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Bulletin of the World Health Organization. 2004 Oct; 82(10):746-749.The rationale for providing antenatal care is to screen predominantly healthy pregnant women to detect early signs of, or risk factors for, abnormal conditions or diseases and to follow this detection with effective and timely intervention. The recommended antenatal care programme in most developing countries is often the same as the programmes used in developed countries. However, in developing countries there is wide variation in the proportion of women who receive antenatal care. The WHO randomized trial of antenatal care and the WHO systematic review indicated that a model of care that provided fewer antenatal visits could be introduced into clinical practice without causing adverse consequences to the woman or the fetus. This new model of antenatal care is being implemented in Thailand. Action has been required at all levels of the health-care systems from consumers through to health professionals, the Ministry of Public Health and international organizations. The Thai experience is a good example of moving research findings into practice, and it should be replicated elsewhere to effectively manage other health problems. (author's)
Eradication of indigenous transmission of wild poliovirus in the Americas. Plan of action, July 1985.
[Washington, D.C.], PAHO, 1985 Jul. 26 p. (EPI-85-102; CD31/7 Annex II)The Pan American Health Organization (PAHO) appointed a Technical Advisory Group (TAG) which met in July 1985 to plan eradication of wild poliovirus in the Americas by 1990 by immunization and surveillance. The strategies to be adopted are mobilization of national resources; vaccine coverage of 80% or more of the target population; surveillance to detect all cases; laboratory diagnosis; information dissemination; identification and funding of research needs; development of a certification protocol; and evaluation of ongoing program activities. The expanded immunization program (EPI) will be organized at the country level by setting up National Work Plans, with inventories of resources and identification of participating agencies and donors, under the guidance of national EPI offices. The TAG will be composed of a core of 5 experts on immunization, with additional consultants as needed, meeting quarterly, semi-annually or annually to review progress and publish recommendations. Regional EPI offices will coordinate eradication activities between the Ministries of Health, the 10-11 epidemiologists/technical advisors in each country and all agencies affiliated with the PAHO. Support personnel will be available at the sub-regional and regional level, including support virologists to assist the laboratory network. Appendices are attached showing estimated costs for regional and regional personnel, vaccines, laboratories, and program activities, predicting that the effort will pay for itself 2.3 times over by 2000.
Clinical management of acute diarrhoea: report of a Scientific Working Group, New Delhi, October 30-November 2, 1978.
[Unpublished] 1979. 21 p.This is a discussion of the clinical management of acute diarrhea, which was covered by a Scientific Working Group at the Southeast Asian Regional meeting of WHO in 1978. Current knowledge on the use of oral rehydration therapy for diarrhea was reviewed at the meeting. The mixture, which works for all age groups and for diarrhea of any etiology, is aimed at restoring normal fluid and electrolyte balances. The chemical means whereby these balances are restored are discussed in detail. There is evidence that the therapy reduces mortality caused by diarrhea to nearly zero and reduces the cost of hospitalization and intravenous therapy. Its great advantage is that it can be administered at home early in the course of the disease. Use of the oral rehydration technique with the complete and the incomplete formulae and by home reconstitution are discussed. Supply has not always kept pace with demand. Other aspects of the clinical management of diarrhea, e.g., with drugs, diet, or intravenous fluids, are covered. Recommendations for future research both on the clinical and the program sides of the issue are proposed. The UNICEF activities connected with national oral rehydration programs are listed.
In: AIDS and associated cancers in Africa, edited by G. Giraldo, E. Beth-Giraldo, N. Clumeck, Md-R. Gharbi, S.K. Kyalwazi, G. de The. Basel, Switzerland, Karger, 1988. 292-302.The global strategy of AIDS prevention, managed by the WHO Special Programme on AIDS (SPA) was created in 1987, and is intended to be as intense as the smallpox eradication campaign. Its objectives are to prevent HIV transmission, to care for HIV-infected persons and reduce morbidity and mortality, and to unify national AIDS programs. AIDS can be prevented because it in only transmitted by 3 routes, sexual, blood and perinatal. AIDS-infected persons must be provided with medical, psychological and social support, without discrimination. The key elements of a national AIDS program are political openness, creation of a national AIDS committee, initial epidemiologic and resource assessment, and development of a medium-term AIDS plan. The plan should include epidemiological surveillance, laboratory capability, education programs for health workers, prevention of sexual transmission, prevention of blood transmission, prevention of intravenous drug abuse, strict single-use of medical and traditional skin-piercing instruments, and prevention of infection of women of childbearing age altogether. HIV-infected women should receive acceptable contraceptive methods. Evaluation of national programs is vital not only to maximize limited resources, but to discover how HIV prevention can best be achieved.
