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Landscape for safe injection, phlebotomy, and waste management equipment. Standards, specifications, and products.
Boston, Massachusetts, JSI, MMIS, 2010 Jan.  p.This document provides guidelines for implementing a procurement policy for safe injection and brings together issues that countries should consider when developing and implementing the procurement aspect of a national injection safety policy. The document points out issues to consider in transitioning from policy to implementation, regulatory factors, public-sector considerations, and the need to sensitize private-sector manufacturers. It also includes a landscape of manufacturers of safe injection equipment.
21 issues for the 21st century: Result of the UNEP Foresight Process on Emerging Environmental Issues.
Nairobi, Kenya, UNEP, 2012.  p.The purpose of the UNEP Foresight Process is to produce, every two years, a careful and authoritative ranking of the most important emerging issues related to the global environment. UNEP aims to inform the UN and wider international community about these issues on a timely basis, as well as provide input to its own work programme and that of other UN agencies, thereby fulfilling the stipulation of its mandate: “keeping the global environment under review and bringing emerging issues to the attention of governments and the international community for action”. This report is the outcome of that process and presents the identified issues titled: 21 Issues for the 21st Century. These issues cut across all major global environmental themes including food production and food security; cities and land use; biodiversity, fresh water and marine; climate change and energy, technology and waste issues. (Excerpt)
Procuring Single-Use Injection Equipment and Safety Boxes: A Practical Guide for Pharmacists, Physicians, Procurement Staff and Programme Managers
Geneva, Switzerland, World Health Organization [WHO], 2003 May 5. (WHO/BCT/03.04)The objective of this guide is to accompany pharmacists, physicians, procurement staff and programme managers through the process of procuring single-use injection equipment and safety boxes of assured quality, on a national or international market, at reasonable prices. International organizations have established standardized procurement procedures for medicines and medical devices. This guide describes how these procedures can be used to ensure the procurement of injection equipment and safety boxes. Institutions procuring injection equipment need to develop a list of manufacturers that are prequalified on the basis of certain criteria which include international quality standards. This guide provides steps and tools for procurement, including a pre-qualification procedure of injection equipment for purchase. Developing a monitoring system for supplier performance will improve and safeguard the quality of injection equipment selected and prevent or eliminate unreliable suppliers.
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2003. v, 44 p. (WHO/FCH/RHR/03.11)The Making Pregnancy Safer (MPR) initiative was launched in 2000 to enhance WHO’s efforts in Safe Motherhood. The initiative is oriented to assist countries in strengthening their health system, focusing on evidence-based interventions that target the major causes of maternal and newborn mortality and morbidity. It states that both improvement of maternal and newborn health services and actions at the community level are required to ensure that women and their newborns have access to the skilled care they need, when they need it. Further, the important role of women, their partners, families and the larger community in improving health is emphasized. T The purpose of this document is to establish a common vision and approach, as well as to identify the role of the WHO Making Pregnancy Safer initiative, for working with women, men, families and communities to improve maternal and newborn health. Part 1 of the document defines the concepts, values and guiding principles; Part 2 presents strategies, settings, and priority areas of intervention; Part 3 proposes an implementation process; and, finally, Part 4 considers the role and functions of WHO. (excerpt)
United Nations learning strategy on HIV / AIDS. Building competence of the UN and its staff to respond to HIV / AIDS.
Geneva, Switzerland, UNAIDS, 2004 Jan. 44 p. (UNAIDS/04.02E)At the core of an effective United Nations system response to HIV/AIDS are the knowledge, skills and capacity of its staff. In April 2003, the Committee of Cosponsoring Organizations of the Joint United Nations Programme on HIV/AIDS (UNAIDS) approved a learning strategy to help the UN system develop the competence of its staff on HIV/AIDS. The goals of the strategy are: to develop the knowledge and competence of the UN and its staff so that they are able to best support national responses to HIV/AIDS; and to ensure that all UN staff members are able to make informed decisions to protect themselves from HIV and, if they are infected or affected by HIV, to ensure that they know where to turn for the best possible care and treatment. This includes ensuring that staff members fully understand the UN's HIV/AIDS workplace policies on eliminating stigma and discrimination against those infected and affected by HIV/AIDS. A recent system-wide survey shows that many staff members of the UN are far from being personally prepared to protect themselves from HIV, are afraid to be tested, are uncomfortable working with people living with HIV, and believe that people living with the virus would not feel comfortable talking about their seropositive status. The good news is that most staff members say that they want to learn more about all of these and other related topics. It goes without saying that the credibility of the UN system with governments, NGOs and others will be undermined if we cannot achieve internally what we are asking the rest of the world to do. (excerpt)
Informed choices for attaining the Millennium Development Goals: towards an international cooperative agenda for health-systems research.
