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  1. 1

    Report of the Expanded Programme on Immunization Global Advisory Group Meeting, 20-23 October 1980, Geneva.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]. Global Advisory Group

    [Unpublished] 1980. 39 p. (EPI/GEN/80/1)

    This report of the Expanded Program on Immunization (EPI) Global Advisory Group Meeting, held during October 1980 in Geneva, Switzerland, presents conclusions and recommendations, global and regional overviews, working group discussions, and outlines global advisory group activities for 1981. In terms of global strategies, the EPI confronts dual challenges: to reduce morbidity and mortality by providing immunizations for all children of the world by 1990; and to develop immunization services in consonance with other health services, particularly those directed towards mothers and children, so they can mutually strengthen the approach of primary health care. Increased resources are needed to support the expansion of immunization services and to establish them as permanent elements of the health care system. The Global Advisory Group affirms the importance of setting quantified targets as a basic principle of management and endorses the principle of setting targets for the reduction of the EPI diseases at national, regional, and global levels. The primary focus for the World Health Organization (WHO) in promoting the EPI continues to be the support to national program implementation in all its aspects. The Group reviewed current EPI immunization schedules and policies and concurs in the following: for measles, for most developing countries, the available data support the current recommendations of administering a single dose of vaccine to children as early as possible after the child reaches the age of 9 months; for DPT, children in the 1st year of life should receive a series of 3 DPT doses administered at intervals of at least 1 month; for tetanus toxoid, the control of neonatal and puerperal tetanus by immunizing women of childbearing age, particularly pregnant women, is endorsed; for poliomyelitis, the Group endorses the "Outline for WHO's Research on Poliomyelitis, Polioviruses and Poliomyelitis Vaccines" prepared by the WHO Working Group convened in October 1980, i.e., for oral (live) vaccines, a 3-dose schedule, administered simultaneously with DPT vaccine, is recommended again; and for BCG concurred with the Advisory Committee on Medical Research conclusion that the use of BCG as an anti-tuberculosis measure within the EPI should be continued as at present. The implementation of programs at the national level remains the foremost priority for the EPI. National commitment, evidenced in part by the designation of a national manager, the establishment of realistic targets, and the allocation of adequate resources, is essential if programs are to succeed.
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  2. 2

    Vaccination against tuberculosis. Report of an ICMR/WHO Scientific Group.

    World Health Organization [WHO]. Scientific Group on Vaccines Against Tuberculosis


    This document reports the discussions of a Scientific Group on Vaccination Against Tuberculosis, cosponsored by the Indian Council of Medical Research and the World Health Organization (WHO), that met in 1980. The objectives of the meeting were to review research on Bacillus Calmete-Guerin (BCG) vaccination, assess the present state of knowledge, and determine how to advance this knowledge. Particular emphasis is placed in this document on the trial of BCG vaccines in South India. In this trial, the tuberculin sensitivity induced by BCG vaccination was highly satisfactory at 2 1/2 months but had waned sharply by 2 1/2 years and the 7 1/2-year follow up revealed a high incidence of tuberculous infection in the study population. It is suggested that the protective effect of BCG may depend on epidemiologic, environmental, and immunologic factors affecting both the host and the infective agent. Studies to test certain hypotheses (e.g., the immune response of the study population was unusual, the vaccines were inadequate, the south Indian variant of M tuberculosis acted as an attenuating immunizing agent, and mycobacteria other than M tuberculosis may have partially immunized the study population) are recommended. A detailed analysis should be made when results from the 10-year follow up of the south Indian study population are available.
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  3. 3

    The global eradication of smallpox. Final report of the Global Commission for the Certification of Smallpox Eradication, Geneva, December 1979.

    World Health Organization [WHO]. Global Commission for the Certification of Smallpox Eradication

    Geneva, Switzerland, WHO, 1980. 122 p. (History of International Public Health No. 4)

