Your search found 63 Results

  1. 1

    Use of maternity register data in Benin.

    Kodjogbé N; Fourn L; Stanton C

    Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center [CPC], MEASURE Evaluation, 2003 Aug. [34] p. (USAID Cooperative Agreement No. HRN-A-00-97-00018-00)

    This report describes a study of the content and use of routinely collected data from maternity registers for the purposes of monitoring for maternal and newborn health at the health facility level in two departments of Benin. Specifically, the objectives of the study are to: Describe the scope, quality, completeness and use of the information collected in maternity registers in the departments of Atlantique and Zou; Calculate indicators which reflect clinical practices and outcome, such as: the cesarean section rate (for health facilities with surgical capacity), the referral rate, the rate of referred patients who are treated at the referral site, the episiotomy rate, the rate of “directed” deliveries (i.e., deliveries where oxytocics were used) and stillbirth and maternal death rates in health facilities in the departments of Atlantique and Zou; Validate the data regarding cesarean section operations recorded in the delivery register against that recorded in the surgical register; Describe the process by which data are recorded in the maternity registers. (excerpt)
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  2. 2

    Bangladesh: contraceptive logistics system. Review of accomplishments and lessons learned.

    Kinzett S; Bates J

    Arlington, Virginia, John Snow [JSI], Family Planning Logistics Management [FPLM], 2000. x, 67 p. (USAID Contract No. CCP-C-00-95-00028-00)

    This report documents the status of technical assistance provided by the USAID-funded Family Planning Logistics Management project to the Bangladesh Family Planning Program in developing a countrywide contraceptive logistics system. A study conducted in November 1999 to evaluate the impact of technical assistance on logistics management and contraceptive security is detailed. The report concludes with findings from the study, lessons learned, and recommendations to continue improvements in the system. (author's)
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  3. 3

    A qualitative evaluation of the impact of the Stepping Stones sexual health programme on domestic violence and relationship power in rural Gambia.

    Shaw M

    [Unpublished] 2002. Presented at the 6th Global Forum for Health Research, Arusha, Tanzania, November, 2002. [6] p.

    The work presented here came from a preliminary evaluation and was followed up by several applications for funding to carry out a prospective community randomised trial. So far none have been accepted. This may be partly due to the fact that such an evaluation runs against current funding culture. Because of it's holistic approach and focus on core skills in couple communication, the Stepping Stones programme is neither just an HIV prevention or just a domestic violence prevention programme, but has something to contribute to both (and would see the two problems as inter-related). Funding on the other hand is often organised 'vertically' by problem, and evaluation criteria may differ from one problem to another. For example donors who fund evaluation of HIV prevention activities usually require a biological outcome, and hence concentrate on geographical areas with high HIV incidence where the epidemic is seen as most severe. Where sociological outcomes are used this tends to be either the use of quantitative tools to assist in risk factor analysis, or qualitative tools which can assist in replication of the intervention. As such they are usually considered secondary to the primary (biological) outcomes. The hope here is that these interventions may provide a 'blueprint' which can subsequently be applied in low prevalence areas. However by concentrating on proximal rather than distal determinants of infection these blueprints may only capture 'half the story', leading to locally inappropriate assumptions about which groups or behaviours HIV prevention programmes should target. An example would be the demand by some donors that interventions should have an exclusive focus on adolescents, when in a polygamous society adolescent's risk is often mediated by the older generation. On the other hand community interventions against domestic violence are forced to rely on self reported behaviour (perhaps backed up by participant observation) as an outcome. If the intervention is also a reflexive process then qualitative studies become essential to describe a process of change which contains empowerment, group dynamic and normative dimensions. The locally appropriate nature of such interventions is used to justify participatory interventions as being more effective than didactic approaches, but at the same time in the epidemiological-evaluation paradigm it can be seen as problematic, because (I would argue incorrectly) a participatory process is assumed to generate a wide spectrum of outcomes (low replicability), which mitigates against quantitative evaluation. (excerpt)
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  4. 4

    Primary schooling in sub-Saharan Africa: recent trends and current challenges.

    Lloyd CB; Hewett PC

    New York, New York, Population Council, 2003. 39 p. (Policy Research Division Working Paper No. 176)

