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Allocation of antiretroviral drugs to HIV-infected patients in Togo: Perspectives of people living with HIV and healthcare providers.
Journal of Medical Ethics. 2017 Dec; 43(12):845-851.Aim To explore the way people living with HIV and healthcare providers in Togo judge the priority of HIV-infected patients regarding the allocation of antiretroviral drugs. Method From June to September 2015, 200 adults living with HIV and 121 healthcare providers living in Togo were recruited for the study. They were presented with stories of a few lines depicting the situation of an HIV-infected patient and were instructed to judge the extent to which the patient should be given priority for antiretroviral drugs. The stories were composed by systematically varying the levels of four factors: (a) the severity of HIV infection, (b) the financial situation of the patient, (c) the patient's family responsibilities and (d) the time elapsed since the first consultation. Results Five clusters were identified: 65% of the participants expressed the view that patients who are poor and severely sick should be treated as a priority, 13% prioritised treatment of patients who are poor and parents of small children, 12% expressed the view that the poor should be treated as a priority, 4% preferred that the sickest be treated as a priority and 6% wanted all patients to get treatment. Conclusions WHO's guideline regarding antiretroviral therapy allocation (the sickest first as the sole criterion) currently in use in many African countries does not reflect the preferences of Togolese people living with HIV. For most HIV-infected patients in Togo, patients who cannot get treatment on their own should be treated as a priority.
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.
Report on the evaluation of the UNFPA-supported women, population and development projects in Indonesia (INS/79/P20 and INS/83/P02) and of the role of women in three other UNFPA-supported projects in Indonesia (INS/77/P03, INS/79/P04, and INS/79/P16).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Apr. vi, 52 p.The Evaluation Mission analyzes and assess the 2 United Nations Fund for Population Activities (UNFPA)-supported Women, Population and Development Projects and the role of women in 3 other UNFPA-assisted projects in Indonesia. The Mission concluded that the family planning and cooperative/income generation scheme as evolved in the 2 projects has contributed to increasing contraceptive acceptance and continuation and to a shift from the less reliable to the more reliable contraceptive methods. The projects have also assisted women and their families to expand their income generating activities, raise their incomes, and improve the family's standard of living. The Mission recommends that: 1) more diversified income producing activities be encouraged; 2) product outlets be identified and mapped and appropriate marketing strategies devised; 2) loan repayment schedules be carefully examined; 4) data collection, monitoring and evaluation be streamlined and strenghthened; and 5) the process of the entire rural cooperatives/income generation scheme be more comprehensively documented. In the 3 other projects, which are addressed to both men and women, the needs and concerns of women have not been adequately taken into account and/or the participation of women in all phases of the projects and their access to project benefits have not been equal to men. The Mission therefore recommends that special consideration be given to women's concerns in the design and formulation of all projects. The Mission ascertained that non-women specific projects tend to perpetuate existing discriminatory or unequal access to, and control of, resources by women unless specific consideration is accorded to them.