    The Global Commission for the Certification of Smallpox Eradication met in December 1978 to review the program in detail and to advise on subsequent activities and met again in December 1979 to assess progress and to make the final recommendations that are presented in this report. Additionally, the report contains a summary account of the history of smallpox, the clinical, epidemiological, and virological features of the disease, the efforts to control and eradicate smallpox prior to 1966, and an account of the intensified program during the 1967-79 period. The report describes the procedures used for the certification of eradication along with the findings of 21 different international commissions that visited and reviewed programs in 61 countries. These findings provide the basis for the Commission's conclusion that the global eradication of smallpox has been achieved. The Commission also concluded that there is no evidence that smallpox will return as an endemic disease. The overall development and coordination of the intensified program were carried out by a smallpox unit established at the World Health Organization (WHO) headquarters in Geneva, which worked closely with WHO staff at regional offices and, through them, with national staff and WHO advisers at the country level. Earlier programs had been based on a mass vaccination strategy. The intensified campaign called for programs designed to vaccinate at least 80% of the population within a 2-3 year period. During this time, reporting systems and surveillance activities were to be developed that would permit detection and elimination of the remaining foci of the disease. Support was sought and obtained from many different governments and agencies. The progression of the eradication program can be divided into 3 phases: the period between 1967-72 when eradication was achieved in most African countries, Indonesia, and South America; the 1973-75 period when major efforts focused on the countries of the Indian subcontinent; and the 1975-77 period when the goal of eradication was realized in the Horn of Africa. Global Commission recommendations for WHO policy in the post-eradication era include: the discontinuation of smallpox vaccination; continuing surveillance of monkey pox in West and Central Africa; supervision of the stocks and use of variola virus in laboratories; a policy of insurance against the return of the disease that includes thorough investigation of reports of suspected smallpox; the maintenance of an international reserve of freeze-dried vaccine under WHO control; and measures designed to ensure that laboratory and epidemiological expertise in human poxvirus infections should not be dissipated.
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  4. 4

    Intermediating development assistance in health: prospects for organizing a public/private investment portfolio.

    Family Health

    Washington, D.C., Family Health, 1980 July 23. 162 p.

    The objective of this study is to identify and assess the potential role of intermediary organizations in furthering AID health assistance objectives. The 1st section of this report is an introduction to the potential roles of intermediaries through health assistance via the private voluntary community. A background of the private voluntary organizations is discussed along with some of the constraints that may impede their activity, such as competing interests, values and priorities. The following section defines what is and should be an intermediary organization along with examples of certain functions involved; a discussion of the experience of AID in the utilization of intermediaries follows. 3 models of utilization of intermediaries are analyzed according to the rationale involved, strategy, advantages and constraints. The 3rd section attempts to define and identify AID's needs for programming its health assistance in regard to primary health care, water and sanitation, disease control and health planning. A detailed analysis of the potential roles of intermediary organizations is discussed in reference to policy development, project development and design, project implementation, research, training and evaluation. The 4th section identifies the programming strengths and interests among listed private voluntary organizations in the US. The 5th section discusses the potential of intermediaries in health assistance in reference to the options for funding them in health and the constraints to direct AID funding of intermediary organizations. The last section discusses a series of recommendations made in regard to the development and funding of an international effort to marshall private resources in support of health assistance. Problems and constraints, as well as resources and opportunities, for the development of this international effort are further discussed.
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  5. 5

    Guidelines for cholera control.

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    Geneva, Switzerland, WHO, 1980. 14 p.

    This manual was designed to help national health workers, particularly managers of diarrheal disease control programs, to implement cholera control activities within the context of national programs. Recent knowledge of the bacteriology and epidemiology of cholera is presented, followed by a discussion of necessary preparations for cholera control. Case fatality rates of as high as 50% have been reported in unprepared communities, but the rate diminishes to under 3% when proper treatment becomes available. Preparations for cholera control including formation of national epidemic control committee, surveillance activities, health education activities, training in clinical management of acute diarrhea, laboratory services, establishment of mobile control teams, and logistics are described. The epidemic phase of a cholera outbreak requires intensification of ongoing diarrheal disease control activities. Components of the epidemic phase program including early case finding, establishing treatment centers, treatment, epidemiological investigation, laboratory support, control and prevention are discussed. Basic supplies for a mobile control team are listed.
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  6. 6

    Delivery systems. [Training module]

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    Geneva, Switzerland, WHO, 1980. 28 p.

    Presented in this module is a training exercise based on a fictitious developing nation, and in order to use this module successfully reference should be made to the 1st module in the series which provides the framework-- "Fictitia" [Training Module], (SI)802686. In this module a delivery system is defined as the manner in which personnel, facilities, equipment and supplies could be organized for the purpose of delivering health care to a specific population. Attention is directed to how to select the delivery systems through which Control of Diarrheal Diseases (CDD) activities will be integrated with other national programs and health activities. The 3 basic steps in selecting delivery systems are: describing existing systems which could deliver primary health care services; selecting from current and potential providers of primary health care those appropriate to deliver CDD services; and assigning CDD responsibilities to selected providers. Each step is described in detail in this module, and it is shown how each step could be performed in a CDD program.
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  7. 7

    Problem solving. [Training Module]

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Geneva, WHO, 1980.] 35 p.

