dominated the process of selecting social indicators. Unfortunately, this domination has given rise to sporadic and unreliable social data for M&E purposes facing every agency involved in development work in Africa. Zimbabwe is no exception. This Practical Note tells the story of UNICEF Zimbabwe’s search for relevant and reliable indicators based on solid data. The guiding philosophy in this effort is the belief that local communities themselves are among the many agencies involved in implementing development programmes—in the sense that they always seek ways of tackling whatever problems they face. These communities must therefore be active participants in the process of selecting indicators. The paper will first discuss the difficulty in establishing relevant data and indicators in the context of Zimbabwe, a task which is now an urgent priority given the dual problems of HIV/ AIDS and a declining economy. It is generally believed that these two problems have been responsible for the reversal of social gains made immediately after independence—hence the need to know exactly what is going on. The paper will then highlight recent attempts by UNICEF Zimbabwe—together with its partners—to establish good and reliable information sources so that not only can it monitor and evaluate the various impacts of its programmes but also the social environment of children. In part, the pressure for community-generated indicators has also been driven by the shift in UNICEF’s approach to its work—an approach underpinned by human rights principles. The final part of the paper discusses the challenges that UNICEF and its partners have faced and continue to struggle with. It draws some lessons learned and points to what more could be done to improve the qualities of social indicators. (excerpt)
CMAJ: Canadian Medical Association Journal. 2004 Jan 20; 170(2):189-190.As of Oct. 29, 2003, Nigeria gained the dubious honour of having the highest number of reported cases of polio (217 new cases) in the world, surpassing the previous leader, India. The resurgence of poliomyelitis in northern Nigeria poses a threat to neighbouring countries and further postpones the goal of the World Health Organization (WHO) to eradicate the disease globally. This is by no means an impossible goal: humans are the only natural reservoir, an inexpensive and effective vaccine is available, immunity is life-long, and the virus can survive for only a very short time outside the human host. (excerpt)
New York, New York, Women's Commission for Refugee Women and Children, 2004 Jan. 43 p. (Watch List on Children and Armed Conflict)This paper is a call to action urging the UN Security Council members, the UN system, regional bodies, civil society, and national governments to respond with the resources and remedies proportionate to the grave state of affairs for children in armed conflicts around the globe. It outlines three essential Action Areas where progress must be made to begin to close the gap between international commitments to protect children and the harsh reality that children experience: gross violations of their rights---with impunity. (excerpt)