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WORLD HEALTH. 1997 Mar-Apr; 50(2):18-9.The American Refugee Committee (ARC) runs the Burmese Border Medical Project in remote areas along the Thai-Myanmar border for refugees from hill tribes who fled their homes in Myanmar. ARC launched a 3-month community health workers' (CHW) course for camp members, while others received 6-18 months of medical training from the Karen Army or the refugee committee. These trained refugees were able to diagnose and treat common illnesses and administer drugs, injections, and intravenous infusions, which was vital because the nearest hospital was hours away. Women of reproductive age suffered from the following common conditions: malnutrition (vitamin B1 deficiency, anemia, and goiter); diarrhea, malaria, and typhoid; miscarriage, stillbirth, and neonatal death; and limited access to family planning. Infants died in the perinatal period because of low birth weight, birth trauma, neonatal tetanus, diarrhea, respiratory infection, malaria, and beriberi. Special maternal and child health (MCH) midwife training was given to selected female CHWs. The class held community awareness sessions, and clinical experience was gained at the camp clinic. A personal record card was developed for each client, antenatal, delivery, and postpartum care services were started, later maternal health clinic and home visits, and referral to the malnutrition program were also instituted. Subsequently a 6-week postpartum training was held by trained midwives for traditional birth attendants (TBAs). This also provided assistance in family planning, child growth monitoring, immunization, and foods to complement breast feeding. The curriculum was translated into Burmese for the midwives. During this year-long training the trainees became invaluable maternal health workers and primary level midwives. A level two training was planned for the following dry season at the mission hospital or a clinic to learn how to perform episiotomies and suturing.
In: Child care: meeting the needs of working mothers and their children, edited by Ann Leonard and Cassie Landers. New York, New York, SEEDS, 1991. 19-24. (SEEDS No. 13)In Ethiopia among the Melka Oba Farmers Producers' Cooperatives which are 120 km from Addis Ababa, child care was managed by the cooperative itself with the assistance of UNICEF and the Integrated Family Life Project (IFLE) interagency committee in 1983. Funding was used to employ a consultant to train child minders and establish the center, pay the cost of training, purchase resource materials for the training, equip the creche and kindergarten, and buy tools for construction of play items. A villa was donated to house the day care program. 8 child minders were selected for their interest in children and their educational level. Training was for 8 months. The child care center has flexible hours to accommodate working mothers and allows breast- feeding visits during the day. It is open to children aged 45 days-6 years, and includes a national preschool curriculum and immunization and health care services. As a byproduct of the center's activities, a family planning, health, and family life education program are operating. The evaluation in 1985 found that there were many reports of improved health among the children and less anxiety for the parents about child care. Production has increased and absenteeism has fallen. Pressure was applied successfully to obtain a local elementary school. A literacy program for adults was also begun. Of the problems encountered, the most difficult was persuading men, who felt that there was not a child care problem and that the women took care of it, to share in child care responsibilities. IFLE and UNICEF replicated the effort in Melka Oba within the Yetnora Agricultural Producer's Cooperative in Dejen, Gojjam Region. 12 lessons learned from this experience are identified: 1) child care needs must also take into account the interrelated needs of working mothers, infants and young children, and child care providers; 2) child care must be accessible, available during work hours, affordable, and trustworthy to mothers; 3) high quality care must have an appropriate curriculum; 4) local women should be trained as providers; 5) need is dependent on the child's age; 6) providers need payment and support; 7) community involvement increases commitment and learning; 8) byproducts are parent education and more schooling options for siblings; 9) teaching needs to be learner centered; 10) no 1 solution is best; 11) quality of care must be contextually judged by mothers and the community; and 12) political commitment is necessary.
