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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)
Belize City, Belize, Ministry of Health, 1984. , 54 p. (EPI/84/003)An evaluation of the Expanded Program on Immunization (EPI) in Belize was conducted by the Pan American Health Organization/World Health Organization at the request of the country's Ministry of Health. The evaluation was undertaken to identify obstacles to program implementation, and subsequently provide national managers and decision makers with viable potential solutions. General background information is provided on Belize, with specific mention made of demographic, ethnic, and linguistic characteristics, the health system, and the EPI program in the country. EPI evaluation methodology and vaccination coverage are presented, followed by detailed examination of study findings and recommendations. Achievements, problems, and recommendations are listed for the areas of planning and organizations, management and administration, training, supervision, resources, logistics and the cold chain, delivery strategies, the information and surveillance system, and promotion and community participation. A 23-page chronogram of recommended activities follows, with the report concluding in acknowledgements and annexes.
Community involvement in health development: challenging health services. Report of a WHO Study Group.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1991; (809):i-iv, 1-56.In order to make community involvement in health development (CIH) a reality, countries need to go beyond endorsement of the idea and take concrete steps, reports a WHO study group examining the issue. While the idea of community involvement has gained widespread acceptance, most health services have been slow in making the necessary institutional and organizational changes, and in providing the necessary money and staff time. Furthermore, most CIH efforts have concentrated on the community side of involvement, neglecting the health development aspects and the context in which the involvement takes place. The Study Group, which met in Geneva on December 1989, was concerned with identifying specific obstacles to CIH implementation and providing recommendations. The report discusses such issues as the political, social, and economic contexts of CIH; the methodology of CIH; the training of health personnel; the strengthening of communities for CIH; and the monitoring and evaluation of such programs. Among the report's major findings: most countries have yet to truly commit to CIH; CIH programs lack the necessary support and resources; effective coordination at all levels is imperative; health personnel must be adequately educated on the principles and practices of CIH; and some health ministries promote too narrow an understanding of health. The report contains recommendations for both countries and for WHO. The recommendations for countries include several measures directed at the ministries of health, including a provision that the ministries develop guidelines for the implementation of CIH at the district level.
Washington, D.C., American Association for World Health, 1998. 47 p.World Health Day, established by the World Health Organization (WHO), is celebrated on April 7 in the 191 WHO member countries. WHO has designated Safe Motherhood as the common theme for 1998 World Health Day activities. Safe Motherhood is an international initiative aimed at ensuring women have safe pregnancies and deliveries and healthy infants. This manual was prepared as a resource for those involved in the planning of World Health Day 1998 in the US, where the slogan is: "Invest in the Future: Support Safe Motherhood." After providing background information on the global importance of the prevention of maternal mortality and morbidity, the manual sets forth detailed guidelines on forming an organizing committee, selecting events and activities, choosing a location, creating a planning schedule, identifying community resources, defining target audiences, using the mass media to publicize events, hospitality arrangements, and program evaluation. World Health Day activities appropriate for individuals, communities, workplaces, schools, religious organizations, government agencies, and health care settings are suggested. Also included, for possible reproduction, is a series of fact sheets on topics such as pregnancy-related mortality in the US, maternal nutrition, sexually transmitted diseases, family planning, prenatal care, warning signs during pregnancy, and breast feeding. Finally, lists of state contacts and hotlines are appended.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1994; 47(3-4):98-100.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.
Developing a focused ethnographic study for the WHO acute respiratory infection (ARI) control programme.
In: RAP: Rapid Assessment Procedures. Qualitative methodologies for planning and evaluation of health related programmes, edited by Nevin S. Scrimshaw and Gary R. Gleason. Boston, Massachusetts, International Nutrition Foundation for Developing Countries, 1992. 215-25.The development process used to construct and test a protocol for conducting community-based, focused ethnographic studies of acute respiratory infections (ARI) in children is described. The development of the Focused Ethnographic Study (FES) protocol is a component of the behavioral research activities of the ARI Program of the World Health Organization, which attempt to generate ethnographic data on beliefs and practices related to pneumonia and other respiratory conditions. The goal of this Program is to reduce mortality from ARI in children in developing countries. Some of the requirements of FES research are the distinction between lower vs. upper respiratory infections and research has to be completed in a relatively short period of time. The protocol on how to collect, analyze, and present data is the primary means of attaining the project objectives. The protocol consists of the overview of the project, guidelines on research management, specific research procedures, preparing the report, using the information from the study, and adapting the ARI household morbidity and mortality treatment survey. The program manager's questions are concerned with: 1) caretaker and household recognition and interpretation of ARI symptoms; 2) ARI household management practices; 3) patterns of care seeking; 4) maternal expectations concerning ARI treatment; 5) perspectives of practitioner on maternal care-seeking; and 6) recommendations concerning communication with mothers. Specific data-gathering techniques included: key informant interviews, free listing of illnesses and symptoms, narratives, hypothetical scenarios, and inventory of home medications. The first field study was carried out in July-August 1989 in Mindoro Oriente Province in the Philippines; the next round of studies took place in Turkey, Ghana, Honduras, Haiti, and Egypt. Common findings from ARI FES studies indicated: 1) peoples' explanatory models of ARI were complex, with differentiation of symptoms, but diagnoses varied; 2) milder conditions were perceived as likely to worsen if not treated; and 3) home remedies were universal.
