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  1. 1

    [Improvement of reproductive health services in rural China: approaches and entry points]

    Zhang K; Liu Y

    Chinese Primary Health Care. 2000; 14(9):11-14.

    To set up the research priorities for the broader reproductive health programmes, the World Health Organization (WHO) has given a high priority to planning and programming for reproductive health, which aims at improvement of the delivery of reproductive health services. In 1998, with a financing support by Ford Foundation, the Foreign Loan Office of the China Ministry of Health (MoH) initiated a program in poor rural areas of China entitled reproductive health improvement project (RHIP) in 4 of the 71 World Bank/MoH of China "Health VIII Project" Counties. This paper reports the approaches and entry points of RHIP: (1) Participatory planning; (2) Operations research; and (3) Listening to women's voice at the rural communities. It is expected that these approaches and entry points will be useful for improvement of reproductive health services in other rural areas of China. (author's)
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  2. 2

    Planning, development and health: an approach to training, 2nd ed., rev.

    United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]; Royal Tropical Institute

    Bangkok, Thailand, ESCAP, 1984. 323 p. (ESCAP Programme on Health and Development Technical Paper No. 66/PHD 19; ST/ESCAP/286)

    This training manual describes the organization of the courses, the course syllabus, the 1983 course on planning, development and health, the follow-up evaluation of the training courses of 1976-82 and the specialized activities in planning for health and development at ESCAP. Planning for health is viewed as an integral part of overall development planning with the conscious incorporation of clear goals, to help ensure that development programs have a positive impact on the health of the region's poor. ESCAP's training program aims to amplify, in concrete terms, the close relationship between health and development and to build the capability to take an integrated and multisectoral approach to inproving health and accelerating development. The design and implementation of a training program oriented to strengthen capacities in planning, development and health is a function of these 3 terms. The basic frame has remained farily similar to the 1976 course. Training aims at behavior change--to strengthen capacity for action, rather than to accumulate knowledge and information for information's sake. Training objectives must be appraised in terms of relevance, adequacy, effectiveness, efficacy and impact before actual implementation beings. The course is conceived as a unified, multi-sectoral approach to assess the health situation and propose intervention measures aimed at the elimination of the social causes of ill-health and disease of a country. The focus is in the relationships between health and development through systems analysis and relevant planning tools. The aim of the courses is to produce a cadre of planners for health with an innovative and intersectoral outlook, consistent with the dynamic approaches in health, development and planning and with abilities to convince the higher planning structures, rally political support and enlist coummunity involvement with focus on Health for All by the Year 2000. Tables and charts facilitate understanding of concepts involved in this training.
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  3. 3
    Peer Reviewed

    A critical review of priority setting in the health sector: the methodology of the 1993 World Development Report.

    Paalman M; Bekedam H; Hawken L; Nyheim D

    HEALTH POLICY AND PLANNING. 1998; 13(1):13-31.

    The 1993 World Development Report (WDR) identifies the following problems in the health sector of developing countries: escalation of costs, misallocation of public funds, and the inefficient and inequitable use of available funds. Policies are suggested in the WDR to help developing country governments improve their populations' health. Technological limitations and resource scarcity mean that not all health needs can be met. Priorities must therefore be set for health services. The report therefore also introduces a new methodology to improve government spending based upon epidemiological and economic analysis, with analysis leading to the establishment of a league table of priority health interventions, cardinally ranked by health gain per dollar spent. Use of the table should improve the efficiency of public health expenditure. The Ministries of Health of many countries have shown interest in designing a national package of essential health services, using the methodology. An overview of the methodology is presented, as well as the main issues and problems in estimating the burden of disease, and the cost-effectiveness of interventions. Strengths and weaknesses in the databases, value judgements, and assumptions are identified.
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  4. 4

    What does "health futures" mean to WHO and the world?

    Sapirie S


    Health futures is defined as a set of tools that can help explore probable, plausible, possible, and preferable futures for guiding actions whereby potential health threats could be anticipated. The World Health Organization (WHO) is promoting national futures studies for health planning and development as confirmed at the World Health Assembly in 1990. WHO began scanning the field of health futures and learning about the methods used for trend assessment and forecasting. An international consultation on health futures was convened in July 1993 and attended by 38 experts. The consultation proposed follow-up activities sharing studies and methods through international publications; establishing electronic communication to this end; developing a handbook on health futures; and cataloguing experts, institutions, and training opportunities in health futures. A variety of people presented a wide range of studies on the purposes of health futures studies, methodologies, and funding; there were 5 scenarios for health care in the United States (continued growth/high technology, hard times/governmental leadership, buyer's market, a new civilization, healing and health care). The consultation focused on 6 themes, including assessing health technology. An extensive study undertaken in the Netherlands between 1985 and 1988 identified emerging health technology: neurosciences, the use of lasers in treating ischemic heart disease, biotechnology, new vaccines, genetic testing, computer-assisted medical imaging, and home care technologies. Health resources projection was also described for China using simulation models for 3 estimates of demand for hospital beds and doctors between 1990 and 2010. Also presented was Statistics Canada's new population-health model (POHEM), which is based on an individual life-cycle theory of health. A well-institutionalized modeling system by the US Bureau of Health Professions was introduced, showing the physician-supply model for forecasting purposes in the debate over health care reform. Artificial neural networking was introduced for predicting hospital length-of-stay.
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  5. 5

