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Paediatrics and International Child Health. 2013 Feb; 33(1):4-17.BACKGROUND: Studies in the last decade have identified major deficiencies in the care of seriously ill children in hospitals in developing countries. Effective implementation of clinical guidelines is an important strategy for improving quality of care. In 2005 the World Health Organization produced the Pocket Book of Hospital Care for Children - Guidelines for Management of Common Childhood Illnesses in Rural and District Hospitals with Limited Resources. OBJECTIVE: To determine the worldwide distribution, uptake and use of the WHO Pocket Book of Hospital Care for Children. METHODS: A systematic online and postal survey was conducted to assess coverage and uptake of the Pocket Book in low- and middle-income countries (LMICs). More than 1000 key stakeholders with varied roles and responsibilities for child health in 194 countries were invited to participate. Indicators used to measure implementation of the guidelines included local adaptation, use as standard treatment and incorporation into undergraduate and postgraduate training. RESULTS: Information was gathered from 354 respondents representing 134 countries; these included 98 LMICs and 50 countries with under-5 childhood mortality rates >40 deaths/1000 live births. Sixty-four LMICs (44% of 145 LMICs worldwide) including 42 high-mortality countries (66% of 64 high-mortality countries worldwide) reported at least partial implementation of the Pocket Book. However, uptake remains fragmented within countries. CONCLUSION: More than half of all LMICs with high rates of child mortality have reported use and substantial implementation activities, a considerable achievement given minimal resources available for implementation. Improving the accessibility of the Pocket Book and its implementation tools to health workers, and developing a strategic approach to implementation in each country could improve quality of hospital care for children and support efforts towards achieving the Millennium Development Goal 4 targets.
Multinational corporations and health care in the United States and Latin America: strategies, actions, and effects. [Corporaciones multinacionales y atención de la salud en Estados Unidos y América Latina: estrategias, acciones y efectos]
Journal of Health and Social Behavior. 2004; 45 Suppl:136-157.In this article we analyze the corporate dominance of health care in the United States and the dynamics that have motivated the international expansion of multinational health care corporations, especially to Latin America. We identify the strategies, actions, and effects of multinational corporations in health care delivery and public health policies. Our methods have included systematic bibliographical research and in-depth interviews in the United States, Mexico, and Brazil. Influenced by public policy makers in the United States, such organizations as the World Bank, International Monetary Fund, and World Trade Organization have advocated policies that encourage reduction and privatization of health care and public health services previously provided in the public sector. Multinational managed care organizations have entered managed care markets in several Latin American countries at the same time as they were withdrawing from managed care activities in Medicaid and Medicare within the United States. Corporate strategies have culminated in a marked expansion of corporations' access to social security and related public sector funds for the support of privatized health services. International financial institution and multinational corporations have influenced reforms that, while favorable to corporate interests, have worsened access to needed services and have strained the remaining public sector institutions. A theoretical approach to these problems emphasizes the falling rate of profit as an economic motivation of corporate actions, silent reform, and the subordination of polity to economy. Praxis to address these problems involves opposition to policies that enhance corporate interests while reducing public sector services, as well as alternative models that emphasize a strengthened public sector. (author's)