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Geneva, Switzerland, WHO, 2015 Nov. 2 p. (Pre-Exposure Prophylaxis (PrEP); Policy Brief)This policy brief defines PrEP, presents the World Health Organization's current recommendations for PrEP use and the evidence for it, discusses PrEP's expected cost-effectiveness, and lists considerations for PrEP implementation.
Quality of care in contraceptive information and services, based on human rights standards: a checklist for health care providers.
Geneva, Switzerland, WHO, 2017. 32 p.Unmet need for contraception remains high in many settings, and is highest among the most vulnerable in society: adolescents, the poor, those living in rural areas and urban slums, people living with HIV, and internally displaced people. The latest estimates are that 225 million women have an unmet need for modern contraception, and the need is greatest where the risks of maternal mortality are highest. There is increasing recognition that promotion and protection of human rights in contraceptive services and programs is critical to addressing this challenge. However, despite these efforts, human rights are often not explicitly integrated into the design, implementation and monitoring of services. A key challenge is how to best support health care providers and facility managers at the point of service delivery, often in low-resource real-world settings, to ensure their use of human rights aspects in provision of contraceptive services. The point of service delivery is the most direct point of contact where potential violations/omissions of rights come into play and requires special attention. This checklist covers five areas of competence needed by health care providers to provide quality of care in contraceptive information and services including: respecting users’ privacy and guaranteeing confidentiality, choice, accessible and acceptable services, involvement of users in improving services and fostering continuity of care and follow-up. International and regional human rights treaties, national constitutions and laws provide guarantees specifically relating to access to contraceptive information, commodities and services. In addition, over the past few decades, international, regional and national legislative and human rights bodies have increasingly applied human rights to contraceptive information and services. They recommend, among other actions, that states should ensure timely and affordable access to good quality sexual and reproductive health information and services, including contraception, which should be delivered in a way that ensures fully informed decision making, respects dignity, autonomy, privacy and confidentiality, and is sensitive to individuals’ needs and perspectives. This document presents a user friendly checklist specifically addressed to health care providers, at the primary health care level, who are involved in the direct provision of contraceptive information and services. It is complimentary to WHO guidelines on Ensuring human rights in the provision of contraceptive information and services: Guidance and recommendations, and the Implementation Guide published jointly with UNFPA in 2015. This checklist also builds on WHO vision document on Standards for Improving Quality of Care for Maternal and Newborn Care and its ongoing work under the Quality, Equity and Dignity initiative. The checklist should be read along with other guidance from WHO and also from partners.
Expanding the evidence base for global recommendations on health systems: strengths and challenges of the OptimizeMNH guidance process.
Implementation Science. 2016 Jul 18; 11:98.BACKGROUND: In 2012, the World Health Organization (WHO) published recommendations on the use of optimization or "task-shifting" strategies for key, effective maternal and newborn interventions (the OptimizeMNH guidance). When making recommendations about complex health system interventions such as task-shifting, information about the feasibility and acceptability of interventions can be as important as information about their effectiveness. However, these issues are usually not addressed with the same rigour. This paper describes our use of several innovative strategies to broaden the range of evidence used to develop the OptimizeMNH guidance. In this guidance, we systematically included evidence regarding the acceptability and feasibility of relevant task-shifting interventions, primarily using qualitative evidence syntheses and multi-country case study syntheses; we used an approach to assess confidence in findings from qualitative evidence syntheses (the Grading of Recommendations, Assessment, Development and Evaluation-Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach); we used a structured evidence-to-decision framework for health systems (the DECIDE framework) to help the guidance panel members move from the different types of evidence to recommendations. RESULTS: The systematic inclusion of a broader range of evidence, and the use of new guideline development tools, had a number of impacts. Firstly, this broader range of evidence provided relevant information about the feasibility and acceptability of interventions considered in the guidance as well as information about key implementation considerations. However, inclusion of this evidence required more time, resources and skills. Secondly, the GRADE-CERQual approach provided a method for indicating to panel members how much confidence they should place in the findings from the qualitative evidence syntheses and so helped panel members to use this qualitative evidence appropriately. Thirdly, the DECIDE framework gave us a structured format in which we could present a large and complex body of evidence to panel members and end users. The framework also prompted the panel to justify their recommendations, giving end users a record of how these decisions were made. CONCLUSIONS: By expanding the range of evidence assessed in a guideline process, we increase the amount of time and resources required. Nevertheless, the WHO has assessed the outputs of this process to be valuable and is currently repeating the approach used in OptimizeMNH in other guidance processes.
