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  1. 1
    Peer Reviewed

    International health policy and stagnating maternal mortality: is there a causal link?

    Unger JP; Van Dessel P; Sen K; De Paepe P

    Reproductive Health Matters. 2009 May; 17(33):91-104.

    This paper examines why progress towards Millennium Development Goal 5 on maternal health appears to have stagnated in much of the global south. We contend that besides the widely recognised existence of weak health systems, including weak services, low staffing levels, managerial weaknesses, and lack of infrastructure and information, this stagnation relates to the inability of most countries to meet two essential conditions: to develop access to publicly funded, comprehensive health care, and to provide the not-for-profit sector with needed political, technical and financial support. This paper offers a critical perspective on the past 15 years of international health policies as a possible cofactor of high maternal mortality, because of their emphasis on disease control in public health services at the expense of access to comprehensive health care, and failures of contracting out and public–private partnerships in health care. Health care delivery cannot be an issue both of trade and of right. Without policies to make health systems in the global south more publicly-oriented and accountable, the current standards of maternal and child health care are likely to remain poor, and maternal deaths will continue to affect women and their families at an intolerably high level.
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  2. 2
    Peer Reviewed

    Involvement of IMA in tuberculosis control.

    Chugh S

    Journal of the Indian Medical Association. 2007 Apr; 105(4):198, 212.

    Tuberculosis has been declared to be a global emergency and the HIV/AIDS is fuelling the epidemic. To contain the disease for its re-emergence a massive funding was earmarked. Widespread implementation of the DOTS strategy specially in countries of high TB burden is a major progress in global TB control. As a sizeable section of TB patients contact a private health provider, so the policy makers of health envisaged the idea for Public-Private Partnership mix model to contain the disease and hence the role of IMA with its two lacs members has definite role to play to stop the menace. The Stop TB strategy is designed to achieve the targets set for the period 2006-2015. Members of IMA have got a life time chance to prove to the people and to the power that they are not lagging behind in providing a service to the nation and there lies the strength of the IMA. (author's)
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  3. 3

    Tuberculosis care and control [editorial]

    Hopewell PC; Migliori GB; Raviglione MC

    Bulletin of the World Health Organization. 2006 Jun; 84(6):428.

    Tuberculosis care, a clinical function consisting of diagnosis and treatment of persons with the disease, is the core of tuberculosis control, which is a public health function comprising preventive interventions, monitoring and surveillance, as well as incorporating diagnosis and treatment. Thus, for tuberculosis control to be successful in protecting the health of the public, tuberculosis care must be effective in preserving the health of individuals. There are three broad mechanisms through which tuberculosis care is delivered: public sector tuberculosis control programmes, private sector practitioners having formal links to public sector programmes (the public--private mix), and private providers having no connection with formal activities. In most countries, programmes in both the public sector and the public--private mix are guided by international and national recommendations based on the DOTS tuberculosis control strategy -- a systematic approach to diagnosis, standardized treatment regimens, regular review of outcomes, assessment of effectiveness and modification of approaches when problems are identified. (excerpt)
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  4. 4

    Public health, innovation and intellectual property rights: unfinished business [editorial]

    Turmen T; Clift C

    Bulletin of the World Health Organization. 2006 May; 84(5):338.

    The context for this theme collection is the publication of the report of the Commission on Intellectual Property Rights, Innovation and Public Health. The report of the Commission -- instigated by WHO's World Health Assembly in 2003 -- was an attempt to gather all the stakeholders involved to analyse the relationship between intellectual property rights, innovation and public health, with a particular focus on the question of funding and incentive mechanisms for the creation of new medicines, vaccines and diagnostic tests, to tackle diseases disproportionately affecting developing countries. In reality, generating a common analysis in the face of the divergent perspectives of stakeholders, and indeed of the Commission, presented a challenge. As in many fields -- not least in public health -- the evidence base is insufficient and contested. Even when the evidence is reasonably clear, its significance, or the appropriate conclusions to be drawn from it, may be interpreted very differently according to the viewpoint of the observer. (excerpt)
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  5. 5

    Can global health be good business? [editorial]

    Lister J

    Tropical Medicine and International Health. 2006 Mar; 11(3):255-257.

