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Progress Toward Eliminating Mother to Child Transmission of HIV in Kenya: Review of Treatment Guideline Uptake and Pediatric Transmission at Four Government Hospitals Between 2010 and 2012.
AIDS and Behavior. 2016 Nov; 20(11):2602-2611.We analyzed prevention of mother-to-child transmission (PMTCT) data from a retrospective cohort of n = 1365 HIV+ mothers who enrolled their HIV-exposed infants in early infant diagnosis services in four Kenyan government hospitals from 2010 to 2012. Less than 15 and 20 % of mother-infant pairs were provided with regimens that met WHO Option A and B/B+ guidelines, respectively. Annually, the gestational age at treatment initiation decreased, while uptake of Option B/B+ increased (all p's < 0.001). Pediatric HIV infection was halved (8.6-4.3 %), yet varied significantly by hospital. In multivariable analyses, HIV-exposed infants who received no PMTCT (AOR 4.6 [2.49, 8.62], p < 0.001), mixed foods (AOR 5.0 [2.77, 9.02], p < 0.001), and care at one of the four hospitals (AOR 3.0 [1.51, 5.92], p = 0.002) were more likely to be HIV-infected. While the administration and uptake of WHO PMTCT guidelines is improving, an expanded focus on retention and medication adherence will further reduce pediatric HIV transmission.
Advocacy, communication, and partnerships: Mobilizing for effective, widespread cervical cancer prevention.
International Journal of Gynaecology and Obstetrics. 2017 Jul; 138 Suppl 1:57-62.Both human papillomavirus (HPV) vaccination and screening/treatment are relatively simple and inexpensive to implement at all resource levels, and cervical cancer screening has been acknowledged as a "best buy" by the WHO. However, coverage with these interventions is low where they are needed most. Failure to launch or expand cervical cancer prevention programs is by and large due to the absence of dedicated funding, along with a lack of recognition of the urgent need to update policies that can hinder access to services. Clear and sustained communication, robust advocacy, and strategic partnerships are needed to inspire national governments and international bodies to action, including identifying and allocating sustainable program resources. There is significant momentum for expanding coverage of HPV vaccination and screening/preventive treatment in low-resource settings as evidenced by new global partnerships espousing this goal, and the participation of groups that previously had not focused on this critical health issue. (c) 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Global Health Action. 2015 Sep 18; 8:29034.Background: Health equity is a priority in the post-2015 sustainable development agenda and other major health initiatives. The World Health Organization (WHO) has a history of promoting actions to achieve equity in health, including efforts to encourage the practice of health inequality monitoring. Health inequality monitoring systems use disaggregated data to identify disadvantaged subgroups within populations and inform equity-oriented health policies, programs, and practices. Objective: This paper provides an overview of a number of recent and current WHO initiatives related to health inequality monitoring at the global and/or national level. Design: We outline the scope, content, and intended uses / application of the following: Health Equity Monitor database and theme page; State of inequality: reproductive, maternal, newborn, and child health report; Handbook on health inequality monitoring: with a focus on low- and middle-income countries; Health inequality monitoring eLearning module; Monitoring health inequality: an essential step for achieving health equity advocacy booklet and accompanying video series; and capacity building workshops conducted in WHO Member States and Regions. Conclusions: The paper concludes by considering how the work of the WHO can be expanded upon to promote the establishment of sustainable and robust inequality monitoring systems across a variety of health topics among Member States and at the global level. Copyright: 2015 World Health Organization. Open Access.
Geneva, Switzerland, WHO, 2011.  p.This tool, developed in collaboration between WHO, the Office of the High Commissioner for Human Rights (OHCHR) and the Swedish International Development Cooperation Agency (Sida) is designed to support countries to strengthen national health strategies by applying human rights and gender equality commitments and obligations. The tool poses critical questions to identify gaps and opportunities in the review or reform of health sector strategies.
