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Monitoring and evaluating actions implemented to confront AIDS in Brazil: civil society's participation.
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:88-93.The United Nations Declaration of Commitment on HIV/AIDS recommends that governments conduct periodic analysis of actions undertaken in confronting the HIV/ AIDS epidemic that involve civil society's participation. Specific instruments and mechanisms should be created towards this end. This paper examines some of the responses of the Brazilian government to this recommendation. Analysis contemplates the Declaration's proposals as to civil society's participation in monitoring and evaluating such actions and their adequacy with respect to Brazilian reality. The limitations and potentials of MONITORAIDS, the matrix of indicators created by Brazil's Programa Nacional de DST/AIDS [National Program for STD/AIDS] to monitor the epidemic are discussed. Results indicate that MONITORAIDS's complexity hampers its use by the conjunction of actors involved in the struggle against AIDS. The establishment of mechanisms that facilitate the appropriation of this system by all those committed to confronting the epidemic in Brazil is suggested. (author's)
Geneva, Switzerland, Joint United Nations Programme on HIV/AIDS [UNAIDS], 2002 Aug. 24 p. (UNAIDS/02.45E; WHO/HIV/2002.17)The purpose of the guidelines is to assist National AIDS Programmes (NAPs) and Ministries of Health in implementing second generation HIV surveillance systems through a logical and standardized process. More specifically, the guidelines are primarily addressed to programme managers, epidemiologists, social scientists and other experts working in or with national programmes on surveillance issues. The practical steps and recommendations place particular emphasis on the initial steps involved in the implementation of second generation surveillance systems. They include the following: assessment, consensus, plan and protocol development, implementation and, finally, monitoring and evaluation. (excerpt)
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.
New York, New York, UNFPA, . v, 36 p. (Report)The former government of Romania sought to maintain existing population and accelerate population growth by restricting migration, increasing fertility, and reducing mortality. The provision and use of family planning (FP) were subject to restrictions and penalties beginning in 1986, the legal marriage age for females was lowered to 15 years, and incentives were provided to bolster fertility. These and other government policies have contributed to existing environmental pollution, poor housing, insufficient food, and major health problems in the country. To progress against population-related problems, Romania most urgently needs to gather reliable population and socioeconomic data for planning purposes, establish the ability to formulate population policy and undertake related activities, rehabilitate the health system and introduce modern FP methods, education health personnel and the public about FP methods, promote awareness of the need for population education, and establish that women's interests are served in government policy and action. These topics, recommendations, and the role of foreign assistance are discussed in turn.
HEALTH POLICY AND PLANNING. 1992 Dec; 7(4):364-74.The Director of WHO's Regional Office for Africa presents a health development framework based on the primary health care (PHC) concept. the government should review national health policies, national health strategies, and national heath services to resolve basic issues. Then it should define the framework for health development by breaking down the goal into operational target-oriented subgoals for individuals, families, and communities, by creating health districts as operational units, and by organizing support for community health. Once this framework has been decided, the government should use it to restructure the national health systems. At the district level, health and development committees, helped by community health workers, and district health teams would be responsible for community health education and activities. The provincial health offices would oversee district activities, select and adapt technologies, and provide technical support to communities. A board would manage the provincial hospitals (public, private, and voluntary). These hospitals would work together to organize secondary medical care programs. A public health office wold link them with the provincial health centers. Other sectors would also be involved, e.g., departments of education and water. The national health ministry would set national policies, plans, and strategies. A suprasectoral health council would coordinate cooperation between universities and other sectors and external agencies. National capacity building would involve establishing management cycles of health development, using national specialists as health advisors, and placing health as a priority in development. To implement this framework, however, the government needs to surmount considerable structural economic, and social obstacles by at least decentralizing and integrating health and related programs at the local level, fostering a national dialogue, and promoting social mobilization.