Lancet. 2004; 364:997-1003.Health systems constraints are impeding the implementation of major global initiatives for health and the attainment of the Millennium Development Goals (MDGs). Research could contribute to overcoming these barriers. An independent task force has been convened by WHO to suggest areas where international collaborative research could help to generate the knowledge necessary to improve health systems. Suggested topics encompass financial and human resources, organisation and delivery of health services, governance, stewardship, knowledge management, and global influences. These topics should be viewed as tentative suggestions that form a basis for further discussion. This article is part of a wide-ranging consultation and comment is invited. The potential agenda will be presented at the Ministerial Summit on Health Research in November, 2004, and revised in the light of responses. Subsequently, we hope that resources will be committed to generate the evidence needed to build the equitable, effective, and efficient health systems needed to achieve the MDGs. (excerpt)
Lancet. 2004 Apr 3; 363(9415):1162.I commend Lee Jong-Wook for his Public health article, the most shocking statistic of which highlights the fact that almost a fifth of all deaths across the world occur in developing countries in children younger than 5 years. Efforts by WHO to alleviate this terrible burden are to be acclaimed. I find it disheartening, however, that a 5000-word essay on global health improvement makes only a few general references to noncommunicable diseases and fails to mention the Framework Convention on Tobacco Control (FCTC), one of WHO’s signal achievements. In fact, the words smoking and tobacco do not appear anywhere in the article, despite WHO’s acknowledgment that 4·9 million people are dying each year from tobacco use—a figure that will double within a generation. According to WHO’s own statistics, the burden of disease is currently shared evenly by developed and developing countries, but 70% of this risk will be borne by those in developing countries by the 2020s. (excerpt)
[Unpublished] 2000. Presented at the XVI FIGO World Congress of Gynecology and Obstetrics, Washington, D.C., September 3-8, 2000.  p.Maternal mortality and morbidity is a major problem health concern in many countries of the World health Organization South-East Asia Region. Despite concerted efforts by countries and the Regional Office to strengthen maternal health services, the Region still accounts for 40 per cent of the world's maternal deaths. Seven out of ten countries in the Region are still confronted with high maternal mortality ratios. The majority of people in these countries reside in rural areas where there is limited access to health facilities. It is not uncommon for women to receive no antenatal care and to deliver by themselves or be attended by a family member or other untrained person. Statistics reveal that more than half of the deliveries in the Region occur at home and most are attended by untrained persons. Many of the maternal deaths occur in homes, communities or during transport to health facilities. Maternal health services in many SEAR countries are inadequate. Special effort has, therefore, been given to address this problem for improved women's health in countries of the Region. It has long been recognized that the cornerstone of quality maternal health care is a person with adequate knowledge and skills in midwifery who lives in or close to the community where women live. Hence, various initiatives have been undertaken by WHO/SEARO to strengthen national capacity in the area of midwifery education and practice. (excerpt)
The US$500 million Multi-Country HIV / AIDS Program (MAP) for Africa. Progress review mission - FY01.
Washington, D.C., World Bank, 2001. 32 p.In September 2000, the World Bank approved the US $500 million Multi-Country HIV/AIDS Program (MAP I) to support national HIV/AIDS programs in Sub-Saharan Africa to accelerate and expand existing programs in prevention, care, treatment, and mitigation and to build capacity. The MAP approach was flexible and innovative in design – multisectoral, using multiple implementation channels, channeling money directly to communities, empowering stakeholders to make their own decisions, and emphasizing speed and responsiveness. From September 2000 through July 2001, the Bank committed US $399 million for nine country programs, more than in the previous decade. In preparation for requesting the Bank’s Board to approve a second MAP operation, a joint UNAIDS/World Bank Progress Review was carried out in June/July 2001 on the preparation and implementation of MAP I to learn lessons so Borrowers and the Bank could improve their performance in the war against HIV/AIDS. (excerpt)
Social Science and Medicine. 2003 Nov; 57(9):1547-1557.Spurred on by donors, a number of developing countries are in the midst of fundamental health and population sector reform. Focused on the performance-oriented norms of efficiency and effectiveness, reformers have paid insufficient attention to the process-oriented norms of sovereignty and democracy. As a result, citizens of sovereign states have been largely excluded from the deliberative process. This paper draws on political science and public administration theory to evaluate the Bangladeshi reform experience. It does so with reference to the norms of efficiency, effectiveness, sovereignty and democracy as a means of making explicit the values that need to be considered in order to make health and population sector reform a fair process. (author's)
Summary measures of population health in the context of the WHO framework for health system performance assessment.