    At the dawn of the twenty-first century we estimate that more than 37 million young adolescents aged 10–14 in sub-Saharan Africa will not complete primary school. Our estimates are based on data from nationally representative Demographic and Health Surveys from 26 countries, collectively representing 83 percent of the sub-Saharan youth population. This number is nearly twice the entire population of children aged 10–14 in the United States, virtually all of whom will complete primary school. Reducing the number of uneducated African youth is a primary objective of the United Nations as laid out in the Millennium Development Goal for education, which sets 2015 as the target year for all children to have completed primary school and for boys and girls to have equal access to education at all levels. Achieving this goal will require a level of international resources and commitment not yet seen; it will also require better tools for monitoring educational progress at the country level. UNESCO draws on enrollment data derived from national management information systems to create two complementary indicators for assessing progress toward universal education: the net primary enrollment ratio and the grade four completion rate. Evaluation of these indicators suggests that they provide, at best, an incomplete and, at worst, a biased picture of levels, trends, and gender differences in school participation and grade attainment. Data from the DHS present a different and, arguably, more realistic picture of trends in schooling and current attendance among sub-Saharan African youth. Whereas steady growth has occurred in attendance and attainment for girls in the last 20 years, educational progress for boys has been stagnant. With the decline in educational disparities between boys and girls, the gap in schooling that remains is between the poorest and the richest households. The gap in schooling delineated by household wealth cannot be monitored even with the best management information systems. It can, however, be captured using household survey data that allow the linking of educational attainment to household economic circumstances. We conclude that current monitoring requirements cannot be fulfilled without substantial new investments in data collection and evaluation. (author's)
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  5. 5

    Evaluation of the community incentive project NFPCB, summary report.

    University of Indonesia. Faculty of Public Health

    Jakarta, Indonesia, University of Indonesia, Faculty of Public Health, 1984. 6 p. (Book - IA)

    This article is a summary of the results of the Community Incentive Project (CIP) in Indonesia. The CIP is a project to maintain and increase family planning acceptance as well as family planning practice through increasing the income of the acceptors. The fund for the project was originated from the World Bank under a loan agreement for the Indonesian government in 1977. The evaluation of the CIP has been carried out under an agreement between the Faculty of Public Health University of Indonesia and the National Family Planning Coordinating Board. The objective of the evaluation is to describe various objects of the project implementation, such as the planning/preparation process, training, loan provision, monitoring and control, recording and reporting, bookkeeping, assistance to the family planning acceptors who received the loan, the participation of the community and other sectors, and the impact of the project on family planning practice.
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  6. 6
    Peer Reviewed

    Methodological quality of WHO medical eligibility criteria for contraceptive use.

    Stanback J; Katz K

    Contraception. 2002 Jul; 66(1):1-5.

    The use of consensus recommendations and clinical guidelines is now widespread in industrialized countries and is becoming more common in developing countries. As guidance documents have become more influential, their methodological rigor has come under closer scrutiny. Using two independently developed scales, the authors assessed the methodological quality of an important set of guidelines developed by the WHO. The consensus recommendation document called Improving Access to Quality Care in Family Planning: Medical Eligibility Criteria for Contraceptive Use has become the basis for national guidelines in dozens of countries. The authors compared the quality of the WHO guidelines to that of over 300 previously assessed published guidelines. In most categories of quality, the WHO exceeded the mean scores for other published guidelines. The authors discuss these comparisons, as well as the strengths and weaknesses of the WHO guidelines. (author's)
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  7. 7

    The listening dimension of evaluation.

    Salmen LF

    In: Evaluation and development: proceedings of the 1994 World Bank conference, edited by Robert Picciotto and Ray C. Rist. Washington, D.C., World Bank, 1995. 211-8. (World Bank Operations Evaluation Study)

    This paper discusses some key findings and pros and cons in using beneficiary assessment (BA) as an eclectic learning tool to improve the quality of development operations. The four basic precepts of beneficiary assessment are: increasing the validity of information; being useful to decision-makers; being credible to the architects of development programs; and directing the learning so as to make development interventions more effective and sustainable. Since 1981, the World Bank has supported 47 BA in 27 countries covering the health, urban, energy, industry, education, and agriculture sectors. Some of the factors behind the positive response of management to this listening approach to evaluation are: usefulness of information derived from the assessment; applicability of using traditional questionnaire survey; less expenses and short time in conducting listening approach; and local knowledge. Meanwhile, the difficulties in applying BA fall into three categories: methodological, political, and cultural. This paper recommends that the BA approach should become the norm rather than the exception in development projects.
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  8. 8
    Peer Reviewed

    Light on population health status.

    Beyrer K; Brauer GW; Fliedner TM; Greiner C; Reischl U


    In response to a World Health Organization's Global Advisory Committee on Health Research initiative, a "visual health information profile" was developed that provides a quantitative description of and an assessment of multidimensional aspects of health in a population. The profile uses a hierarchy of indicators, with first-level domains covering: 1) disease conditions and health impairments, 2) the health care system, 3) sociocultural characteristics, 4) environmental determinants, and 5) food and nutrition. Indicators at all levels can be disaggregated. A decile reference method can be used to display indicators by country and to rank performance for specific years, thus allowing country and time comparisons. The circular visual health information profile has radial sectors representing health domains (with sectors representing the indicators in each domain). Scaling is arranged so that situations needing urgent attention are displayed on the periphery. With fixed reference points, comparisons can be made over time. A prototype of this profile is available via the World Wide Web at The profile was evaluated by superimposing indicators for Tunisia for 1994 over those for 1966. Because of the immediate impact of the visual display of information, the profile, which can be applied to indicators at various levels, can contribute to the improvement of public health.
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  9. 9

    Household and community responses to HIV and AIDS: implications for the planning of successful interventions.

