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IN TOUCH 1991 Mar; 10(98):3-11.In order to institute the Alma Ata Conference goals of health for all (HFA) and primary health care (PHC), the author has provided an overview of the tenets of basic management as it pertains to a health services system in Bangladesh. Central government structure is diagrammed. The internal operation is described as composed of administrative decisions; operational management; operational planning; organizing resources; motivating health personnel; appraising staff performance; coordinating; developing public relations; managing information systems; monitoring; conducting evaluations; identification and collection of data pertinent to evaluations; methods and techniques of data collection; reporting of background information; and objectives and methodology of evaluations, findings, and major achievements. Activity is evaluated based on relevance, progress, effectiveness, adequacy, efficiency, and impact. The author finds that Bangladesh's lack of any formal document on national health policy impedes the managerial process. Other inadequacies involve the lack of dissemination of the HFA country paper and unsuitable perceptions of the PHC approach; the deficiencies in the 5 year plans to address the main concerns of the PHC in the health care system such as community finances or inequitable resource allocation; the lack of preventive and integrated care in upazila health management; the lack of definition of responsibilities of institutions; the lack of motivated grass roots level workers who provide coordination with other sectors; the lack of micro or macro evaluations of quality of care; and management deficiencies. Supervision is incompetent. Linkage between formal and informal health sectors are missing. Skills are lacking in operational planning. Conceptualization of PHC is inadequate.
WORLD HEALTH FORUM. 1989; 10(3-4):438-47.A detailed study of the World Health Organization's (WHO) need to analyze its technical cooperation in management development took place in 1987-88 in developing and developed countries. Premises of the study were: 1) that management is not a separate function but is essential to the health system served by it; 2) the full range of management involves programming, funding, developing the health system, and guiding its operations; and 3) the adequacy of management is measured by the efficiency and effectiveness with which services and other health promoting interventions are delivered. Data was supplied by observing national personnel ranging from village health workers to health ministers in developing countries in 4 WHO regions. Several countries have good health development systems. The poorest countries have the least developed health systems. Countries with early stage developing systems have made little progress in health development. Countries with middle stage developing systems have been able to set up strategies and policies for health development. Countries with mature systems emphasize curative medical care. There are many problems, however, and are many mistaken notions of management. Management involves guidance. Health system capacity should offer many things. Health system development is limited by environmental factors. Leaders must have a systematic view of health development. An assessment of health system strengths and weaknesses should be made. The management part of a system building strategy should have attention paid to it. Management of resource development should not be neglected. Operational factors should also be considered.
JOURNAL OF HEALTH AND SOCIAL BEHAVIOR. 1989 Dec; 30(4):345-52.Third World originated in the 1950s as a political ideology and concept. As an empirical reality it is a world characterized by economic underdevelopment. Attention is beginning to focus on its cultural and human aspects, including health and health care. The 9 articles in this special issue show the application of sociology to the study of 3rd World health and health care. The articles are classified into 4 categories--social factors in disease, utilization of health services, provider-patient relationships, and organization of health services. Their relationship to research issues and methods in medical sociology is discussed. In conclusion, the World Health Organization's (WHO) "Health for ALL" program is critiqued in light of finding in the articles. 2 topics require closer sociological analysis than they have received, and these are discussed. The 1st concerns health manpower, especially the role of the physician, in relation to 3rd World health priorities. The 2nd is the place of traditional health personnel and practices within the general development of national health resources. Given the high regard for technical clinical skill that is imparted through medical education worldwide, it is not clear that 3rd World physicians can be persuaded to become health educators or coordinators for social resources, however necessary those functions may be. Even so, the Health for All agenda can switch to another priority, namely, the radical reform of medical education to produce physicians who are more strongly oriented toward goals of community health and less concerned with technical skill. (author's modified)
WORLD HEALTH. 1987 Oct; 26-9.In the next 13 years, health services must be created that will double present coverage. Preparations must be made for a population in which the proportion of elderly persons is increasing each year, and which is becoming increasingly urbanized, both geographically and culturally. The approval in 1986 by the Pan American Sanitary Conference--the highest policy organization of the Pan American Health Organization/World Health Organization (PAHO/WHO) in the Western Hemisphere--of program priorities for the 1987-1990 quadrennium has provided the tools to confront these challenges in a systematic and pragmatic way. This political decision established the quadrennial frame of reference for the Organization's cooperation in transforming health systems, with its activities now underway in 3 related areas of priority: the development of the health infrastructure, with emphasis on primary health care; specific programs for priority health problems among the most vulnerable groups; and the information management needed to carry out these programs. By targeting these 3 areas, the member countries have given the Organization a mandate to move effectively against the potential catastrophe of 300 million people lacking health services by century's end. This is a regional approach, developed on the basis of the particular socioeconomic and health conditions of the Western Hemisphere. But it is also an approach fitting perfectly within the principles which the Member States of the WHO accepted when they approved in 1977 the universal call for Health for All by the Year 2000.