In: Summary measures of population health: concepts, ethics, measurement and applications, edited by C.J.L. Murray, J.A. Salomon, C.D. Mathers and A.D. Lopez. Geneva, Switzerland, World Health Organization [WHO], 2002. 1-11.This volume addresses the conceptual, ethical, empirical and technical challenges in summarizing the health of populations. This is critical for monitoring whether levels of population health are improving over time and for understanding why health differs across settings. At the same time, it is also important to recognize that improving population health is not the only goal of health policy and to understand the way health improvements interact with these other goals. For that reason, we briefly review the World Health Organization (WHO) framework for assessing the performance of health systems and the role of summary measures of population health (SMPH) in this framework. Following the recent peer review of the methodology used for health system performance by WHO (Anand et al. 2002), this framework will continue to evolve in response to the detailed recommendations of the scientific peer review group and to ongoing scientific debates and research. (excerpt)
Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections. [Pour de meilleures pratiques de surveillance des infections dans le cas des aiguilles à injections intradermiques, sous-cutanées et intramusculaires]
Bulletin of the World Health Organization. 2003 Jul; 81(7):491-500.Objective: To draw up evidence-based guidelines to make injections safer. Methods: A development group summarized evidence-based best practices for preventing injection-associated infections in resource-limited settings. The development process included a breakdown of the WHO reference definition of a safe injection into a list of potentially critical steps, a review of the literature for each of these steps, the formulation of best practices, and the submission of the draft document to peer review. Findings: Eliminating unnecessary injections is the highest priority in preventing injection-associated infections. However, when intradermal, subcutaneous, or intramuscular injections are medically indicated, best infection control practices include the use of sterile injection equipment, the prevention of contamination of injection equipment and medication, the prevention of needle-stick injuries to the provider, and the prevention of access to used needles. Conclusion: The availability of best infection control practices for intradermal, subcutaneous, and intramuscular injections will provide a reference for global efforts to achieve the goal of safe and appropriate use of injections. WHO will revise the best practices five years after initial development, i.e. in 2005. (author's)
New York, New York, United Nations Population Fund [UNFPA], 2003 May. xii, 124 p. (Population and Development Strategies Series No. 7)The papers included in this document are selected from two meetings expressly aimed at identifying ways of promoting the continuation of decennial national censuses while at the same time coming up with innovative ways to contain or reduce costs without reducing quality, timeliness or output. After going through these papers (presented here as chapters), the reader should be left in no doubt that a census is a mammoth undertaking requiring meticulous planning and execution but reliant on adequate funding if it is to produce the quality information at the level of resolution and disaggregation required for small area and special-topic analyses. Developed countries have other potential sources of information that, if really necessary, can be used as proxies for census data. By contrast, developing countries rarely, if ever, have comparable sources because of the absence of the well-maintained administrative databases that might be mined for statistical purposes. This makes the conduct of regular, periodic censuses extremely important for national, regional and socio-economic planning in less developed countries both for government and for those national and international agencies that aim to improve the standard of living of the citizens in those countries. This report is aimed principally at census planners/managers who have the unenviable task not only of being responsible for the planning and execution of their country’s national census but of marshalling the campaigns needed to raise the funds required for such an undertaking. This has commonly been a difficult task in most countries contemplating the next census but it is now apparent that, for developing countries, the task has recently become even more challenging. A secondary target for this report is the local representative of the international donor community to which NSOs go for assistance to help finance their censuses or other surveys. These papers demonstrate to the sympathetic, statistically under-informed potential donor, what is involved in census taking and can assist in understanding the risks involved in supporting such an enterprise, what the NSO is doing to mitigate those risks, and the benefits that will accrue if a census is successfully completed. The report also provides the local representative of the donor community with some ideas for convincing those in the local office that statistical assistance is warranted and worthwhile. (excerpt)
Guidelines for the microbiological quality of treated wastewater used in agriculture: recommendations for revising WHO guidelines.
Bulletin of the World Health Organization. 2000; 78(9):1104-16.Three different approaches for establishing guidelines for the microbiological quality of treated wastewater that is reused for agriculture are reviewed. These approaches have different objectives as their outcomes: the absence of fecal indicator organisms in the wastewater, the absence of a measurable excess of cases of enteric disease in the exposed population and a model-generated estimated risk below a defined acceptable risk. If the second approach (using empirical epidemiological studies supplemented by microbiological studies of the transmission of pathogens) is used in conjunction with the third approach (using a model-based quantitative risk assessment for selected pathogens) a powerful tool used is produced that aids the development of regulations. This combined approach is more cost-effective than the first approach and adequately protects public health. The guideline limit for fecal coliform bacteria in unrestricted irrigation (1000 or fewer fecal coliform bacteria per 100 ml) is valid, but for restricted irrigation 100,000 or fewer fecal coliform bacteria per 100 ml is recommended when adult farmworkers are exposed to spray irrigation. A limit of 1000 or fewer fecal coliform bacteria per 100 ml is recommended if flood irrigation is used or children are exposed. The guideline limit for nematode eggs for both types of irrigation is adequate except when conditions favor the survival of nematode eggs and where children are exposed; in these cases it should be reduced from 1 egg or less per liter to 0.1 egg or less per liter. (author's, modified)
Sanitation in emergency situations. Proceedings of an international workshop, held in Oxford, December 1995.