    Verrall JE; Aggleton PJ; Kippax S; Bharat S; Leshabari M

    [Unpublished] 1994. Presented at the 10th International Conference on AIDS, Yokohama, Japan, 1994. [4] p.

    The Social and Behavioral Studies and Support Unit of the World Health Organization's Global Program on AIDS has launched a 2-year research project to examine household and community responses to HIV/AIDS in developing countries through interviews, focus group discussions, and participant observation. This paper reports the findings of an initial Rapid Assessment Process from Bombay, India, and Mbeya, Tanzania. In India, at both the individual and household levels, fear of social stigma and HIV transmission to others predominate. Families tend to conceal HIV infection in a household member from the community to avoid further stress. In Tanzania, where there is more history of community mobilization to aid victims of natural disasters and a belief that AIDS is a result of supernatural forces, stigmatization of HIV-infected individuals is not a major problem. However, the tradition of widow inheritance threatens to increase HIV transmission. The differences in scenarios in these two countries indicate that interventions intended to assist families and communities to cope with HIV/AIDS should begin with a local needs assessment. Part of this assessment should be the identification of existing forms of household and community support.
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  10. 10

    Transnational responses to AIDS and the global production of science: a case-study from Rio de Janeiro.

    Bastos C

    Ann Arbor, Michigan, UMI Dissertation Services, 1996. [2], xv, 399 p. (UMI No. 9630436)

    The study presented in this dissertation focuses on 1) the interaction of the AIDS social movement and the medical establishment and 2) the transnational partnerships formed in response to the global pandemic. The first chapter provides an overview of the production of biomedical knowledge and of social commentary about this knowledge. Chapter 2 analyzes the social movement sparked by the inability of the medical establishment to respond to the AIDS crisis efficiently and effectively. The third chapter examines the level of awareness that HIV/AIDS is a global problem and the efforts of international agencies, such as the World Health Organization (WHO), to prepare a global response. Rio de Janeiro, Brazil is then used as a case study for evaluation of the extent to which the global responses were accompanied by interactive structures which attempted to bridge global gaps and create the conditions for the production of transformative knowledge (chapters 4 and 5). Data for this case study were gathered through ethnographic research conducted among medical, scientific, and activist settings in Rio. The final chapter discusses war metaphors in germ theory and immunology and presents ideas about the possible development of a new paradigm. The study revealed that the period of 1989-90 saw responses to AIDS characterized by networking and interdisciplinary efforts. When the WHO's revolutionary commitment was replaced with a more medicalized approach, efforts towards a major transformation of the paradigm guiding the fields of immunology and infectious disease declined, and each discipline retreated to its specialty.
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  11. 11
    Peer Reviewed

    Validating population surveys for the measurement of HIV / STD prevention indicators.

    Konings E; Bantebya G; Carael M; Bagenda D; Mertens T

    AIDS. 1995 Apr; 9(4):375-82.

    During 1993, in a squatter community outside Kampala, Uganda, in-depth interviews and administration of WHO's Global Programme on AIDS (WHO/GPA) questionnaire and of a short, direct questionnaire about sexual behavior were conducted among 75 key informants and 246 respondents per questionnaire type, respectively. Observations were made during visits and at schools, youth centers, bars, nightclubs, and brothels. Researchers wanted to evaluate the quality of data on self-reported preventive sexual behavior. Prostitutes had a lower participation rate than the general population (60% vs. 91.3%), suggesting that high risk groups may be unwilling to take part in population surveys. The two strategies using questionnaires yielded similar numbers of reported sex partners and prevalence of condom use. In-depth interviews yielded different results. In-depth interviewing found a higher proportion of persons having non-regular sexual intercourse during the last 12 months than did the population surveys (e.g., men, 45.5% vs. 33.9-35.3%; female prostitutes, 87.1% vs. 50-59.4%). It found a higher proportion of men reporting condom use during last casual sexual intercourse than did the population surveys (70% vs. 51.4-54.3%). It also found a lower proportion of non-prostitutes using condoms during last sexual intercourse than the surveys (14.3% vs. 26.7-38.5%). These findings indicate that the WHO/GPA questionnaire may not be able to identify people at high risk of AIDS and sexually transmitted diseases. Yet it is the most realistic and cost-effective choice. Small qualitative studies (e.g., in-depth interviews and observations) should complement longer questionnaires (e.g., WHO/GPA) designed to evaluate HIV interventions in the general population to identify and iron out biases in interpreting results.
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  12. 12

    Quality design helps to remove barriers to latrine use.

    Center for Human Services. Quality Assurance Project

    Q.A. REPORTS. 1993 Jun; 1-2.