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1987.  p. (USAID Contract No. DPE-5927-C-00-5068-00)In 1987, consultants went to Niger to prepare the plan of operations for the national Expanded Programme on Immunization (EPI). US$ 6 million from the World Bank Health Project and around US$ 5 million from the UNICEF EPI Project were available for EPI activities. Low vaccination coverage prevailed outside Niamey. Outbreaks of diseases that EPI can prevent continued to kill children. The cold chain was not maintained, especially at the periphery. Mobile teams continued to use inadequate strategies. Record keeping did not exist. The central level did not supervise the periphery. EPI staff at departmental and division levels did not have current written guidelines. Not only did poor working communications exist between the central level and the periphery, but also between the EPI Director and the other Minister of Health divisions, between WHO and UNICEF, and between both UN agencies and EPI. The EPI Director did have a good relationship with the USAID office, however. No one took inventory of EPI resources or monitored temperatures at any point in the cold chain. Even though the World Bank Health Project intended to five EPI 50 ped-o-jets, 46% of the existing 88 ped-o-jets were in disrepair and no one knew how to repair and maintain them. Thus EPI should not routinely use ped-o-jets. The consultants recommended that USAID stay involved with EPI in Niger since the EPI Director considered it an acceptable partner. EPI staff at each level should take a detailed inventory of all material resources. Effective and regular supervision should occur at the central, regional, and peripheral levels. A health worker needs to record the temperature of the refrigerator twice a day. Technical grounds should determine the standardization and selection of all equipment. Someone should maintain an adequate supply of spare parts and technicians should undergo training in maintenance.
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1986 Jun. , 31,  p. (USAID Contract No. DPE-5927-C-00-5068-00)In the mid 1980s, the Government of The Gambia (GOTG) sought funds from the World Bank and other donors to restructure and strengthen its health system. Since the World Bank thought that recurrent cost obligations that the GOTG would find unacceptable should accompany the implementation of the National Health Project (NHP), this study was undertaken. The Italian Government agreed to fund US $9.8 million to NHP, most of the funds going to renovating and refurbishing the pediatric ward and central laboratory at Royal Victoria Hospital in Banjul. Trends in health sector expenditures showed that the devaluation of the dalasi continued to bring about shortfalls in nonsalary costs, especially in drugs and dressings. Therefore the GOTG must address the shortfalls before even considering expansion of the already inefficient health delivery system. It also needs to develop a cost recovery system for drugs which maintains a reliable source and adequate supplies of drugs in the proper amounts, effectively distributes the drugs, and manages the finances effectively. The GOTG should also develop the Ministry of Health's ability to coordinate donor support and to develop a process of budgeting, spending, and planning. The study team also recommended consolidating staff rather than expand staff in light of financial constraints. A flotation policy and exchange rates less favorable to the dalasi may grant the GOTG more access to exchange within the banking system.
London, England, Macmillan, 1988. x, 165 p.Evaluations of progress made toward greater primary health care (PHC) among nations since the Alma Ata Conference of 1978 indicate that problems exist in managing PHC and reorienting existing services to PHC. The overwhelming majority of plans set forth through country policy have not been set into motion. Contributors from a host of disciplines and interests were called upon to explore manners in which countries may reorient their health services to the ideal of PHC and Health for All by the Year 2000. Prescription for change is avoided, yet a number of successful country examples are described in the text. Principles with potential application for other country setting are then explored. PHC and change is first explored, followed by a discussion of the theory and practice of organizational change. Subsequent chapters address PHC as it relates to ministries of health, district management, hospitals, medical education, nursing, intersectoral collaboration, and NGOs and international organizations. Challenges for the future close the text. Health professionals must help enable individuals, families, and communities to take the major responsibility for their health; a concept central to PHC. Continual dialogue, popular consultation, and organizational adaptation and change are required along with a bottom-up approach for setting targets and identifying needs. The authors understand that intersectoral collaboration along with administrative flexibility and adaptation are needed if goals are to be met. Finally, the health sector should get its house in order before working out the details of PHC policy.
