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Integrating systematic screening for gender-based violence into sexual and reproductive health services: results of a baseline study by the International Planned Parenthood Federation, Western Hemisphere Region.
International Journal of Gynaecology and Obstetrics. 2002 Sep; 78 Suppl 1:S57-S63.Three Latin American affiliates of the International Planned Parenthood Federation, Western Hemisphere Region, Inc. (IPPF/WHR) have begun to integrate gender-based violence screening and services into sexual and reproductive health programs. This paper presents results of a baseline study conducted in the affiliates. Although most staff support integration and many had already begun to address violence in their work, additional sensitization and training, as well as institution-wide changes are needed to provide services effectively and to address needs of women experiencing violence. (c) 2002 International Federation of Gynecology and Obstetrics.
Geneva, Switzerland, World Health Organization [WHO], 2018. 458 p.Girls and women who have been subjected to female genital mutilation (FGM) need high quality, empathetic and appropriate health care to meet their specific needs. This handbook is for health care providers involved in the care of girls and women who have been subjected to any form of FGM. This includes obstetricians and gynaecologists, surgeons, general medical practitioners, midwives, nurses and other country-specific health professionals. Health-care professionals providing mental health care, and educational and psychosocial support – such as psychiatrists, psychologists, social workers and health educators – will also find this handbook helpful. It includes advice on how to: 1) communicate effectively and sensitively with girls and women who have developed health complications due to FGM; 2) communicate effectively and sensitively with the husbands or partners and family members of those affected; 3) provide quality health care to girls and women who have health problems due to FGM, including immediate and short-term urogynaecological or obstetric complications; 4) provide support to women who have mental health and sexual health complications caused by FGM; 5) make informed decisions on how and when to perform deinfibulation; 6) identify when and where to refer patients who need additional support and care; and 7) work with patients and families to prevent the practice of FGM.
Strengthening health systems to respond to women subjected to intimate partner violence or sexual violence: a manual for health managers.
Geneva, Switzerland, WHO, 2017. 172 p.This manual is intended for health managers at all levels of the health systems. The manual is based on the World Health Organization (WHO) guideline Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines, 2013. Those guidelines inform this manual and its companion clinical handbook for healthcare providers, Health care for women subjected to intimate partner violence or sexual violence, 2014. The manual draws on the WHO health systems building blocks as outlined in Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action..
Cervical cancer screening and management of cervical pre-cancers. Training of health staff in VIA, HPV detection test and cryotherapy -- Trainees' handbook.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 171 p.The Trainees’ handbook is designed for paramedical workers, midwives, nurses and clinicians involved in cervical cancer screening to help them acquire the necessary skills to perform VIA, collect samples for HPV test and treat cervical pre-cancers by ablative methods. The publication of the World Health Organization guidance document Comprehensive cervical cancer control: A guide to essential practice, 2nd edition, 2014 has necessitated modifications in the existing training resources for cervical cancer screening and treatment. The new screening recommendations and management algorithms have been incorporated in the present Trainees’ handbook. The Trainees’ handbook contains guidelines and information intended to be used both by trainees and facilitators while participating in the structured training on cervical cancer screening and treatment. The handbook contains different modules to assist trainees to learn various screening and treatment procedures step- by-step and to comprehend their underlying principles. The modules contain checklists that serve as ready reckoners to develop skills in various procedures during clinical sessions. These checklists are also intended to be used by trainees during their post-training practice. (Excerpt)
Cervical cancer screening and management of cervical pre-cancers. Training of health staff in VIA, HPV detection test and cryotherapy -- Facilitators' guide.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 123 p.This manual is an instruction guide for facilitators to provide competence based training to providers for screening (with VIA or HPV test) and ablative treatment services in a cervical cancer screening programme. The training is intended to assist midwives, paramedical workers, nurses and clinicians to learn and improve upon their skills to perform counselling, screening tests and treatment. Facilitators are required to consult both the Facilitators’ guide and the Trainees’ handbook while training through interactive presentations, group discussions, role plays, simulated learning sessions, and clinical practice sessions. The Facilitators’ guide contains detailed training methodologies, structure of the individual training sessions, simulated learning sessions and guidelines for assessment of trainees. (Excerpt)
New York, New York, UNFPA, 2015 Nov. 101 p.Gender based violence is a life-threatening, global health and human rights issue that violates international human rights law and principles of gender equality. In emergencies, such as conflict or natural disasters, the risk of violence, exploitation and abuse is heightened, particularly for women and girls. UNFPA’s “Minimum Standards for Prevention and Response to GBV in Emergencies (GBViE)” promote the safety and well being of women and girls in emergencies and provide practical guidance on how to mitigate and prevent gender-based violence in emergencies and facilitate access to multi-sector services for survivors.
