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Geneva, Switzerland, World Health Organization [WHO], 2015. 44 p.Key populations at higher risk of HIV include people who sell sex, men who have sex with men (MSM), transgender people and people who inject drugs. Young people who belong to one or more of these key populations – or who engage in activities associated with these populations – are made especially vulnerable to HIV by factors including widespread discrimination, stigma and violence, combined with the particular vulnerabilities of youth, power imbalances in relationships and, sometimes, alienation from family and friends. These factors increase the risk that they may engage – willingly or not – in behaviours that put them at risk of HIV, such as frequent unprotected sex and the sharing of needles and syringes to inject drugs. This technical brief is one in a series addressing four young key populations. It is intended for policy-makers, donors, service-planners, service-providers and community- led organizations. This brief aims to inform discussions about how best to provide services, programmes and support for young people who sell sex. It offers a concise account of current knowledge concerning the HIV risk and vulnerability of young people who sell sex; the barriers and constraints they face to appropriate services; examples of programmes that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build the strengths, competencies and capacities of young people.
Geneva, Switzerland, World Health Organization [WHO], 2015. 40 p.Key populations at higher risk of HIV include people who sell sex, men who have sex with men (MSM), transgender people and people who inject drugs. Young people who belong to one or more of these key populations – or who engage in activities associated with these populations – are made especially vulnerable to HIV by factors including widespread discrimination, stigma and violence, combined with the particular vulnerabilities of youth, power imbalances in relationships and, sometimes, alienation from family and friends. These factors increase the risk that they may engage – willingly or not – in behaviours that put them at risk of HIV, such as frequent unprotected sex and the sharing of needles and syringes to inject drugs. This technical brief is one in a series addressing four young key populations. It is intended for policy-makers, donors, service-planners, service-providers and community-led organizations. This brief aims to inform discussions about how best to provide health services, programmes and support for young MSM. It offers a concise account of current knowledge concerning the HIV risk and vulnerability of young MSM; the barriers and constraints they face to appropriate services; examples of programmes that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build to the strengths, competencies and capacities of young MSM.
Scaling up proven innovative cervical cancer screening strategies: Challenges and opportunities in implementation at the population level in low- and lower-middle-income countries.
International Journal of Gynaecology and Obstetrics. 2017 Jul; 138 Suppl 1:63-68.The problem of cervical cancer in low- and lower-middle-income countries (LLMICs) is both urgent and important, and calls for governments to move beyond pilot testing to population-based screening approaches as quickly as possible. Experiences from Zambia, Bangladesh, Guatemala, Honduras, and Nicaragua, where scale-up of evidence-based screening strategies is taking place, may help other countries plan for large-scale implementation. These countries selected screening modalities recommended by the WHO that are within budgetary constraints, improve access for women, and reduce health system bottlenecks. In addition, some common elements such as political will and government investment have facilitated action in these diverse settings. There are several challenges for continued scale-up in these countries, including maintaining trained personnel, overcoming limited follow-up and treatment capacity, and implementing quality assurance measures. Countries considering scale-up should assess their readiness and conduct careful planning, taking into consideration potential obstacles. International organizations can catalyze action by helping governments overcome initial barriers to scale-up. (c) 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
State of world population 2012. By choice, not by chance. Family planning, human rights and development.
New York, New York, United Nations Population Fund [UNFPA], 2012 Nov 14. 140 p.All human beings – regardless of age, sex, race or income – are equal in dignity and rights. Yet 222 million women in developing countries are unable to exercise the human right to voluntary family planning. This flagship report analyzes data and trends to understand who is denied access and why. It examines challenges in expanding access to family planning. And it considers the social and economic impact of family planning as well as the costs and savings of making it available to everyone who needs it. The report asserts that governments, civil society, health providers and communities have the responsibility to protect the right to family planning for women across the spectrum, including those who are young or unmarried. Nevertheless, the report finds that financial resources for family planning have declined and contraceptive use has remained mostly steady. In 2010, donor countries fell $500 million short of their expected contribution to sexual and reproductive health services in developing countries. Contraceptive prevalence has increased globally by just 0.1 per cent per year over the last few years.
Universal access to reproductive health. Accelerated actions to enhance progress on Millennium Development Goal 5 through advancing Target 5B.
