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Design and initial implementation of the WHO FP umbrella project - to strengthen contraceptive services in the sub Saharan Africa.
Reproductive Health. 2017 Jun 15; 14(1):1-6.BACKGROUND: Strengthening contraceptive services in sub Saharan Africa is critical to achieve the FP 2020 goal of enabling 120 million more women and girls to access and use contraceptives by 2020 and the Sustainable Development Goals (SDG) targets of universal access to sexual and reproductive health (SRH) services including family planning by 2030. METHOD: The World Health Organization (WHO) and partners have designed a multifaceted project to strengthen health systems to reduce the unmet need of contraceptive and family planning services in sub Saharan Africa. The plan leverages global, regional and national partnerships to facilitate and increase the use of evidence based WHO guidelines with a specific focus on postpartum family planning. The four key approaches undertaken are i) making WHO Guidelines adaptable & appropriate for country use ii) building capacity of WHO regional/country staff iii) providing technical support to countries and iv) strengthening partnerships for introduction and implementation of WHO guidelines. This paper describes the project design and elaborates the multifaceted approaches required in initial implementation to strengthen contraceptive services. CONCLUSION: The initial results from this project reflect that simultaneous application these approaches may strengthen contraceptive services in Sub Saharan Africa and ensure sustainability of the efforts. The lessons learned may be used to scale up and expand services in other countries.
Geneva, Switzerland, WHO, 2016. 64 p.This report is a companion to the World Health Organization’s 2016 guide for “Introducing HPV Vaccine Into National Immunization Programmes.” It summarizes experiences introducing HPV vaccine and provides guidance for introduction.
Geneva, Switzerland, UNAIDS, 2016.  p.This report highlights best practices and provides examples of countries that are already coming close to achieving the 90–90–90 targets, which are that 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads. The report outlines steps that are needed to expedite gains towards each of the three 90s. Technological and service delivery innovations rapidly need to be brought to scale, communities must be empowered to lead the push to end the epidemic, new resources must be mobilized to reach the final mile of the response to HIV and steps must urgently be taken to eliminate social and structural barriers to service access.
Applying lessons learned from the USAID family planning graduation experience to the GAVI graduation process.
Health Policy and Planning. 2015 Jul; 30(6):687-95.As low income countries experience economic transition, characterized by rapid economic growth and increased government spending potential in health, they have increased fiscal space to support and sustain more of their own health programmes, decreasing need for donor development assistance. Phase out of external funds should be systematic and efforts towards this end should concentrate on government commitments towards country ownership and self-sustainability. The 2006 US Agency for International Development (USAID) family planning (FP) graduation strategy is one such example of a systematic phase-out approach. Triggers for graduation were based on pre-determined criteria and programme indicators. In 2011 the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunizations) which primarily supports financing of new vaccines, established a graduation policy process. Countries whose gross national income per capita exceeds $1570 incrementally increase their co-financing of new vaccines over a 5-year period until they are no longer eligible to apply for new GAVI funding, although previously awarded support will continue. This article compares and contrasts the USAID and GAVI processes to apply lessons learned from the USAID FP graduation experience to the GAVI process. The findings of the review are 3-fold: (1) FP graduation plans served an important purpose by focusing on strategic needs across six graduation plan foci, facilitating graduation with pre-determined financial and technical benchmarks, (2) USAID sought to assure contraceptive security prior to graduation, phasing out of contraceptive donations first before phasing out from technical assistance in other programme areas and (3) USAID sought to sustain political support to assure financing of products and programmes continue after graduation. Improving sustainability more broadly beyond vaccine financing provides a more comprehensive approach to graduation. The USAID FP experience provides a window into understanding one approach to graduation from donor assistance. The process itself-involving transparent country-level partners well in advance of graduation-appears a valuable lesson towards success. Published by Oxford University Press 2014. This work is written by US Government employees and is in the public domain in the US.
Geneva, Switzerland, World Health Organization [WHO], 2011.  p.The thirteen case studies contained in this publication were commissioned by the research node of the Knowledge Network on Priority Public Health Conditions (PPHC-KN), a WHO-based interdepartmental working group associated with the WHO Commission on Social Determinants of Health. The case studies describe a wealth of experiences with implementing public health programmes that intend to address social determinants and to have a great impact on health equity. They also document the real-life challenges in implementing such programmes, including the challenges in scaling up, managing policy changes, managing intersectoral processes, adjusting design and ensuring sustainability.