Current Opinion In HIV and AIDS. 2015 Nov 16;PURPOSE OF REVIEW: We summarize key lessons learned from contraceptive development and introduction, and implications for preexposure prophylaxis (PrEP). RECENT FINDINGS: New approaches to HIV prevention are urgently needed. PrEP is a new technology for HIV prevention. Uncertainty remains about its acceptance, use and potential to have an impact on the HIV epidemic. Despite imperfect use and implementation of programs, the use of modern contraception has led to significant reproductive health and social gains, making it one of the public health's major achievements. Guided by the WHO strategic approach to contraception introduction, we identified the following lessons for PrEP introduction from contraception: the importance of a broader focus on the method mix rather than promotion of a single technology, new technologies alone do not increase choice - service delivery systems and providers are equally important to success, and that failure to account for user preferences and social context can undermine the potential of new methods to provide benefit. SUMMARY: Taking a strategic approach to PrEP introduction that includes a broader focus on the technology/user interface, the method mix, delivery strategies, and the context in which methods are introduced will benefit HIV prevention programs, and will ensure greater success.
Geneva, Switzerland, United Nations High Commissioner for Refugees [UNHCR], 2008 Apr. 20 p.This Guidance on Infant feeding and HIV aims to assist UNHCR, its implementing and operational partners, and governments on policies and decision- making strategies on infant feeding and HIV in refugees and displaced populations. Its purpose is to provide an overview of the current technical and programmatic consensus on infant feeding and HIV, and give guidance to facilitate elective implementation of HIV and infant feeding programmes in refugee and displaced situations, in emergency contexts, and as an integral element of coordinated approach to public health, HIV and nutrition programming. The goal of this guidance is to provide tools to prevent malnutrition, improve the nutritional status of infants and young children, to reduce the transmission of HIV infection from mother to child after delivery, and to increase HIV-free survival of infants.
Geneva, Switzerland, UNAIDS, 2000 Sep. 111 p. (UNAIDS Best Practice Collection; Summary Booklet of Best Practices Series No. 2; UNAIDS/00.34E)AIDS is now the leading killer in sub-Saharan Africa. Whereas 200,000 people died as a result of conflict or war in Africa in 1998, AIDS killed 2.2 million. The progression of the disease has outpaced all projections. In 1991, WHO projected that in 1999 there would be 9 million infected individuals and nearly 5 million cumulative deaths in Africa. The reality in 2000 is two to three times higher, with 34.3 million infected individuals and 18.8 cumulative deaths. Nearly 70 per cent of the world’s HIV infection and 90 per cent of deaths from AIDS are to be found in a region that is home to just 10 per cent of the world’s population. In the sub-Saharan region, infection levels are highest, access to care is lowest, and social and economic safety nets that might help families cope with the impact of the epidemic are badly frayed. Resources are not keeping pace with the challenge. Incidence of the disease is increasing three times faster than the money to control it. Current national AIDS activities in Africa must be expanded dramatically to make an impact on the epidemic. African leaders are demonstrating unprecedented leadership in fighting HIV/AIDS; the time is ripe for an extraordinary effort. The International Partnership against AIDS in Africa (IPAA) is such a mobilization. At the same time, the Best Practice process – accumulating and applying knowledge about what is working and not working in different situations and contexts – is crucial within the framework of the Partnership. (excerpt)