Geneva, Switzerland, World Health Organization [WHO], 2011.  p. (WHO/RHR/HRP/11.02)The World Health Organization (WHO) Department of Reproductive Health and Research convened a technical consultation involving stakeholders from countries, regions and partner agencies to review strategies applied within countries for advancing universal access to sexual and reproductive health with a view to identifying strategic approaches to accelerate progress in achieving universal access. Case-studies from seven countries (Brazil, Cambodia, India, Morocco, United Republic of Tanzania, Uzbekistan and Zambia) illustrating application of a variety of strategies to improve access to sexual and reproductive health, lessons learnt during implementation and results achieved, allows identification of a range of actions for accelerated progress in universal access. In order to achieve MDG 5 a holistic approach to sexual and reproductive health is necessary, such that programmes and initiatives will need to expand beyond focusing only on maternal health and address also family planning, sexual health and prevention of unsafe abortion. Programmes should prioritize areas of engagement based upon country and regional needs while establishing practical ways to ensure equity through integration of gender and human rights. The strategic actions in countries outlined here will help accelerate progress towards attainment of MDG Target 5B within the wider context of implementation of the WHO Global reproductive health strategy. (Excerpt)
[Washington, D.C]., World Bank. 2010 May.  p.Reproductive health is a key facet of human development. Improved reproductive health outcomes -- lower fertility rates, better pregnancy outcomes, and fewer sexually transmitted infections -- have broader individual, family, and societal benefits. The benefits include a healthier and more productive work force, greater financial and other resources for each child in smaller families, and enabling young women to delay childbearing until they have achieved educational and other goals. Women's full and equal participation in the development process is contingent on accessing essential reproductive health services, including the ability to make voluntary and informed decisions about fertility. Reproductive health issues have only recently begun to be a priority in the development agenda. Even though Official Development Assistance (ODA) for reproductive health has increased, the share of health ODA going to reproductive health declined in the past decade. This document presents a detailed operationalization of the reproductive health component of the Bank's 2007 Health, Nutrition, and Population (HNP) strategy.
Monitoring equity in access to AIDS treatment programmes: a review of concepts, models, methods and indicators.
Geneva, Switzerland, WHO, 2010.  p.The World Health Organization (WHO) and the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through REACH Trust Malawi and Training and Research Support Centre (TARSC) developed this review. It provides a practical resource for programme managers, health planning departments, evaluation experts and civil society organizations working on health systems and HIV / AIDS programmes at sub-national, national and regional levels in East and Southern Africa. Many of the orientations and tools in this document were developed through a wide consultation process, starting in 2003. We draw on the broader analysis of health equity advanced by EQUINET, as well as evidence from five background studies on equity and health systems impacts of ART programming in East and Southern Africa which were supported by EQUINET, TARSC and DFID (available at www. equinetafrica.org). (Excerpt)
Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth, 2009.
Geneva, Switzerland, WHO, 2010.  p.The telemedicine module of the 2009 survey examined the current level of development of four fields of telemedicine: teleradiology, teledermatogy, telepathology, and telepsychology, as well as four mechanisms that facilitate the promotion and development of telemedicine solutions in the short- and long-term: the use of a national agency, national policy or strategy, scientific development, and evaluation. Telemedicine -- opportunities and developments in Member States discusses the results of the telemedicine module, which was completed by 114 countries (59% of Member States). Findings from the survey show that teleradiology currently has the highest rate of established service provision globally (33%). Approximately 30% of responding countries have a national agency for the promotion and development of telemedicine, and developing countries are as likely as developed countries to have such an agency. In many countries scientific institutions are involved with the development of telemedicine solutions in the absence of national telemedicine agencies or policies; while 50% of countries reported that scientific institutions are currently involved in the development of telemedicine solutions, 20% reported having an evaluation or review on the use of telemedicine in their country published since 2006. (Excerpt)
[Bangkok, Thailand], ITPC, 2007 Dec.  p.In the first section of the report, nine country teams provide first-hand reports on central issues related to AIDS service scale-up in their countries. Each demonstrates that increasing access to AIDS treatment brings not only better life and new hope, but also shines light on challenges and effective approaches to a spectrum of health, poverty, and human rights issues. In part two of this report, 14 national teams review drug access issues, and find that global and national processes for AIDS drug registration are burdened by inefficiencies, duplications, delay, and, in some instances, corruption. In many cases key ARVs, particularly newer and second-line therapies, are not yet registered in high impact countries - an administrative roadblock that puts lifesaving care out of reach for hundreds of thousands of people. The report makes a number of concrete recommendations to the key players who are responsible for making near universal access to AIDS treatment a reality by 2010. (excerpt)
The practice of charging user fees at the point of service delivery for HIV / AIDS treatment and care.