Geneva, Switzerland, World Health Organization, [WHO], 2009. 48 p. (Analytic Case Studies. Initiatives to Increase the Use of Health Services by Adolescents)This case study describes how the Government of Mozambique scaled up its successful youth HIV prevention and sexual and reproductive health program to a national level. Geared toward developing-country governments and nongovernmental organizations, the case study provides a technical overview of the program and its interventions, a detailed description of the scale-up process and lessons learned, and the program's achievements.
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.
Reproductive health surveillance in the US-Mexico border region: beyond the border (and into the future) [editorial]
Preventing Chronic Disease. 2008 Oct; 5(4):A109.This editorial examines reproductive health surveillance in the US- Mexico border region. It offers improvements for reproductive health data system methods and recommendations for sustainability of the project. It also proposes revisions to the Brownsville-Matamoros Sister City Project for Women’s Health (BMSCP) in the following areas: maternal birthing experiences, women’s health over the life course, migration history, acculturation/cultural identity/border region identity, Latina reproductive health, and MCH policy relevance.
Washington, D.C., World Bank, 2008.  p.The World Bank is committed to support Sub-Saharan Africa in responding to the HIV/AIDS epidemic. This Agenda for Action (AFA) is a road map for the next five years to guide Bank management and staff in fulfilling that commitment. It underscores the lessons learned and outlines a line of action. HIV/AIDS remains - and will remain for the foreseeable future - an enormous economic, social, and human challenge to Sub-Saharan Africa. This region is the global epicenter of the disease. About 22.5 million Africans are HIV positive, and AIDS is the leading cause of premature death on the continent. HIV/AIDS affects young people and women disproportionately. Some 61 percent of those who are HIV positive are women, and young women are three times as likely to be HIV positive than are young men. As a result of the epidemic, an estimated 11.4 million children under age 18 have lost at least one parent. Its impact on households, human capital, the private sector, and the public sector undermines the alleviation of poverty, the Bank's overarching mandate. In sum, HIV/AIDS threatens the development goals in the region unlike anywhere else in the world. (excerpt)
Washington, D.C., World Bank, Human Development Network, Health, Nutrition and Population Team, 2007 Aug. 51 p. (Policy Research Working Paper No. 4295)Tuberculosis is the most important infectious cause of adult deaths after HIV/AIDS in low- and middle-income countries. This paper evaluates the economic benefits of extending the World Health Organization's DOTS Strategy (a multi-component approach that includes directly observed treatment, short course chemotherapy and several other components) as proposed in the Global Plan to Stop TB, 2006-2015. The authors use a model-based approach that combines epidemiological projections of averted mortality and economic benefits measured using value of statistical life for the Sub-Saharan Africa region and the 22 high-burden, tuberculosis-endemic countries in the world. The analysis finds that the economic benefits between 2006 and 2015 of sustaining DOTS at current levels relative to having no DOTS coverage are significantly greater than the costs in the 22 high-burden, tuberculosis-endemic countries and the Africa region. The marginal benefits of implementing the Global Plan to Stop TB relative to a no-DOTS scenario exceed the marginal costs by a factor of 15 in the 22 high-burden endemic countries, a factor of 9 (95% CI, 8-9) in the Africa region, and a factor of 9 (95% CI, 9-10) in the nine high-burden African countries. Uncertainty analysis shows that benefit-cost ratios of the Global Plan strategy relative to sustained DOTS were unambiguously greater than one in all nine high-burden countries in Africa and in Afghanistan, Pakistan, and Russia. Although HIV curtails the effect of the tuberculosis programs by lowering the life expectancy of those receiving treatment, the benefits of the Global Plan are greatest in African countries with high levels of HIV. (author's)
Decentralising HIV M&E in Africa. Country experiences and implementation options in building and sustaining sub-national HIV M&E systems, in the context of local government reforms and decentralised HIV responses.