[Unpublished] 1988 May 21. 18 p. (NCIH 15th Annual International Health Conference; Papers)This address covers the 3 phases of National Primary Health Care (PHC) Implementation in Nigeria from 1975 to the present. The concept for the implementation of the 1st phase was to build and equip health centers, then train and post health workers to the facilities. No attempt was made to involve the community, use appropriate health technology, or set up management systems (such as referrals, supplies, monitoring, and evaluation of the delivery system). In short, at the end of the planned period, nowhere in the Federation were services, as described in the Alma Atta Declaration, being delivered. Between 1980 and 1985, because of the failure of the Basic Health Services Scheme, the Federal Ministry of Health abandoned any attempt to set up a PHC system and began the implementation of vertical systems of health care. Within the Ministry, groups attached themselves to particular agencies, leading to severe fragmentation of the Ministry. The Ministry as a whole had ceased to pursue the goals of PHC and adopted new objectives agreeable to each donor agency. Since 1985, the present Nigerian administration has aimed at establishing local government by local government, with the nation's PHC system incorporating the existing vertical programs. The considerable resources available through many AID agencies, international organizations, and governments need to be harnessed to achieve Nigeria's goals. Nigeria must therefore be clear as regards what these are and how to achieve them, bearing in mind that most of these agencies and organizations have their mandates and objectives limiting the activities in which they may engage.
In: Management information systems and microcomputers in primary health care, edited by Ronald G. Wilson, Barbara E. Echols, John H. Bryant, and Alexandre Abrantes. Geneva, Switzerland, Aga Khan Foundation, 1988. 17-20.A wide array of issues must be addressed if the development and use of management information system (MIS) and microcomputers are to improve management of primary health care (PHC) programs and increase the equity and cost-effectiveness of PHC. These issues include: specification of the purpose and objectives of MIS at community and district levels; distinquishing types of information required; the understanding of organizational issues that must be resolved as a result of introducing MIS; the practical definition of the most useful indicators of program effectiveness and efficiency; the specification and monitoring of data collection, compilation, and analysis requirements and procedures; procedures for generating and using processed MIS data and management information; the PHC program's capacity to absorb technological innovations; and personnel requirements. The need for improved data systems must be recognized. Data quality and systematic flow of information must be ensured from the field level upwards, and minimum information requirements need to be defined. The success of any MIS is heavily dependent on feedback of the data collected. Unless staff at all levels of a PHC program understand the importance of the data they are collecting, the value and use of the information system will be negligible. Examples of the Egyptian government's National Health Information System and the role of the World Bank are used to show how MIS and microcomputer can be introduced and used in PHC.
Social Science and Medicine. 1987; 25(6):615-20.It is expected that community involvement in health policy be not only cost-effective but also the best way of providing comprehensive solutions to public health problems. Over 50 years of experience in India show that public enthusiasm does tend to wane after a short period of time, but efforts continue to be made. Governmental and other organizations and UN agencies have been active in promoting the concept of community involvement. The best that can be expected is that people will come forward voluntarily to participate in public health programs formulated by governments and other agencies. Generally, however, public cooperation has to be sought and participation motivated. There is little support for coercive measures. Community participation is often hampered by a wide range of factors including: difficult terrain; inegalitarian social structure; the tendency to depend on others to look after one's needs; and the absence of an understanding of healthful conditions and practices. Also, bureaucrats and medical professionals often consider community involvement an interference. Nevertheless individuals and organizations are everywhere engaged in experiments in such involvement, and certain Indian projects have provided valuable insights which may be of use in other developing countries.