[Kuching, Malaysia, SFPA, 1991]. ii, 35 p.The Sarawak Family Planning Association's (SFPA's) main focus in 1990 was the strengthening of the Family Planning Clinic Service Program. Although the number of clinics has remained at 8, the number of resupply points increased from 50 in 1989 to 112 in 1990. These resupply points are set up in areas where transportation, financial, or social factors impede the ability of established acceptors to attend the static clinics. In part because of the increased availability of contraceptive services, the number of acceptors increased by 3352 over 1989, to reach 28,996 in 1990. The remaining 31, 847 acceptors in the country are serviced by the Ministry of Health. The SFPA utilizes a "cafeteria approach" to contraceptive choice; methods available are oral contraceptives, IUD, condom, injectable, spermicides, vasectomy, and natural family planning. At SFPA's clinic sites, the pill accounts for 57-93% of total contraceptive acceptance. The physicians at the 8 clinics also provide clients with cervical and breast cancer screening, pregnancy testing, infertility counseling, gynecological examinations and referral, and premarital advice. An extension of the Clinic Service Program, the Community Clinic Extension Family Planning Program, operates in the main towns. Involved in this program are 41 physicians, who distributed largely hormonal forms of contraception to 3587 acceptors, and 76 non-medical workers, who distributed condoms to 289 acceptors. As the major source of family planning information in Sarawak, the SFPA has an extensive IEC program that uses talks, home parties, fieldwork motivation, mass media campaigns, and community meetings to recruit new acceptors. Finally, the Family Life Education Project sought, in 1990, to increase the involvement of young people in determining their own programs and activities.
IN TOUCH 1991 Jun; 10(99):21-2.Despite obstacles to expanding immunization coverage (EPI) in developing countries, progress has been made in Bangladesh and is described. A February, 1991, World Health Organization cluster evaluation survey indicates that government efforts during the 1980s, with the cooperation and assistance of non-governmental organizations (NGO), have increased the degree of immunization coverage in Bangladesh. 80% coverage for BCG, measles, and DPT-3 antigens is realized in the Rajshahi division, 1 of 4 divisions sampled in the survey. Use of existing FWAs and HA as vaccinators; DC, UNO, and upazila chairmen involvement; partner recruitment for mobilization efforts; steam sterilization of needles; maintenance of an effective cold chain; and monthly vaccination sessions at more than 108,000 sites throughout the country worked together to successfully yield greater immunization coverage. Sustained efforts are, however, required to ensure vaccine protection of the 4 million children born into the population each year. 80% or greater universal coverage in Bangladesh is the focus of continued efforts. Eradication of polio, measles, and neonatal tetanus is possible in the 1990s, while Vitamin A distribution and more effective promotion of family planning services are also objectives. Government and NGO workers must promote awareness of EPI, monitor EPI service delivery, and encourage HAs, FWAs, UHFO Civil Surgeons, UNOs, DCs, and upazila chairmen to provide regular EPI services.
PEOPLE. 1987; 14(2):33.3 agencies in Turkey are placing family planning centers in factory settings: the Family Planning Association of Turkey (FPAT), the Confederation of Trade Unions (TURK-IS), and the Family Health and Planning Foundation, a consortium of industrialists. The FPAT started with 27 factories 7 years ago, educating and serving 35,000 workers. The 1st work with management, then train health professionals in family planning, immunization, infant and child care, maternal health, education, motivation techniques, record-keeping and follow-up. Worker education is then begun in groups of 50. New sites are covered on a 1st-come-1st-served basis. This program is expected to be successful because newcomers to city jobs are beginning to see the need for smaller families, and accept family planning. TURK-IS has conducted seminars for trade union leaders and workers' representatives and provided contraceptives in 4 family planning clinics and in 20 hospitals run by Social Security, a workers' health organization. They have distributed condoms in factories and trained nurses to insert IUDs in factory units. The businessmen have opened family planning services in 15 factories, with support from the Pathfinder Fund, and hope to make the project self-supporting.
World Health Forum. 1983; 4(2):157-61.In developing countries, the delivery of basic health care services is often hampered by communications problems. A pilot project in Guyana, involving 2-way radio in 9 medex (medical extension) locations, was funded by USAID (United States Aid for International Development). A training manual was prepared, and a training workshop provided the medex workers with practical experience in using the radios. The 2-way radios have facilitated arrangements for the transport of goods, hastened arrangements for leave, and shortened delays in correspondence and other administrative matters. Communication links enable rural health workers to treat patients with the advice of a doctor and allow doctors to monitor patient progress. Remote medex workers report that regular radio contacts with their colleagues have lessened their sense of isolation, boosted their morale, and helped build their confidence. 1 important element of the project was the training given to the field workers in proper use of the radio and in basic maintenance. Another key to the success of the system appears to be the strength and professionalism of the medex organization itself. Satellite systems may eventually prove to be the most cost effective means of providing rural telephone and broadcasting services and may also be designed to include dedicated medical communications networks at very little additional cost.