    A lavishly sponsored Global Health Summit conference in New York organized in early November by Time magazine included a panel discussion on the pertinent issue of whether global health can be good for business,1 and in the process highlighted many of the contradictions confronting health care providers, policy makers and planners the world over. Attempts to graft compassion onto the root stock of global capitalism have been only partially successful, if at all. Certainly none of the big players in the $3 trillion plus health care industry - whether they be pharmaceutical corporations, equipment manufacturers, hospital chains or health insurers - has been able to demonstrate any long term or sustained commitment to the delivery of health care services to the billions of people in low income countries who currently lack access to them. Many of the 'Global Public Private Partnerships' favoured by the WHO appear to serve largely as public relations campaigns for the private sector 'partners' and also as a means to help them to secure and potentially expand their longer-term market for drugs and vaccines. Meanwhile some of the largest donors supporting such partnerships come from outside of the health care industry altogether - most notably Bill and Melinda Gates, whose benevolent billions also help make Microsoft's cosmic profits seem more socially acceptable. (excerpt)
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  6. 6

    Public-private partnerships for public health.

    Reich MR

    Cambridge, Massachusetts, Harvard Center for Population and Development Studies, 2002 Apr. ix, 205 p. (Harvard Series on Population and International Health)

    This book presents the results of the workshop. The essays in this volume offer some fresh perspectives on partnerships, probe some troubling questions, and provide empirical evidence of both benefits and challenges of public-private partnerships. The participants in the meeting also achieved some progress in creating a shared vocabulary, or at least shared understanding, on points of contention, suggesting that dialogue among partisans in public health can help move debates about critical issues forward. (excerpt)
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  7. 7

    World Bank's world development report [letter]

    Costello A; Woodward D

    Lancet. 1993 Aug 14; 342(8868):440-1.

    The policy recommendations in the 1993 world development report (WDR) call for more investment in public health and clinical care, reducing poverty, increasing education for girls, and private health care provision. The structural adjustment policies supported by the World Bank influence growth, poverty, and health expenditure. All but 2 of the 10 studies on the effect of such policies on poverty and health were produced by or for the Bank. One study concluded that poverty levels increased in both Latin America and Africa between 1985 and 1990 and remained static in south Asia. Another study endorsed the view that structural adjustment in Africa had failed to generate economic growth, and it had resulted in a significant decline in investment. After nearly $150 billion of adjustment lending by the World Bank and the International Monetary Fund, there is a need to look for alternative policies. WDR claims that public spending on health in countries implementing structural adjustment policies recovered faster in the last few years of the 1980s than in non-adjusting countries. Yet the adjusting countries' per capita expenditure declined by the same amount as that of the non-adjusting countries between 1980 and 1990. The report's estimate of $12 per person for the cost of public health and essential clinical services in low-income countries is far beyond the health budgets of many for minimum levels of coverage of health services. In sub-Saharan Africa, donors already finance an average of 20% of health expenditure. In many areas where user charges have been introduced, there have been sharp declines in essential services and primary education and some evidence for reversals in maternal and perinatal mortality rates. In Guinea and Benin, the success of cost-recovery schemes and the improved services were in part achieved by the subsidies by UNICEF. The report does not suggest a strong commitment to integrated health systems.
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  8. 8

    Cereal based oral rehydration solution and the commercial private sector. Conference proceedings, March 27, 1992.

