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Paris, France, UNESCO, 2010. 72 p.This booklet identifies the key characteristics of efficient and effective HIV prevention in a user-friendly and accessible format. It explains how programme implementers and project managers can apply, integrate and institutionalize these characteristics in planning and implementing HIV and AIDS responses. The booklet targets programme implementers and project managers developing and implementing activities (largely in the area of HIV prevention) within UNESCO. However, it will also be useful to other stakeholders undertaking similar work, including technical staff, programme implementers and managers in ministries involved in the AIDS response, UN and other development partners, and civil society. As a quick reference guide, users can find out about the key characteristics of a specific approach, check on definitions, identify tools to help put the approach into practice. It is not intended to substitute for the vast amount of existing literature in these areas. Rather, it guides users through the literature via web links and additional reference material for further exploration.
Washington, D.C., Futures Group, Health Policy Initiative, 2010 Sep.  p. (USAID Contract No. GPO-I-01-05-00040-00)The Global Fund to Fight AIDS, Tuberculosis and Malaria is a major funder of HIV programs worldwide, including programs that support orphans and vulnerable children (OVC). Following on a desk review of OVC-related content in Global Fund HIV / AIDS grants, this study in Kenya sought to explore the country-level processes and issues that affect inclusion of OVC goals and strategies in Global Fund country proposals and grants. The study involved interviews with 23 OVC stakeholders, including representatives of government ministries, international agencies, the country coordinating mechanism, principal and sub-recipients, NGOs, faith-based organizations, and OVC network members.
Entre Nous. 2009; (68):6-7.The WHO Regional Office for Europe has been promoting family and community health (FCH) interventions since 1992, including biennial meetings for FCH focal points in Member States. Our FCH activities follow a holistic approach, focusing on the health and development of individuals and families across the life course. For sexual and reproductive health (SRH) this means focusing on overall SRH, health of mothers and newborns, children and adolescents, as well as healthy aging. In recent years, the contribution of health systems to improve health has been re-evaluated in many countries. The WHO European Ministerial Conference on Health Systems “Health Systems, Health and Wealth” in Tallinn, June 2008 has discussed the impact of people’s health and economic growth, and has taken stock of recent evidence on effective strategies to improve the performance of health systems. In line with these developments, the WHO Regional Office for Europe held the FCH focal points meeting in Malta, September 2008 with the aim of contributing to the improvement of FCH in a health systems framework.
Evidence behind the WHO Guidelines: Hospital care for children: What is the appropriate empiric antibiotic therapy in uncomplicated urinary tract infections in children in developing countries?
Journal of Tropical Pediatrics. 2007 Jun; 53(3):150-152.Urinary tract infection (UTI) is an important cause of morbidity and mortality in children. Studies from developing countries show that the around 10% of children with febrile illnesses have UTI . Studies have shown a higher UTI prevalence of 8-35% in malnourished children. The risk of developing UTI before the age of 14 is ~1% in boys and 3-5% in girls. Due to lack of overt clinical features in children less than 2 years, appropriate collection of urine samples and basic diagnostic tests at first-level health facilities in developing countries, UTI are not generally reported as a cause of childhood mortality. If poorly treated or undiagnosed, UTI is an important cause of long-term morbidities such as hypertension, failure to thrive and end-stage renal disease. Unfortunately, many of the organisms responsible for UTI in developing and industrialized countries have become resistant to first-line antimicrobials. It is thus necessary to establish the type of pathogen and antimicrobial sensitivities in the local environment in order to treat the UTI with the appropriate antibiotic. (excerpt)
New York, New York, IPPF, WHR, 2005 Jan.  p. (IPPF / WHR Spotlight on Youth)For more than a decade, the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) and its member associations in Latin America and the Caribbean have worked to address the sexual and reproductive health needs of adolescents and young people. Early on, it became clear that effectively reaching youth would require formulating and adopting a new model of youth-friendly service provision. Creating these services would involve sensitizing and training staff to young people's rights and needs; creating separate waiting rooms, spaces, or clinics where youth would feel comfortable; and developing educational materials that would be attractive to youth. In November 2002, IPPF/WHR held a workshop with medical providers and youth program coordinators from 11 associations in Latin America to improve their capacity to provide youth-friendly sexual and reproductive health (SRH) services. The workshop addressed: understanding how adolescent needs differ from adult needs; viewing SRH and services through the framework of youth rights; components of youth-friendly services and their implementation; communicating with youth about SRH; and review and distribution of tools for strengthening youth-friendly services. (excerpt)