Geneva, Switzerland, ILO, 2001. vi, 32 p.The objective of this code is to provide a set of guidelines to address the HIV/AIDS epidemic in the world of work and within the framework of the promotion of decent work. The guidelines cover the following key areas of action: (a) prevention of HIV/AIDS; (b) management and mitigation of the impact of HIV/AIDS on the world of work; (c) care and support of workers infected and affected by HIV/AIDS; (d) elimination of stigma and discrimination on the basis of real or perceived HIV status. This code should be used to: (a) develop concrete responses at enterprise, community, regional, sectoral, national and international levels; (b) promote processes of dialogue, consultations, negotiations and all forms of cooperation between governments, employers and workers and their representatives, occupational health personnel, specialists in HIV/AIDS issues, and all relevant stakeholders (which may include community-based and non-governmental organizations (NGOs)); (c) give effect to its contents in consultation with the social partners: in national laws, policies and programmes of action; in workplace/enterprise agreements; and in workplace policies and plans of action. (excerpt)
Journal of Family Planning and Reproductive Health Care. 2004 Apr; 30(2):131.May I congratulate the Journal and the Clinical Effectiveness Unit for continuing to produce excellent Guidance for those of us working in the field of reproductive health. The wide dissemination of these articles will ensure uniformity and quality in contraception provision in primary and secondary care. I have, however, one concern. This has been alluded to in a recent article describing the consensus process for adapting the World Health Organization (WHO) Selected Practice Recommendations for UK Use. As a result of the relaxation of some of the more cautious rules a very small number of women may become pregnant. An obvious example is giving Depo- Provera injections 2 weeks late (i.e. at 14 weeks) without any precautionary measures. The Selected Practice Recommendations for Contraceptive Use were developed to improve and extend contraceptive provision in developing countries. In developed countries, however, those becoming pregnant may take a more litigious view particularly when patient information leaflets and the Summaries of Product Characteristics (SPCs) state contrary and more cautious advice. In addition, new evidence regarding follicular development potential suggests that more, rather than less, caution may be advisable. Could the Faculty of Family Planning and Reproductive Health Care or the University of Aberdeen be sued? (excerpt)
Lancet. 2004 Apr 3; 363(9415):1160.Amir Attaran and colleagues highlight a very serious public-health issue. Provision of ineffective drugs for a life-threatening disease is indefensible. There is no doubt that chloroquine is now ineffective for the treatment of falciparum malaria in nearly all tropical countries, and that its usual successor, sulfadoxine-pyrimethamine, is falling fast to resistance. As a result, malaria mortality in eastern and southern Africa, where hundreds of thousands of children die each year from the infection, has doubled in the past decade. We have failed to roll back malaria, and we in the developed world bear the responsibility for this humanitarian disaster. Malaria is not an insoluble problem. We already have the tools (insecticides, bednets, highly effective drugs) to reduce substantially the terrible death toll. But we are not providing them to the people who need them desperately, but who cannot pay for them. Only a tiny fraction of the millions with malaria today receive highly effective treatments. The donors must take some responsibility for this failure. Given the choice between receiving donor support for ineffective chloroquine or sulfadoxine-pyrimethamine and receiving nothing, most countries have naturally opted for the former. It is not easy to protest, particularly when the main donors, and the representatives of international organisations, both claim these drugs are still “programmatically effective”. (excerpt)
Report of the Expert Group on Strategies for Combating Trafficking of Women and Children. Best practice.
