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American Mock World Health Organization: An Innovative Model for Student Engagement in Global Health Policy.
Global Health: Science and Practice. 2017 Mar 24; 5(1):164-174.The American Mock World Health Organization (AMWHO) is a model for experiential-based learning and student engagement in global health diplomacy. AMWHO was established in 2014 at the University of North Carolina at Chapel Hill with a mission to engage students in health policy by providing a simulation of the World Health Assembly (WHA), the policy-forming body of the World Health Organization that sets norms and transforms the global health agenda. AMWHO conferences are designed to allow students to take their knowledge of global health beyond the classroom and practice their skills in diplomacy by assuming the role of WHA delegates throughout a 3-day weekend. Through the process of developing resolutions like those formed in the WHA, students have the unique opportunity to understand the complexities behind the conflict and compromise that ensues through the lens of a stakeholder. This article describes the structure of the first 2 AMWHO international conferences, analyzes survey results from attendees, and discusses the expansion of the organization into a multi-campus national network. The AMWHO 2014 and 2015 post-conference survey results found that 98% and 90% of participants considered the conference "good" or "better," respectively, and survey responses showed that participants considered the conference "influential" in their careers and indicated that it "allowed a paradigm shift not possible in class."
Brazzaville, Republic of the Congo, WHO, Regional Office for Africa, 2017. 23 p. (Policy Brief)Community health worker (CHW) programmes have seen a renaissance in the last two decades and now many countries in Africa boast of such national or substantial sub-national programmes. The 2013 Third Global Forum on Human Resources for Health concluded that CHWs and other frontline primary health care workers “play a unique role and can be essential to accelerating MDGs and achieving UHC”, and called for their integration into national health systems. The Ebola virus disease (EVD) outbreak of 2014-2015 highlighted the imperative of ensuring the functioning of the health systems at the community level for both their day-to-day resilience and disaster preparedness. The purpose of this policy brief is to inform discussions and decisions in the World Health Organization (WHO) African Region on policies, strategies and programmes to increase access to primary health care (PHC) services and make progress towards universal health coverage (UHC) by expanding the implementation of scaled-up CHW programmes. This brief summarizes the existing evidence on CHW programmes with a focus on sub-Saharan Africa and offers a number of context-linked policy options for countries seeking to scale up and improve the effectiveness of their CHW programmes, particularly with regard to needs such as those of Guinea, Liberia and Sierra Leone, the three countries that were the most affected by the 2014-2015 EVD outbreak. For the purposes of this policy brief, a broad definition of CHW is used. CHWs are individuals “carrying out the functions related to health care delivery [who are] trained in some way in the context of the intervention [but have] no formal professional or paraprofessional certificated or degreed tertiary education [in a health-related field]”). WHO states that CHWs “should be members of the communities where they work, selected by the communities, answerable to the communities for their activities, and supported by the health system but not necessarily a part of its organization”. For the purposes of this brief, a working definition for a scaled-up CHW programme has been developed, where the term refers to a programme that is designed to be more than a pilot or demonstration project and has the intention of covering a substantial population size or geographic area, depending on the country’s context. (Excerpts)
Community health care: Bringing health care at your door. Report of side event at 67th World Health Assembly.
[Geneva, Switzerland], World Health Organization [WHO], Global Health Workforce Alliance, 2014.  p.The side event held at the 67th World Health Assembly provided an opportunity to deliberate on integrated community health care (CHC) in attaining the Millennium Development Goals (MDGs) and Universal Health Coverage (UHC). The session also explored effective policies and strategies that could be used to remove the obstacles to deliver quality health care and positioning community health workers (CHWs) as an integral part of local health teams.
Challenging inequity through health systems. Final report: Knowledge Network on Health Systems. WHO Commission on the Social Determinants of Health.
[Johannesburg], South Africa, University of the Witwatersrand, Centre for Health Policy, Health Systems Knowledge Network, 2007 Jun.  p.The way that health systems are designed, financed and operated acts as a powerful determinant of health. The Health Systems Knowledge Network reviewed the evidence on different approaches to improving health equity outcomes through health systems. The focus was on innovative approaches that effectively incorporate action on the social determinants of health, and on strategies of policy development and implementation. Key themes were: Using the health sector to leverage inter-sectoral actions that address the social determinants of health; Enabling social empowerment in support of health equity; Identifying key elements of vision and health system architecture necessary to secure social protection and universal coverage; Building and maintaining national policy space for health policies that seek social justice; and Strengthening management and stewardship capacities within the health sector. The Health Systems Knowledge Network was chaired by Lucy Gilson of the Centre for Health Policy, and made up of 14 experienced policy-makers, academics and members of civil society from around the world. The Network engaged with other sections of the Commission and also commissioned a number of systematic reviews and case studies. This is the final report of the network.
