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Health Policy and Planning. 2002 Sep; 17(3):225-234.How do global disease control priorities change? This paper examines the post-World War II histories of efforts to control three diseases--polio, malaria, and tuberculosis--to investigate this issue. The paper draws from the policy studies literature to evaluate three models of the priority generation process. A rational model suggests logical selection based on global burden and the availability of cost-effective interventions. An incremental model suggests a drawn out process in which health priorities emerge gradually and interventions reach affected populations through slow diffusion. A punctuated equilibrium model suggests a more complex pattern: long periods of stability during which interventions are available only to select populations, punctuated by bursts of attention as these interventions spread across the globe in concentrated periods of time. The paper finds that the punctuated equilibrium model corresponds most closely to efforts to control these three diseases. Bursts are associated with the convergence of three conditions: the widespread acceptance of the disease as a threat: a perception that human interventions can control disease transmission; and the formation of a transnational coalition of health actors concerned with fighting the disease. The generation of each condition requires considerable groundwork, the reason for long periods of stability. Initiatives take off rapidly when the conditions couple, the reason for bursts. The paper aims to spark additional research on the subject of global disease control agenda setting, a neglected issue in the health policy literature. (author's)
A review of the USAID grant to UNICEF for EPI in Uganda, and a follow up visit on strengthening disease surveillance in Uganda, 29 May - 6 June 1997.
Arlington, Virginia, Partnership for Child Health Care, Basic Support for Institutionalizing Child Survival [BASICS], 1997. , 8,  p. (Report; USAID Contract No. HRN-C-00-93-00031-00)This report presents the key observations and recommendations of a Basic Support for Institutionalizing Child Survival (BASICS) review of a US Agency for International Development (USAID) grant to UNICEF for the Uganda National Expanded Programme on Immunization (UNEPI). To date, UNEPI's disease surveillance plan has focused almost entirely on acute flaccid paralysis. The need remains for more activities and surveillance concerning measles and neonatal tetanus. The government of Uganda's decentralization process and UNICEF's Community Capacity Building project provide potential for increasing awareness of EPI diseases and improving their detection and reporting. However, UNEPI must first ensure that District Health Teams are prepared, both technically and financially, for responding to reports of EPI diseases. It is recommended that UNEPI continue the revision of its work plan and budget for disease surveillance to include all activities and funding needs for measles and neonatal tetanus as well as the district operational costs. Where possible, UNEPI should provide a facilitator during any Ministry of Health surveillance training to ensure that EPI-related content is adequately covered. Establishment of a reliable, sustainable EPI disease surveillance system in Uganda will contribute to the development of such systems in other African countries.
Arlington, Virginia, Partnership for Child Health Care, 1995. , 10,  p. (BASICS Trip Report; BASICS Technical Directive: 000 HT 51 012; USAID Contract No. HRN-6006-C-00-3031-00)In March 1995, a BASICS (Basic Support for Institutionalizing Child Survival) Project technical officer participated in a World Health Organization (WHO) Global Programme on Vaccines and Immunization (GPV) meeting in Geneva, Switzerland, about introduction of vaccine vial monitors (VVMs). VVMs constitute color-coded labels that can be affixed to vials of vaccines which, when exposed to heat over time, change irreversibly. In 1994, WHO and UNICEF requested that, starting in January 1996, VVMs be affixed on all UNICEF-purchased vials of oral polio vaccine. Yet, UNICEF does not require vaccine manufacturers to include VVMs in their vaccine labels. USAID has supported much of the development and field testing of VVMs since 1987. Participants discussed status of interactions between UNICEF and vaccine manufacturers, issues and means related to introducing VVMs worldwide, and the prospect for conducting a study or studies on the initial effect of VVMs on vaccine-handling practices. They also heard an update on the pilot introduction of VVMs in some countries. BASICS could contribute to the development of a plan for global VVM introduction, since time constraints and heavy workloads face WHO/GPV leaders. UNICEF and GPV staff suggested that other VVM products from different manufacturers also be sold to avoid a monopoly. Participants considered issues of global introduction and resolution of issues with manufacturers of VVMs and vaccines to be high priority issues. WHO and UNICEF asked BASICS to draft general training materials for staff at the central, provincial, district, and periphery levels, focusing on actions that each level should take as a result of VVM use. They also asked BASICS to develop a quick-reference sheet for policy makers.