London, England, Commonwealth Secretariat, Human Rights Unit, 2003. 55 p.The Commonwealth as a voluntary organisation of sovereign independent States is committed to fundamental principles enshrined in the Harare Declaration of 1991. These principles include international peace and order, liberty of the individual under the law, human dignity and equality for all. Commonwealth Heads of Governments have also pledged to vigorously pursue the protection and promotion of the fundamental political values of the Commonwealth, fundamental human rights, equality of women so that they may exercise full and equal rights and the promotion of sustainable development and alleviation of poverty. Trafficking in persons, especially women and children, for commercial sexual exploitation is one of the fastest growing areas of international criminal activity and of increasing concern to the international community, including the Commonwealth. Trafficking for the purposes of labour exploitation, forced labour, marriage, adoption and the trade in organs are additional areas of concern, but are less-well documented. The overwhelming majority of trafficked persons are women and girls. Consequently, this discussion focuses primarily on strategies to combat the unlawful trafficking of women and children. (excerpt)
Cluster randomized trial of an active, multifaceted information dissemination intervention based on the WHO Reproductive Health Library to change obstetric practices: methods and design issues [ISRCTN14055385]. [Estudio clínico aleatorizado por grupos de una intervención activa y multifacética de difusión de información basada en la Biblioteca de Salud Reproductiva de la OMS y destinada a la modificación de prácticas obstétricas: aspectos metodológicos y de diseño (ISRCTN14055385)]
BMC Medical Research Methodology. 2004 Jan 15; 4: p..Effective strategies for implementing best practices in low and middle income countries are needed. RHL is an annually updated electronic publication containing Cochrane systematic reviews, commentaries and practical recommendations on how to implement evidence-based practices. We are conducting a trial to evaluate the improvement in obstetric practices using an active dissemination strategy to promote uptake of recommendations in The WHO Reproductive Health Library (RHL). A cluster randomized trial to improve obstetric practices in 40 hospitals in Mexico and Thailand is conducted. The trial uses a stratified random allocation based on country, size and type of hospitals. The core intervention consists of three interactive workshops delivered over a period of six months. The main outcome measures are changes in clinical practices that are recommended in RHL measured approximately a year after the first workshop. The design and implementation of a complex intervention using a cluster randomized trial design is discussed. Designing the intervention, choosing outcome variables and implementing the protocol in two diverse settings has been a time-consuming and challenging process. We hope that sharing this experience will help others planning similar projects and improve our ability to implement change. (author's)
Global Consultation on Adolescent Friendly Health Services: a consensus statement, Geneva, 7-9 March 2001.
Geneva, Switzerland, WHO, 2002. 29 p. (WHO/FCH/CAH/02.18)In 1995, WHOorgadized a studygroup on programming for adolescent health and development along with UNICEF and UNFPA. This resulted in the development of a 'Common Agenda for Action' on adolescent health and development, endorsed by the three agencies. The Common Agenda called for the application of a package of'actions' by a variety of 'players', to promote healthy development in adolescents and to prevent and respond to health problems if and when they arise. The 'actions' include: the creation of a safe and supportive environment; the provision of information; building life-skills; the provision of health and coupselling services. (excerpt)
Sex work and HIV / AIDS. UNAIDS technical update. [Prostitución y VIH/SIDA. Actualización técnica de ONUSIDA]
Geneva, Switzerland, UNAIDS, 2002 Jun. 19 p. (UNAIDS Best Practice Collection; UNAIDS Technical Update)This Technical Update focuses on the challenges involved in the protection of sex workers (and, subsequently, the general population) from HIV infection, and discusses the key elements of various effective interventions. Significantly higher rates of HIV infection have been documented among sex workers and their clients, compared with most other population groups. Though sex work is often a significant means of HIV infection entering the general population, studies indicate that sex workers are among those most likely to respond positively to HIV/STI prevention programmes—for example, by increasing their use of condoms with clients. This document explores the many issues involved in providing care and support for sex workers, preventing entry into sex work, and reducing risk and vulnerability through programmes at the individual, community and government levels. (author's)
Jakarta, Indonesia, University of Indonesia, Faculty of Public Health, 1984. 6 p. (Book - IA)This article is a summary of the results of the Community Incentive Project (CIP) in Indonesia. The CIP is a project to maintain and increase family planning acceptance as well as family planning practice through increasing the income of the acceptors. The fund for the project was originated from the World Bank under a loan agreement for the Indonesian government in 1977. The evaluation of the CIP has been carried out under an agreement between the Faculty of Public Health University of Indonesia and the National Family Planning Coordinating Board. The objective of the evaluation is to describe various objects of the project implementation, such as the planning/preparation process, training, loan provision, monitoring and control, recording and reporting, bookkeeping, assistance to the family planning acceptors who received the loan, the participation of the community and other sectors, and the impact of the project on family planning practice.