    Presented in this module is a training exercise based on a fictitious developing nation, and in order to use this module successfully reference should be made to the 1st module in the series which provides the framework -- "Fictitia" [Training Module], (SI)802686. It is imperative that a program manager in a program for Control of Diarrheal Diseases (CDD) be continually alert in order to recognize the existence of problems which might prevent CDD targets, sub-targets, and desired outputs from being realized. Focus in this module is on identifying specific performance problems in a CDD program, what the reasons for these problems might be, and what can be done to resolve them. 4 basic steps are practiced in this module in the problem solving process: identifying a performance problem; describing the performance problem; identifying possible causes of the performance problem; and identifying reasonable solutions to the performance problem. The exercise relates to the CDD program that has been in progress in the Coastal Region of Fictitia for about 1 year.
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  8. 8

    Objectives and targets. [Training module]

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Geneva, WHO, 1980.] 43 p.

    Presented in this module is a training exercise based on a fictitious developing nation, and in order to use this module successfully reference should be made to the 1st module in the series which provides the framework, "Fictitia" [Training Module], (SI)802686. Focus in this module is on establishing objectives and targets for a national program for control of diarrheal disease. Objectives and targets are the morbidity and mortality reduction goals which are identified. A long-term effort is necessary, and committed national leadership and budgeting support are essential to sustained progress in an integrated program of diarrheal disease control. In this module, consideration will be given to national diarrheal disease control objectives, and the emphasis to be placed on each of the recommended control strategies in Fictitia. A target worksheet and data on Fictitia will then be used to write targets for reduction of diarrheal mortality in children under age 5 in Fictitia. This module should improve one's ability to recognize the benefits, constraints, and requirements involved in using the recommended diarrheal control strategies in one's own country and to write medium-term and long-term national targets for reduction of mortality due to diarrhea in children under age 5.
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  9. 9

    Introduction. [Training module]

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Geneva, WHO, 1980]. 15 p.

    This training module, the first in a series predicated upon demographic data presented in the next module in this series entitled "Fictitia" PIP/802686, a wholly fictitious developing nation, is designed to introduce the issue of diarrheal diseases as a global public health issue. In the developing world, diarrheal disease is one of the most important causes of morbidity and mortality among children under 5 years old. This course, presented in modules, is designed to help improve the skills and knowledge of health care delivery managers of national programs for diarrheal disease control. The introduction explains the course's organization and course operations. It also provides a glossary of terms used in these training materials and a list of abbreviations applicable to the subsequent teaching materials as well. This series of training modules was designed by WHO.
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  10. 10

    Evaluation. [Training module]

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Geneva, WHO, 1980]. 54 p.

    In this training module, 1 in a series of such modules published by WHO, the student is asked to practice the following selected tasks involved in evaluation of a national program for control of diarrheal diseases. 1) Review a data collection form for clarity, simplicity, and completeness. 2) Plan collection of data for evaluation of a specific subtarget. 3) Prepare a chart showing numbers of diarrhea cases, and identify disease trends. 4) Calculate and compare annual mortality rates in an area. 5) Explore reasons for failure to achieve an expected mortality reduction. 6) Estimate the amount of money saved by providing vs. hospital therapy. This workbook can be used in conjunction with another in this WHO series on the teaching of programs for control of diarrheal diseases in developing countries, where they are a major cause of morbidity and mortality among children under 5, "Fictitia PIP/802686 which provides fictitious data on a made up developing country to use in solving workbook problems during this course.
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  11. 11

    Logistics. [Training module]

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Geneva, WHO, 1980]. 45 p.