Geneva, Switzerland, UNAIDS, 2004. Prepared for the 4th Meeting of the UNAIDS Global Reference Group on HIV / AIDS and Human Rights, August 23-25, 2004. 5 p.To shed light on the different ways a human rights based approach (HRBA) is understood, this paper draws on the statements made by the UN system, and selected UN agencies, donor governments and international NGOs on how they define HRBAs and how they use them in their work. Because the UN and bilateral donor assistance agencies work under the broad umbrella of development, attention to “human rights based approaches” to development are also explored. The focus is however on how HRBAs are defined, and how they affect (or not) HIV/AIDS programming, and not on development policies per se. (excerpt)
The effect of structural characteristics on family planning program performance in Cote d'Ivoire and Nigeria. [Effet des caractéristiques structurelles sur les performances du programme de planning familial en Côte d'Ivoire et au Nigeria]
Social Science and Medicine. 2003 May; 56(10):2123-2137.This paper uses Côte d’Ivoire and Nigeria survey data on both supply and demand characteristics to examine how structural and demographic factors influence family planning provision and cost. The model, which takes into account the endogenous influence of service provision on average cost, explains provision well but poorly explains what influences service cost. We show that both size and specialization matter. In both countries, vertical (exclusive family planning) facilities provide significantly more contraception than integrated medical establishments. In the Nigeria sample, larger facilities also offer services at lower average cost. Since vertical facilities tend to be large, they at most incur no higher unit costs than integrated facilities. These results are consistent across most model specifications, and are robust to corrections for endogenous facility placement in Nigeria. Model results and cost recovery information point to the relative efficiency of the International Planned Parenthood Federation, which operates large, mostly vertically organized facilities. (author's)
Lancet. 2000 Apr 8; 355(9211):1245.On April 7, 2000, the WHO launched the new blood-safety campaign, which aims to increase the availability of safe blood in developing countries. The organization issued facts and figures on the state of the world's blood supply to spur governments to establish national transfusion systems. However, critics reported that the approach is unworkable in the very regions that it aims to protect. Jean Emmanuel, WHO director of blood safety and clinical technology, claimed that efficacy of transfusion services depends on national coordination and government support. On the other hand, Josef DeCosas, director of the Southern African AIDS Training Program in Zimbabwe, states that the success of organized blood-transfusion services in Zimbabwe depends on the network of roads and telephones and the availability of vehicles and fuel. In other African countries, these organized central blood-transfusion services take an enormous chunk of the health care budget. Furthermore, he stated that the central blood-bank scheme of the WHO would work for only a short while and would eventually fall since it does not complement the rest of the health care system, road system and electric supply.
SAFE MOTHERHOOD. 1996; (20):1.Interventions that are routine at births around the world may be "unhelpful, untimely, inappropriate, and/or unnecessary" according to a WHO expert group. Only interventions that support the process of normal birth should be used and many that are poorly evaluated or potentially harmful should done away with. WHO's Technical Working Group on Normal Birth met in Geneva from March 25 to 29 this year. The group came up with a working definition of what normal birth includes and assessed whether various routine interventions really do bring benefit to mother or infant. In quite a few cases, the group found, interventions that are routine simply cannot be justified. Since most births are normal it is both wasteful and wrong to treat them all as if they were complicated, the members of the Technical Working Group said. (full text modified)
POPULI. 1995 Jan; 22(12):4-5.According to speakers from 45 countries, at a UN General Assembly debate (November 17-18), "a major mobilization of resources and effective monitoring of follow-up actions are needed" in order to implement the Programme of Action of the International Conference on Population and Development (ICPD). Algeria spoke for developing countries in the Group of 77 (G77) and China; commended the Programme's recognition of the key role played by population policies in development and its new approach that centered on people rather than numbers; called for concerted international mobilization to meet ICPD goals for maternal, infant, and child mortality, and access to education; and, since G77 had agreed at the Cairo Conference that developing countries should pay two-thirds of the implementation costs of the Programme, asked industrialized countries to provide the remaining third from new resources, rather than by diversion of existing development aid. It was reported that G77 is preparing a draft resolution which will address distribution of ICPD follow-up responsibilities. Germany spoke for the European Union; commended the shift of focus from demographics and population control to sustainable development, patterns of consumption, women's rights, and reproductive health; and suggested that the World Summit on Social Development and the Fourth World Conference on Women, which will be held in 1995, could carry on the Cairo agenda (a point underscored by Thailand). It was reported that several Western European countries had already pledged substantial increases in population assistance. Indonesia and South Korea addressed increasing South-South cooperation in population and development. Nigeria and the Holy See noted the emphasis on national sovereignty in regard to law, religion, and cultural values. Many called for a global conference on international migration. To ensure a common strategy for ICPD follow-up within the UN system, UN Secretary General Boutros Boutros-Ghali has asked UNFPA Executive Director Nafis Sadik to chair an inter-agency task force. All UN agencies and organizations have been asked to review how they will promote implementation of the Programme of Action.