New York, New York, UNFPA, . ix, 66 p.This paper discusses Sri Lanka's population policy with special focus upon UNFPA's role in establishing and implementing a successful multi-sectoral family planning program for the country. Progress made in the past years must continue, while ongoing efforts are made to attain the goal of 2.1 TFR by year 2000. A suitable program must be better coordinated with a view to cutting waste and duplication, guarantee an adequate supply of appropriate contraceptive supplies, streamline research operation, more fully implement its educational programs, and recognize women's centrality in population programs, and recognize women's centrality in population programs. UNFPA assistance should be offered to effect such programmatic change and development, with service delivery needs addressed 1st. The Government of Sri Lanka lacks adequate resources to supply calls for an integrated approach focused upon creating a National Coordinating Council; developing a more sophisticated and targeted approach to information, education, and communication; providing contraceptive supplies, software for service delivery, and client counseling; training providers; and improving coordination with other multilateral programs for child care and human resource development. The present population and development situation, the national population program, proposed sectoral strategies for implementation, the role of technical assistance, and general recommendations for external assistance are discussed in detail.
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA. 1991 Jun; 5(2):221-34.Public and private domestic expenditures for health in a total 148 developing countries for 1983, were estimated to be $100 billion. 1986 external donor health expenditures totalled $4 billion, a small percentage of overall health expenditure for developing countries. U.S. direct donor assistance for development was 0.5% of the federal budget for 1988, with approximately 10% of all U.S. development assistance allocated for health, nutrition, and population planning. As such, the U.S. accounts for 13% of total health contributions from external donors to developing countries. Approximate at best, private and volunteer organizations are estimated to contribute 20% of all such health assistance. Developing countries are therefore required to efficiently use their own resources in the provision of national health services. Technical assistance and donor experience also counting as external assistance, the overall supply of health financing is far greater than developing country demand in the form of well-articulated, officially approved proposals. Reasons for this imbalance include health ministry unfamiliarity with potential donor sources, passive approaches to external financing, unfamiliarity with proposal preparation, increasing competition from other sectors of developing nations, limited numbers of trained personnel, and lack of an international system of support to mobilize financing. The paper discusses 6 years of Pan American Health Organization interventions for resource mobilization in Latin America and the Caribbean, and suggests World Health Organization regional extension backed by U.S. encouragement and support.
Geneva, Switzerland, WHO, 1988. vi, 80 p.This publication focuses on the action needed to improve child health in growing urban centers in the 3rd world and outlines the staggering problems that stand in the way. It also gives an overview of community and governmental efforts to make improvements. Lastly, summary conclusions are drawn and recommendations given. The unprecedented population growth that has taken place in urban areas has created serious housing and health problems. Many people are living in illegally constructed housing with little or no provision for piped water, sanitation, collection and disposal of household waste, or health care. Chapter 1 discusses the health problems and poor living conditions that are common in urban centers. Studies of low-income settlements have identified 3 major types of pathology: infectious and gastrointestinal diseases, chronic degenerative diseases, and pathogenic conditions. It is estimated that up to 44% of all deaths in children under 4 years of age is a result of diarrhoeal disease. Respiratory infections and nutritional deficiencies are the other 2 major causes of morbidity and mortality in young children. Malnutrition poses one of the most serious threats to clinical health. It is estimated that 145 million children under 5 have insufficient diets. In urban low income communities up to 50% of children may show signs of malnutrition, 10% of this group in severe form. Malnutrition is a complex problem that involves not only a shortage of food, but also inadequate preparation and storage of food and lack of knowledge about nutrition. Many urban centers within developing countries share these relevant difficulties in regard to child health, but it is important not to make sweeping generalizations. As the book points out, urbanization has taken a multitude of forms, and the health problems of these urban centers need a variety of approaches. This publication sees a growing gap between child health needs and the responses of government. The last century has seen tremendous growth in urban population, as well as tremendous growth in the associate urban problems. Local and national response has been slight at best. Further, approaches have primarily been "sectoral " instead of the "multi-sectoral" approach that this book recommends. A "multi-sectoral" approach addresses a combination of urban problems all at once. It is further recommended that those in need of help to be targeted and prioritized. Also, a systematic coordination of individuals, households, neighborhood groups, local government, national government, and aid agencies is strongly urged. Local governments are deemed particularly crucial in the fight for child health.