New York, New York, UNFPA, 1997. iv, 51 p. (Evaluation Report No. 8)This document presents an evaluation report made by the UN Population Fund (UNFPA) on the quality of family planning services in Botswana, Ecuador, Indonesia, Mexico, Niger, Pakistan, Turkey, and Vietnam. This thematic evaluation aimed to assess the extent to which UNFPA-supported family planning service programs are being complied based on the Guidelines for UNFPA Support with Family Planning Programs. The introductory part offers background information, purpose and methodology adopted in evaluating the services and presents summaries of case-study projects. Evaluation findings are discussed along six dimensions: choice of contraceptive methods; technical competence; information and counseling; interpersonal relations; mechanisms to encourage continuation; and appropriateness and acceptability of family planning services. Finally, this report outlines conclusions and recommendations concerning policy and programmatic issues.
New York, New York, UNFPA, 1994. iv, 51 p. (Evaluation Report No. 8)Consultants visited 8 countries to determine the extent to which UNFPA-supported family planning services complied with the Guidelines for UNFPA Support to Family Planning Programmes. They concentrated on the quality of family planning services by examining choice of contraceptive methods, technical competence of service providers, information and counseling available to clients, client-staff relations, mechanisms to encourage continuation of contraceptive use, and appropriateness and acceptability of services and their implications for contraceptive use. The countries were Botswana, Niger, Turkey, Indonesia, Pakistan, Viet Nam, Ecuador, and Mexico. UNFPA's support made a significant contribution to improving women's access to family planning services. Positive findings included family planning service facilities were reasonably close to clients, an assortment of contraceptive methods were available, service providers had had some training, and facilities had basic medical equipment. Staff had implemented the basic management systems with relative success. There were limitations on the quality of family planning services. Government and service provider bias, incomplete and/or inaccurate contraceptive information, and a disregard for client's reproductive goals and needs restricted clients' ability to choose an appropriate contraceptive method. Insufficient content of training kept service providers from being effective. There was no follow-up after training to determine whether trainees applied their skills and learning in a clinical setting. Inferior quality of technical supervision and poor parts of organization that influence the safety and effectiveness of service delivery were also found. No follow-up mechanisms and insufficient record-keeping restricted the programs' ability to ensure client satisfaction and effective continuous contraceptive use. The evaluation teams made recommendations on policy issues and programmatic issues.
International Journal of Gynecology and Obstetrics. 1992; 38 Suppl:S67-73.A staff person from the Population, Health, and Nutrition Division of the World Bank presents leading successful methods in evaluating maternal health programs in developing countries and their limitations. 1st it is important to define the program in terms of provider, setting, activities, interventions, and expected outcomes. It may be either a program with a single intervention or a complex program. The program evaluation must include coverage, equity, technical quality, women's satisfaction, efficiency, and cost effectiveness. The evaluators must compare these criteria with some standard usually based on previous research, so they need to define this standard. These standards can be theoretical standards or empirical standards such as best possible standards derived from randomized clinical and community trials and best achievable standards. Best achievable standards should be used, however, when significant differences exist between the outcomes of the health program in question and the best achievable standard. Depending on the choices made based on the aforementioned components, evaluators can choose the method and indicators to use. The most exact method for evaluating the efficacy of health interventions is the randomized clinical trial, but it is best for single interventions. Randomized clinical trials are not always achievable, however, because it is difficult to find similar communities in sufficient quantities for an adequate sample size and are costly. The most often used method is quasi-experiments including before and after measurements of the indicators, control group experiments, and demonstration health projects. The case control method is the only acceptable observational method. Another possible method is confidential investigations into maternal deaths. The most common indicators include structure, process, and outcome.
INTEGRATION. 1991 Sep; (29):4-5.The work of the Soviet Family Health Association (SFHA) is described. Created in January, 1989, the organization boasts 25 state-paid workers, and as of June 1991, membership of 15,000 corporate and individual members. Individual annual membership fee is 5 rubles, and entitles members to counseling and family planning (FP) services. The SFHA works in cooperation with the Commission on Family Planning Problems of the USSR's Academy of Sciences, and has been a member of the International Planned Parenthood Federation (IPPF) since 1990. Association activities include lectures for students, newly-weds, adolescents, and working women on modern contraceptive methods; research on attitude regarding sex, sex behaviors, and the perceived need for effective contraception; clinical trials of contraceptive suitability for women; and the training of doctors in FP and contraceptives. Problems central to the SFHA's operations include insufficient service and examination equipment, a shortage of hard currency, and the small number of FP specialists in the country. Solutions to these obstacles are sought through collaboration with the government, non-governmental organizations in the Soviet Union, and international groups. The SFHA has a series of activities planned for 1991 designed to foster wider acceptance of FP. Increased FP services at industrial enterprises, establishing more FP centers throughout the Soviet Union, and studying FP programs in other countries are among Association targets for the year. Research on and promotion of contraceptives has been virtually stagnant since abortion was declared illegal in 1936. Catching up on these lost decades and remaining self-reliant are challenges to the SPHA.