Strong ministries for strong health systems. An overview of the study report: Supporting Ministerial Health Leadership: A Strategy for Health Systems Strengthening.
[Kampala], Uganda, African Centre for Global Health and Social Transformation [ACHEST], 2010 Jan.  p.This overview is adapted from the report Supporting Ministerial Health Leadership: A Strategy for Health Systems Strengthening by Dr. Francis Omaswa, executive director and founder of The African Center for Global Health and Social Transformation (ACHEST) and Dr. Jo Ivey Boufford, president of The New York Academy of Medicine (NYAM). The study and report were commissioned by the Rockefeller Foundation to explore the feasibility of establishing a support mechanism for ministers and ministries of health especially in the poorest countries, as part of the Foundation’s Transforming Health Systems initiative, The study was initially designed to assess the potential value of three proposed programs to strengthen the leadership capabilities of ministers of health: a global executive leadership program for new ministers; an ongoing, regional, in-person and virtual leadership support program for sitting ministers; and a virtual global resource center for ministers and high level ministerial officials providing real-time access to information. During the course of the study, it became clear that it was essential to expand the inquiry to better understand the challenges and needs of ministries as a whole, as they and their ministers provide the stewardship function for country health systems.The content of the report was derived from six major activities:a comprehensive literature review of the theory and practice of effective leadership development and organizational capacity building, and an environmental scan to identify any existing or planned leadership development programs for ministers of health or any that have occurred in the recent past globally; a survey of the turnover of ministers of health; targeted interviews with ministers, former ministers, and key stakeholders who interact with them, conducted between October 2008 and September 2009, to better understand the roles of ministers and ministries, the challenges they face, resources at their disposal, and their thoughts on what additional resources might enhance their personal effectiveness and that of their ministries; a consultative meeting of experts and stakeholders held in Bellagio, Italy part way through the project; participation of the project leaders (Omaswa and Boufford) in relevant global and regional meetings, as well as individual meetings about the project with critical leaders in international and donor organizations and potential champions of this effort; and a consultation with African regional health leaders to discuss the final report, held in Kampala, Uganda. (Excerpt).
The World Health Organization European Health in Prisons project after 10 years: persistent barriers and achievements.
American Journal of Public Health. 2005 Oct; 95(10):1696-1700.The recognition that good prison health is important to general public health has led 28 countries in the European Region of the World Health Organization (WHO) to join a WHO network dedicated to improving health within prisons. Within the 10 years since that time, vital actions have been taken and important policy documents have been produced. A key factor in making progress is breaking down the isolation of prison health services and bringing them into closer collaboration with the country’s public health services. However, barriers to progress remain. A continuing challenge is how best to move from policy recommendations to implementation, so that the network’s fundamental aim of noticeable improvements in the health and care of prisoners is further achieved. (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)
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)
American Journal of Public Health. 2005 Jan; 95(1):8.The term global as applied to human development emerged in the 1960s at the time of the green revolution, when the World Bank advocated the need to “think globally, act locally.” The terms global, international, and intergovernmental have different roots and translate differently in policy; institutional functions; and level of analysis, action, and accountability. They are not mutually exclusive. While the term international has framed much of the work in health across countries over the past decades, the term global has become more politically viable in that it elevates the vision of health to the whole planet, moving beyond geopolitical boundaries and including not only governments but nongovernmental stakeholders and actors. The World Health Organization (WHO), created shortly after World War II as a specialized, intergovernmental agency, is intended to lead and coordinate the health actions of governments worldwide. The work of WHO is facilitated when consensus is reached among countries on global priorities, as was the case for malaria and smallpox eradication in the 1960s, primary health care and immunization in the 1970s, and the Global Program on HIV/AIDS in the 1980s. (excerpt)
Indian Journal of Community Medicine. 2002 Jul-Sep; 27(3): p..Health systems have undergone overlapping generations of reforms in the past 100 years, including the founding of national health care systems and extension of social insurance schemes. Subsequently to realize the goal of "Health for all" the system of primary health care was adopted the world over. The system of primary health care paid too little attention to the people's demand for health care and it concentrated exclusively on the perceived needs. In the past decade or so there has been gradual shift of vision towards what WHO calls the "New Universalism" high quality delivery of essential care, defined mostly by criterion of cost-effectiveness, for everyone, rather than all possible care for the whole population or only the simplest and most basic care for the poor. (excerpt)
The level of effort in the national response to HIV / AIDS: the AIDS Program Effort Index (API), 2003 round.