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.
Statement by the Head of Delegation of the Republic of Korea at the International Conference on Population (ICP).
[Unpublished] 1984 Aug. Presented at the International Conference on Population, Mexico City, August 6-13, 1984. 3 p.In a 5-year plan, the Korean government has integrated family planning programs, including maternal and child health, medical insurance, and social welfare programs, into its primary health ervices in order to reach its hard-core low-income residents in both urban and rural areas. The Korea Women's Development Institute was established in 1982 to enchance the status of women, and the Labor Standard Law has been revised to try to overcome deep-rooted son-preference among Korean parenst. Migration out of rural areas is creating rural manpower problems, and stepped-up rural community development programs are planned. Population predictions by the mid-21st century stand at 61 million, too great for a country with such limited natural resources to support. Korea recommends an exchange of information on population and development between all countries, the setting aside of 1% of each country's annual budget for national population programs, and convening the world population conference every 5 instead of every 10 years so that more progress can be made in solving the problem.
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.
Report of the evaluation of UNFPA assistance to Colombia's Maternal, Child Health and Population Dynamic's Programme, 1974-1978.
New York, United Nations Fund for Population Activities, July 1981. 181 p.This report for UNFPA (United Nations Fund for Population Activities) on Colombia's Maternal and Child Health and Population Dynamics (MCH/PD) program was prepared by an independent team of consultants which spent 3 weeks in Colombia in February 1980 reviewing documents, interviewing key personnel and observing program services. The report consists of 8 chapters. The 1st describes the terms of references of the evaluation mission. The 2nd chapter provides background information on Colombia and identifies some of the principal environmental factors that affect the program. Chapter 3 describes the organizational context within which the program operates. The chapter also includes a discussion of the UNFPA funding and monitoring mechanism and how that affects program planning and operations. Chapter 4 is a description of the program planning process; goals, strategies and objectives, and of the UNFPA and government inputs to the program between 1974-1978, the period under review. A large part of the report is devoted to describing and assessing each program activity. Chapter 5 consists of descriptions of management information; maternal care; infant, child and adolescent care; family planning; supervision; training; community education; and research and evalutation studies. Chapter 6 is an analysis of the program's impact on: maternal morbidity and mortality; infant morbidity and mortality; and fertility. Chapter 7 summarizes the Mission's conclusions and lists its recommendations. The final chapter deals with the Mission's position in relation to the 1980-1983 proposal. Appendices provide statistical data on medical activities, contraceptive distribution and use, content of training courses, target population, total expenditures, and norms for care, as well as organizational charts, individuals interviewed, and UNFPA assistance to other agencies in Colombia. (author's modified)
World Health Organization, Technical Report Series.. 1970; 50.Add to my documents.
In: Seminar on India's Population Future, Bombay, 1974: Proceedings. Bombay, International Institute for Population Studies, 1975. pp. 59-71Add to my documents.
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.
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. 194-206.There is a genuine interest now being taken in phytotherapy and medicinal plants throughout the world. In industrialized countries there is a trend of going back to nature or wanting to combat the chemical pollution of the body provoked by inopportune chemotherapy or by the misuse of convenience drugs of chemical origin; third world countries are primarily concerned with providing their peoples with adequate coverage of their essential drug needs. A new type phytotherapy is proposed, to produce phytotherapeutic preparations for use in modern medical practice from the resources of traditional medication. In view of difficulties experienced by developing countries in meeting their needs for essential drugs, 4 measures might be taken to encourage utilization for primary health care of their vast local resources: 1) a real health policy option at national and regional level; 2) determination of priorities regarding health problems and definition of possible solutions; 3) goal-oriented applied scientific research on medicinal plants, incorporating properly planned programs; 4) effective implementation of these programs with regard to technical and financial resources and appropriate personnel. Cooperation among developing countries, with the industrialized countries and with organizations of the United Nations system is recommended. A table illustrates integrated overall organization.