    Tucker H; Jansen W

    Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1992. 23, [80] p. (USAID Contract No. DPE-5969-Z-00-7064-00)

    Public health professionals are coming to realize that the private sector provides a significant share of health care and that efforts need to be taken to improve access to and use of preventive and curative services. Further, while most USAID-supported activities have and will support the government sector, it nonetheless remains important to mobilize private sector resources to meet public health objectives. PRITECH's initial overtures to foster private sector participation and cooperation between the public and private sectors led it to sponsor an 1-day meeting on cereal-based oral rehydration solution (CBORS) and the private sector. The conference was convened to review the status of ORS products within developing country markets and to develop recommendations for what PRITECH should do to prepare for the arrival of commercial ORS products in these markets. Participants included officials from the WHO, UNICEF, and USAID as well as diarrheal disease experts and marketing specialists from public health organizations. Presentations were made on possible options in cereal-based ORT for dehydrating diarrhea; a WHO perspective on ORS and the commercial marketplace in developing countries; and a market analysis of the arrival of CBORS products. Participants agreed that PRITECH should stay involved with the private sector; that PRITECH should not actively promote the adoption of CBORS products by companies and instead help guide those which choose to manufacture them; and that impact assessments should be conducted in countries where commercial CBORS products exist. Studies will explore caretaker behavior, private health care provider behavior, ORS consumption patterns, ORS market performance, and clinical performance. A section offers precautions for companies introducing commercial CBORS products, while 1 of 8 appendices discusses mobilizing the commercial sector for ORS marketing in Pakistan.
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  9. 9

    The national immunization campaign of El Salvador: against the odds.

    Argueta RH; Jaramillo H

    Assignment Children. 1985; 69/72:397-414.

    The recent immunization campaign in El Salvador has been a success despite the civil war. Both the government and the guerrillas agreed that the goal of immunizing children was an ideal transcending all differences, and that immunization should be taken to all parts of the country and all Salvadorian children. The campaign had the personal support of the head of state, the church, UNICEF, PAHO/WHO, ICRC and other organizations who worked with the parties to implement the campaign. The 3 national immunization days, held on February 3, March 3, and April 21, 1985 were transformed into days of tranquillity. This article describes how the campaign was organized and presents an assessment of its achievements. An executive committee was created and both UNICEF and PAHO/WHO took part in its meetings. Specific commissions handled channeling, training, supplies, the cold chain, information and evaluation, and promotion and education. The plan of action proposed that all branches of government and the private sector support the immunization campaign and a national support council was establish for this purpose. The original goal was to immunize 400,000 children under 3 years of age against diphtheria, pertussis, tetanus, polio, and measles. The goal was extended to cover children under 5 years of age. Funding was provided from both public and private organizations. Reasons the campaign was a success despite war conditions include: the campaign was backed by political commitment; the mechanisms created to implement the campaign functioned smoothly; mobilizing the media generated a change in opinion and attitude. The campaign rested on solid technical and political foundations. It reached 87% of children under 5 in the area.
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  10. 10
    Peer Reviewed

    New patterns in health sector aid to India.

    Jeffrey R

    International Journal of Health Services. 1986; 16(1):121-39.

    This article analyzes the patterns of health sector aid to India since 1947, summarizing criticisms such as the extension of dependency relationships, inappropriate use of techniques and models (maintenance costs of large projects are often too high for poor undeveloped countries), and Malthusianism in population programs. The major source of foreign assistance has been the US, amounting to US$107 million from 1950-1973; this figure is broken down to detail which foundations and agencies provided assistance, and how much, over this time period. Foreign assistance for family planning is also discussed. Most health policies adopted in India today predate independence and were present in plans established by the British. New patterns in health aid are described, such as funding made available in local currency to be spent on primary care and especially maternal and child health. The focus of foreign aid has been preventive in emphasis and oriented towards the primary care sector. In some periods it has contributed a substantial share of total public sector expenditures, and in some spheres, it has played a major role, particularly the control of communicable diseases. However, the impact of less substantial sums going to prestige medical colleges or to population control programs should not be ignored. Several aid categories have been of dubious origin (PL-480 counterpart funds and US food surpluses as the prime examples). However, the new health aid programs do not deserve the ready dismissal they have received in some quarters.
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  11. 11

    International consultation of NGOs on population issues in preparation of the 1984 United Nations International Conference on Population: report of the consultation.