Washington, D.C., World Bank, Global HIV / AIDS Program, 2007 Aug. 10 p. (HIV / AIDS M&E -- Getting Results)In operationalising the 3rd of the Three Ones - One HIV M&E system, a growing number of countries in Africa are opting to decentralise their national HIV monitoring and evaluation (M&E) systems. This decentralization is primarily driven by other decentralisation processes happening within government, and by the fact that the HIV response itself is changing towards less centralized intervention and increased community ownership. Decentralisation of national HIV M&E systems is an arduous and resource intensive process, but experience has shown that it is essential to decentralise M&E functions as HIV services are rolled out. This note summarizes the experience of countries that are decentralizing their national HIV M&E systems and describes how it can be done. It defines decentralization, discusses the rationale and benefits of decentralizing the HIV response, and key factors to take into account when doing so. Decentralizing the HIV M&E system is linked to decentralizing the HIV response. The note describes how each of the 12 components of a HIV M&E system can be decentralized, with country examples. (author's)
Geneva, Switzerland, UNAIDS, .  p.Funding for AIDS has grown significantly over the past decade. In 2007, US$10 billion is expected to be available for the AIDS response - about one third coming from developing countries - compared to less than US$300 million in 1995. The substantial increase in financial resources has allowed countries to scale up their AIDS response with the ultimate goal of achieving universal access to HIV prevention, treatment, care and support. However, many countries face difficulties in effectively implementing large-scale grants made available by funding bodies such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank, and bilateral actors. They require rapid and adequate technical support to effectively implement AIDS programmes. To address this implementation challenge, UNAIDS has taken a leading role in "making the money work" in countries. It has invested significant resources over the past two years in strengthening countries' national AIDS programmes, particularly through the establishment of Technical Support Facilities in five regions. (excerpt)
Woking, England, Plan, 2004 Oct. 52 p. (Working Paper Series)Safe water and environmental sanitation services (by which we mean solid and liquid waste facilities, vector and pest control as well as food hygiene) are vital for people's dignity and health, and are especially important in ensuring the healthy development of children. The lack of such facilities is responsible for over two million child deaths each year. This working paper aims to support Plan staff by looking at the whole issue of water and environmental sanitation and enable the organisation as a whole to direct resources in an integrated and cost-effective way. By doing so, we will be able to play a crucial role in achieving the Millennium Development Goals and in the 'International Decade for Action, Water for Life (2005-15)'. There is a clear link between poverty, poor water quality and a lack of environmental sanitation facilities. This working paper aims to position Plan's approach to water and environmental sanitation within the context of the broader international development goals andwithin Plan's own commitment to child centred community development. From this standpoint, it then looks in more detail at the main challenges linked to water and environmental sanitation and in each case details how Plan staff can put our approach into practice and the main issues to bear in mind while doing so. Further important issues to consider are also included. (excerpt)
Health Policy and Development. 2004 Aug; 2(2):131-135.International agencies are beginning a rapid scaling up of antiretroviral distribution programs in Africa. Some are particularly looking for "faith-based organizations" (FBOs) as partners. The new initiatives may offer both unprecedented opportunities and some dangers for FBOs who wish to join in. The opportunities include increasing our capacity to provide not only HIV/AIDS care but other aspects of health care, and a potential for increased communication and cooperation between Christian organizations. The dangers include the likely widespread appearance of antiretroviral resistance; long term sustainability; negative impact on other aspects of HIV care and prevention; indirect costs to FBOs; corruption; encouragement of a culture of money and power, drawing FBOs away from their perceived missions; overextension; and harmful competition among FBOs. Organizations should be aware of the opportunities and dangers, and review their own calling and mission, before embarking on large-scale, externally-funded programs of ARV distribution. (author's)
Bethesda, Maryland, Abt Associates. Private Sector Partnerships-One [PSP-One], 2006 Dec. 48 p. (Technical Report No. 6; USAID Contract No. GPO-I-00-04-00007-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ADI-754)Government health sectors in many countries face an uphill battle to reach the Millennium Development Goals (MDGs) set for 2015. In the last six years, Ministries of Health (MOHs) in many less developed countries (LDCs) have been unable to invest sufficiently in their health systems. To achieve the MDGs despite inadequate resources, new approaches for delivering critical clinical services must be considered. This paper explores the potential for private-sector midwives to provide services beyond their traditional scope of care during pregnancies and births to address shortcomings in LDCs' ability to reach MDGs. This paper examines factors that support or constrain private practice midwives' (PPMWs') ability to offer expanded services in order to inform the policy and donor communities about PPMWs' potential. Data was collected through literature reviews, stakeholder interviews, and field-based, semi-structured interviews in Ghana, Indonesia, Peru, Uganda, and Zambia. Ghana, Indonesia, and Uganda were chosen because they are countries where PPMWs provide expanded services. Peru and Zambia were selected as examples where midwives have struggled to develop private practices or they provide expanded services despite issues about midwives' roles and legal sanctions for private practices. (excerpt)
International Workshop on Food Aid: Contributions and Risks to Sustainable Food Security -- Berlin Statement.