Strengthening the capacity of community health workers to deliver care for sexual, reproductive, maternal, newborn, child and adolescent health.
Geneva, Switzerland, World Health Organization [WHO], 2015. 20 p.Government institutions, United Nations agencies, and global partners have been repositioning the role that community health workers (CHWs) can play in increasing access to essential quality health services in the context of national primary health care and universal health coverage. Given the growing momentum and interest in training CHWs, the United Nations health agencies (H4+) have developed this technical brief to orient country programme managers and global partners as to key elements for strengthening the capacity of CHWs, including health system and programmatic considerations, core competencies, and evidence-informed interventions for CHWs along the SR/MNCAH continuum of care. These key elements need to be adapted and contextualized by countries to reflect the structure, gaps, and opportunities of the national primary health care system, the interaction between the health sector with other sectors, and the specific roles and competencies that CHWs already have within that system. These key elements should also guide H4+ members and partners to take a joint and harmonized approach to supporting countries in their capacity-development efforts. Annex 1 lists SR/MNCAH interventions that CHWs can perform based on the best available evidence and existing WHO guidance.
2016 Nov; New York, New York, UN Women, 2016 Nov. 2 p.Violence against women and girls is one of the most universal and pervasive human rights violations in the world, of pandemic proportions, with country data showing that about one third of women in the world report experiencing physical or sexual violence at some point in their lifetime, mainly by their partners. UN Women provides knowledge-based policy and programming guidance to a diverse array of stakeholders at international, regional and country levels often partnering with other UN agencies and stakeholders. UN Women’s work is broadly focused on a comprehensive approach to ending violence against women and girls that addresses legislation and policies, prevention, services for survivors, research and data. The briefs included in this package aim to summarize in a concise and friendly way, for advocates, programmers and policy makers, the essential strategies for addressing violence against women in general, for preventing violence and providing services to survivors in particular.
Caring for newborns and children in the community. Planning handbook for programme managers and planners.
Geneva, Switzerland, World Health Organization, Department of Maternal, Newborn, Child and Adolescent Health, 2015. 168 p.Prevention and treatment services need to be brought closer to children who are not adequately reached by the health system. To help meet this need, WHO and UNICEF have developed state-of-the-art packages to enable community health workers to care for pregnant women, newborns and children. Caring for Newborns and Children in the Community comprises three packages of materials for training and support of CHWs. Countries will assess their current community-based services and choose to what extent they are able to implement these packages for improving child and maternal health and survival: (1) Caring for the newborn at home, (2) caring for the child's healthy growth and development, (3) caring for the sick child in the community.
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: What’s new. Policy brief.
Geneva, Switzerland, WHO, 2015 Nov.  p. (Policy Brief)The 2015 guidelines includes 10 new recommendations to improve the quality and efficiency of services to people living with HIV. Implementation of the recommendations in these guidelines on universal eligibility for ART will mean that more people will start ART earlier. The updated guidelines present both new recommendations and previous WHO guidance. They include clinical recommendations (“the what” of using ARVs for treatment and prevention) and service delivery recommendations to support implementation (“the how” of providing ARVs), organized according to the continuum of HIV testing, prevention, treatment and care. For the first time the guideline includes “good practice statements” on interventions whose benefits substantially outweigh the potential harms.
Guideline: Managing possible serious bacterial infection in young infants when referral is not feasible.