    Guidelines for the development of a national AIDS prevention and control programme.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1988. iv, 27 p. (WHO AIDS Series 1)

    The World Health Organization (WHO) has prepared a set of guidelines for national AIDS programs that includes objectives, initial assessment, strategies, medium-term goals, suggested activities and necessary periodic evaluation. Because of the nature of the HIV infection, national tactics are similar, regardless of the case rate in any particular region. HIV has spread world-wide, and checking its further spread will entail education for the change of deep-seated behaviors by all. The objectives of an AIDS control program are to prevent HIV transmission, and to reduce the consequent morbidity and mortality. Strategies include prevention of its spread by sexual and perinatal transmission, blood products, injections, skin-piercing practices, and iatrogenic spread. Countries 1st form a national AIDS committee. An initial epidemiological and resource assessment is made. Sexual transmission is controlled primarily through a long-term commitment to a factual, consistent education campaign. Later, more specific targets and behaviors must be addressed. A more detailed list of activities is suggested for securing the blood and blood product system, and supplying clean medical instruments. Perinatal transmission should be addressed by identifying, educating, and counseling infected women. The impact of AIDS on individuals, groups and societies can be reduced by diagnosis, treatment, counseling, training of health workers, setting up a case-reporting system. A re-evaluation strategy is vital for replanning, learning by doing, assessing trends and providing information for donors.
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  6. 6

    Food emergency in wonderland: a case study prepared by the League of Red Cross and Red Crescent Societies for the training of relief workers.

    Peel S

    In: Advances in international maternal and child health, vol. 4, 1984, edited by D.B. Jelliffe and E.F. Jelliffe. Oxford, England, Oxford University Press, 1984. 110-23.

    This monograph chapter is an exercise whose aim is to help relief workers to be better equipped to solve the practical problems of an emergency relief operation. Its events and contents are imaginary, but are drawn from direct experience. It has been used extensively in Red Cross training projects in several countries, and is designed, 1st, to be complemented with other types of educational media, and 2nd, to be adapted to the training requirements of diverse types of project, through "biasing" in favor of health, nutrition, sanitation, or logistics. A description is given of the management of the case study educational setting, based on real experience with the use of the material; the best results appeared achieveable through a class session on part 1, consisting of initial assessment of an hypothetical nutritional emergency, followed by work in small groups on part 2. Part 1 consists of presentation of situation characteristics, e.g. "overworked health assistant reports a big increase in chest infections, diarrhea, and typhus," and "there is a hand-dug well 1/2 mile from the shelter." Part 2 describes the situation 2 months later, after intervention has begun. Situation characteristics appear such as, "Records from clinic attendance indicates that the commonest disease symptoms are diarrhea, cough with or without temperature, general aches and pains, worms, and eye infections." The case study also includes additional information on food stocks, demographic data, and nutritional survey data (the latter not included in this article). Concluding the article are examples of topics for group discussions and presentations.
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  7. 7

    Basic community services through primary health care: a training approach, 2nd ed., rev.

    United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]; UNICEF. East Asia and Pakistan Regional Office

    Bangkok, Thailand, ESCAP, 1984 Apr. 175 p. (ESCAP Programme on Health and Development Technical Paper No. 65/BCS 12; ST/ESCAP/291)

    The recognition of the necessity of involving the community in development efforts has been a turning point in the evolution of development thinking in recent years. Since 1978, the UNICEF Regional Office for East Asia and Pakistan and ESCAP have been conducting a series of training seminars where local development, basic services and primary health care are discussed as part of village reality. This volume reviews this experience, generalizing it to enhance adaptation. The seminars are a learning by doing and experience-sharing process. Group discussion and reflection on relevant issues are focused on. The seminars are oriented to community life as a whole, considering primary heatlh care as an entry point for coummunity development which involves generation of services within the community, supplemented by delivery of services from other institutional levels. This report describes the overall framework, including the organization of the 1983 seminar and the training approach, and the syllabus and evaluates the seminars. The goal of the seminar is the promotion of basic community health care in the countries of the region to improve the quality of life of the poor. Each participant discusses his/her work experience. Basic needs, basic services and primary health care are examined and a field-study phase at village-level is organized. Planning capabilities are developed by a phase of planning for basic and community services and primary health care. A module on national development, basic needs approach and production-oriented development is introduced. Finally, each participant prepares a draft project proposal for training for his/her own country situation. The evaluation of a program includes both its delivery system component and its eventual impact. The seminars used questionnaires, special group discussions and interviewing of the participants. The aim was to scrutinize the relevance and potential for modification of knowledge, attitudes and practice (KAP) rather that the actual impact actual impact achieved. Behavioral change should be evaluated on at least 2 levels: the individual and the collective. The structure, clustering and frequency of response to a given question in an evaluation questionnaire and the average level of awareness about a particular issue are 2 important measures to analyze. Seminar participants were mainly middle level personnel, but included some junior and senior officials from ministries of health, interior or home affairs and agriculture; training institutes; rural development institutes; planning commissions and universities.
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  8. 8

    [Operational sequence for the implementation of a subregional food and nutrition strategy] Secuencia operativa para la implementacion de una estrategia subregional de alimentacion y nutricion.