UNDP study addresses world's victimization, neglect and human rights abuse of people with disabilities. [Press release].
[Unpublished] 1993 Dec 3.  p.A study entitled Prejudice and Dignity: An Introduction to Community-Based Rehabilitation by Dr. Einar Helander, Senior Program Coordinator for UNDP's Interregional Programme for Disabled People, reveals the distressing situation of the disabled worldwide, and recommends measures that need to be taken both in industrial and developing countries to address this problem. People with disabilities now comprise 5% of the global population and in 1992 there were 290 million people worldwide with moderate or severe disabilities. Adding to this approximately 23,000 a day, the number of people who are disabled is expected to reach 573 million by the year 2025. With rehabilitation, people with disabilities are enabled to take care of themselves. Governments, however, have often relied on charitable organizations to provide traditional less than satisfactory institutional-based care. A review of existing services in 57 such institutions in an Asian country showed insufficient funding, deplorable physical conditions, apathetic and/or abusive care, untrained or poorly-trained staff, unskilled management, deficient programs, and lack of family involvement. Recently the involvement of a strong organized movement of the disabled themselves has made governments increasingly aware of the problem and has somewhat improved their situation in developed countries. The study proposes a rehabilitation program with equality, social justice, solidarity, and integration. This community-based rehabilitation approach advocates the creation of a caring society by the local community members within a permanent system in which governments provide training for personnel, offer technical supervision, and operate the referral system. A current collaborative endeavor in Ghana, between a number of UN agencies, the national government, several NGOs, the local community, and the disabled themselves provides community-based services for people with disabilities. A community in Portugal all but replaces its geriatric hospital with in-home care provided to the elderly by local volunteers.
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 Mar; 37(3):229.This article discusses the components involved in "appropriate technology" as it applies to maternal and child health. The World Health Organization (WHO) defines appropriate technology as methods, procedures, techniques, and equipment that are scientifically valid, can be adapted to local needs, acceptable to those for whom they are used, and can be afforded and maintained by the community or country. "Scientifically valid" refers to the technology's effectiveness in achieving its objective. As the article notes, obstetric and pediatric procedures have a history of being introduced into clinical practice without undergoing careful evaluation through clinical trials. If a technology is to "adapt to local needs," it must address the public health's rather than rare diseases of academic interest. The "acceptability" criterion, a basic health care principle, often requires health care professionals to carefully explain procedures or techniques to consumers, as well as the use of consent forms. The issue of "maintenance and cost" arises because medical equipment developed and tested in industrialized countries if often unsuitable for developing countries, and the purchase of such technologies can waste the resources of developing countries. The concept of appropriate technology has several implications for maternal and child health, including: antenatal, delivery, and postnatal practices should be justified in terms of quantitative outcome measures before general acceptance; and properly conduced epidemiological studies which take into account cultural and economic factors should provide the basis for appropriate maternal-child health care practices. Health care professionals should encourage adherence to the principle of appropriate technology.