Geneva, Switzerland, WHO, 2015.  p.This guideline, developed by a panel of international experts and informed by a thorough review of existing evidence, contains a number of recommendations on the use of antibiotics for neonates (0–28 days old) and young infants (0–59 days old) with PSBI in order to reduce young infant mortality rates. The guideline is intended for use in resource-limited settings in situations when families do not accept or cannot access referral care. The goal of the guideline is to provide clinical guidance on the simplest antibiotic regimens that are both safe and effective for outpatient treatment of clinical severe infections and fast breathing (pneumonia) in children 0–59 days old. In addition, the guideline seeks to provide programmatic guidance on the role of CHWs and home visits in identifying signs of serious infections in neonates and young infants.
Geneva, Switzerland, WHO, 2013 Oct.  p.The postnatal period is a critical phase in the lives of mothers and newborn babies. Most maternal and infant deaths occur during this time. Yet, this is the most neglected period for the provision of quality care. WHO guidelines on postnatal care have been recently updated based on all available evidence. The guidelines focus on postnatal care of mothers and newborns in resource-limited settings in low- and middle-income countries. The guidelines address timing, number and place of postnatal contacts, and content of postnatal care for all mothers and babies during the six weeks after birth. The primary audience for these guidelines is health professionals who are responsible for providing postnatal care to women and newborns, primarily in areas where resources are limited. The guidelines are also expected to be used by policy-makers and managers of maternal and child health programmes, health facilities, and teaching institutions to set up and maintain maternity and newborn care services. The information in these guidelines is expected to be included in job aids and tools for both pre- and in-service training of health professionals to improve their knowledge, skills and performance in postnatal care. These recommendations will be regularly updated as more evidence is collated and analysed on a continuous basis, with major reviews and updates at least every five years. The next major update will be considered in 2018 under the oversight of the WHO Guidelines Review Committee.
Postnatal care for mothers and newborns: Highlights from the World Health Organization 2013 guidelines.
[Geneva, Switzerland], World Health Organization [WHO], 2015 Apr.  p. (WHO/RHR/15.05; USAID Leader with Associates Cooperative Agreement No. GHS-A-00-08-00002-00; USAID Cooperative Agreement No. AID-OAA-A-14-00028)This evidence brief provides highlights and key messages from World Health Organization’s 2013 Guidelines on Postnatal Care for Mothers and Newborns. These updated guidelines address the timing and content of postnatal care for mothers with a special focus on resource-limited settings in low- and middle-income countries. This brief is intended for policy-makers, programme managers, educators and providers who care for women and newborns after birth.
WHO ethical and safety recommendations for researching, documenting and monitoring sexual violence in emergencies.
Geneva, Switzerland, WHO, 2007.  p.Sexual violence in humanitarian emergencies, such as armed conflict and natural disasters, is a serious, even life-threatening, public health and human rights issue. Growing concern about the scale of the problem has led to increased efforts to learn more about the contexts in which this particular form of violence occurs, its prevalence, risk factors, its links to HIV infection, and also how best to prevent and respond to it. Recent years have thus seen an increase in the number of information gathering activities that deal with sexual violence in emergencies. These activities often involve interviewing women about their experiences of sexual violence. It is generally accepted that the prevalence of sexual violence is underreported almost everywhere in the world. This is an inevitable result of survivors' well-founded anxiety about the potentially harmful social, physical, psychological and/or legal consequences of disclosing their experience of sexual violence. In emergency situations, which arecharacterized by instability, insecurity, fear, dependence and loss of autonomy, as well as a breakdown of law and order, and widespread disruption of community and family support systems, victims of sexual violence may be even less likely to disclose incidents. (excerpt)
Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2005 Jan 10.  p.Acute Respiratory Infections (ARIs) are a major cause of mortality and morbidity in emergencies. About 20% of all deaths in children under 5 years are due to Acute Lower Respiratory Infections (ALRIs - pneumonia, bronchiolitis and bronchitis); 90% of these deaths are due to pneumonia. Early recognition and prompt treatment of pneumonia is life saving. Causative organisms may be bacterial (most commonly Streptococcus pneumoniae and Haemophilus influenzae) or viral. However, it is not possible to differentiate between bacterial and viral ARIs based on clinical signs or radiology. Low birth weight, malnourished and non-breastfed children and those living in overcrowded conditions are at higher risk of getting pneumonia. These children are also at a higher risk of death from pneumonia. (excerpt)
Geneva, Switzerland, WHO, 2004 Jan. 118 p. (Integrated Management of Adolescent and Adult Illness [IMAI] No. 1; WHO/CDS/IMAI/2004.1)The IMAI guidelines are aimed at first-level facility health workers and lay providers in low-resource settings. These health workers and lay providers may be working in a health centre or as part of a clinical team at the district clinic. The clinical guidelines have been simplified and systematized so that they can be used by nurses, clinical aids, and other multi-purpose health workers, working in good communication with a supervising MD/MO at the district clinic. Acute Care presents a syndromic approach to the most common adult illnesses including most opportunistic infections. Instructions are provided so the health worker knows which patients can be managed at the first-level facility and which require referral to the district hospital or further assessment by a more senior clinician. Preparing first-level facility health workers to treat the common, less severe opportunistic infections will allow them to stabilize many clinical stage 3 and 4 patients prior to ARV therapy without referral to the district. (excerpt)
Paris, France, UNESCO, 2001 Apr 24.  p. (161 EX/18)At its 159th session, the Executive Board of UNESCO requested the Director-General to draw up a strategic plan of action concerning UNESCO’s contribution to the United Nations system strategy against HIV/AIDS for the five-year period 2001-2005. Fighting HIV/AIDS is one of the top priorities of the United Nations. At its fifty-fifth session, the General Assembly, in its resolution 55/13 of 3 November 2000, decided to convene, as a matter of urgency, on 25 to 27 June 2001, a special session of the General Assembly to review and address the problem of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in all its aspects. The aim of the special session is to secure a global commitment to enhancing coordination and the intensification of national, regional and international efforts to combat the epidemic in a comprehensive manner. All entities of the United Nations system, including programmes, funds, specialized agencies and regional commissions, is to be actively involved in the preparatory activities and are encouraged to participate at the highest level in the special session. (excerpt)
Geneva, Switzerland, WHO, 2004.  p. (WHO/FCH/CAH/04.13)According to current UN recommendations, infants should be exclusively breastfed for the first six months of life, and thereafter should receive appropriate complementary feeding with continued breastfeeding up to two years or beyond. However, there are a number of infants who will not enjoy the benefits of breastfeeding in the early months of life or for whom breastfeeding will not occur or will stop before the recommended duration of two years or beyond. A group that calls for particular attention is the infants of mothers who are known to be HIV positive. To reduce the risk of transmission, it is recommended that, when acceptable, feasible, affordable, sustainable and safe, these mothers give replacement feeding from birth. Otherwise, they should breastfeed exclusively and stop as soon as alternative feeding options become feasible. Another group includes those infants whose mothers have died, or who for some reason do not breastfeed. Recommendations for appropriate feeding of breastfed infants from six months onwards have been summarized by PAHO in the publication Guiding Principles for Complementary Feeding of the Breastfed Child. Some of these guiding principles are not applicable to non breast fed children, others need adaptation. WHO convened this informal meeting to identify an analogous set of guiding principles for feeding of non-breastfed children after six months of age. For infants less than six months, guidelines for decision makers and a guide for health care manager are already available. (excerpt)
Making pregnancy safer: the critical role of the skilled attendant. A joint statement by WHO, ICM and FIGO.