Washington, D.C., USAID, 2003 Dec.  p.The success of HIV/AIDS programs can be affected by many factors, including political commitment, program effort, socio-cultural context, political systems, economic development, extent and duration of the epidemic , and resources available. Many programs track low-level inputs (e.g., training workshops conducted, condoms distributed) or outcomes (e.g., percentage of acts protected by condom use). Measures of program effort are generally confined to the existence or lack of major program elements (e.g., condom social marketing, counseling and testing). To assist countries in such evaluation efforts, several guides have been developed by the Joint United Nations Program on HIV/AIDS (UNAIDS), the World Health Organization (WHO), the United States Agency for International Development (USAID) and other organizations (see, for example, “Meeting the Behavioural Data Collection Needs of National HIV/AIDS and STD Programmes” and “National AIDS Programs: A Guide to Monitoring and Evaluation of HIV/AIDS Programs”). However, information about the policy environment, level of political support, and other contextual issues affecting the success and failure of national AIDS programs has not been addressed previously. (excerpt)
Geneva, Switzerland, WHO, 2003. xvi, 140 p. (USAID Cooperative Agreement No. HRN-A-00-97-00007-00)This Tool is designed to assist users in assessing the status of infant and young child feeding practices, policies, and programmes in their country. The purpose of such an assessment is to identify strengths and possible weaknesses, with a view to improving the protection, promotion, and support of optimal infant and young child feeding. The Tool is designed to be a flexible instrument. It can be used in its entirety, which is preferred, or in part, and can be employed by a range of users for various purposes. The approach taken may depend on: - the stage of policy and programme development in the country concerned; - the commitment of key decision-makers to undertake the assessment and to use the results; and - the human and financial resources available. The Tool can be used as a companion piece to the Global Strategy for Infant and Young Child Feeding as an assessment tool to help determine where improvements might be needed to meet the Global Strategy targets. Consideration should be given to using the Tool periodically, every several years, to track trends on the various indicators, report on progress, identify areas still needing improvement, and assist in the planning process. (excerpt)
Lancet. 2003 Nov 29; 362(9398):1773.December 1 is the 16th World AIDS Day. The major theme of the past year has been on strengthening the campaign for cheap antiretroviral drugs. This thrust, some critics maintain, has been to the detriment of HIV prevention efforts. Perhaps the most ambitious HIV/AIDS development in the past year has been WHO’s focus on the “3 by 5” target—a commitment to provide antiretroviral drugs to 3 million people in developing countries by the end of 2005. For many the “3 by 5” initiative, if successfully implemented, will bring a longer life. But how useful is this and other antiretroviral-based initiatives to those people with AIDS in the developing world who will die today, tomorrow, or in the very near future? For these people, the stark reality is that it is too late for antiretroviral treatment; what they need, yet rarely receive, is palliative care. (excerpt)
Epidemiology of measles in the central region of Ghana: a five-year case review in three district hospitals.