Food and Nutrition Bulletin. 2004; 25(1):89-92.For decades, food aid has been a contentious instrument for addressing hunger and food insecurity. The workshop carefully considered the pros and cons of food aid on the basis of past and current evidence, including practitioners' experiences. In particular, the workshop re-visited food aid in view of the perspectives of the ongoing WTO trade negotiations, the experience gained with the Food Aid Convention, the initiatives related to the human right to adequate food resulting from the World Food Summit, and the challenges of health crises, i.e. HIV/AIDS. The "Statement" results from an open and participatory process of working groups, and from more comprehensive plenary presentations by main actors in food aid (recipient governments, bilateral and multilateral donors, international agencies, NGOs). While reflecting a fair amount of consensus, the individual workshop participants and delegates cannot be held responsible for the "Statement". It is meant to serve stimulation of further discussion for innovation and improvement of key aspects of food aid for sustainable food security. (excerpt)
Food and Nutrition Bulletin. 2001; 22(4):352-356.In several Eastern and Southern African countries, between one-third and one-half of the children are vitamin A deficient. Not just one strategy, but a combination of supplementation, fortification, and dietary diversification will provide the solution to the elimination of vitamin A deficiency. Food diversification in general is limited by increasing poverty and household food insecurity. Supplementation coverage rates increased from an average of 22% to 68% during the last four years. This was mainly due to integration of supplementation into national immunization days. Now the challenge is to integrate supplementation into sustainable delivery systems. Several countries have started or are planning maize and/or sugar fortification initiatives, but most of the experience so far has been on a pilot scale, and little is known about the impact of the interventions. There is a need to develop strategies for vitamin A supplementation and fortification of different foods to reach all areas and individuals in a country. (author's)
Notes from the Field. 2002 Jan; (12): p..Paraguay is usually overlooked by international donors because it's geographically isolated and dwarfed by its large, high-needs neighbors like Bolivia, Brazil and Argentina. But the reproductive health needs in Paraguay are as great if not greater than in other countries. It has the highest fertility rate in South America, 4.7 [children per woman], teen pregnancy is high, and maternal mortality is also high. CEPEP is managing to do a lot with few resources. In addition to four of its own clinics, it works with independent "associated clinics," institutions and professionals to increase access to sexual and reproductive health services and contraceptives. When looking at quality, CEPEP distinguishes between "calidad" and "calidez," and emphasizes both. "Calidad" refers to the quality of clinical procedures, infection prevention, etc., and "calidez" [warmth] refers to client satisfaction issues like courtesy, expedience and clinic environment. Through this focus on quality, CEPEP hopes to increase clinic attendance and sustainability. It seems to be working: One of the clients I spoke with had traveled four hours to get to the clinic. She said there was a Ministry of Health clinic closer, but she chose to come to CEPEP. (excerpt)
Annals of Tropical Medicine and Parasitology. 2001 Dec; 95(8):741-754.Owing to the breakdown of health systems, mass population displacements, and resettlement of vulnerable refugees in camps or locations prone to vector breeding, malaria is often a major health problem during war and the aftermath of war. During the initial acute phase of the emergency, before health services become properly established, mortality rates may rise to alarming levels. Establishing good case management and effective malaria prevention are important priorities for international agencies responsible for emergency health services. The operational strategies and control methods used in peacetime must be adapted to emergency conditions, and should be regularly re-assessed as social, political and epidemiological conditions evolve. During the last decade, research on malaria in refugee camps on the Pakistan± Afghanistan and Thailand± Burma borders has led to new methods and strategies for malaria prevention and case management, and these are now being taken up by international health agencies. This experience has shown that integration of research within control programmes is an efficient and dynamic mode of working that can lead to innovation and hopefully sustainable malaria control. United Nations' humanitarian and non-governmental agencies can play a significant part in resolving the outstanding research issues in malaria control. (author's)
Potential interventions for the prevention of childhood pneumonia in developing countries: improving nutrition.