Social Science and Medicine. 1988; 26(9):971-7.The polarization between selective and comprehensive primary health care is examined in light of the 1978 conference at Alma Ata. Criticism of UNICEF is countered by drawing directly on UNICEF's own work in the field and its own record of success, even at a time when developing countries are battling severe economic constraints and health budgets are being slashed--a contingency not foreseen at Alma Alta. World Health Organization evaluations of both the Expanded Program of Immunization (EPI) and Oral Rehydration Therapy (ORT) show that accelerated programs develop best with a good health infrastructure. The challenge is to develop priority programs in such a way as to build on or strengthen this infrastructure. An encouraging development is that, in the 1980s, a diversity of ccountries have tried different approaches to accelerate health action, mobilizing resources and people in ways markedly different from those tried earlier. At the same time, major changes have been taking place in the health systems of countries such as China, which had earlier set the models on which the Alma Alta view of primary health care had been built. Flexibility is the key in adapting national priorities to local programs. The point is made that international agencies should be careful to limit themselves to advocacy and support.
Social Science and Medicine. 1988; 26(9):963-9.UNICEF is dangerously mistaken in believing that its present emphasis on selective primary health care over comprehensive primary health care is a precursor or 'leading edge' of comprehensive primary health care. The approach of UNICEF--diffusion of a package of technologies by campaigns organized from the top down--is more likely to undermine the social basis for comprehensive care. The kinds of implementation UNICEF has chosen in order to minimize costs and maximize impact on child mortality, namely 'social marketing' via mass media and massive, ad hoc delivery systems seriously undermine the development of grassroots organization among parents and primary health care workers. Indigenous, local organizations are distorted and limited to conduits of a delivery system. Needs are defined outside the communities affected. In addition, UNICEF's so-called revolution has in common with other selective approaches an ideology accepting as inevitable the health effects of economic crisis in the 1980s, further undermining the confidence of local groups and health workers who might otherwise conceive of their desire to control health conditions as a right. The UNICEF interventions popularly known as GOBI-FFF are 'targeted' at individuals, in particular 'ignorant' mothers. As such, they are especially destructive to the process of group formation and self-organization of the poor around their just demands for water and sanitation, land, shelter, and employment. UNICEF's GOBI should either be abandoned or integrated into comprehensive primary health care programs that put parents and local workers in control and that emphasize continuing political struggle for health rights.
In: Jain SC, Kanagaratnam K, Paul JE, ed. Management development in population programs. Chapel Hill, University of North Carolina, School of Public Health, Dept. of Health Administration and Carolina Population Center, 1981. 113-51.This case study examines the management development aspect of the Korean national family planning program which was initially adopted in 1962. The nation's goal in the 1st 10 years of the program was to reduce the rate of population growth from 2.9-2.0%. Subsequent targets were established to reduce the growth rate to 1.5% by 1976 and 1.3% by 1981. Recent census figures indicate that these latter figures were not reached. The total fertility rate declined from 6.0 in 1960 to 2.7 in 1978, a 55% decline. The age specific fertility rate also declined except for women between 25-29 years of age. Program costs during the last 18 years totaled about $126.7 million; 80% of these funds came from the government and the rest from foreign assistance. 3811 full time employees were engaged in the program in 1979; 4.9% at the central level, 8.1% at the provincial level, and 87% at the urban and county level. 69% are considered family planning workers. Between 1962-79, 6.1 million cumulative acceptors have received contraceptive services. The IUD was the principal method of contraception until 1976 when female sterilization services were introduced. The contraceptive practice rate has increased from 9-49% between 1964-78. Organization of the program is structured on a national, provincial, and local basis. Assessment of the program indicates that there has been success but the following problems still remain in the, 1) rural oriented program structure, 2) high discontinuation rates of contraceptive usage and inadequate follow-up, 3) high turnover of field workers, 4) difficulties in using local civil administration services, 5) poor quality research, 6) weak management training, and 7) poor relationships among special projects. Other program management problems exist in planning, resource allocation, training, use of private clinics, coordination, interagency coordination, program supervision, recording systems, and overall program evaluation. Emphasis is placed on the operational and managerial capacity of the program managers to successfully implement family planning programs. Improvements in the current managerial system and the role of international agencies are discussed.