    The Quality Assurance Project (GAP) has collaborated with CARE-Guatemala to carry out a unique application of quality assurance methods to public health promotion. CARE asked GAP to analyze the problem of inadequate latrine use among those rural communities served the CARE's water and sanitation project. GAP used a quality design techniques known as quality function deployment (QFD), which originated in Japanese industry, and considers client preferences at the product design stage. The method users matrices to compare products and to explore the relationships between a product's technical components and the user's needs and preferences. In September, 1992, GAP led a workshop for CARE and Ministry of Health staff showing the application of a simplified QFD approach by a flow chart. The group listed five priority quality characteristics for the optimal latrine: easy to clean, safe for children, allows for corn cob use, not scary to sit on, and does not smell bad. Then competing products were consideration; the latrine, the open field, and the flush latrine. Measurements were used to score each products: 1) the rate of improvement required; 2) determination of the key features for latrine promotion; and 3) the calculation of absolute and demanded quality weight. During the workshop, a water and sanitation expert presented an overview of various latrine designs from around the world and their respective worth and disadvantages. A spirited discussion made it clear that insufficient health education promoting the use of latrines was not the only factor that contributed to low utilization rates. Areas of high correlation indicated a priority area for redesign. The chart revealed a strong relationship between the toilet seat and children's safety. Guatemalan Ministry officials and USAID are considering future use of QFD in their latrine design efforts. This exercise helped them to explore user attitudes and their implications for technical design.
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  13. 13

    Meaning of morbidity measures in the Third World.

    Adjei S

    In: International Population Conference / Congres International de la Population, Montreal 1993, 24 August - 1st September. Volume 1, [compiled by] International Union for the Scientific Study of Population [IUSSP]. Liege, Belgium, IUSSP, 1993. 477-82.

    The definition of morbidity, its measurement, and the data collecting techniques commonly used are presented. Morbidity measures must be interpreted in a way that: 1) common definitions of good health and of morbidity must be used; 2) the measures of morbidity must be explained; and 3) the data collection technique employed in assessment of the morbidity state are also examined. WHO has defined health as not merely the absence of disease but includes social and mental well-being. The distinction between disease and illness derives from the contrast between biomedical definitions and culturally determined phenomena. The International Classification of Impairments, Disability and Handicaps (ICIDH) is the framework for classification of disease using 3 levels of disease consequences: impairment, disability, and handicap. The classification allows for assessment of functional activities at the personal level. These include behavior, communication, and personal care. Handicapping conditions deal with disadvantages that limit fulfillment of a normal role. The classification allows for a variety of rates to be calculated for specific age and sex groups. One paper dealt with morbidity causes and morbidity derived from signs, symptoms, laboratory test results, health examination, and medical records. Individual factors for selecting use of health service include accessibility, availability, and the socioeconomic status of the individual. Qualitative techniques employed include observational methods, focus group interviews, and in 2 depth interview. Cultural conceptions of illness in the measurement of morbidity and local ethnomedical classification of illness must be considered. The commonly employed quantitative method is the large-scale household survey. Comparison of the results of diarrhea prevalence by the Demographic Health Survey and CDD/WHO survey found that a close agreement between the 2 figures occurred in only 1 country. There is a marked contrast between medically defined morbidity and mortality reported by a person interviewed.
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  14. 14

    What use is a clinical case definition for AIDS in Africa?

    Gilks CF

    BMJ. British Medical Journal. 1991 Nov 9; 303(6811):1189-90.

    The article proposes that the clinical case definition for Acquired Immunodeficiency Syndrome in Africa is an unworkable concept, with the wrong definition, incorrect validation, improper use, and consequently is a poor surveillance tool. The definition was proposed by the World Health Organization in 1986 to satisfy the use in countries with limited diagnostic resources, and resources for serological testing. Critical review until now of this procedure was lacking. Currently serological testing is available and of high quality. It does not seem justifiable to continue using a provisional surveillance definition. Abandoning this classification procedure may also lead to the focus on problems other than opportunistic infections and AIDs. Clinical surveillance is important, but as well morbidity and mortality need monitoring. It is argued that the definition is an unworkable concept because patients with underlying immunosuppression disorders such as AIDs can not be easily distinguished from chronic disease patients; i.e., pulmonary tuberculosis, renal failure, uncontrolled diabetes, or diarrhea with weight loss. Clinical accuracy is insufficient. It is the wrong definition because pulmonary tuberculosis with a persistent cough cannot be distinguished for those HIV positive and those not. There is inconsistency in the WHO clinical definition and the Centers for Disease Control definitions of AIDs. The incidence of tuberculosis in countries with unmodified clinical case definitions may contribute to an inflated number of AIDs cases. The wrong standards were used to validate the WHO definition in evaluative studies. The reference sensitivity ranges indicate that the definition is insensitive to identifying seropositive patients. Also, the HIV status of patients does not equate with AIDs. Although designed for surveillance, the clinical case definition is used by doctors for individual patient management. Labeling a patient as having AIDs, when he is HIV negative, leads to negative consequences. Researchers compare African AIDs data with North American data with imprecise and noncomparable definitions. As a surveillance tool in countries with a fragmentary or without a vital registration system, it is an inaccurate tool. Alternatives to obtaining data about the spread and impact of HIV are cluster sampling, hospital surveillance of selected populations, anonymous testing of pregnant women or patients in sexually transmitted disease clinics. In Nairobi, a necropsy survey found that 16% had AIDs but 38% were HIV positive.
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  15. 15

    AIDS surveillance in Africa: a reappraisal of case definitions.