East African Medical Journal. 2003 Jun; 80(6):312-317.Objective: As part of a national accelerated campaign to eliminate measles, we conducted a study, to define the epidemiology of measles in the Central Region. Design: A descriptive survey was carried out on retrospective cases of measles. Setting: Patients were drawn from the three district hospitals (Assin, Asikuma and Winneba Hospitals) with the highest number of reported cases in the region. Subjects: Records of outpatient and inpatient measles patients attending the selected health facilities between 1996 and 2000. Data on reported measles eases in all health facilities in the three study, districts were also analysed. Main outcome measures: The distribution of measles eases in person (age and sex), time (weekly, or monthly, trends) anti place (residence), the relative frequency, of eases, and the outcome of treatment. Results: There was an overall decline in reported eases of measles between 1996 and 2000 both in absolute terms and relative to other diseases. Females constituted 48%- 52% of the reported 1508 eases in the hospitals. The median age of patients was 36 months. Eleven percent of eases were aged under nine months; 66% under five years and 96% under 15 years. With some minor variations between districts, the highest and lowest transmission occurred in March and September respectively. Within hospitals, there were sporadic outbreaks with up to 34 weekly eases. Conclusion: In Ghana, children aged nine months to 14 years could be appropriately targeted for supplementary, measles immunization campaigns. The best period for the campaigns is during the low transmission months of August to October. Retrospective surveillance can expediently inform decisions about the timing and target age groups for such campaigns. (author's)
East African Medical Journal. 2003 Jun; 80(6 Suppl):S1-S20.Health sector reform is 'a sustained process of fundamental changes in national health policy, institutional arrangements, etc. guided by government and designed to improve the functioning and performance of the health sector and, ultimately, the health status of the population'. All the forty six countries in the African Region of the World Health Organisation have embarked on one form of health sector reform or the other. The contexts and contents of their health reform programmes have varied from one country to another. Health reforms in the region have been influenced largely by the poor performance of the health systems, particularly with regard to the quality of health services. Most countries have taken due congnizance of the deficiencies on their health systems in the design of their health reform programmes and they have made some progress in the implementation of such programmes. Indeed, some countries have adopted sector-wide approaches (SWAps) in developing and implementing their health reform programmes. Since countries are at various stages of implementing their health reform programmes, there is a lot of potential for countries to learn from one another. This paper is a synthesis of the experiences of the countries of the Region in the development and implementation of their health sector reform programmes, it also highlights the future perspectives in this important area. (author's)
In: Population studies (lectures on population education), [compiled by] Sri Venkateswara University. Population Studies Centre. Tirupati, India, Sri Venkateswara University, Population Studies Centre, 1979. 41-50.This paper highlights the importance of health education in population education. Definition of health, as well as, the objectives of health education in the prospects of the WHO is presented in this paper. Furthermore, it focuses on the different aspects of health education, namely: personal hygiene and environmental sanitation; maternal and child health; nutrition education; applied nutrition program; school health education; transmission of diseases and cultural practices; national health programs; age at marriage of women and health; and population explosion and health hazards.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1994; (845):i-iv, 1-31.This World Health Organization expert committee report presents chapters on new public health action towards health for all; current issues in health information; health information needs at the district level; methods for collecting and processing information; the analysis, presentation, and reporting of health information; facilitating the use of health information; and resources and management support to district health information development. Many countries in recent years have developed national health information systems to supply a range of essential health information for national policy making and health planning. National health systems at the district level are closely involved in data collection and reporting. These systems face the challenges of how to continue supporting district-level managers in implementing primary health care and how to decide what new information will be required at the local level, especially for monitoring the equity, coverage, quality, and efficiency of health interventions, as a country undergoes major health system reforms. Health information systems suffer from a number of well-known problems, with further improvements still required in data collection processes, methods of analysis, use of microcomputers and informatics, and the presentation and communication of health information. These new challenges emphasize the critical need that all countries have for reliable, relevant, timely, and useful health information. Recommendations are made for member states and the World Health Organization.
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.
Epidemiology and control of schistosomiasis: report of a WHO Expert Committee, Geneva, 6-10 November, 1978.