    As part of a series of WHO-designed training modules on developing a national program (in a developing nation) for the control of diarrheal diseases, this volume teaches how to determine logistical problems of supply and distribution of therapeutic modules for control of diarrheal disease. In this module, the student is expected to learn how to determine the quantity of oral rehydration salts (ORS) necessary in Fictitia, a wholly made up country, data on which is published in another module in this series called "Fictitia" PIP/802686, to recommend a distribution system for Fictitia, to determine the number of ORS packets the program manager needs to stock for proper inventory in Fictitia, to specify a schedule for reordering ORS packets in Fictitia, to determine the cost of local production of ORS in Fictitia, and to recommend whether Fictitia should produce its own ORS by target date 1986 or import the ORS the country needs.
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  12. 12

    Course facilitator guide. [Training module]

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Geneva, WHO, 1980]. 123 p.

    This course facilitator, or teacher, guide is part of a series of modules which comprise a training course for health care deliverers in developing countries designed to teach the skills necessary to implement a program for control of diarrheal diseases on a national scale. In this course, each participant is provided with a set of booklets called modules that serve as the primary subject matter resource. The materials are designed to assist the participant in developing specific skills. The participant in this course is encouraged to work at his or her own pace within the time constraints imposed by the course length. The participant is expected to discuss any problems or questions with the course facilitor as they arise, and this teacher's module is designed to help the course facilitor provide immediate feedback of completed course work. WHO designed this training program, and all of the modules which comprise the student material are in POPLINE.
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  13. 13

    Priorities. [Training module]

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Geneva, WHO, 1980]. 20 p.

    As part of the WHO series of training modules on programs for the control of diarrheal disease in developing nations, this module teaches how to select the priority health problems in children under age 5 for the country of Fictitia, a wholly made up collection of data on demographics and population characteristics which is presented in another, separate cover, training module in this series, "Fictitia" PIP/802686. The skills of priority selection gleaned from using this workbook in conjunction with fictitious data on a theoretical developing country called Fictitia should help health care providers in real developing nations learn the skills to allow them to select the priority health problems in their own country. Theoretical problems are put forth for users of these modules, designed by WHO, to solve (e.g., assess the incidence of a given health problem based on the data in "Fictitia" for a given year, or assess mortality from a health problem based on data for the theoretical developing country of Fictitia).
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  14. 14

    Sub-targets. [Training module].

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Geneva, WHO, 1980]. 65 p.

    This WHO publication, one in a series which comprise a complete course on how to set up a diarrheal disease control program in a developing nation, is designed to teach the skills to health care providers from developing countries required to isolate specific sub-targets during different phases of implementation of a theoretical national program. This and its companion volumes which stress various aspects of designing a national diarrheal disease control program may be used in conjunction with a volume that publishes fictitious data on demographic and population characteristics in a fictitious country, "Fictitia" PIP/802686. This module on subtargeting has the student consider the plan for phasing of a national program for control of diarrheal diseases in the theoretical developing country of Fictitia, write subtargets for a region of the initial phases of such a national program, determine whether or not achievement of regional or coverage subtargets throughout Fictitia is likely to lead to achievement of the medium-term mortality reduction, and specify the major activities necessary to achieve 1 of the regional subtargets.
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  15. 15

    Fictitia. [Training module]

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Geneva, WHO, 1980]. 19 p.

    As part of a series of training modules which form a course, the purpose of which is to train health care practitioners and deliverers how to effectively set up an in-country program for control of diarrheal disease, this module presents ficticious data (demographics and population characteristics) about a made-up developing nation, Fictitia. Further modules in this series train users how to order priorities in a diarrheal control program, how to focus on targets and sub-targets in the population and delivery system, how to design an effectively administered diarrheal disease control program, and how to evaluate any such program once implemented in an actual developing nation. Since diarrheal disease is 1 of the largest causes of morbidity and mortality among children under 5 in developing nations of this world, WHO created these training manuals as exercises, which would provide skills, upon course completion, applicable to an actual developing nation on earth.
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  16. 16

    Annual report January 1-December 31, 1979.

    International Project of the Association for Voluntary Sterilization

    New York, IP, 1980. 171 p. (Contract AID/pha-G-1128)