Oxford, England, Oxfam, 1996. 51 p. (Oxfam Working Paper)This report presents summaries of plenaries, workshop papers, working group discussions, and a complete list of recommendations from the December 1995 International Inter-Agency Workshop on Sanitation in Emergency Situations. The 45 participants included delegates from nongovernmental organizations, UN organizations, the Red Cross, and independent sanitation workers. The aim was to discuss organizational and technical problems and to agree on operating principles, program implementation, and recommendations. The workshop papers focused on: principles for better sanitation, excreta disposal kits, first-phase excreta disposal, latrine construction, excreta disposal on difficult sites, emergency solid waste management/disposal, vector control, personal hygiene and water collection-storage, drainage and washing-bathing facilities, sanitation in enclosed centers, environmental impact, community participation, staff training, and evaluations. The discussions addressed topics on the principles for sanitation promotion in emergencies, first-phase excreta disposal, second phase and longer excreta disposal, off-site/on-site excreta disposal, flow charts for emergency excreta disposal for many specific conditions, refuse disposal, hygiene education, personal hygiene kits, vector control, hygiene facilities, environmental impact, sanitation in enclosed centers, and staff training. Priority should be given to sanitation techniques and guidelines for improving practices; initial assessments of emergency situations; and sanitation. Improvements are needed in information exchanges, community participation, and staff training. Five other recommendations are discussed.
Lancet. 1997 Jul 19; 350(9072):194.According to UNICEF's "Progress of Nations 1997" report, 3 billion people are living without adequate sanitation facilities. Access to potable water has improved on a global level. By 1994, three-quarters of the world's population had access to safe drinking water compared with 61% in 1990. On the other hand, the large number of people without decent toilets or latrines continues to serve as a major obstacle to health and development. As a result of the inability of sanitation facilities to keep pace with population growth, an additional 300 million individuals since 1990 have been added to the numbers of those forced to defecate in open spaces or dispose of waste in gullies and streams. The percentage point gap between water and sanitation access is 54% in Egypt (83% access to safe water and 29% access to sanitation). Gaps of similar magnitude exist in India, Bangladesh, China, and Brazil. Universal adequate sanitation could be achieved by redirecting only 1% of the global military budget. Another section of the report addresses violence against women and girls, characterized as "the most pervasive violation of human rights in the world" and the cause of an estimated 60 million unnecessary deaths.
BULLETIN OF THE PAN AMERICAN HEALTH ORGANIZATION. 1992; 26(4):370-8.In 1902 the First General International Sanitary Convention specified that countries should dispose of garbage to prevent the spread of diseases and to disinfect the discharges of all typhoid and cholera patients. The Pan American Sanitary Bureau was to elicit information regarding the sanitary conditions in their ports and territories and to encourage seaport sanitation, sewage disposal, soil drainage, street paving, and elimination of the sources of infection from buildings. The 2nd and 3rd Pan American Conferences of National Directors of Health, in 1931 and 1936, focused on topics of urban and rural sanitation, safe water and milk supplies, and industrial hygiene. In 1948 the Inter American Association of Sanitary Engineering (AIDIS) was created for the exchange of new ideas, experiences, and technologies. From 1942 to 1948, these special public health services benefited an estimated 23 million people by extending potable water supply and sanitation in the region and training hundreds of Latin American sanitary engineers. The 1961 American Governments' Charter of Punta del Este envisioned extending, over a 10-year period, water supply and excreta disposal services to 70% of the urban and 50% of the rural populations. In 1968, the Pan American Health Organization (PAHO) established the Pan American Center for Sanitary Engineering and Environmental Sciences (CEPIS), with headquarters in Lima. Over the years, CEPIS projects have encompassed air pollution, wastewater treatment and stabilization ponds, water treatment systems, solid waste collection and treatment, development of water and sewerage systems, and industrial hygiene. The 10-Year Health Plan for the Americas (1971-1980) stipulated that cities with more than 500,000 inhabitants establish programs to control pollution. 10 years later, actual coverage was: urban water supply, 82%; urban sewerage, 78%; rural water supply, 47%; and rural excreta disposal, 22%. PAHO's recent policy, Strategic Orientations and Program Priorities for 1991-1994, formulates workers' health programs with the aim of increasing service coverage to curtail risks to occupational health.