Geneva, Switzerland, WHO, 2005 Dec.  p. (WHO Discussion Paper; WHO/HIV/2005.11)The global movement to expand access to antiretroviral treatment for people living with HIV/AIDS as part of a comprehensive response to the HIV pandemic is grounded in both the human right to health and in evidence on public-health outcomes. However, for many individuals in poor communities, the cost of treatment remains an insurmountable obstacle. Even with sliding fee scales, cost recovery at the point of service delivery is likely to depress uptake of antiretroviral treatment and decrease adherence by those already receiving it. Therefore, countries are being advised to adopt a policy of free access at the point of service delivery to HIV care and treatment, including antiretroviral therapy. This recommendation is based on the best available evidence and experience in countries. It is warranted as an element of the exceptional response needed to turn back the AIDS epidemic. With the endorsement by G8 leaders in July 2005 and UN Member States in September 2005 of efforts to move towards universal access to HIV treatment and care by 2010, health sector financing strategies must now move to the top of the international agenda. Rapid scale-up of programmes within the framework of the "3 by 5" target has underscored the challenge of equity, particularly for marginalized and rural populations. It is apparent that user charges at the point of service delivery "institutionalize exclusion" and undermine efforts towards universal access to health services. Abolishing them, however, requires prompt, sustained attention to long-term health system financing strategies, at both national and international levels. (excerpt)
Bulletin of the World Health Organization. 2006 Jul; 84(7):506.June 2006 marks the 25th anniversary of a report of five cases of Pneumocystis carinii (now jirovecii) pneumonia in men who have sex with men, heralding the acquired immunodeficiency syndrome (AIDS). Over 65 million infections with the causative agent, human immunodeficiency virus (HIV), have now caused at least 25 million deaths. Following recognition at the XI International Conference on AIDS in 1996, that combination antiretroviral therapy (ART) dramatically improves survival, various initiatives have helped to bring treatment to people with HIV/AIDS in developing countries. Although the target of treating 3 m people by the end of 2005 (WHO's "3 by 5" initiative) was not reached, about 1.3 m people now receive ART in low- and middle-income countries. Major lessons from the initiative include the utility of country-owned targets in mobilizing efforts and promoting accountability, the need for extensive partnerships to scale up activities, the importance of identifying and resolving health systems constraints, the challenges of ensuring equity, and the synergy between treatment initiatives and a simultaneous scaling-up of HIV prevention. (excerpt)
[Chapel Hill, North Carolina], Ipas, 2004. (8)  p.This document compiles facts and recommendations for action to prevent maternal mortality due to unsafe abortion, ensure that legal abortion is safe and accessible for all women, guarantee that legal abortion and postabortion care services are within reach of all women throughout health systems, and review laws and policies that place women's lives in danger. These essential steps to protect women's health and guarantee their human rights--endorsed by the world community over the past decade--require concerted action from health systems, professional associations, parliamentarians, women's organizations and all relevant stakeholders. Implementing safe, legal abortion services, removing barriers to existing services, and informing the public about where they can obtain abortion care are key measures to ensure safety and access to abortion. (excerpt)
[Unpublished] 1994. Presented at the meeting of the USAID cooperating agencies, Washington, D.C., February 22-24, 1994. 6,  p.Elements of quality of care according to the Bruce/Jain framework include: choice of methods, information given to clients, technical competence, interpersonal relations, mechanisms to ensure follow-up, and appropriateness of services. Access to family planning (FP) services and quality of care shape the image of the FP program in the eyes of potential clients. There are 4 barriers to seeking out services: 1) economic (the cost to the client of reaching the service delivery point and obtaining the contraceptive services and supplies); 2) administrative (unnecessary rules and regulations that can inhibit contraceptive choice and use, e.g., restricted clinic hours for family planning services, age/parity criteria for the use of certain methods, spousal consent); 3) cognitive (lack of knowledge of the existence of FP services, of the location of such services, or of the methods available); 4) psychosocial (psychological, attitudinal, or social factors that inhibit motivated potential clients in seeking out family planning services); 5) elements of quality of care (choice of methods, information given to clients, technical competence, interpersonal relations, mechanisms to ensure follow-up, continuity, appropriate constellation of services). In addition, there are medical barriers as a subset of access and quality: inappropriate contraindications (quality), process/scheduling hurdles (access), eligibility criteria, such as age, parity, spousal consent (access), limits on providers to provide certain methods (access), provider bias (quality), regulatory barriers (access), location of services (access), and how side effects are managed (quality). Other concerns about quality of care and medical barriers are: demedicalizing FP may remove protective safeguards to health; the removal of medical barriers may inadvertently limit reproductive health care for some women; the focus on access could orient managers to quantity (of clients generated) rather than quality (of services provided); and medical barriers could consume resources that should be used for improving quality of care.
IPPF COUNTRY PROFILES. 1992 Aug; SAR 19-24.In 1984 in Pakistan, the government's Council of Islamic Ideology banned contraception unless pregnancy would jeopardize a woman's life. The government soon realized that its 2.9% population growth rate was too high to achieve social and economic development, so it implemented a national population policy, hoping to reduce population growth to 2.5% by 2000. The policy calls for a multisectoral approach, emphasizing mobile services to promote birth spacing and maternal and child health and providing family planning services through the public and private sector and family welfare centers. The policy also aims to increase literacy, reduce unemployment, and improve health care. It targets rural areas where 72% of the population lives. In 1989, only 9.1% of 15-49 year old married women used contraceptives and 58.6% wanted to control their fertility but did not have access to family planning information and services. Pakistan depends greatly on the family planning services of the nongovernmental organization. Family Planning Association of Pakistan (FPAP). FPAP introduced family welfare centers, social marketing, and reproductive health centers to Pakistan. It continues to introduce new contraceptives. FPAP's major projects include educational programs in population, family planning, and nutrition; family planning training; promotion of family planning and maternal and child health; programs emphasizing male involvement in family planning; information, education, and communication; and lobbying Parliament for more funding for family planning and for improvement in women's status.