Fees-for-services, cost recovery, and equity in a district of Burkina Faso operating the Bamako Initiative. [Prestation de services, couverture des coûts et équité dans une région au Burkina-Faso exploitant l'Initiative de Bamako]
Bulletin of the World Health Organization. 2003 Jul; 81(7):532-538.Objective: To gauge the effects of operating the Bamako Initiative in Kongoussi district, Burkina Faso. Methods: Qualitative and quasi-experimental quantitative methodologies were used. Findings: Following the introduction of fees-for-services in July 1997, the number of consultations for curative care fell over a period of three years by an average of 15.4% at ‘‘case’’ health centres but increased by 30.5% at ‘‘control’’ health centres. Moreover, although the operational results for essential drugs depots were not known, expenditure increased on average 2.7 times more than income and did not keep pace with the decline in the utilization of services. Persons in charge of the management committees had difficulties in releasing funds to ensure access to care for the poor. Conclusion: The introduction of fees-for-services had an adverse effect on service utilization. The study district is in a position to bear the financial cost of taking care of the poor and the community is able to identify such people. Incentivesmust be introduced by the state and be swiftly applied so that the communities agree to a more equitable system and thereby allow access to care for those excluded from services because they are unable to pay. (author's)
Management of severely ill children at first-level health facilities in sub-Saharan Africa when referral is difficult. [La prise en charge au niveau des installations sanitaires de premier niveau des enfants gravement malades, en Afrique sub-saharienne, en cas de difficulté d'orientation vers d'autres structures]
Bulletin of the World Health Organization. 2003 Jul; 81(7):522-531.Objectives: To quantify the main reasons for referral of infants and children from first-level health facilities to referral hospitals in sub- Saharan Africa and to determine what further supplies, equipment, and legal empowerment might be needed to manage such children when referral is difficult. Methods: In an observational study at first-level health facilities in Uganda, the United Republic of Tanzania, and Niger, over 3–5 months, we prospectively documented the diagnoses and severity of diseases in children using the standardized Integrated Management of Childhood Illness (IMCI) guidelines. We reviewed the facilities for supplies and equipment and examined the legal constraints of health personnel working at these facilities. Findings: We studied 7195 children aged 2–59 months, of whom 691 (9.6%) were classified under a severe IMCI classification that required urgent referral to a hospital. Overall, 226 children had general danger signs, 292 had severe pneumonia or very severe disease, 104 were severely dehydrated, 31 had severe persistent diarrhoea, 207 were severely malnourished, and 98 had severe anaemia. Considerably more ill were 415 young infants aged one week to two months: nearly three-quarters of these required referral. Legal constraints and a lack of simple equipment (suction pumps, nebulizers, and oxygen concentrators) and supplies (nasogastric tubes and 50% glucose) could prevent health workers from dealing more appropriately with sick children when referral was not possible. Conclusion: When referral is difficult or impossible, some additional supplies and equipment, as well as provision of simple guidelines, may improve management of seriously ill infants and children. (author's)
The role of health centres in the development of urban health systems: report of a WHO Study Group on Primary Health Care in Urban Areas.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1992; (827):i-iv, 1-38.The WHO Study Group on Primary Health Care (PHC) in Urban Areas has written a report after examining the development of reference health centers in urban areas in various parts of the world. It considers such centers to be a potentially important way to improve urban health services. Reference health centers, with real roots in the community and good links to first level and referral level care, can address the problems of access to health care and intersectoral collaboration. Each center should be based on a general model, but its exact operation depends on local conditions and on a comprehensive situation analysis that considers social and financial factors and the level of organizational development. Each reference center should determine what needs to be done locally with local and national resources. Outside donors should only provide assistance for operational costs and a last resort. To plan services adequately, decision makers must define geographical catchment areas and travel times. These definitions must see to it that services integrate with each other vertically (with services at health post and hospital levels), and horizontally (with government, and nongovernmental, and community projects). A solid epidemiological understanding of major local health problems is essential for expanding PHC through reference health centers. This knowledge comes from an assessment of demographic, morbidity, mortality, and social data an evaluation of coverage of underserved and marginal groups. Reference health centers would be in an ideal position to gather and analyze these data. Innovative ways to obtain the resources for urban PHC are collection of user fees and close supportive links with universities and nongovernmental organizations. The Study Group looks at how reference health centers in Cali, Colombia; Manila, the Philippines; and Newark, New Jersey in the US, developed.
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.
