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Tokyo, Japan, WHO, 1994 Mar. 13 p.During Cambodia's transition to a parliamentary democracy, the World Health Organization (WHO) assisted various administrative authorities as they determined immediate health policies and strategies and established mechanisms for national and international coordination of health activities. WHO identified national requirements that formed the foundation for a national health development process and of de facto policies and strategies. The generation of war and suffering had the most impact on women and children (e.g., maternal mortality 900/100,000 live births and child mortality >200/1000). Significant conditions in Cambodia include malaria, dengue hemorrhagic fever, tuberculosis, diarrhea, HIV/AIDS, and loss of limbs and other physical injuries. The Ministry of Health (MOH) is responsible for health care for almost the entire population. The priority health development strategy is improving district health systems in support of community health services. The currently managed vertical programs will eventually be integrated and managed as one comprehensive health service system from the provincial level. The human resource development strategy includes workforce planning and management, continuing education, and formal training. Cambodia's system of procurement and distribution of essential drugs, supplies, and equipment of public sector health facilities needs to be improved. WHO is supporting Cambodia's expanded program on immunization. MOH considers reduction of maternal and young child mortality a top priority and is promoting birth spacing. Mental health problems have not been traditionally addressed in Cambodia. The government plans on establishing a central program of planning and management to support and develop mental health services. Other areas WHO and MOH are addressing include nutrition, health and environment, and health sector resources (e.g., health personnel, capital investment).
FRONT LINES. 1991 Nov; 16.Indonesia's success in reaching World Health Organization (WHO) universal immunization coverage standards is described as the result of a strong national program with timely, targeted donor support. USAID/Indonesia's Expanded Program for Immunization (EPI) and other USAID bilateral cooperation helped the government of Indonesia in its goal to immunize children against diphtheria, pertussis, tetanus, polio, tuberculosis, and measles by age 1. The initial project was to identify target areas and deliver vaccines against the diseases, strengthen the national immunization organization and infrastructure, and develop the Ministry of Health's capacity to conduct studies and development activities. This EPI project spanned the period 1979-90, and set the stage for continued expansion of Indonesia's immunization program to comply with the full international schedule and range of immunizations of 3 DPT, 3 polio, 1 BCG, and 1 measles inoculation. The number of immunization sites has increased from 55 to include over 5,000 health centers in all provinces, with additional services provided by visiting vaccinators and nurses in most of the 215,000 community-supported integrated health posts. While other contributory factors were at play, program success is at least partially responsible for the 1990 infant mortality rate of 58/1,000 live births compared to 72/1,000 in 1985. Strong national leadership, dedicated health workers and volunteers, and cooperation and funding from UNICEF, the World Bank, Rotary International, and WHO also played crucially positive roles in improving immunization practice in Indonesia.
A national approach to health service management information services. The work of the English Steering Group on Health Services Information.
[Unpublished] 1984. 23 p. (WHO/HS/NAT.COM/84-387)In February 1980 the Secretary of State for Social Security appointed the joint National Health Service/Department of Health and Social Security Group on Health Services Information to conduct the 1st comprehensive review of national health services (NHS) management information services since the inception of the NHS. The 1st report presents the Group's conclusions and recommendations about the information required by management regarding clinical facilities and departments in hospitals and the patients using them. In due course this report will be followed by reports on information about community services, paramedical services, personnel, finance, patient transport services, dental service, and other areas of interest. The Steering Group's approach to its task has been based on the requirement to collect data because they are essential for operational purposes. The Group also aims to establish a series of minimum data sets, covering the major areas of management activity in the NHS, to provide the information needed by a district health authority and its officers to manage health services, and to actively influence the allocation of services. The Group began with a review of existing data systems. Working groups were established to investigate hospital facilities used by consultant medical staff, laboratory and scientific services, paramedical services, community health services, health service personnel, health service management accounting, and patient transport services. The smooth implementation of recommendations requires training of the staff responsible for data collection. In formulating proposals, focus has been on the information required by a district health authority and its officers. It is believed possible to identify a minimum set of data which should be used in all districts and that the data should be collected largely as a byproduct of operational procedures. The approach to information for management postulates that the needs of the district tier of the NHS are paramount. In developing the district minimum data set, the working groups paid particular attention to the following characteristics of data: relevance; timeliness; and ability to be collated with data from other sources. Statistical information about the clinical services in a district is drawn from activity data, health services personnel data, and financial data. The major areas of clinical work can be categorized as services provided on hospital premises, off hospital premises, and in or for the community. This report is a synthesis of the recommendations of the 2 working groups which have reviewed the data required about the activity of: the services provided on hospital premises (except radiotherapy); the services provided in consultant outpatient clinics; the services provided in day care facilities; and the services related to a registrable birth. Recommendations are summarized.