Intercountry consultative meeting on recent advances in contraceptive technology, National Institute of Health and Family Welfare (NIH and FW) New Delhi, 1-5 December 1986.
[Unpublished] 1986. 60 p. (ICP MCH 011; RAS/85/P23)The objectives of the intercountry consultative meeting on recent advances in contraceptive technology, held in New Delhi, India in December of 1986, were to review the state-of-the-art on contraceptive methods used in the South East Asia Region (SEAR) region of the World Health Organization (WHO); to review problems with the delivery of family planning services to the countries of SEAR; to review the status of long-acting contraceptives in the SEAR countries; and to review the newer contraceptive methods; and to make recommendations for improvement of the family planning program acceptance in theses countries. Countries include Bhutan, India, Indonesia, Maldives, Nepal, Sri Lanka, and Thailand. The current status of each country is discussed, as is methods, difficulties, and research. ICMR experience in newer contraceptive technology methods is presented, as is data related to the present status of long-acting contraceptive agents. The status of injectable contraceptives in 1986 is presented in tabular form, as is data on phase III clinical trials, and field trials. Norplant-6 was the only implantable contraceptive available for use in family planning programs. The status of implantable contraceptives, 1986; the cumulative rate per 100 Norplant acceptors per year; and the 1-year cumulative rate per 100 acceptors are given in tabular form. The WHO Special Program for Research Training and Development (HRP) has established a Task Force which is looking into the development of a contraceptive vaccine. Substances being examined include sperm antigens, oral antigens, and peptide hormones. Some antiestrogens have been promising in experimental animals as far as postovulatory contraceptives are concerned. They have not, however, been shown to be effective in humans. Recent developments in male contraception are discussed, as are problems relating to family planning programs, (FPPS). Discussions were held on newer developments and improvements related to contraceptive methods; and problems relating to family planning programs and acceptance of FPPs. Recommendations are given on both of these discussion groups.
Lancet. 1990 Jul 7; 336(8703):56-7.In response to The Lancet's April 14 editorial on structural adjustment and health in Africa, it is surprising that the World Bank report did not include maternal mortality as a yardstick for monitoring health standards in Africa: maternal mortality seems to be a better index of social and economic development than perinatal or infant mortality. Obstetric performance was reviewed in parts of Nigeria after the introduction of the structural adjustment program (SAP). In the 1970's and early 1980's the Nigerian economy was buoyant, thanks to petroleum exports, but when oil prices slumped the government was forced to introduce SAP. As a result most of the costs that had been borne by the government were gradually passed on to individuals, of all the sectors affected health seems to have been the hardest hit. Looking at factors that might have been responsible for the rising maternal mortality rate in the Zaria area of Northern Nigeria, it was found that between 1983 and 1988 there had been no significant change in the numbers of obstetricians and obstetric residents at the Ahmadu Bello Teaching Hospital; there was a slight rise in the number of midwives. However, the number of deliveries in 1988 was only 46% of the figure for 1983, and the proportion of obstetric admissions that were complicated more than tripled. Maternal deaths at the hospital numbered 48 per year in 1983-85 and 75 in 1988, an increase of 56%. These changes in obstetric indices may not be unrelated to financial policies in hospital care. In 1983 all aspects of maternity care at the hospital were free. In 1985, following the reduction in government subsidy, fees were introduced for some services, leading to a fall in the number of pregnant women attending the hospital. By 1988 patients were asked to pay for their treatment; with the mean interval between admission and surgery increasing significantly and contributing to the high maternal morbidity and mortality rates in Zaria. (Full text modified)
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.