Geneva, Switzerland, WHO, 1980. (WHO Technical Report Series No. 643)The World Health Organization (WHO) Expert Committee on Epidemiology and Control of Schistosomiasis met in Switzerland in November 1978 and dealt with epidemiology (the parasite, the snail intermediate host, human infection), control (review of progress in selected national control programs, control tools and techniques, factors influencing the choice of control methods in schistosomiasis, and evaluation of control), training courses in parasitology and in epidemiology, the feasibility of control, the strategy of control, and control policies in the future. Although reliable and effective schistosomiasis control measures have become available, the most appropriate combinations of these measures still need to be worked out. Both disease control in the human population and transmission control of the biological cycle are essential to the concept of total control of schistosomiasis. Drug treatment will have an increasingly significant role in disease and transmission control, but there is also a need for operational research in order to define the best ways of using the available drugs. The cost of control at this time will make it difficult for the poorer endemic countries to have effective programs within the constraints of their health budgets, meaning that less expensive methods of control are necessary. Programs that have depended exclusively on chemotherapy experienced problems after some years, and it is important to encourage the use of other methods in programs using chemotherapy on a large scale.
Geneva, Switzerland, WHO, 1977. 28 p. (OCP/STAC/77.2)The STAC (Scientific and Technical Advisory Committee) is evaluating the feasibility for economic development in the Volta River Basin. The main obstacle is the danger of onchocerciasis which could lead to blindness. The onchocerciasis control program hopes to reduce the disease to a low enough level that it no longer poses a major health problem or an obstacle to socio-economic development as well as to maintain the disease at a tolerable level. Therefore, studies, plans, and recommendations on insecticides are being made. The program is treating waterways with Abate, a biodegradable larvicide, in addition to undertaking parasitological surveillance. Blackflys are captured and their larvae are analyzed; data is recorded; and tests are conducted to detect any insecticide resistance. The STAC also examined villagers to diagnose human microfilariae in their skin and determine if eye lesions were present. Treatment currently used to combat the disease is either by nodulectomy and/or chemotherapy, but neither is fully effective and mass treatment is difficult. Metrifonate is a promising drug which affects the microfilariae in the cornea without irritating the anterior segment of the eye. Although there are some difficulties in overcoming onchocerciasis, reclamation of the valleys will benefit the population.
Geneva, WHO, 1976. (WHO Technical Report Series No. 600) 98 p.Approximately 125 million infants were born in 1975 and approximately 10-12 million died before their first birthday. The WHO Expert Committee on Maternal and Child Health met in Geneva December 9-15, 1975 to consider new approaches and trends in delivering maternal and child care health services. The Committee decided to redefine health problems and adapt delivery of services in light of social and environmental changes. The effect of careful and informed mothering on the health of the entire family and the relation of family health to community health are important factors in individual, national, and community development. The roles of environmental and socioeconomic factors in mortality, morbidity, and growth and development have been further clarified during the last decade. In countries where data was not previously available, the mmultiple causation of the main health problems of mothers and children has been better documented. The priority health problems are related to the synergistic effects of malnutrition, infection, and unregulated fertility, together with poor socioeconomic conditions and scarcity of health services.
Geneva, World Health Organization, 1971. (Technical Report Series No. 483). 47 p.A WHO Study Group on Health Education in Health Aspects of Family Planning met in Geneva from December 15-21, 1970. A report of the group is presented. It is asserted that family planning contributes materially to 1 of the main aims of health services, by helping to ensure that every child, wherever possible, lives and grows up in a family unit with love and security in healthy surroundings, receives adequate nourishment, health supervision, and efficient medical attention, and is taught the elements of healthy living. The Study Group gave primary consideration to an analysis of the educational components fundamental to achieving the objectives of family planning services within the context of health services: the programming process, implementation, evaluation, methodology, coordination, and needs for studies and research. The Group noted that in many countries the integration of family planning care into health services not only has important educational implications but also brings many administrative and technical advantages. The contents of the report include sections on 1) family planning and its dependence on many services, 2) dependence of family planning on people, 3) some important requirements and difficulties, 4) objectives of education in health aspects of family planning, 5) a systematic approach to education in the health aspects of family planning, 6) importance of an organized health education service, 7) coordination of effort, 8) studies and research, and 9) recommendations.