    With funds from a contract with the USAID, the International Prpject of the Association for Vuluntary Sterilization (IPAVS) has published this annual report to justify its expenditures and delineate its achievements as they relate to the contract goals. In 1979, the quantifiable program achievements were that: 1) voluntary sterilization services were provided to 78,873 men and women worldwide (30% increase over the previous year); 2) 674 physicians were trained in the techniques of surgical contraception (60% increase); 3) 249 health support personnel were trained by IPAVS auspices (4-fold increase); 4) IPAVS helped establish National associations based on its own philosophy in 28 developing countries in 1979; 5) 53 of 81 subgrants allotted included information service components; 6) 17 conferences on voluntary steilization or related health topics were attended by IPAVS, and the organization sponsored 1 regional, 3 national, and 1 international conference during 1979; 7) 57 of 73 countries attending the 4th International Conference on Voluntary Sterilization in Korea sponsored by IPAVS were developing nations; and 8) an IPAVS regional office for Asia was opened in Bangladesh. Other topics covered include grant management and policy development, program development, program accomplishments, information and education, and program support functions for management activities. This large volume publishes standards required by the IPAVS for medical procedures and minimal equipment.
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  17. 17

    Smallpox eradication.

    Henderson DA

    PUBLIC HEALTH REPORTS. 1980 Sep-Oct; 95(5):422-6.

    The implications of the eradication of smallpox in the context of epidemiology are presented. Eradication of disease has been conceived since the 1st smallpox vaccination was developed in the 18th century. Since then, attempts to eradicate yellow fever, malaria, yaws and smallpox have been instituted. Most public health professionals have been rightfully skeptical. Indeed, the success with smallpox was fortuitous and achieved only by a narrow margin. It is unlikely that any other disease will be eradicated, lacking the perfect epidemiological characteristics and affordable technology. The key to success with smallpox was the principle of surveillance. This concept has a vigorous developmental history in the discipline of epidemiology, derived from the work of Langmuir and Farr. It involves meticulous data collection, analysis, appropriate action and evaluation. In the case of smallpox, only these techniques permitted the key observations that smallpox vaccination was remarkably durable, and that effective reporting was fundamental for success. The currently popular goal of health for all, through horizontal programs, is contrary to the methods of epidemiology because its objective is vague and meaningless, no specific management structure is envisioned, and no system of surveillance and assessment is in place.
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  18. 18


    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    Geneva, Switzerland, WHO, EPI, [1980]. 3 p. (Training for Mid-level Managers; 7M1505879)

    This course is designed to help mid-level managers of Expanded Programs on Immunization (EPI) develop the skills needed to manage immunization activities. The course is designed around the major tasks which must be done to manage an immunization program. Each major task is described and taught in a booklet -- a module. These tasks are: allocate resources; manage the cold chain system; evaluate vaccination coverage; supervise performance; provide training; conduct disease surveillance; and ensure public participation. Each module is separate from the other lessons and can be used in any order. Most modules contain practice exercises. The trainee should complete each exercise and check his/her answers with the instructor.
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  19. 19

    [Smallpox eradication] Certification de l'eradication de la variole

    Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1980 Feb 1; 55(5):33-4.

    At its final meeting in December 1979, the Global Commission for the Certification of Smallpox Eradication concluded that smallpox eradication has been achieved on a worldwide basis and there is no evidence that smallpox will return as an endemic disease. The 65th session of the WHO's Executive Board, held on January 25, 1980, endorsed these conclusions and made 19 recommendations covering the areas of vaccination policy, reserve stocks of vaccine, investigation of suspected smallpox cases, laboratories retaining variola virus stocks, human monkeypox, laboratory investigations, documentation of the smallpox eradication program, and WHO headquarters staff. Sufficient freeze-dried smallpox vaccine to vaccinate 200 million people will be maintained by WHO in refrigerated depots in 2 countries. WHO will ensure that appropriate publications are produced describing smallpox and its eradication, with special emphasis on the principles and methods that are applicable to other programs.
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  20. 20

    Regional population communication unit for Africa. [Activities, 1974-1979].

    UNESCO. Regional Office for Education in Africa. Regional Population Communication Unit for Africa

    [Unpublished] [1980]. [49] p. (XA/01472/00)

