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Engaging all health care providers in TB control. Guidance on implementing public-private mix approaches.
Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2006. 52 p. (WHO/HTM/TB/2006.360)A great deal of progress has been made in global tuberculosis control in recent years through the large-scale implementation of DOTS. It has been acknowledged though that TB control efforts worldwide, although impressive, are not sufficient. The global TB targets -- detecting 70% of TB cases and successfully treating 85% of them, and halving the prevalence and mortality of the disease by 2015 as part of the Millennium Development Goals (MDGs) -- are likely to be met only if current efforts are intensified. Among the important interventions required to reach these goals would be a systematic involvement of all relevant health care providers in delivering effective TB services to all segments of the population. Therefore, engaging all health care providers in TB control is an essential component of WHO's new Stop TB strategy¹ and the Stop TB Partnership's Global Plan to Stop TB 2006-2015. (excerpt)
IN POINT OF FACT 1991 Jun; (76):1-3.This paper describes the serious effect of diarrheal and acute respiratory (ARI) disease upon children under 5 years old, and international efforts undertaken by the World Health Organization (WHO) to reduce such mortality. Combined, these diseases account for more then 1/2 of all deaths in this age group, and constitute the most serious threat to their health. WHO estimates for 1990 that diarrheal illnesses caused 3.2 million childhood deaths and that ARI caused 4.3 million. While some child deaths are due to measles and pertussis, the majority is caused by pneumonia and the consequences of diarrheal illnesses. These deaths could be readily averted through the timely, effective treatment of trained health workers with essential drugs. Immunization as well as improved nutrition, particularly through the practice of exclusive breast feeding of the child's 1st 4-6 months of life, are addition weapons potentially employed against child mortality. WHO programs for diarrhea and ARI control focus upon simplified treatment guidelines, training, communication messages, drug supplies, and evaluation methodology. Despite obstacles such as the marketing of useless and/or potentially dangerous anti-diarrheal drugs and cough and cold remedies, and inappropriate breastmilk substitutes and unnecessary foods, widespread progress in program development and implementation has been made over the past decade. Increased amounts of oral rehydration therapy and solutions are available and used, while many health workers have benefited from training programs.
Arlington, Virginia, Partnership for Child Health Care, 1994.  p. (BASICS Trip Report; BASICS Technical Directive: 000 IN 00 011; USAID Contract No. HRN-6006-C-00-3031-00)An appraisal team travelled to Indonesia in late 1994 to assess the World Bank Health Project IV (HP-IV). This project seeks to improve the quality, equity, and accessibility of basic health services in five provinces through measures such as child survival programs and improvements in health services provided through the private sector. Support from national policy makers was obtained for collaboration in East Java between HP-IV and the Basics Support for Institutionalizing Child Survival Project. Evaluators noted an excessive amount of training, causing health workers to be away from their jobs for extended periods of time. Recommended were alternatives such as on-the-job courses, a training information system, and a ceiling on time allowed off work to attend courses (e.g., nine days every six months).
IN TOUCH 1989 Mar; 13(90):17-9.An expanded immunization program (EPI) in Bangladesh was begun in 1979 in which a technician would be assigned to each subdistrict health unit. These subdistricts had approximately 150,000 to 200,000 people. The technician was responsible for collecting vaccines, immunizing, record keeping, and reporting to the district. In 1985 a review of the immunization program revealed that coverage of infants under 1 year for vaccines on tetanus, diphtheria, whooping cough, polio, tuberculosis, and measles was less than 2% for every year of vaccination. The United Nations agencies helped design new strategies for the national vaccination program. To improve the service delivery, the government in partnership with WHO, UNICEF and the Bangladesh Rural Advancement Committee (BRAC) launched an intensive program. UNICEF supplied the materials and equipment. CARE provided planning, training, management, and social mobilization components at all levels. WHO assisted in training support and BRAC's activities where similar to CARE's. With the CARE staff at all levels there was a continuous flow of information up from the field and down from the national level. Because of the feedback from the field, decisions and changes were made on a regular and continuous basis through an institutionalized system. Outreach service delivery and community participation were the focus of the new program. The lessons learned after 2 years of operation suggest that the project staff should be assigned at every level from the grass roots to the national level. Information should flow up from the field and down from the national level continuously. A forum should be set up at the national level and be attended by all parties constantly. Also, a relationship should be developed by immediate counterparts at each level.