    De Cock KM; Selik RM; Soro B; Gayle H; Colebunders RL

    BMJ. British Medical Journal. 1991 Nov 9; 303(6811):1185-8.

    Surveillance of Acquired Immunodeficiency Syndrome (AIDS) provides a measure of severe morbidity and mortality caused by the human immunodeficiency virus (HIV); these cases represent severe symptomatic illness within the health care system. AIDs reporting in the US is considered complete with 70-90% of deaths related to HIV. In Africa, WHO estimates that 10% of AIDs cases are reported. This article suggests modifications in the WHO clinical definition of AIDs and discusses problems in the surveillance system. It is noted that clinical work required a simple staging system of HIV infection and disease, rather than epidemiological monitoring. The WHO definition requires 2 major symptoms with at least 1 minor sign in the absence of known causes of immunosuppression such as cancer or severe malnutrition or other recognized etiologies. The major signs are weight loss >10% of body weight, chronic diarrhea >1 month, and prolonged fever >1 month (intermittent or constant). Minor signs are persistent cough >1 month, generalized pruritic dermatitis, recurrent herpes zoster, oropharyngeal candidiasis, chronic progressive and disseminated herpes simplex infection, and generalized lymphadenopathy. The present of generalized Karposi's sarcoma or cryptococcal meningitis are sufficient alone for an AIDs diagnosis. Inadequacies of the WHO definition are its lack of sensitivity, moderate predictive value, and failure to include common symptoms of HIV infection. There is evidence of HIV associated disease not recognized as AIDs. The common symptoms of AIDs in Africa are profound weight loss, chronic diarrhea, and chronic fever (slim disease). The WHO definition was modified in 1987 to include the manifestation of the wasting syndrome. This increased sensitivity was shown in a hospital study in Abidjan in 1988/9. The WHO clinical case definition based on tuberculosis patients in Abidjan. HIV infection and case definitions for AIDs in patients with neurological disease and Kaposi's sarcoma is also discussed. Recommendations for future action are proposed including surveillance of severe HIV associated disease based on clinical presentation combined with serologic tests of HIV--I or II. The WHO definition with modifications is suggested and the need for strong political and medical commitment to complete and timely reported of AIDs and interventions to control the spread of HIV infection.
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  16. 16

    What does equity in health mean? Qu'est-ce que l'equite en matiere de sante?

    Mooney G


    The author posits some ethical concerns and theories of distribution in order to gain some insight into the meaning of equity in health, as referred to in WHO documents. It is pointed out that the lack of clarity in the WHO positions is evidenced by examining 1) the European strategy document, which focuses on giving equal health to all and equity access to health care, and 2) the Global Strategy for Health, which talks about reducing inequality and health as a human right. The question raised in document 1 is whether more equal sharing of health might mean less health for the available quantity of resources. The question raised in document 2 is whether there is a right to health per se. The question is how does one measure health policy effects. Health effects are different for an 8-year-old girl and an octogenarian. How does one measure the fairness of access to health care in remote mountain villages versus an urban area? Is equal utilization which is more easily measured comparable to equal need as a measure? How does one distribute doctors equitably? The author espouses the determinant of health as Aday's illness and health promotion, which is not biased by class and controversy. The Aday definition embraces both demand and need, although his definition is still open to question. Concepts of health with distinction between need and demand are made. Theories of Veatch which relate to distributive justice and equity in health care are provided as entitlement theory (market forces determine allocation of resources), utilitarianism (greatest good for the greatest number regardless of redistribution issues), maximum theory (maximize the minimum position or giver priority to the least well off), and equality (fairness in distribution). Different organizational and financing structures will influence the approach to equity. The conclusion is that equity is a value laden concept which has no uniquely correct definition. 5 theories of equity in distribution of health resources are discussed: 1) a theory of maximum (Rawl's theory modified to include health care institutions providing opportunity as the social good), 2) altruism as a basis for equity (Titmuss' Kantian view of national responsibility to provide equitable service delivery altruistically or equal access), 3) a fair share theory of distribution (Margolis' process utility theory of doing one's fair share or equality of access for equal need, 4) commitment to equity (Sen's focus on sympathy and commitment to another's ill health status and access), and 5) equity as externality (Culyer's health care consumption where government determines the merit good or extent of consumption). If policy objectives are not clear and the definitions muddy, resources may be badly wasted or misdirected and the pursuit of equity unfulfilled, even though there is agreement in principle.
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  17. 17

    New needs in health management.

    Schaefer M

    WORLD HEALTH FORUM. 1989; 10(3-4):438-47.

