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Washington, D.C., World Bank, 1991. x, 51 p. (World Bank Technical Paper No. 159)A World Bank report outlines the results of an empirical study. It lists institutional characteristics connected with successful tropical disease control programs, describes their importance, and extracts useful lessons for disease control specialists and managers. The study covers and compares 7 successful tropical disease control programs: the endemic disease program in Brazil; schistosomiasis control programs in China, Egypt, and Zimbabwe; and the malaria, schistosomiasis, and tuberculosis programs in the Philippines. All of these successful programs, as defined by reaching goals over a 10-15 year period, are technology driven. Specifically they establish a relevant technological strategy and package, and use operational research to appropriately adapt it to local conditions. Further they are campaign oriented. The 7 programs steer all features of organization and management to applying technology in the field. Moreover groups of expert staff, rather than administrators, have the authority to decide on technical matters. These programs operate both vertically and horizontally. Further when it comes to planning strategy they are centralized, but when it comes to actual operations and tasks, they are decentralized. Besides they match themselves to the task and not the task to the organization. Successful disease control programs have a realistic idea of what extension activities, e.g., surveillance and health education, is possible in the field. In addition, they work with households rather than the community. All employees are well trained. Program managers use informal and professional means to motivate then which makes the programs productive. The organizational structure of these programs mixes standardization of technical procedures with flexibility in applying rules and regulations, nonmonetary rewards to encourage experience based use of technological packages, a strong sense of public service, and a strong commitment to personal and professional development.
SCIENCE. 1991 Oct 25; 254:511-2.The 1st Director of the World Health Organization's (WHO) Global Program on AIDS (GPA) abruptly resigned March, 1990. Jonathan Mann led the GPA in an innovative, aggressive, and comparatively non-bureaucratic style since its inception in 1986, building a staff of nearly 200 under an eventual 1990 budget of $90 million. Mann's non-conformist style and ever-growing budget, however, ran counter to the bureaucratic forces in WHO, causing him to leave for a position at Harvard University. A 12-year WHO veteran, Michael H. Merson succeeded Mann, and has since managed the GPA in a more conventional, bureaucratic manner. Senior staff have resigned, and the budget will drop to only $75 million for 1992. Staff replacements are used to the bureaucratic structure and demands of WHO, but lack experience in the field of AIDS. This paper discusses the markedly different management styles and approaches of Merson and Mann, with concern voiced over the future of the GPA. Critics are uncertain of GPA's present direction, and whether or not it is a necessary, positive change in the fight against the AIDS pandemic. As AIDS appears with less frequency and centrality i the world's media, the GPA is needed now even more than just a few years ago to inform the world of the dangers of AIDS. Merson is expected to promote relatively simple treatment options for AIDS, with some emphasis upon technological fixes like the condom. With cuts to the behavioral research budget, however, it is almost certain that inadequate steps will be taken to effect behavioral change for the prevention and control of HIV infection.
Dhaka, Bangladesh, ICDDR,B, 1991. , 99 p.This publication reports on the 1990 activities of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). a non- profit organization that promotes and conducts research, education, training, and clinical service on diarrheal diseased and related subjects. headquartered in Dhaka, ICDDR,B operates through funding from donor nations and international aid organizations. The Center contains 4 scientific divisions: Population Science and Extension, Clinical Services, Community Health, and Laboratory Sciences. In the introductory section of the report, the director of the Center, Dr. Demissie Habte, discusses the Center's efforts to confront budgetary and staffing concerns. During 1990, the Center reduced the number of redundant staff and was able to fill some key positions that had been previously vacant. The Center also succeeded in avoiding a potentially large deficit, partly a result of the streamlining of staff and austerity measures. The director also reports that while research output remained at the same level as in the past few years, some major initiatives in research and service delivery took place, including the introduction of a microcomputer-based health and family planning management information and research system in Matlab. Furthermore, construction on the Matlab Health and Research Center was completed in February 1990. The bulk of the report describes following research: 1) watery and persistent diarrhea, and dysentery research; 2) diarrhea- related research -- urban, population, environmental, and family planning and maternal and child health studies; and 3) health care research. The report also discusses the accomplishments in the areas of support services, training and staff development.