International Journal of Health Services. 1985; 15(2):275-99.Until the mid 1960s, Latin American health system reflected the skewed distribution of wealth in the region: most health resources were found in curative care medicine and were concentrated in the capital cities, where they primarily served the needs of the elite. For many countries, however, the 1964 Pan American Health Organization's (PAHO) efforts to introduce health planning, intended as a 1st step in rationalizing the health sector, marked a fundamental turning point in the structural development of their delivery systems. Guatemala, however, was and remains an exception. Its technocrats have proven unable to plan effectively; no single entity is responsible for health sector planning, and the 5-year plans have come to consist of disjointed mini-plans, each reflecting the aims, desires and goals of a particular vested interest group or institution. The Guatemalan oligarchy has proven unwilling to appropriate the resources necessary to effect change. The reforms that have been made have been the products of bilateral and multilateral agencies such as the InterAmerican Development Bank, USAID, UNICEF, Kreditanstaldt and PAHO, which have conceptualized, promoted, designed, built and underwritten them. Those changes have not altered the fundamental structure of the system, but instead have been tacked onto it, and exemplify what may be termed additive reform. The government of Guatemala's own commitment to these outside agency funded projects is reflected in the recurrent shortfall of current or operating funds, and in the rapid depreciation of facilities. Evidence suggests that without the continued sponsorship, support, and guidance of the bilateral and multilateral agencies, even these additive reforms will not last.
Alternative approaches to meeting basic health needs in developing countries: a joint UNICEF/WHO study.
Geneva, World Health Organization, 1975. 116 p.Based on the failure of conventional health services and approaches to make any appreciable impact on the health problems of developing populations, this study examined successful or promising systems of delivery of primary health care to identify the key factors in their success and the effect of some of these factors in the development of primary health care within various political, economic, and administrative frameworks. In the selection of new approaches for detailed study, emphasis was placed on actual programs that are potentially applicable in different sociopolitical settings and on programs explicitly recognizing the influence of other social and economic sectors such as agriculture and education on health. Information was gathered from a wide range of sources; including members, meeting reports, and publications of international organizations and agencies, gathered country representatives, and field staff. The 1st section, world poverty and health, focuses on the underprivileged, the glaring contrasts in health, and the obstacles to be overcome--problems of broad choices and approaches, resources, general structure of health services, and technical weasknesses. The main purpose of the case studies described in the 2nd part was to single out, describe, and discuss their most interesting characteristics. The cases comprised 2 major categories: programs adopted nationally in China, Cuba, Tanzania, and, to a certain extent, Venezuela, and schemes covering limited areas in Bangladesh, India, Niger, and Yugoslavia. Successful national programs are characterized by a strong political will that has transformed a practicable methodology into a national endeavor. In all countries where this has happened, health has been given a high priority in the government's general development program. Enterprise and leadership are also found in the 2nd group of more limited schemes. Valuable lessons, both technical and operational, can be derived from this type of effort. In all cases, the leading role of a dedicated individual can be clearly identified. There is also evidence that community leaders and organizations have given considerable support to these projects. External aid has played a part and apparently been well used. Every effort should be made to determine the driving forces behind promising progams and help harness them to national plans.
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.
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.
Delhi, D.K. Publishing House, . 130 p.The population program of India was examined from a descriptive analytical perspective. The organizational layout was examined and methods of operation were scrutinized from the standpoint of program policy. The 8 chapters of the monograph deal with the following: management and population; role of public administration; family planning system; an appendage of health; the law of sinecure and success; international assistance; population mangement; resume and results. The systems concept is a useful approach to the job of management, for it provides a framework for visualizing internal and external environmental factors as an integrated whole. The systems concept also permits recognition of the proper place and function of subsystems. Public administration in India suffers from several problems: 1) too many levels and positions to effect any rapid program decision and implementation; 2) too many boards and committees with vague or obscure duties and lack of responsibility on the part of any single individual or group; control orientation; and 4) generalist administration.
Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 92 p. (Syncrisis: the dynamics of health, XVII)This article uses available statistics to analyze health conditions in Bangladesh and their impact on the country's socioeconomic development. Background information on the country is first given, after which population characteristics, health status, nutrition, national health policy and adminstration, health services and programs, population programs, environmental sanitation, health sector resources, financing of health care and donor assistance are examined. Bangladesh's 3% annual population increase is expected to increase already great population pressure and to have a negative impact on the health status of the population. Although reliable health statistics are lacking, infant mortality is estimated at 140 per 1000, 40% of all deaths occur in the 0-4 age group, and maternal mortality is high. Infectious diseases exacerbated by malnutrition are the main causes of death. 4 key factors are responsible for the general malnutrition: 1) rapidly growing population, 2) low per capita income, 3) high incidence of diarrheal diseases, and 4) dietary practices that restrict nutrient intake. Most of the population has access only to traditional health services, and medical education is hospital oriental and curative, with minimal emphasis on public health. The level of environmental sanitation is extremely low.
INTERNATIONAL JOURNAL OF HEALTH EDUCATION. 1974; 17(4):235-47.Extracts from the backgound paper for the Consultation Meeting of the World Health Organization and the Pan American Health Organization are presented. The meeting's purpose was to obtain specific recommendations that might be used by WHO, PAHO, and the member countries in developing educational personnel for programs dealing with family health and health aspects of reproduction. After reviewing the problems in Latin America and the Caribbean, the various kinds of constraints which have implications for health problems are examined, and key issues relating to family health are analyzed. Many health experts maintain that the family planning approach is the most effective and least expensive means of reducing maternal and infant mortality and morbidity, yet in most countries it is perceived primarily as a means of containing or reducing population growth. In most family planning programs the number of new acceptors appears to be the criterion for measuring success; little if any emphasis is given to continuation of use, teaching the health reasons for regulating reproduction, or increasing acceptance among women with high health risks. In some programs, eligibility requirements are such that many women of high health risk cannot be served. Thus far, research and studies to promote the development of the educational component of family planning programs or to orient selection of educational methodology have had minimal support. In most countries the full potential of the resources invested to achieve improvements in maternal and child health is not being realized. This is partly because of the fact that there is no explicit national policy giving direction to the development of an integrated approach. Few countries have policies and plans for health manpower development and utilization that are based on a careful analysis of priority health needs.
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.
[The strategy of health for all in all its magnitude] Estrategia de salud para todos en toda su magnitud.
Boletin de la Oficina Sanitaria Panamericana. 1983 Oct; 95(4):361-6.Around 1970, interest in the concept of social justice began to be reflected in analyses of health systems in developing countries, and in the rapid acceptance and popularization of the goal of health for all by the year 2000, to be achieved through primary health care programs providing universal coverage. UN member states can maintain the impulse to provide universal health care by carrying out within their borders the health care policies collectively recommended by the UN General Assembly, aided by the World Health Organization (WHO) which has put aside the paternalistic policies of the past and which now seeks to assist nations in carrying out their own goals. 1 step in assuring that the goals will be met involves continual surveillance of the progress of implementation, which is to be reported in various meetings and conferences at regional levels and at the World Health Assembly in 1984. Identification of problems in implementation should not be interpreted as placing blame, but rather as signalling the need to search for common solutions to them. New principles in the use of WHO aid are that the member governments should assume responsibility for the application in their countries of the jointly agreed upon policies as well as the utilization of WHo resources reserved for that end, that WHO resources be used only for activities compatible with policies defined at the national and international levels; that WHO resources be used to achieve adequate planning and administration of the health infrastructure, with assistance from WHO; that individual countries participate in evaluation of WHO sponsored activities to assure the optimal use of resources; and that countries assume much greater responsibility for the use of WHO resources. Application of the new principles will require a new type of interaction with the various organs and personnel of WHO at different levels. External aid which requires excessive concentration on only 1 aspect of health care, such as immunization or control of some forms of diarrhea, is counterproductive and continues past tendencies to impose health goals and programs from outside.