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.
Guidelines on improving delivery and evaluation of population and family planning programmes in African countries.
Addis Ababa, Ethiopia, United Nations Economic Commission for Africa, 1991 Dec. vi, 82 p. (ECA/POP/TP/91/2 [1.2(ii)])In December, 1991, the UN Economic Commission for Africa (UNECA) released guidelines geared toward professionals involved in population and family planning programs in Africa. By this time, many African countries had adopted such programs either for health and human rights reasons or to influence demographic trends. Yet several countries still had laws against family planning from the colonial days. UNECA stressed that programs should be central to socioeconomic development planning, since changes in population affect socioeconomic development and vice versa. It also emphasized the importance of planning and formulation of programs and policies. This included political commitment and leadership; involvement of women, men, youth, and communities; consideration of resource allocation, institutional arrangements, and infrastructure; and wide discussion of policies and programs at all levels including the grass roots levels. UNECA pointed out the need for policy makers and program managers to clearly state objectives and that the objectives be tied with socioeconomic development and improvement of the welfare of the people. It encouraged population and family planning professionals to give consideration to the delivery and evaluation of programs. For example, they should incorporated information, education, and communication efforts designed to improve attitudes and encourage quality services into these programs. Leaders should strive to reform legislation which acts against population and family planning programs. UNECA also stressed the need to integrate evaluation activities into these programs. The guidelines ended with experiences on implementation of programs from Botswana, Ghana, Kenya, Mauritius, Tunisia, Zimbabwe, China, and Thailand.
SCIENCE. 1991 Mar 15; 251:1312-3.AIDS scientists met in February 1991 to discuss international trials of AIDS vaccines because of the urgency in conducting such trials since the US Food and Drug Administration approved 6 vaccines for trails. Major problems discussed were how to insure access to potential AIDS vaccines to developing countries, where to conduct future tests of vaccine efficacy, and which of the leading institutions should coordinate such an effort. The most difficult issue centered around who assumes the risks and who benefits. Many researchers considered conducting AIDS vaccine trials in developing countries since they have a large population varied in age and gender at high risk of HIV infection. Assuming an HIV vaccine is effective, additional questions must be addressed: How can a developing country afford a vaccine at free market prices? If that country does get the vaccine should not other developing countries also get it? Who will pay for it and distribute it? WHO has already contacted ministries of health about AIDS trials. Other organizations, e.g., the US Centers for Disease Control and the US National Institutes of Health, also already involved in international AIDS vaccine research do not want to be kept out of the Phase III trials. Some recommended that WHO be the international umbrella, others suggested that no organization control all the research. Nevertheless the vaccine will be produced in a rich country, and if left to the free market, it will be too expensive. 1 suggestions is a 2-tiered pricing plan in which rich countries pay higher prices thereby subsidizing the price in poor countries. Another is a patent exchange where the vaccine developers donate the vaccine patent to an international organization and they in turn can get an extension on an existing patent. Another alternative includes removing AIDS vaccines from the private sector altogether.
In: Health care of women and children in developing countries, [edited by] Helen M. Wallace, Kanti Giri. Oakland, California, Third Party Publishing, 1990. 85-95.Primary health care (PHC) taken alone is not enough to significantly reduce the death and suffering currently experienced by 3rd world nations. There are a variety of other factors such as severe poverty, lack of education, contaminated environments, social fragmentation, and political instability that prevent people from leading healthy and productive lives. The purpose of this chapter is to make some brief observations about the nature of health problems of mother and children in developing countries and use some of these problems as models for discussing broader issues, followed by an examination of some approaches to the design, management, and evaluation of PHC systems. The discussion includes social, economic, and political factors that determine health outcomes. It is clear from the available data that recurrent health problems exist for mothers and children in the 3rd world. The primary causes of ill health and death for children are malnutrition, immunizable diseases, diarrheal diseases, and acute respiratory infection. The primary cause of ill health and death for mothers are associated with pregnancy and child birth. In order to achieve health care for everyone, the World Health Organization follows 5 essential rules; universal coverage with care based on need or risk; effective, affordable, accessible, culturally acceptable care; promotive, preventive, curative, rehabilitative; community participation that promote self-reliance; and interaction with other sectors of development.