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2004.  p.In 2000, the largest-ever gathering of heads of state at the United Nations in New York, USA, adopted the UN Millennium Declaration. This historic compact among nations includes eight critical goals—the Millennium Development Goals (MDGs)—for combating poverty and accelerating human development. Two of the eight MDGs relate to reducing child mortality and improving maternal health, respectively, pointing to the importance of these health factors in global development and poverty reduction. The World Health Organization (WHO), the International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO) are pleased to see the inclusion in the MDGs of the target to reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio. This inclusion is the result of many years of advocacy (by WHO, ICM and FIGO, among others) for the need to recognize the link between maternal health and development. The MDGs send yet another reminder to planners and policy-makers that for the world’s poor motherhood still carries a high risk of morbidity and mortality. But years of previous work in making motherhood safer has not all been in vain. There is now a global consensus on what must be done to eliminate the menace of maternal deaths once and for all. Already in 1999, a joint WHO/UNFPA/ UNICEF/World Bank statement called on countries to “ensure that all women and newborns have skilled care during pregnancy, childbirth and the immediate postnatal period”. (excerpt)
Geneva, Switzerland, WHO, 1996.  p. (WHO/FRH/MSM/96.8)A Technical Working Group on Antenatal Care was convened in Geneva, 31 October - 4 November 1994, by the World Health Organization. The original objectives of the Technical Working Group were: 1. To review current antenatal care practices and make recommendations for the identification of high-risk pregnancies and their management, taking into account the timing of the pregnancy, resources available, and skills of the health worker; 2. To draw up recommendations on antenatal care and specifically outline the tasks and procedures health workers are expected to perform at different levels of the health care system; 3. To review the basic equipment, procedures, and supplies used in antenatal care from the point of view of cost, maintenance, scientific validity, and skills required to employ them appropriately; 4. To examine how to optimize antenatal care in terms of clinical tasks and procedures in relationship to the timing of the visits, distance to referral centres, and frequency of attendance. (excerpt)
Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center [CPC], MEASURE Evaluation, 2003 Aug.  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)
Management of severely ill children at first-level health facilities in sub-Saharan Africa when referral is difficult. [La prise en charge au niveau des installations sanitaires de premier niveau des enfants gravement malades, en Afrique sub-saharienne, en cas de difficulté d'orientation vers d'autres structures]
Bulletin of the World Health Organization. 2003 Jul; 81(7):522-531.Objectives: To quantify the main reasons for referral of infants and children from first-level health facilities to referral hospitals in sub- Saharan Africa and to determine what further supplies, equipment, and legal empowerment might be needed to manage such children when referral is difficult. Methods: In an observational study at first-level health facilities in Uganda, the United Republic of Tanzania, and Niger, over 3–5 months, we prospectively documented the diagnoses and severity of diseases in children using the standardized Integrated Management of Childhood Illness (IMCI) guidelines. We reviewed the facilities for supplies and equipment and examined the legal constraints of health personnel working at these facilities. Findings: We studied 7195 children aged 2–59 months, of whom 691 (9.6%) were classified under a severe IMCI classification that required urgent referral to a hospital. Overall, 226 children had general danger signs, 292 had severe pneumonia or very severe disease, 104 were severely dehydrated, 31 had severe persistent diarrhoea, 207 were severely malnourished, and 98 had severe anaemia. Considerably more ill were 415 young infants aged one week to two months: nearly three-quarters of these required referral. Legal constraints and a lack of simple equipment (suction pumps, nebulizers, and oxygen concentrators) and supplies (nasogastric tubes and 50% glucose) could prevent health workers from dealing more appropriately with sick children when referral was not possible. Conclusion: When referral is difficult or impossible, some additional supplies and equipment, as well as provision of simple guidelines, may improve management of seriously ill infants and children. (author's)
Evaluation of the WHO / UNICEF algorithm for integrated management of childhood illness between the age of two months to five years.
Indian Pediatrics. 1999 Aug; 36(8):767-8.Objective: To evaluate the utility of the "WHO/UNICEF algorithm for integrated management of childhood illness (IMCI) between the age of 2 months to 5 years. Design: Prospective observational. The Outpatient Department and Emergency Room of a medical college hospital. 203 children presenting to Outpatient Department (n= 101) or Emergency Room (n=102) were assessed and classified as per 'IMCr algorithm and treatment required was identified. A detailed evaluation with all relevant investigations was also done for these subjects. The final diagnoses made and therapies instituted on this basis served as "gold standard'. The diagnostic and therapeutic agreements between the "gold standard' and the IMCI and vertical (on the basis of primary presenting complaint) algorithms were computed. Results: More than one illness was present in 135 (66.5%) of subjects as per "gold standard'. The mean (SD) numbers of morbidities as per the gold standard and IMCI- low and high malaria risks were 2.1 (1.1), 1.8 (1.0) and 2.2 (1.1), respectively. Subjects having any referral criteria as per IMCI module had a greater co-existence of illnesses (mean 2.6 vs. 1.6 illnesses per child, respectively). The referral criteria proved useful