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)
Studies in Family Planning. 1984 Nov-Dec; 15(6/1):253-66.This paper critically analyzes claims for the effectiveness of the Billings method of natural family planning and raises questions about the wisdom of actively promoting this method. The Billings method, developed in Australia, is based on client interpretation of changing patterns of cervical mucus secretion. Evaluation of the method's use-effectiveness has been hindered by its supporters' insistence on distinguishing between method and user failures and by the unreliability of data on sexual activities. However, the findings in 5 large studies aimed at investigating the biological basis of the Billings method provide little support for the claims that most fertile women always experience mucus symptoms, that these symptoms precede ovulation by at least 5 days, and that a peak symptom coincides with the day of ovulation. Although many women do experience a changing pattern of mucus symptoms, these changes do not mark the fertile period with sufficient reliability to form the basis for a fully effective method of fertility control. In addition, the results of 5 major field trials indicate that the Billings method has a biological failure rate even higher than the symptothermal method. Pearl pregnancy rates ranged from 22.2-37.2/100 woman-years, and high discontinuation rates in both developed and developing countries were found. Demand for the method was low even in developing countries where calendar rhythm and withdrawal are relatively popular methods of fertility control, suggesting that women of low socioeconomic status may prefer a method that does not require demanding interaction with service providers and acknowledgment of sexual activity. The Billings method is labor-intensive, requiring repeated client contact over an extended time period and high administrative costs, even when teachers are volunteers. It is concluded that although natural family planning methods may make a useful contribution where more effective methods are unavailable or unacceptable, many of the claims made for the Billings method are unsubstantiated by scientific evidence.
In: International Planned Parenthood Federation [IPPF]. Male involvement in family planning: programme initiatives. London, England, IPPF, . 177-83.The International Labor Organization (ILO) has enlarged its traditional concern and responsibility for labor welfare to encompass the worker's welfare not only at the workplace but also in his living environment. The purpose of this paper is to introduce the ILO's Population/Family Welfare Education Programme. The basic objective of this program is to improve the quality of life of workers and teir families through educational activities aimed at creating an appreciation of interrelations between family income and expenditure, family budgeting and determining of priorities for various needs of the family, including family size. The program is implemented at country level through labor ministries, employers' groups, trade unions, or co-operatives. The program is designed for workers in the organized sector; its content and approach are refined for 4 main sub-groups: male workers, young workers undergoining vocational training, young unmarried female workers, and plantation workers and cooperative members in rural areas. In all cases the ILO program uses existing welfare and educational institutions, and is presented in terms of family level relationships. Once the inter-relationships of needs and resources within the context of the family is considered, it becomes apparent that needs are predominantly determined by family size. To the extent that couples are prepared to regulate their fertility, this decision may be influenced by family decision making. On the other hand, the potential for influencing family resources is limited. Family well-being can thus be seen in terms of family needs, resources and decision making. Workers must therefore be shown that they can determine their family size. This is the basic family welfare education message. It has a distinct ILO flavor about it and has proved to be acceptable to governments, employers, trade union leaders and members.
American Journal of Public Health. 1981 May; 71(5):459-61.The World Health Organization's stated goal is "health for all by the year 2000," which may be an example of wishful thinking. An attempt at applying simple health interventions failed in Nicaragua for lack of utilization by patients and poor delivery of services. Primary health care must be appropriate to local conditions. Commitments to the objectives of primary health care must be compatible among donor agencies, technical aid personnel, and health authorities at the relevant levels. Health and other objectives must be translated into activities with measurable goals. The primary health care system is an organism in which each part must perform its allotted tasks in coordination with the other parts. Coordination requires an efficient information system. Data collection for patient management and referral, and for supervision, logistics, and accounting should be an integral part of any program. Systems for evaluating the health outcomes of primary health care programs are essential. Every new activity should be strictly screened for its effectiveness in attaining the objectives of primary health care. The evidence for effectiveness in the literature cited as the basis for the interventions in Nicaragua ranges from the artifactual to the probably valid, and from major public health significance to none at all. In the Nicaragua example each partera had to make a certain number of patient contacts per year, and this was not realized.