Social Policy. 1975 Nov/Dec; 6(3):19-23.Failure of family planning efforts in the Third World is inherent in the assumptions of the program. From the beginning family planning has been viewed as a specialized function which can be pursued in isolation from its socioeconomic context. Even though it touches on sex, reproduction, and family life, the most emotion-laden segments of human behavior, the approaches to family planning have been rationalistic. This has been compounded by the fact that most motivators have been college-trained young people and not traditional village leaders. Both the message and the medium resemble a college seminar, which helps preserve the empire of the professionals. Before people can be induced to come to family planning clinics, they have to feel the health services are reliable. In many instances, however, a bride has to be paid to see the doctor and medicines go into the black market. Seldom do family planners point out the necessity of reforming incompetent, arrogant, and corrupt public services. At the Bucharest population conference the Third World nations pointed out that the standards of living of the masses must be improved before family planning will come about. However, between a society and project there is an intermediate institution, the bureaucracies and organizations, which must be reformed . Unless these services are fair, efficient, and accountable, people will not trust their advice. It is popular to blame the failure of family planning on the resistance of the masses, yet the poor and illiterate have adopted tea, Western dress, radios and loudspeakers, vaccinations, and fertilizers -- all over initial objections. If something is of value to them, people will adopt it. Family planning has also become the symbol of outside intervention to the emerging middle class and it is popular to criticize these efforts because they are backed by international organizations. Unfortunately these international efforts merely reinforce the self-seeking careerists who use the conferences and symposiums for international travel, honor, and opportunities to reinforce their position in the power structure. To be effective, family planning programs must be developed by people familiar with local traditions in a setting which will make best use of the circumstances. By appropriating the leadership Western organizations are choking off such local initiative.
In: Brem S, ed. Message from Calcutta: highlights of the 3rd International Congress of the World Federation of Public Health Associations [WFPHA] and the 25th Annual Conference of the Indian Public Health Association. Washington, D.C., WFPHA Secretariat, 1982. 52-66.The Declaration and Recommendations of the Alma Ata Conference were the culmination of a series of activities in many countries in favor of the primary health care concept. The role of the World Health Organization is to support national efforts to improve health situations through collective definition by member states of health goals, the adoption of principles for realizing them, and the promotion of reforms in the health and socioeconomic sectors that will enable the goals to be attained. The relevance of primary health care to those objectives is obvious. Despite differing interpretations of what primary health care really is, the most urgent need is for a workable strategy for implementing primary health care in each country as part of a self-sustaining process of health development rather than for further intellectual efforts at conceptualizing primary health care. Constraints on the implementation of primary health care include fragmentation of health care delivery systems and disregard of the real needs of the people to be served. The primary health care concept on the other hand makes it possible to develop a comprehensive and systematic approach to health services. Requirements for development of primary health care systems include political commitment and the will to effect needed reforms, a progressive transferrence of health care responsibility from specialized professionals to the population at large, the adaptation of appropriate technologies, multisectoral coordination at the national and local levels, and a referral system uniting the different levels of health services. The problem is to initiate primary health care activities while fulfilling these requirements. Support for primary health care by international nongovernmental organizations in such areas as assistance to corresponding national nongovernmental organizations and facilitation of exchanges of experiences and information should be viewed not merely as a challenge but as a moral duty.
Contact. 1983 Oct; (75):1-16.Investigates health planners' assumptions about community particiation in health care. Primary health care aims to make essential health care accessible to all individuals in the community in an acceptable and affordable way and with their full participation. It is the strategy propagated by the World Health Organization to provide health for everyone by the year 2000. Community participation is seen as the key to primary health care and has raised many assumptions and expectations among health planners. Community people are seen as a vast untapped resource which can help to reduce the cost of health care by providing additional manpower. It is also expected that community people want to participate in their own health care because they wish to serve their community and to have a part in decisions which affect them. In the early 1970's, programs were developed out of church-related efforts. They pioneered many of the ideas which became principles of primary health care. The church-related programs were nongovernmental and therefore flexible. They had the same goal of letting the community take responsibility for their own health care; program planners were primarily medical people trained in Western medicine. The planners were concerned with the plight of the poor. However, the programs tended to reflect planners' hopes for, rather than the community's understanding of, the community health problem. The author concludes that the assumptions that planners make about their programs need to be critically analyzed. Investigations need to be made into community perceptions and expectations of their role in health programs. Studies need to be undertaken to identify the potentials and problems of community participation and the record of established community health care programs needs to be examined.