VACCINE. 1988 Oct; 6(5):393-8.In developing countries, where economic development is lacking and literacy rates are low, priority must be given to primary health care and to the establishmend of sustainable health care delivery systems. The World Health Organization's Expanded Program of Immunization was designed with the goal of immunizing all children against measles, pertussis, tetanus, poliomyelitis, tuberculosis, and diphtheria by 1990. A second function of the immunization program is to establish a health care delivery system. Today 50% of infants receive 3 doses of diptheria/pertussis/tetanus and polio vaccines, and 70% receive at least 1 dose. Measles kills 2 million children every year. The standard strain of attenuated vaccine is given at 9 months, and 1 dose protects 95% of children for life. Tetanus kills 800,000 infants every year. The vaccine must be refrigerated, and 2 doses are essential. Tuberculosis kills 2 million children under 5 every year. The attenuated BCG vaccine should be given at birth, and a single dose confers some protection. Diphtheria is most common among poor, urban children in termperate climates, and 3 doses of toxoid at monthly intervals are recommended. Poliomyelitis paralyzes 250,000 children a year. 4 doses of live attenuated Sabin vaccine are recommended. The vaccine is very sensitive to heat. Other vaccines in use or being developed include yellow fever, meningococcus, Japanese B encephalitis, rubella, hepatitis B, cholera, rotavirus, pneumonococcus, and Haemophilus influezae. 2 problems that confront the delivery of health services, including immunization, are lack of funds and lack of access to susceptible populations. Approaches to the lack of funds problem include fee for service, taxation, beter management of existing resources, reallocation of health resources, and increased funding from donor nations. Approaches to the problem of access include vaccination whenever children come into contact with a health facility for any reason, channeling by members of the community, involvement of traditional healers and birth attendants, outreach services, mass campaigns, pulse technics, and financial incentives.
JOURNAL OF TROPICAL PEDIATRICS. 1989 Aug; 35(4):197-8.The 'Child Survival Revolution' (CSR) which emphasizes the technological approaches of Primary Health Care (PHC) as defined in Alma Ata, disregards the structural conditions and processes that lead to seldom diminishing morbidity and mortality rates among the poor in the Third World. The CSR may save some lives, but will not attack the underlying and basic causes of child mortality in developing countries. We must not rely on GOBI as a technical solution to what is essentially a socioeconomic and political problem. Choices to seek or not to seek better health for family members are all intimately linked to the state of poverty of most potential beneficiaries of GOBI-FF. Some additional empowerment of the people is needed for meaningful choices to become realistic options. GOBI-FF and the CSR are a combination of new technologies communicated by social marketing with mostly a top-down implementation, taking for granted the existing social and political institutions. Although the messages of the program call for political will, for social mobilization, for involvement of the population, and for changes in the health infrastructure, these concepts are used in a very inconsistent, demagogic, fuzzy and empty way. GOBI is too strongly supply oriented and ignores the social constraints behind a weak demand for the effective utilization of existing or new health services. Third World countries often end up following rules dictated from or set-up outside the country. Social marketing too, makes people mostly consumers, not protagonists and promoters. People need access to significant remedial interventions; knowledge is not enough. Evidence shows that people are 'patterning' their behavior to what the provider wants from them just to receive the program's benefits. Health professionals must help create the necessary support systems to empower the poor. (author's modified)
The potential of national household survey programmes for monitoring and evaluating primary health care in developing countries. L'apport potentiel des enquetes nationales sur les menages a la surveillance et a l'evaluation des soins de sante primaires dans les pays en developpement.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(1):38-64.National programs of household sample surveys, such as those being encouraged through the National Household Survey Capability Program (NHSCP), are a principal source of information on primary health care in developing countries. Being representative of the total population, the major population subgroups and geographic subdivisions, they permit calculation of health status and utilization of health services. Household surveys have an important role to play in monitoring and evaluating primary health care since they sample directly the intended beneficiaries, and so can be used to judge the extent to which programs are meeting expected goals. Caution is necessary, however, since methodological problems have been experienced for many evaluation surveys. National surveys are especially appropriate for measuring many indicators of progress towards national goals within a broad socioeconomic perspective. Future directions in making the optimum use of household surveys for health program purposes are indicated. The NHSCP is a major undertaking of the UN system including WHO to collaborate with developing countries to establish a continuing flow of integrated statistics on a recurrent basis to support the national development process and information priorities. It brings together the principal users and producers of data to plan and conduct surveys which respond to national needs and priorities. The NHSCP encourages countries to employ a permanent national field organization for data collection. Areas of discussion are: the potential for monitoring and evaluation, the household survey as a source of health indicators, the demand for household surveys of health, followed by a summary of the health and health-related topics covered by 6 national health and nutrition surveys conducted in several developing countries. The special themes of infant and child mortality, morbidity and nutritional surveillance are also considered. The experience of many developed countries has been very positive with the use of nonmedically organized health surveys. Although the sample survey can be used in many settings to obtain population-based data, it must be carefully designed and implemented according to scientific procedures in order for the results to be validly extrapolated to the population or subgroups of primary concern.