In: RAP: Rapid Assessment Procedures. Qualitative methodologies for planning and evaluation of health related programmes, edited by Nevin S. Scrimshaw and Gary R. Gleason. Boston, Massachusetts, International Nutrition Foundation for Developing Countries, 1992. 51-9.The objectives of nutritional surveillance were published in 1976 by the World Health Organization and subsequently elaborated upon by the Cornell Nutritional Surveillance Program (CNSP) in 1984. The uses of nutritional surveillance are: 1) problem identification and political sensitization; 2) policy formulation and planning; 3) program management and evaluation; and 4) timely warning and intervention. The vast majority of countries embarking on nutritional surveillance did so without having performed the prior steps of identifying decision-makers and the type of surveillance systems required. The most common type was nutritional monitoring, which could not facilitate decisions on immediate action. Ancillary data were adequate only for confirming that locations with a high prevalence of protein-energy malnutrition (PEM) also have a high prevalence of socioeconomic deprivation without pinpointing specific factors. Rapid assessment procedures (RAP) face similar problems, which could be improved by the development of guidelines. Another reason for linking qualitative methodologies to nutritional surveillance is that the infectious disease model of surveillance is not the most appropriate one for nutritional surveillance because of the complex etiology of chronic PEM. Timely warning and intervention systems (TWIS) are relevant in warding off possible food crises, as the case of Central Lombok District of Indonesia illustrated. Qualitative information methods were used in collecting agro-meteorological indicators by extension workers; assessing household food consumption patterns; alerting of district officials to an impending food crisis; and evaluating the extent to which this system triggered decisions. Nutritional surveillance for policy and planning is difficult to implement, as the examples of Costa Rica and Kenya showed. In the former, a national sample survey of low-weight-for-age children stratified according to father's occupation revealed the highest rate of malnutrition in sugar cane and banana plantations because of poor water and high food prices. This finding led to legislative action.
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.
An agenda for action in sub-Saharan Africa. A collaborative initiative of the World Bank, UNFPA and IPPF.
INTEGRATION. 1991 Mar; (27):10-7.An Agenda for Action to Improve the Implementation of Population Programs in Sub-Saharan African in the 1990s is a joint project of the World Bank, the UN Population Fund, the IPPF, the WHO and the African Development Bank. The goals of the agenda are to build public consensus and commitment to population activities, to bring together beneficiaries, implementors and policy makers with these groups to improve population program implementation, to share country program experiences, to make African institutions responsible for ("Africanize") the Agenda, or ultimately to include demographic factors in development. 20 African countries are the focus of the Agenda, grouped by region and language. Major issues include socio-cultural and economic roadblocks, poor transportation infrastructure, lack of community participation, no alternatives to early marriage for women, poor political commitment by decision-making or health ministries. Family planning programs can be improved by better contraceptive technology, program design, and human and financial resources for implementing programs. The methods by which the Agenda proposes to reach its goals are to do literature searches of action strategies, in-depth country analyses, inter-country sharing of experiences, analysis of implementation capability based on case studies, and analysis of contraceptive technology assisted by WHO's Special Programme of Research, Development and Research Training in Human Reproduction and the Population Council. The Agenda will be managed by a Population Advisor Committee, which is an African "think tank," and regional Country Group Task Forces, coordinated by the World Bank's Africa Technical Department.
[Unpublished] 1989. 30 p. (WHO/GPA/NPS/89.1)Of the 83 countries whose National Acquired Immunodeficiency Syndrome (AIDS) Program (NAP) which have already implemented a medium-term plan, 7 have carried out a systematic review of program progress and efficiency; 4 more such reviews are planned fo r 1989 and over 60 for 1990. To assess early experiences with NAP reviews, an informal consultation was organized in Geneva in October 1989 by the World Health Organization's Global Program on AIDS. Although the review is a management tool and distinct from evaluations of program effectiveness and management, both processes are required for program assessment and reprogramming. The main areas that should be covered by NAP reviews include management, strategies, financing and policies, and monitoring. The review of the management system should focus on internal administrative capacities, personnel management, program coordination effectiveness, and logistics. The review of strategies should focus on whether management structures for the implementation of various goals are in place. The pertinent areas for the financing review are the use of adequate resources, accountability, potential for program sustainability, and efficient use of resources. Finally, monitoring is achieved through the establishment of a management information system. In addition, there are 3 review grades. Grade 1 is an annual internal review conducted by the program manager and key NAP staff, Grade 2 is a more limited review with participants from outside the NAP with expertise in a specific program area, and a Grade 3 review is a comprehensive exercise aimed at bringing about major changes in the NAP. For this review process to be meaningful, there should be an active exchange of information between NAPs, the World Health Organization, and the international community.
Assessing the impact of new contraceptive technologies on user satisfaction, use-dynamics, and service systems.
PROGRESS. 1989; (11):2-3.A summary of the recommendations stemming from conference on the Demographic and Programmatic Consequences of Contraceptive Innovations, sponsored by the U.S. National Academy of Sciences in 1988, is provided by the WHO. While typical research on introduction of new contraceptive methods concerns cohort studies of users' problems and perspectives, a larger view of use-dynamics, choice behavior and client satisfaction with overall care is lacking. It is popular to hypothesize that user satisfaction improves with numbers of contraceptive options, but the literature does not provide clear evidence on this point, and none at all on introduction of new methods. Three main issues should be addressed: what is the impact of a new method on client perception of overall care, on contraceptive behavior, and on operation of the family planning program. To get this information usually requires prohibitively costly, time-consuming research. Low cost approaches are available, however, taken from the type of large-scale, community-based repeat observation studies now used to monitor trials of pharmaceuticals for tropical diseases, and treatments of rare conditions, such as vitamin A. Statistical techniques have been developed to adjust for censoring bias. Another type of field research that can be adapted to this research is the epidemiological field research of the type used in the Matlab, Bangladesh cholera vaccine study, later utilized to study acceptance of family planning services. Without such studies, the social and programmatic rationale for introduction of new contraceptives will be open to debate.
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.