    A detailed study of the World Health Organization's (WHO) need to analyze its technical cooperation in management development took place in 1987-88 in developing and developed countries. Premises of the study were: 1) that management is not a separate function but is essential to the health system served by it; 2) the full range of management involves programming, funding, developing the health system, and guiding its operations; and 3) the adequacy of management is measured by the efficiency and effectiveness with which services and other health promoting interventions are delivered. Data was supplied by observing national personnel ranging from village health workers to health ministers in developing countries in 4 WHO regions. Several countries have good health development systems. The poorest countries have the least developed health systems. Countries with early stage developing systems have made little progress in health development. Countries with middle stage developing systems have been able to set up strategies and policies for health development. Countries with mature systems emphasize curative medical care. There are many problems, however, and are many mistaken notions of management. Management involves guidance. Health system capacity should offer many things. Health system development is limited by environmental factors. Leaders must have a systematic view of health development. An assessment of health system strengths and weaknesses should be made. The management part of a system building strategy should have attention paid to it. Management of resource development should not be neglected. Operational factors should also be considered.
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  18. 18
    Peer Reviewed

    Clinical trials of the ovulation method.

    Benagiano G; Bastianelli C


    In 1975, World Health Organization (WHO) Special Program of Research, Development, and Research Training in Human Reproduction carried out a multicenter, cross-cultural evaluation of the ovulation method in 5 countries--El Salvador, India, Ireland, New Zealand, and the Philippines. Clinical studies were also conducted by others. The WHO trial involved 869 women. More than 10% were illiterate; more than 20% had a technical or university education. The study was planned so that a woman's ability to calculate fertile days could be evaluated. The trial was divided into a learning phase of 3 months (extended to 6 for slow learners) and a 13-cycle effectiveness phase. In 3 months, more than 93% of the women learned to recognize their mucus pattern; only 1.3% failed. Self-recognition of mucus changes was learned equally well regardless of education. 45 pregnancies occurred in this phase. 725 women entered the effectiveness phase. In general, the method was well accepted. 130 pregnancies occurred during the effectiveness phase. 121 of these (almost 70%) were caused by conscious departures from the method; only 17 were truly method-related (less than 10%). An overall Pearl rate (per 1300 cycles) was 22.3. It was only 2.2% for method-related failures. As for pregnancy outcomes, live births accounted for 85.9% of the total. Where the child's sex was known, the proportion of males was .58 (81 males; 59 females). It was .61% when coitus occurred 2-5 days before the peak day (PD) and .67 among coitus occurring 2-4 days after PD. The proportion of males among those conceived within 1 day of PD was .55. This does not differ from the typical population value of .51. The WHO study does not support the hypothesis of an increased risk of malformations and spontaneous abortions in women practicing natural family planning (NFP). Partners were less satisfied with the method than women. However, more than 1/2 found no difficulty with abstinence. This indicates proper selection; not a true acceptance rate. The major drawback of NFP seems to be conscious rule breaking. 3 additional trials of the ovulation method were undertaken--1 in Tonga; a multicenter US study; and a Los Angeles study. These trials confirmed the main features of the method.
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  19. 19

    Thai perspectives on the consulting process: an inquiry into organization renewal strategies for rural development agencies.

    French JH

    [Unpublished] 1988. xv, 212 p. (Doctoral dissertation, North Carolina State University, 1988.)

    A researcher interviewed 18 Thai consultants, 4 of their clients, and 4 other change agents to learn what processes Thai consultants use in deciding upon intervention strategies. The researcher drew upon organization development literature, Thai history, anthropology, social psychology, and adult education. A wide range of interacting variables influenced these Thai consultants when constructing intervention strategies. Unlike Western consultants who use a system for decision making, Thai consultants make intuitive judgments by determining opportunities for change in light of environmental forces (social, political, economic, and historical forces) and the norms of predominant subcultures in the client agency. They must deal with status relations (e.g., debt and favors), resistance (e.g., power), and "balance" (e.g., having presence of mind) in Thai society which strongly lead them in determining change strategies based on values and culturally determined behaviors. The mix of clients which consultants must cope with includes members of the bureaucratic culture, the culture of technocrats, and the new breed. The 1st 2 cultures are characteristic of governmental agencies while the new breed are generally associated with nongovernmental organizations. All 3 subcultures are represented to some degree in every large development organization. Based on this research, 6 propositions were developed ranging from the proposition that despite systems theory being a useful tool for diagnosis of problems and assessment of change opportunities, it does not contribute to determining how to intervene in the Thai context to the proposition that only new practices and beliefs rationalized within the Thai culture will take root.
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  20. 20

    Voluntary surgical contraception in Brazil.