    [Unpublished] [1984]. 83 p.

    196 individuals from 44 countries, representing national and international non-governmental organizations, bilateral agencies and intergovernmental organizations attended the consultation. The purposes of the consultation were: 1) to provide an overview of the contributions of non-governmental organizations to the implementation of the World Population Plan of Action through a wide range of population and population related programs carried out since the Plan was adopted in 1974; 2) to explore what non-governmental organizations believe needs to be done in the world population field during the balance of the century; 3) to prepare for participation in the January 1984 Conference Preparatory Committee meeting and in the Conference itself to be held in August 1984; and 4) to provide suggestions for activities of national affiliates relative to the 1984 Conference. This report provides a synopsis of the plenary sessions and their recommendations. Addresses by numerous individuals covered the following topics: the creative role of non-governmental organizations (NGOs) in the population field; vital contributions of NGO's to the implementation of the world population plan of action; the family; population distribution and migration; population, resources, environment and international economic crisis; mortality and health; and NGO prospects for the implementation of the world population plan of action.
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  12. 12

    The interaction of private and voluntary organizations and the World Health Organization in relation to Health for All by the Year 2000.

    Bryant JH

    In: International Health Conference, 6th, American University, 1979: health for humanity; the private sector in primary health care. Washington, D.C., National Council for International Health, 1979. 37-47.

    Health for All by the Year 2000 (HFA) has received technical and skeptical response from developed nations and expressions of hope in a social and political context from less developed countries. HFA is an important concept which is being given a serious commitment by many nations and the World Bank, in addition to the World Health Organization (WHO). HFA encompasses and draws together many strands of recent technical, political, social and ethical thinking. Health can be a bridge between factions which are concerned only with national growth and those concerned only with noneconomic development, because better health increases productivity while meeting basic human needs. WHO plays a crucial role in international health as the single coordinator, convener and planner. Private and voluntary organizations (PVOs), including indigenous PVOs, are an underappreciated resource. PVOs make 2 major contributions to international health: 1) 1/2 billion dollars are spent annually, an amount comparable to those spent by bilateral and multilateral organizations; 2) PVOs have understanding and practical field experience. PVOs have pioneered in many areas that have later been picked up by others. Problems with PVOs are lack of coordination and a collective voice, PVOs sometimes push inappropriate projects, and some PVOs have no clear objectives. WHO should give PVOs a more important role in global health planning. PVOs need to make some changes in order to become full participants in this global effort of Health for All. They need better coordination among themselves and more effective interaction with international organizations and agencies.
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  13. 13

    Planner's approaches to community participation in health programmes: theory and reality.

    Rifkin SB

    Contact. 1983 Oct; (75):1-16.

    Investigates health planners' assumptions about community particiation in health care. Primary health care aims to make essential health care accessible to all individuals in the community in an acceptable and affordable way and with their full participation. It is the strategy propagated by the World Health Organization to provide health for everyone by the year 2000. Community participation is seen as the key to primary health care and has raised many assumptions and expectations among health planners. Community people are seen as a vast untapped resource which can help to reduce the cost of health care by providing additional manpower. It is also expected that community people want to participate in their own health care because they wish to serve their community and to have a part in decisions which affect them. In the early 1970's, programs were developed out of church-related efforts. They pioneered many of the ideas which became principles of primary health care. The church-related programs were nongovernmental and therefore flexible. They had the same goal of letting the community take responsibility for their own health care; program planners were primarily medical people trained in Western medicine. The planners were concerned with the plight of the poor. However, the programs tended to reflect planners' hopes for, rather than the community's understanding of, the community health problem. The author concludes that the assumptions that planners make about their programs need to be critically analyzed. Investigations need to be made into community perceptions and expectations of their role in health programs. Studies need to be undertaken to identify the potentials and problems of community participation and the record of established community health care programs needs to be examined.
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