American Journal of Clinical Nutrition. 1999 Sep; 70(3):309-320.Acute respiratory infections are the leading cause of childhood death in developing countries. Current efforts at mortality control focus on case management and immunization, but other preventive strategies may have a broader and more sustainable effect. This review, commissioned by the World Health Organization, examines the relations between pneumonia and nutritional factors and estimates the potential effect of nutritional interventions. Low birth weight, malnutrition (as assessed through anthropometry), and lack of breast-feeding appear to be important risk factors for childhood pneumonia, and nutritional interventions may have a sizeable effect in reducing deaths from pneumonia. For all regions except Latin America, interventions to prevent malnutrition and low birth weight look more promising than does breast-feeding promotion. In Latin America, breast-feeding promotion would have an effect similar to that of improving birth weights, whereas interventions to prevent malnutrition are likely to have less of an effect. These findings emphasize the need for tailoring interventions to specific national and even local conditions. (author's)
Geneva, Switzerland, UNAIDS, 1997 Apr.  p. (UNAIDS Best Practice Collection; UNAIDS Technical Update)UNAIDS understands a "mobilized community" to have most or all of the following characteristics: members are aware -- in a detailed and realistic way -- of their individual and collective vulnerability to HIV/AIDS; members are motivated to do something about this vulnerability; members have practical knowledge of the different options they can take to reduce their vulnerability; members take action within their capability, applying their own strengths and investing their own resources -- including money, labour, materials or whatever else they have to contribute; members participate in decision-making on what actions to take, evaluate the results, and take responsibility for both success and failure; the community seeks outside assistance and cooperation when needed. (excerpt)
New York, New York, UNICEF, 2005 Apr.  p.The past decade has seen UNICEF take the very best practices from its long and productive history and apply them in the service of today's children who live in a world previously unimagined. A complex world marked by intractable poverty, pervasive political instability, serial conflicts, HIV and AIDS. A world where there are few, if any, single causes, easy solutions or quick fixes. At $1.7 billion in 2004, UNICEF's income almost doubled in 10 years. The money, all voluntary contributions, was invested in programmes that prioritized early childhood, immunization, girls' education, improved protection and HIV and AIDS. Global progress on many fronts has been phenomenal: Mortality rates for children under five have dropped by around 15 per cent since 1990; Deaths from diarrhoea, one of the major killers of children under five, have been cut in half since 1990; Polio, once a deadly killer, is nearly eradicated; Measles deaths dropped by nearly 40 per cent; More children are in school than ever before; National laws and policies to better protect children have been enacted in dozens of countries. And, perhaps most profoundly of all, nearly every country in the world has ratified the Convention on the Rights of the Child. (excerpt)
Geneva, Switzerland, UNAIDS, 2005 Aug. 35 p. (UNAIDS/05.18E)The primary goal of this paper is to energize and mobilize an intensification of HIV prevention with an ultimate aim of universal access to HIV prevention and treatment. The paper defines the central actions that must be taken to arrest the spread of new HIV infections and to turn the tide against AIDS. It identifies what needs to be done to speedily and effectively bridge the HIV prevention gap, building on synergies between HIV prevention and care, and to ensure the sustainability of HIV treatment scale-up in the present context. It highlights the role of UNAIDS in relation to intensifying HIV prevention and points to ways in which jointly supportive action can be achieved. This paper is directed towards all those who have a leadership role in HIV prevention, treatment and care. Its foundations lie in the Declaration of Commitment on HIV/AIDS endorsed by all member states of the United Nations in June 2001 and the Global Strategy Framework on HIV/AIDS endorsed by the 10th meeting of the UNAIDS Programme Coordinating Board in Rio de Janeiro in December 2000. The paper also builds upon commitments expressed in the International Conference on Population and Development (ICPD) Programme of Action and the Beijing Platform for Action, together with their follow-up reviews. It highlights significant opportunities for a strengthening of HIV prevention in the context of antiretroviral programmes such as the "3 by 5" Initiative to expand HIV antiretroviral treatment in developing countries. (excerpt)
Health Promotion International. 2005; 20(1):1-6.Millions of young people in the developing world never achieve two decades of life, let alone seven, and so it is with mixed feelings that Health Promotion International celebrates its 20th birthday this issue. Much has been written and said about the antecedents and milestones of the health promotion phenomenon, but what is clear from history is that any rapidly growing movement or organization needs to re-invigorate its purpose for existence as well as build its capacity for success. This is vital if health promotion is to be truly a response to both national and global challenges. The forthcoming Bangkok Conference and foreshadowed Bangkok Conference will seek to fill this gap. (excerpt)
Forced Migration Review. 2005 Nov; (24):61.The UN Office for the Coordination of Humanitarian Affairs (OCHA) reports that there are currently 1,100 vehicles used by the 81 agencies meeting the needs of over two million displaced people in Darfur. Are the vehicles the right type to do the job as safely and reliably as possible? How should they be maintained in a place where there are no garages or mechanics trained to service imported high-tech trucks? Do drivers understand how to use their vehicles in the very insecure environment along roads – if they exist at all – that are among the worst in the world? If more attention were paid to the procurement, management and maintenance of vehicle fleets, could agencies use fewer vehicles and ensure they are not worn out after two years – the estimated life-span of trucks used in the rigorous Darfur conditions? (excerpt)