    Aguinaga H

    [Unpublished] 1988 Oct 26. Paper presented at the "Meet the Experts" panel sponsored by The World Federation for Voluntary Surgical Contraception, at the XII World Congress of Gynecology and Obstetrics sponsored by The International Federation of Gynecology and Obstetrics [FIGO], October 26, 1988, Rio de Janeiro, Brazil. 25 p. (ME62/ME21)

    Brazil, the largest country in area and population in Latin America, has not had the benefit of a government-sponsored family planning program and until recently such activities were sensitive and done with much constraint. The Centro de Pesquisas de Assistencis Integrada a Mulher e a Crianca (CPAIMC) which began offering family planning in its clinics in 1978, joined with Johns Hopkins Program for Education in Gynecology and Obstetrics (JHPIEGO), in 1980, to train medical doctors in the techniques of voluntary surgical contraception. It was followed by the support of the Association for Voluntary Surgical Contraception (AVSC) and Development Associates. During the years that followed the 1st project with JHPIEGO, AVSC and Development Associates, more than 125 courses were performed, 180 for nurses and 210 for auxiliary nurses and administrative personnel delivered by CPAIMC, ABEP and BEMFAM, and more than 350 institutions received technical assistance in voluntary surgical contraception. In recent national studies done by BEMFAM in contraceptive method prevalence, the most common methods were oral and surgical contraception. 65% of married women report they or their husbands are currently using contraceptives. Nationally, 27% of couples are using female sterilization and 25% oral contraceptives. Female sterilization is the most common method in all regions except the South, where pills are the most prevalent method. About 7% of the males have had vasectomies. Sterilization is more common in urban areas and increases in accordance with a woman's age, reaching prevalence rate of 73% between the age of 25 to 39. Average age was 31.4 years but 40% of the women were sterilized before age 29. Data is given on duration of marriage with sterilization, place of operation, complications, client profile, medical/surgical data, and sterilization failure. It was found that cumulative failure rates for sterilization in Brazil are comparable to or somewhat lower than those reported elsewhere; they decreased significantly as age at sterilization increases; failure during training periods are not significantly different, and cumulative failure rates increased, although not significantly, as the number of sterilizations per surgeon/day increased (author's modified)
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  21. 21

    Essentials drug lists and health relief management.

    Simmonds S; Mamdani M

    TROPICAL DOCTOR. 1988 Oct; 18(4):155-8.

    Based on suggestions made by Simmonds and Walker in 1982, The World Health Organization developed a standard Emergency Health Kit intended for use in refugee camps during the first 3 months of an emergency, by populations of 10,000. The complete kit had a weight of 858 kg and a volume of 2.6 cubic meters. Among its contents was a list of the drugs and equipment it contained. The list was divided into drugs that could be used by health workers with minimal training; drugs to be prescribed only by doctors and senior health workers; and simple laboratory and clinic equipment. The kit was used in many relief settings, some of which were quite different from those it was intended for. In 1986 WHO commissioned a survey of representatives of relief organizations, on their experiences with the kit. 153 questionnaires were sent to 128 organizations. Based on the 55 responses from 50 organizations (36% return), the advantages of the kit were its ease of transport, time savings, the use of drugs familiar to most volunteers, guaranteed quality, and usability in establishing a national basic health unit. Disadvantages included unfamiliarity of some national staff with drug names and doses, ethical dilemmas where refugees might receive better health care than native populations, long receipt times, high costs of transport, use and storage (sometimes = to cost of kit, c. US$4800), incompatibility with some national emergency drug lists, a size too large for small countries or scattered populations, and non-adaptability to varying local situations. Recommendations of kit revision cover decreasing kit size, provision for cold storage, purchase of most liquids locally and elimination of glass containers, more detailed labelling, and better customs and shipment procedures. The list of drugs proved to be the most valuable item for those surveyed. A WHO committee is currently implementing these suggestions and a draft document of a revised kit has been prepared.
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  22. 22

    Ten years after Alma-Ata.

    Bryant JH

    WORLD HEALTH. 1988 Aug-Sep; 10-5.

    The 1978 International Conference on Primary Health Care (PHC) in Alma-Ata, USSR, sponsored by the World Health Organization (WHO) and by UNICEF, culminated in the Declaration of Alma-Ata. This Declaration, signed by representatives of 134 nations, pledged urgent action for the development of PHC and toward the goal of "Health for All by the Year 2000." Among the most important principles of PHC are these 5: 1) that care should be accessible to all, especially those in greatest need; 2) that health services should promote popular understanding of health issues, and should emphasize preventive as well as curative measures; 3) that health services should be adapted to local economic and cultural circumstances, and be effective; 4) that local communities should be actively involved in the process of defining health problems and developing solutions; and 5) that health development programs should involve cooperation among all the community and national development efforts that have an impact on health. Even before the Declaration 10 years ago, the concepts underlying PHC had been taking root around the world. Progress toward the ideals of PHC has been made. Immunizations rates increased from 5% in 1970 to 40% in 1980. Only 34 countries had under-5 mortality rates of 178/1000 or more in 1985. 1/2 the number of 25 years earlier. However, PHC has in general achieved much better coverage in the developed countries than in the developing ones. The increase in world poverty -- to 1 billion people in absolute poverty today -- is a major setback for PHC. A major cause of health problems in the 3rd World is the too-rapid growth of unwieldy cities. Another common problem is that the training of medical professionals has not prepared them for leadership roles in community-oriented, preventive health programs. The ideals of PHC have been widely accepted throughout the world, and progress has been made, but much remains to be done.
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  23. 23

    Evaluation of the WHO clinical case definition for AIDS in Uganda.