Geneva, World Health Organization, 1970.A WHO Expert Committee on Training in National Health Planning met in Geneva from 24 November to 2 December 1969 to review different training programs based on modern concepts of health planning in order to answer such specific questions as why there is a need to train various types of personnel in this field, which particular catagories of personnel needed, which different types of planning courses and factors should be considered in each category, and what types to medical and nonmedical institutions should be used. Because of the general and specific variables that are found in each country situation, the report does not prescribe 1 or more standard courses to be adopted universally to accomplish training in national health planning. The category of generalist health planners is the most urgently needed. The training of the health planners requires a diversified faculty who have a grasp of the whole field and expects in pedagogy. Factors which influence training in national health planning include politico-social variables, availability of resources, the character of the health and educational systems, the trainees' educational level and future role, and the state of technology. Certain recommendations are made for the future development of training in health planning including: 1) the necessity of determining the validity of a model of national health planning, and 2) the advisability of subjecting the various roles in national health planning to systematic analysis in order to delineate more sharply the functions for which training is required and the most appropriate backgrounds for those to be selected for training, 3) Plans for training must be evaluated and, if necessary, reformulated. 4) Institutions should make a systematic and joint approach to the development of training and to the exchange of teaching materials. 5) A clearinghouse should be created for literature, resources, and experiences in national health planning. 6) International cooperation and exchange in national health planning should be improved and made more systematic. 7) Professional publication in the field of national health planning should be stimulated and supported.
Report on progress in implementing the Health Initiative: Equitable Access to Basic Health Services. Informe sobre los avances en la implementacion de la Iniciativa de Salud: Acceso Equitativo a los Servicios Basicos de Salud.
Washington, D.C., PAHO, . , 42 p.This report presents the progress of the implementation of the Health Initiative: Equitable access to basic health services in the Americas. In accordance with the 1994 Miami Plan of Action, the Pan American Health Organization (PAHO) and WHO presented this summary of the progress achieved in regional work towards the goal of Initiative 17: Equitable Access to Basic Health Services. Initiative 17 is the government s endorsement on the maternal and child health objectives for the 1990 World Summit for Children, and the 1994 International Conference on Population and Development. The endorsement reaffirms their commitment toward reducing child mortality by one-third and maternal mortality by one-half from 1990 levels by the year 2000. Also included in this summary is progress in other initiatives that are also related to the work of PAHO in the Hemisphere. In parallel with the Summit of the Americas, the Wives of Heads of States and Governments of the Americas held a Symposium on Health of the Children of the Americas. This symposium resulted in several health actions that have impacted the Initiative 17 program and other related projects.
WORLD HEALTH FORUM. 1998; 19(1):91-6.In this memoir, a retired World Health Organization (WHO) field worker reflects on her experiences. Her first shock came when she realized that she was going to be sent to her first assignment with no specific instructions. Fortunately, she encountered helpful WHO staff when she arrived in Manila. Conditions for delivering health care were primitive, health statistics were frightful, and working conditions were indescribable and were hampered by the lack of electricity and running water. The WHO focused on creating health services from scratch in the poorest countries and then training teachers to prepare staff. WHO nurses functioned as teams that were thrown together with no regard for compatibility. Another challenge was learning to work with national counterparts to prepare an appropriate training curriculum and to decide how students would gain experience in local hospitals, where the teaching staff was viewed with suspicion. As WHO field workers gained experience, they were able to design innovative programs, such as moving training from the classroom to a village setting. In some countries, there were numerous WHO staffers in residence, but before WHO began holding regular meetings there were few opportunities to coordinate activities. The regional office, however, maintained excellent relationships with the field staff. Being a WHO field worker meant hard, but extremely satisfying, work.