New York, New York, United Nations, 1989. , vii, 397 p. (ST/CSDHA/6)This is the 1st update of the World Survey on the Role of Women in Development published by WHO. 11 chapters consider such topics as the overall theme, debt and policy adjustment, food and agriculture, industrial development, service industries, informal sector, policy response, technology, women's participation in the economy and statistics. The thesis of the document is that while isolated improvements in women's condition can be found, the economic deterioration in most developing countries has struck women hardest, causing a "feminization of poverty." Yet because of their potential and their central role in food production, processing, textile manufacture, and services among others, short and long term policy adjustments and structural transformation will tap women's potential for full participation. Women;s issues in agriculture include their own nutritional status, credit, land use, appropriate technology, extension services, intrahousehold economics and forestry. For their part in industrial development, women need training and/or re-training, affirmative action, social support, and better working conditions to enable them to participate fully. In the service industries the 2-tier system of low and high-paid jobs must be dismantled to allow women upward mobility. Regardless of the type of work being discussed, agricultural, industrial, primary or service, formal or informal, family roles need to be equalized so that women do not continue to bear the triple burden of work, housework and reproduction.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care, 1988. 51,  p. (USAID Contract No. AID/DPE-5927-C-00-3083-00)Personal interview, site visits to Regions VII and VIII (Philippines), and record reviews were the principal methods used to evaluate the Oral Rehydration Therapy (ORT) component of the Primary Health Care Financing (PHCF) Project designed to increase the use of oral rehydration therapy as a primary preventive measure against diarrheal death among infants and young children. The project is designed to increase ORT utilization through a 2-pronged approach which creates demand for ORS products through training physicians, nurses, midwives, and health educators in the public and private sectors; and information, education, and communication campaigns to promote ORT among the public. The most serious concern regarding clinical training was the poor quality of case management observed in regional, provincial, and district hospitals. There seems to be no national plan or budget for the production of print materials to support IEC program activities. A wide disparity was found between projected demand and actual use of ORS, called ORESOL. The present distribution practices of the Department of Health translate to oversupply or nonavailability of ORS. Private sector pharmaceutical firms take a limited/traditional approach to product distribution, and commercial distributors capable of reaching the rural population should be identified and encouraged to market ORS.
General lessons learned from evaluations of MCH/FP projects in Botswana, Malawi, Swaziland and Zambia.
New York, New York, UNFPA, 1984 Dec. iv, 41 p.4 maternal-child health/family planning (MCH/FP) projects were evaluated by the United Nations Fund for Population Activities (UNFPA) in the Southern Africa Region between 1981-1984. The projects were in Botswana, Malawi, Swaziland and Zambia. An overriding finding at the time of the Evaluation Missions was the acceptance of family planning (child spacing) by all 4 governments, when at the onset of the projects, family planning was either not included in the project documents or was included only as a minor contributant to the MCH programs. The intervention by UNFPA was very important for the acceptance and promotion of family planning activities by the governments. The Evaluation Missions concluded that there were 3 primary reasons for the successful intervention: UNFPA has a broad mandate to provide assistance in MCH and FP, a commitment to development projects in line with the governments' priorities, and the ability to fund projects very quickly, facilitating project implementation. Each of the 4 projects is assessed in terms of population policy changes, MCH/FP program strategy and serive delivery, organization of the MCH/Fp unit, health education, training, evaluation and research systems, and administration and management. Essential factors affecting the project are outlined and recommendations made. The last section discusses general lessons derived from the MCH/FP projects evaluated. 5 areas are identified where similar problems exist to varying degrees in all the projects evaluated. These are: training of medical personnel in FP (the main MCH/FP service provider in these projects was the nurse/midwife); supervision of personnel and the supply and distribution of contraceptives; research and evaluation, especially regarding the sociocultural setting of target populations and the inadequacy of existing service statistics and other sources of data; project monitoring (technical and financial) and finally project execution by the World Health Organization (WHO). Specifically in regard to the recruitment of experts, the provision of supplies and equipment, and the provision of funds for local costs, WHO execution has been deficient.
Evaluation of population education projects executed by the ILO in the Asia and Pacific region: general conclusions and recommendations.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1983 Dec. xiii, 27,  p.The United Nations Fund for Population Activities (UNFPA) has provided funds over the past decade to the International Labor Organization (ILO) or to Governments to undertake population education activities directed at the organized sector. About 44% of this assistance has gone to UNFPA-funded regional and country projects in the Asia and Pacific Region. In order to assess these projects, a review of 21 projects took place and 8 projects in 3 countries (Bangladesh, India, Nepal) were visited by Evalutation Missions. The Missions found that the main immediate objective for all projects was to stimulate awareness and interest in family planning and to support population education. All projects but one were directed at industrial workers, and the provision of family planning was explicitly stated as an objective in 2 projects. All projects had a goal to institutionalise population education as a part of the agency/ministry implementing the projects. The Mission concluded that the greatest effect of these types of projects had been in the change of attitude and behavior of top and middle level management toward family planning for their workers, as illustrated by conduct of in-plant classes for population education on company time and provision of incentives for family planning acceptors. At the worker level, as a result of the extensive training activities, there is now a large cadre of trained worker motivators in many industrial establishments who can influence fellow workers and potentially other members of the community to accept family planning. However, no information was available, except for 2 projects evaluated, to assess the effects of the projects on contraceptive use. It was noted that some projects had focused mainly on groups already motivated towards family planning; more emphasis should be put on reaching audiences not yet motivated for family planning. The institutionalization of population education within the implementing agents of the projects is likely to be achieved in most of the projects evaluated, although this objective cannot be fully evaluated at this point in time. General conclusions and recommendations were made in 4 areas: planning of projects, approach to reach the organized sector, implementation of projects and administration of projects.