    Widy-Wirski R; Berkley S; Downing R; Okware S; Recine U; Mugerwa R; Lwegaba A; Sempala S

    JAMA. 1988 Dec 9; 260(22):3286-9.

    In Africa, as in many developing countries where AIDS has been documented, the specific serologic test for antibody to the human immunodeficiency virus is not feasible, and the case definition of the Centers for Disease Control is impracticable because facilities for diagnosing the opportunistic infections are inadequate and the clinical spectrum of AIDS is different in tropical countries. The World Health Organization developed a clinical case definition at a 1985 AIDS workshop in the Central African Republic. It was tested to determine its generalizability in Zaire, and the present paper is a report on experience using the definition to identify AIDS in Uganda. A clinical case of AIDS is defined by the presence of at least 2 major signs and 1 minor sign. The major signs are fever for more than 1 month, weight loss greater than 10%, and chronic diarrhea for more than 1 month. The minor signs are persistent cough for more than 1 month, pruritic dermatitis, herpes zoster, oropharyngeal candidiasis, ulcerated herpes simplex, and general lymphadenopathy. The presence of disseminated Kaposi's sarcoma or disseminated cryptococcosis is sufficient by itself to diagnose AIDS. The Uganda study included 1328 patients at 15 hospitals. 562 patients (42%) tested positive by enzyme-linked immunosorbent assay, and 776 (58%) tested negative. 424 patients (32%) met the world Health Organization clinical case definition for AIDS. The World Health Organization definition had a sensitivity of 55%, a specificity of 85%, and a positive predictive value of 73%. However, so many of the patients in this sample had active tuberculosis that it was decided to substitute "persistent cough for more than 1 month without concurrent tuberculosis" as a minor sign in place of "cough for longer than 1 month." With this modification 350 patients met the clinical case definition for AIDS. Sensitivity dropped to 52%, but specificity rose to 92%, and positive predictive value rose to 83%. Moreover, 26% of the seropositive females indicated amenorrhea as a symptom. Addition of amenorrhea to the modified case definition gave it a sensitivity of 56%, a specificity of 93%, and a positive predictive value of 86%. However, this is the 1st report of amenorrhea as a symptom of AIDS, and it may only be a symptom of severe weight loss in women of childbearing age. The findings in the Ugandan experience support the generalizability of the modified World Health Organization clinical case definition of AIDS and its use for surveillance purposes in Africa.
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  24. 24

    Evaluating progress.

    Roy L

    WORLD HEALTH. 1988 Jan-Feb; 10-11.

    In 1979 WHO invited its member states to participate in a global strategy for health and to monitor and evaluate its effectiveness using a minimum of 12 indicators. Members' 1982 implementation reports and 1985 evaluation reports form the basis for evaluating each measure. Indicators 1-6 have strong political and economic components in both developed and developing countries and are not complete. Indicator 7, for which rates of reply are satisfactory, asks whether at least 5 elements of primary health care are available to the whole population. The 8th gauge seeks information on the nutritional status of children, considering birth weight (a possible indicator of risk) and weight for age (a monitor of growth). Infant mortality rate and life expectancy at birth, indicators 9 and 10, are difficult to estimate in developing countries, and health services are not always kept informed of current estimates. Indicator 11 asks whether the literacy rate exceeds 70%; it can provide information on level of development and should emphasize literacy for women, for whom health information is critical. The last global measure yields information about the gross national product, which is not always the most recent, despite the trend of countries to publish their gross domestic product. Failure to make use of the best national sources, such as this, is one of several problems encountered by WHO's member states in collecting accurate data. Other problems include lack of universally acceptable definitions, different national accounting systems, disinterest of health authorities in economic matters, lack of staff, lack of financial resources in developing countries, and inadequately structured health system management. Each country must choose the most appropriate methods for collection of data. If an indicator cannot be calculated, the country is encouraged to seek and devise a substitute. WHO must produce more precise and reliable indicators. It must respond to requests for ways of improving or strengthening national systems.
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  25. 25

    Incentives, disincentives, and family planning: selective bibliography for countries in the ESCAP region: annotated.

    Yap MT

    [Unpublished] 1987 Jan. 141 p.

    This is a first draft of an annotated bibliography on incentives and disincentives in family planning programs in the ESCAP region. Each entry contains fields for author, title, citation, type (type of study), country, sponsor, recipient, positive or negative, form (type of incentive), structure (graduated or fixed), timing, objective (use, space or limit), and effect measures (observed endpoint). The annotation consists of an abstract or condensed conclusion in most cases. Over 100 documents are reviewed.
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