    Salazar de Buckle T; Tantalean J

    In: Lineamientos de una estrategia Andina de alimentacion y nutricion [by] Junta del Acuerdo de Cartegena. Grupo de Politica Technologica. Proyectos Andinos de Desarollo Technologico en el Area de los Alimentos. Lima, Peru, Junta del Acuerdo de Cartagena, Grupo de Politica Technologica, Proyectos Andinos de Desarollo Technologico en el Area de los Alimentos, 1983. 143-74.

    This article outlines and diagrams a recommended operational sequence for implementation of food and nutrition strategy for the Andean region. The multisectorial strategy envisioned by the planners would involve the supply and demand for foods; basic health, environmental sanitation and educational services; and food information and technology. The integrated, multisectorial nature of the strategy requires policies, plans, and programming designed to facilitate harmonious development of all the necessary elements within the 5 Andean countries. The proposed methodology for operationalizing the strategy is based on a systems focus which covers all aspects of production, processing, distribution, final consumption, and technoeconomic policies for food and nutrition. Because the food and nutrition strategy is more than a production program, its design should identify interrelations between the availability and prices of foods, external commerce, industrial trends, food commerce and distribution, and food consumption in adquate quantities by the entire population. A basic service component for health should also be included for the Andean population because of its relationship to nutritional aspects. The suggested instrument for operationalizing the systems focus is the "Methodology for Evaluation andprogramming of Technological and Economic Development of Production and Consumption Systems" developed by the Andean Projects for Technological Development Food Group for the Group for Technological Policy of the Cartagena Accord. The methodology consists of a manual and a "Model of Numerical Experimentation", which permits identification of system components, calculation and evaluation of relevant aspects of each production factor, and design and selection of development alternatives. The Model of Numerical Experimentation" allows simulation of goals for satisfaction of needs, exports of final products, import substitution, different production technologies, commercial margins, subidies, customs duties, taxes and exchange rates and related variables. Various food production systems have already been studied using the methodology in each of the 5 Andean countries. It is recommended that implementation of aspects of the food and nutrition strategy involving food production and consumption proceed in 8 operational sequences: 1) characterization of the current industrial, agroindustrial, and fishing economy 2) identification and selection of basic foods and/or strategies 3) representation and quantification of each of the selected systems 4) evaluation of each system and intersystem relationship 5) identification and selection of systems of production of alternative foodstuffs 6) proposal for a national and regional food system 7) concerted development programming for the regional food system and 8) design of mechanisms of evaluation and follow-up.
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  9. 9

    [Towards a subregional food and nutrition strategy. How to begin?] Hacia una estrategia subregional en alimentacion y nutricion por donde empezar?

    Uribe Mosquera T

    In: Lineamientos de una estrategia Andina de alimentacion y nutricion [by] Junta del Acuerdo de Cartegena. Grupo de Politica Technologica. Proyectos Andinos de Desarollo Technologico en el Area de los Alimentos. Lima, Peru, Junta del Acuerdo de Cartagena, Grupo de Politica Technologica, Proyectos Andinos de Desarollo Technologico en el Area de los Alimentos, 1983. 111-42.

    This work suggests objectives, rationale, methods, and organizational structure for an Andean regional food and nutrition strategy. Although a food and nutrition policy is a desired goal in the region, the complexities of the problem and the fact that definitive solutions require a broad development strategy hamper development of a food and nutrition strategy. The food strategy initially should address aspects of food supply, food demand and utilization through provision of basic services, and food information and technology. The food supply strategy should involve 4 types of foods and 3 types of nutrients causing specific deficiencies. The food types should include 1) foods competitively produced in the region but not widely utilized by the Andean population, such as rice from Colombia or fish and seafoods from Peru and Ecuador 2) required foods not yet produced competitively in the region but capable of production within 5 years, such as meat from Bolivia or oils from Venezuela, Ecuador, Peru, and Colombia 3) foods competitively produced whose availability should be assured more widely in seasonal and geographic terms, such as sugar cane, bananas, potatoes, and yucca. 4) foods not currently produced competitively in the region and not likely to be produced within 5 years but which are important to the local diet and are in chronically short supply, such as maize, wheat, flours, oils, and fats. The deficiency-causing nutrients would be iodine, vitamin A, and ferrous sulphate or other iron derivatives. Basic services to be added or improved should include primary health care programs and environmental sanitation programs. Information and technology components of the food and nutrition strategy would initially involve the investigation and transferrance of technology for each step affecting food supply and demand for goods and services included in the overall strategy, as well as attempts to develop a basic data base concerning the interventions adopted. The organizational structure for the food and nutrition strategy should be flexible, with a lower level including a technical work group and an upper level composed of representatives of various sectors and organizations which would coordinate policy design and implementation.
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