New England Journal of Medicine. 1983 Fall; 61(4):659-86.In this examination of Saudi Arabia's health care accomplishments, it is argued that the World Health Organization's primary health care model is not the most appropriate for Saudi Arabia and countries like it. Saudi Arabia's health care policy is closely linked to its very rapid emergence as a new and distinctive society. Whereas most developing countries export physicians, Saudi Arabia imports them because the demand for physicians services cannot be met by the supply of indigenous physicians. Saudi health care development is very different from that of most of the third world. Although the country does have a great deal of western technology, Saudi Arabia seems to be following a different course of development from both the third world and the West. Unlike the West, the cost of medial technolgoy is not a problem for Saudi Arabia. Rather, it solves the problem of how to allocate its oil wealth to maintain political stability. The Saudis intend to make the best health care available to all its citizens; they are very concerned about the effect of modern technology on tradition. Therefore, the selection of technology is based on its cultural compatability, rather than on its costs. Primary care may be more technological and specialized than in the West. In Saudi Arabia primary health care may eventually be delivered entirely by specialists, rather than by general or family practitioners. The Saudis are expected to develop a health care system that will meet their particular needs. As with Saudi Arabia itself, health care is experiencing unprecedented change. Thus, the emerging Saudi system will be unique and innovative. Some of its accomplishments will be adopted by other developing countries; Western countries may look to Saudi Arabia as a natural laboratory of health care experimentation.
Journal of Tropical Pediatrics. 1983 Aug; 29(4):217-9.The World Health Organization (WHO) launched the Expanded Program of Immunization (EPI) in 1974 based on the belief that most countries already had some elements of national immunization activities which could be successfully expanded if the program became a national priority with a commitment from the government to provide managerial manpower and funds. The federal government of Nigeria quickly adopted the policy of WHO on EPI and urged the state governments to set up administrative arrangements for planning and implementation of EPI. The program started off in Oyo State of Nigeria after a pilot study conducted at Ikire in Irewole Local Government area in 1975. The stated objectives of the programs were: to provide immunization service to at least 85% of the target population e.g. children under 4 years; and to integrate immunization programs into routine activities of all static primary health centers in the state. This study focuses on administration of the immunization program in the Oranmiyan Local Government area of Oyo State, within the structure of the local government health system and the field health administration of the state government. This study shows that the stated objectives of the EPI are not likely to be achieved in the near future because of low coverage of the eligible population, due to inadequate community involvement in the planning and implementation of the program; 2) poor communication between different government departments; and 3) inadequate publicity. The effect of improvement in health status because of immunization programs, has been very difficult to demonstrate in Nigeria because a lack of accurate data on birth, morbidity, and mortality patterns of the population. Other socioeconomic and health factors of significance in the battle against infectious diseases include environmental sanitation, adequate and safe water supply, housing and nutrition. Nevertheless, immunization programs constitute one of the most economical and effective approaches to the prevention of communicable diseases and can produce dramatic effects in the battle to lower infant and childhood mortaltiy rates in the developing countries if they are well implemented.
Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 144 p. (Syncrisis: the dynamics of health, XIX)This report uses available statistics to examine health conditions in Senegal and their interaction with socioeconomic development. Background data are presented, after which population, health status, nutrition, environmental health, health infrastructure, facilities, services and manpower, national health policy and planning, international organizations, and the Sahel are discussed. Diseases such as malaria, measles, tuberculosis, trachoma and venereal diseases are endemic in Senegal, and high levels of infant and childhood mortality exist throughout the country but especially in rural areas. Diarrhea, respiratory infections, and neonatal tetanus contribute to this mortality and are evidence of the poor health environment, and lack of basic services including nutrition assistance, health education, and potable water. Nutrition in Senegal appears to be good in general, but seasonal and local variations sometimes produce malnutrition. Lowered fertility rates would reduce infant and maternal mortality and morbidity and might slow the present decline in per capita food intake. At present the government of Senegal has no population policy and almost no provisions for family planning services. Health services are inadequate and inefficient, with shortages of all levels of health manpower, poor planning, and overemphasis on curative services.
Bulletin of the Pan American Health Organization. 1983; 17(2):201-3.A field study to ascertain the status of drug delivery systems for primary health care centers in Latin America was conducted by the Pan American Health Organization (PAHO) in 1980-81. Countries studied included Bolivia, Ecuador, Peru, Honduras, Panama, and the Dominican Republic. The planning and purchasing functions of the drug distribution systems were found to be highly centralized, failing to take local morbidity patterns or drug demand levels into account. Storage areas lacked adequate equipment and were poorly designed. Personnel were insufficiently trained and were found to ignore procedures regarding the handling of damaged or expired drugs. Also noted was a lack of adequate equipment for transporting medicines to rural clinics. A widespread characteristic was the lack of formal supervision and control (excluding fiscal) at national, regional, and local levels. Many essential drugs were unavailable at the local level, and formulations with unjustified associations and products for which there are more advantagous substitutes were found. These results were presented at the PAHO-sponsored Regional Workshop on Administration and Supply of Essential Drugs held in 1981. The workshop made 5 recommendations to governments: 1) every national health plan should include a national drug policy; 2) the drug policy should encompass a registry of all drugs sold, a list of essential drugs by level of care, quality control measures, educational activities for personnel, proper financing, and an evaluation methodology; 3) an integrated system for managing drug distribution should be designed; 4) information on essential drugs, legislation, pricing, and quality control should be exchanged among regions; and 5) centers should participate in the WHO-developed quality certification system. In addition, it was recommended that PAHO should: 1) participate in developing a system of regional cooperation, 2) identify regional centers for training personnel in the management of drug distribution systems, 3) stimulate development of training programs, and 4) support operational research on drug distribution systems.
In: Bannerman RH, Burton J, Ch'en Wen-Chieh. Traditional medicine and health care coverage: a reader for health administrators and practitioners. Geneva, Switzerland, World Health Organization, 1983. 281-9.It is now widely recognized that there is great potential in traditional medicine to contribute to primary health care, specially in developing countries. Such a potential is due not only to the wide acceptance of these systems at the community level but also to their simple, inexpensive, non-toxic, and time-tested remedies for the alleviation of disease and disability. In order to contribute usefully to primary health care, these systems must be functionally integrated into the country's health system. A thorough study should therefore be made of the prevailing traditional systems in their entirety--the type of system, the available manpower, the existing training programs, including any linkage to the official health services and the budgetary requirements. The identification of areas of health care to which these systems can contribute effectively and problems relating to their further development also require scrutiny. A list of recommendations given by WHO in 1979 for the development of traditional medicine are given. These include: manpower planning, the development of traditional medicine programs at the community level, and the identification of research priorities (drug research, the characteristics of traditional practitioners, integration programs, and cost effectiveness of traditional remedies and practices). An additional area of research suggested is the effectiveness of traditional remedies against chronic diseases for which there are no satisfactory treatments in modern medicine. WHO has been actively promoting traditional medicine as an integral part of primary health care through its technical cooperation programs with member states. In the last few years, a useful program to encourage visits of teams from different countries to China has been carried out in collaboration with the United Nations development program. The emphasis of WHO's programs are on coordinated and integated efforts to foster traditional systems and to maximize their usefulness towards the attainment of health for all.