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Pediatrics. 2008 Apr; 121(4):e984-92.Deficiencies in the quality of health care are major limiting factors to the achievement of the Millennium Development Goals for child and maternal health. Quality of patient care in hospitals is firmly on the agendas of Western countries but has been slower to gain traction in developing countries, despite evidence that there is substantial scope for improvement, that hospitals have a major role in child survival, and that inequities in quality may be as important as inequities in access. There is now substantial global experience of strategies and interventions that improve the quality of care for children in hospitals with limited resources. The World Health Organization has developed a toolkit that contains adaptable instruments, including a framework for quality improvement, evidence-based clinical guidelines in the form of the Pocket Book of Hospital Care for Children, teaching material, assessment, and mortality audit tools. These tools have been field-tested by doctors, nurses, and other child health workers in many developing countries. This collective experience was brought together in a global World Health Organization meeting in Bali in 2007. This article describes how many countries are achieving improvements in quality of pediatric care, despite limited resources and other major obstacles, and how the evidence has progressed in recent years from documenting the nature and scope of the problems to describing the effectiveness of innovative interventions. The challenges remain to bring these and other strategies to scale and to support research into their use, impact, and sustainability in different environments.
Achieving the millennium development goals for health and nutrition in Bangladesh: key issues and interventions--an introduction.
Journal of Health, Population, and Nutrition. 2008 Sep; 26(3):253-60.Among the mega-countries, Bangladesh stands out in terms of the density of population. As opposed to other countries with a population exceeding 100 million, the density of population in Bangladesh is more than twice the density of other populous countries, and the population continues to grow. Bangladesh is only half way up the population curve such that, during the next 50 years, the difference in density between Bangladesh and other countries will widen even further. Thus, the density of population, as well as poverty, and the rapid urbanization of the country are major constraints for Bangladesh while it attempts to achieve the Millennium Development Goals (MDGs). Hopefully, the fertility rate will continue to fall to levels less than needed for replacement, since this will ease one of these constraints. (excerpt)
Public choices, private decisions: sexual and reproductive health and the Millennium Development Goals.
[New York, New York], United Nations Development Programme, UN Millennium Project, 2006.  p.Sexual and reproductive health (SRH) was given an international consensus definition at the International Conference on Population and Development (ICPD) in 1994. At its core is the promotion of healthy, voluntary and safe sexual and reproductive choices for individuals and couples, including decisions on family size and timing of marriage, that are fundamental to human well-being. Sexuality and reproduction are vital aspects of personal identity and key to creating fulfilling personal and social relationships within diverse cultural contexts. SRH does not only involve the reproductive years but emphasizes the need for a life-cycle approach to health. It touches on sensitive, yet important, issues for individuals, couples and communities, such as sexuality, gender discrimination and male/female power relations. Attainment of SRH depends vitally on the protection of reproductive rights, a set of long-standing accepted norms found in various internationally agreed human rights instruments. The ICPD adopted the goal of ensuring universal access to reproductive health by 2015 as part of its framework for a broad set of development objectives. The Millennium Declaration and the subsequent Millennium Development Goals (MDGs) set priorities closely related to these objectives. Progress towards the MDGs depends on attaining the ICPD reproductive health goals. The leaders of the world ratified that understanding in the 2005 World Summit Outcome Document. (excerpt)
UN Chronicle. 1989 Sep; 26(3): p..Promoting a better and healthier life for children, after ensuring their survival, will increasingly occupy the agenda of the United Nations Children's Fund (UNICEF) in the 1990s. The pursuit of primary health care systems, safe motherhood activities, birth spacing, better water supply and sanitation, and basic education, particularly for women and girls, will be UNICEF priorities through the end of the century. At its 1989 session the UNICEF Executive Board asked the Fund to formulate a global strategy through the last decade of the century to promote the well-being of children. (excerpt)
Lancet. 2003 Jul 19; 362(9379):233-241.Gaps in child mortality between rich and poor countries are unacceptably wide and in some areas are becoming wider, as are the gaps between wealthy and poor children within most countries. Poor children are more likely than their better-off peers to be exposed to health risks, and they have less resistance to disease because of undernutrition and other hazards typical in poor communities. These inequities are compounded by reduced access to preventive and curative interventions. Even public subsidies for health frequently benefit rich people more than poor people. Experience and evidence about how to reach poor populations are growing, albeit largely through small-scale case studies. Successful approaches include those that improve geographic access to health interventions in poor communities, subsidised health care and health inputs, and social marketing. Targeting of health interventions to poor people and ensuring universal coverage are promising approaches for improvement of equity, but both have limitations that necessitate planning for child survival and effective delivery at national level and below. Regular monitoring of inequities and use of the resulting information for education, advocacy, and increased accountability among the general public and decision makers is urgently needed, but will not be sufficient. Equity must be a priority in the design of child survival interventions and delivery strategies, and mechanisms to ensure accountability at national and international levels must be developed. (author's)
Arlington, Virginia, Partnership for Child Health Care, 1995. , 11,  p. (Trip Report; BASICS Technical Directive: 008-GU-01-015; USAID Contract No. HRN-6006-Q-08-3032)As part of a series of activities designed to reduce morbidity and mortality from acute respiratory infections in children under the age of 5 in Guatemala, a consultant from the BASICS (Basic Support for Institutionalizing Child Survival) program visited Guatemala in 1995 to analyze, modify, and field test the protocol developed by the USAID Mission to document the degree to which drugs prescribed for pneumonia are available in the community through the private sector. This field report provides background information and describes the current situation in Guatemala in terms of availability of drugs in the public sector through the Ministry of Health, the Drogueria Nacional, municipalities, and the Pan American Health Organization. Relevant activities in the private sector are also described, including the for-profit businesses as well as services provided by UNICEF, the European Union, and nongovernmental organizations. A brief overview of one health area gives an example of the current situation. The result of this consultancy visit was the determination that the situation merited adjustment of the originally requested study and that the survey as designed would likely require modification and application within target communities. Included among the appendices is the original protocol developed for assessing community drug availability.