in predicting hospitalization and a combination of hospitalization and observation; their sensitivity and specificity were 81% and 69% and 74% and 85%, respectively. IMCI algorithms covered majority (92%) of the recorded illnesses. A total agreement with IMCI (malaria low risk) was found in 129 (64%) cases while in 43 (22%) cases, there was partial agreement. Corresponding figures for vertical (split IMCI) program were 93 (46%; p<0.001) and 41 (25%). The difference was primarily due to under diagnoses (30%). Diagnostic discordance of IMCI algorithm and gold standard was evident for the cough category due to under diagnosis of bronchial asthma and bronchiolitis and an over diagnosis of pneumonia whereas the discordance for fever was due to an over diagnosis of malaria. Identical results were found for broad treatment categories. The IMCI algorithm had a provision for preventive services of immunization (16.3% possibility of availing missed opportunities) and feeding advice. There is a sound scientific basis for adopting the IMCI approach since: (i) co-existence of morbidities is frequent; (ii) severe illness is assessed with good sensitivity and specificity; and (iii) the IMCI algorithm is diagnostically and therapeutically superior to the vertical disease specific algorithms. The generic IMCI algorithm needs adaptation to reflect the regional morbidity profile. (author's)
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (ZAI-10)This project grew out of the need to monitor the quality of care in the various community-based contraception distribution (CBD) projects which were subprojects of the Tulane Family Planning Operations Research Project. The objectives of this activity were to: 1) assure that women who use the services of CBD workers were properly screened for use of oral contraceptives (if that was the method they chose), that they received correct information about the methods and their use, and that they were referred to other levels in the health system when appropriate; 2) to strengthen the position of existing CBD programs if they were to come under attack in the future over the issue of quality of service; and 3) to develop a methodology that could be used in other CBD programs, including those outside of Zaire. The project consisted of a series of activities designed to improve the quality of care in CBD programs, including conducting workshops among project personnel and standardizing medical norms and program procedures. A system for evaluating distributor performance, based on a knowledge test, observation of interactions with clients, and a client survey, was developed and tested in the field. A guide for implementing contraceptive CBD programs and a manual for training CBD distributors were produced to standardize many of the procedures used in the CBD programs and to provide certain norms for service delivery. A methodology was subsequently developed for evaluating distributor performance which included: a knowledge test for distributors to assure that they were able to answer basic questions about the contraceptives and other medications they sold (correct use, side effects, contraindications); an observation guide consisting of a list of points which a distributor should cover during visits to a potential (new) client as well as to a continuing user; and a subjective measurement of rapport between distributor and client. A short questionnaire was prepared for clients to determine whether they knew the correct use of the method chosen and whether they were satisfied with the services of the distributor. This 3-pronged approach to the evaluation of distributor performance was tested at 2 sites: Kisangani and Matadi. The knowledge test was also administered in Mbuyi Mayi and Miabi. While the knowledge test proved to be a quick way to determine whether distributors were informed on key points, the full evaluation approach proved too labor-intensive to be practical as a tool for continuously monitoring distributor performance. Based on experience with the full model, a supervisory form was developed which included some of the same elements but was more practical for routine use in the field.
The hospital in rural and urban districts. Report of a WHO Study Group on the Functions of Hospitals at the First Referral Level.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1992; (819):i-vii, 1-74.In 1992, the WHO Study Group on the Functions of Hospitals at the First Referral Level compiled a report on the functions of the hospital in rural and urban districts. It advocates that the 1st referral level hospital should be integrated into the district health care system, which is administered by a district health council. This approach strengthens primary health care and uses hospital resources to promote health. The most pressing need for this approach to work is changing people's attitudes and motivation. Various obstacles invariably slow this integration process such as resistance by central and local government officials and inadequate funding. The district hospital should help people to find health rather than just cure disease. Further it must accept the fact that it is not the center of the health system. This means a redistribution of both finance and effort. Governments need to improve the decentralization process to facilitate integration. The study group proposes a step by step methodology to integrate the health system. The 1st step is creating a district health council with representatives from the district health office, the hospital, other sectors of the health care system, and the community. The council determines the community diagnosis including population trends, patterns of morbidity and mortality, and disease and risk distribution by age and location. It also needs to review health services in the district. The council can divide these services into preventive, promotional, curative, rehabilitative, and organizational services. It also must reassess distribution of resources including people, buildings, equipment, and materials. The council must draft a plan and deliberate on implementing the plan. Once the council has taken these steps, it can then implement, monitor, and evaluate the plan and its results.