El autentico espiritu de la cooperacion international. The true spirit of international cooperation, statement made at the Meeting of the National Population Council of the Government of Mexico, Mexico City, Mexico, 16 March 1981.
New York, N.Y., UNFPA, . 8 p. (Speech Series No. 63)Mexico's achievements in the field of population and development stand out clearly among the countries of the Western Hemisphere. The family planning program has made considerable progress since it was initiated in 1973. A major reason for the success is the commitment of the Government. This support is reflected in Mexico's unique 1974 General Population Law which established the National Population Council and which provides legal basis for the population programs. With this legislation, Mexico has taken the lead among the countries in Latin America in recognizing the population factor as an integral component of the development process. UNFPA has provided modest assistance to the Government of Mexico, but it has been a partnership in the true spirit of international co-operation.
The World Fertility Survey: a basis for population and development planning, statement made at the World Fertility Survey Conference, London, England, 7 July 1980.
New York, N.Y., UNFPA, . 5 p. (Speech Series No. 54)The World Fertility Survey (WFS) is the largest social science research survey undertaken to date. From its inception in 1972 the WFS has received the full support of the UN and the UNFPA. This program has not only enhanced considerably our knowledge of fertility levels and fertility regulation practices in developing as well as developed countries but has also provided the UN system with internationally comparable data on human fertility on a large scale for the 1st time. The methodology developed by the WFS has made it possible to collect data on the individual and the household as well as the community. Information has become available not only on fertility levels, trends and patterns but also on fertility preferences and nuptiality as well as knowledge and use of family planning methods. Initial findings document the rather dramatic fertility decline taking place in many developing countries under various socioeconomic and cultural conditions. They also show the magnitude of existing unmet needs for family planning in the developing world which must be continuously brought to the attention of the governments of all countries. A most encouraging effect of the program, however, has been the fact that 21 industrialized countries have carried out, entirely with their own resources, fertility surveys within the WFS framework and in accordance with its recommendations, making it truly an internationally collaborative effort.
Health and Population: Perspectives and Issues. 1982 Jan-Mar; 5(1):23-33.A new discipline, health economics, which reflects the relationship between the health objective procuring adequate health care and the financial resources available, is becoming increasingly important. The WHO definition of health, that health is a "state of complete physical, mental and social well being and not merely the absence of disease or infirmity," is criticized for not lending itself to direct measurement of the health of the individual or community. This concept should include consideration of the process of being well as well as the absence of disease. It must also recognize that services to promote health, to prevent, diagnose and treat disease and rehabilitate incapacitated people must be included in the concept. For economic analysis purposes, health services can be classified into medical care, public health services and environmental public health services. It is suggested that the cost of education and training of medical personnel and medical research should be included in computing the cost of health services. In defining economic concepts many factors including capital and current costs, and depreciation must be considered. In addition all health economists have differentiated the direct cost of sickness including cost of prevention, detection, treatment, rehabilitation, research, training, and capital investments from indirect costs which include loss of output to the economy, disability and premature death. Using these concepts, some understanding of cost trends, cost accounting, cost benefit analysis and cost efficiency analysis should be made available in the medical curriculum and for health administrators so that health management can be more standardized and effective. (summary in HIN)
In: Quenum CA. The health development of African communities: ten years of reflection. Brazzaville, World Health Organization, Regional Office for Africa, 1979. 63-115. (AFRO Technical Papers No. 15)The author, regional representative for the World Health Organization, encourages the development of scientific management, systematic thinking, and techniques set in a strategy of long-term plans which encompass short and medium-term plans as well. Science and technology must also be developed as the basis of planning. The author goes on to explain the importance of regional coordination in Africa in order to promote the integrated socioeconomic development of the area. Each branch of the World Health Organization must be given freedom to pursue its tasks. This will function best when the UN secretariat gives guidance and leadership. The rapid improvement of conditions in Africa will require the training of many lower level health technicians and the promulgation of teamwork among groups with diverse skills. This will assist as well planning of the health system and regional integration of Africa in its developmental and health work.