    The Regional Population Communication Unit for Africa, operational in Nairobi, Kenya in September 1974, and a sub-unit operational since 1977 in Dakar, Senegal, work closely with the population education office in Dakar and with other international, regional, and subregional organizations which are active in population, family planning research, rural development, women, youth, and educational matters. In the years ahead, the Regional Unit will concentrate its efforts on assisting individual member states in addition to activities at regional or subregional levels, which are considered by member states to have a multiplier effect. The Unit's main objectives include: to assist national governments in the development of their communication plans, policies, and projects in support of their population/family planning and overall development programs; to work out with regional and international organizations or agencies a practical and effective system of coordinating communication and education activities in support of population and development communication programs at the national, subregional, and regional levels; to develop regional and national institutions for training, research, and development of appropriate communication materials; and to establish a population communication clearinghouse to serve as an exchange center for population and development communication programs in the region. The immediate objectives are to assist member states in their quest for self sufficiency in the training and development of manpower in the field of population; to provide member states with technical support in the development of their population activities; to promote the exchange of information, experience, materials, and know-how in the region; to develop and evaluate innovative communication approaches, which could improve the performance of national programs; to develop, pretest, produce, and evaluate a variety of prototype educational materials for use at the national level; and to improve the capacity of the Regional Population Communication Unit to assist in providing advisory services to national governments. The Unit's program of activities concentrates on 4 areas at both national and regional levels -- training, research and studies, media development, and technical assistance and advisory services. The activities of the Unit are geared to provide support for existing projects and programs, study tours, regional specialized workshops, and seminars and participation in the training seminars and workshops. Training programs provided by the Unit include seminars, workshops, and conference on development support communication. The training strategy emphasizes training as a continuing activity.
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  21. 21

    Health for all by the year 2000: strategies.

    Pan American Health Organization [PAHO]

    Washington, D.C., Regional Office of the World Health Organization, 1980. x, 189 p. (Official Document No. 173)

    The World Health Assembly decided in 1977 that the main social target of the Governments and the WHO in the decades ahead should be "the attainment by all the citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life." Subsequently, the World Health Assembly in 1979 urged the member states to define and implement national, regional, and global strategies for attaining the goal of health for all by the year 2000. This monograph reprints UN documents dealing with this goal. The 1st document addresses 2 specific issues, the developments in the health sector in the 1971-1980 decade, and strategies for attaining the goal of health for all by the year 2000. The 2nd document addresses 8 areas of interest; 1) social and environmental aspects of the region of the Americas; 2) evaluation of the 10-year health plan for the Americas; 3) implications of the goal and the new international economic order for the achievement of the objectives; 4) a method for analyzing strategies and developing a primary health care work plan and indicators for evaluating progress towards the goal; 5) objectives for the health and social sectors; 6) regional baseline targets for priority health conditions; 7) summary of revised regional strategies for attaining the goal; 8) national, intercountry, regional, and global implications of the regional strategies. The 3rd and 4th documents are resolutions 20 and 21 of the 27th meeting of the directing council of the Pan American Health Organization. Resolution 20 addresses regional strategies for attaining the goal. Resolution 21 discusses the ad hoc working group to complement the regional strategies.
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  22. 22

    Conventional health care systems and meeting the essential needs of underserved population groups in developing countries.

    Rifka G

    In: American University of Beirut. Faculty of Health Sciences. Human resources for primary health care in the Middle East. Beirut, Lebanon, American University of Beirut, 1980. 5-12.

    Although health is now recognized as a human right, it is questionable whether the right to health is a reality for all people. Many rural and peri-urban areas of developing countries lack any system of organized health care. Only a small proportion of rural communities have access to safe and adequate water supplies, and millions of persons are undernourished. Communicable diseases are widely prevalent, and poor housing conditions exist in many areas. Conventional health services have failed to meet the needs of the underserved populations in rural and peri-urban areas for the following reasons: total coverage of the population has not been provided; the gap in health status between the urban and rural populations has not been closed; ways and means for the participation of the community served has not been provided because the responsibility of the community for its own health care has been ignored; services provided are not relevant to the priority health problems of the majority but are oriented toward the provision of sophisticated care for the minority; the model of health care has usually been copied from developed countries where health problems, population age structure, and resources are totally different; and health workers are not trained to meet priority health needs, nor are they trained in the setting in which the majority are expected to work, i.e., the rural areas and health centers. Faced with the challenge, governments have recognized the need to develop a new approach to improve the state of the health of their people, as revealed by the series of resolutions adopted by the World Health Assembly and by Regional Committees, which are the governing bodies of the World Health Organization (WHO). The alternative approach hopefully will serve as an important mechanism for realizing the main social goal of "health for all by the year 2000," as projected by WHO. The strategy of primary health care (PHC) has been gaining wider recognition in the region and shows particular promise for the extension of health coverage to larger groups of the rural population. PHC has been defined as a "simplified, though essential, health care which is accessible, acceptable and affordable." A more detailed definition was outlined in the "Declaration of Alma-Ata," which was adopted by 140 governments participating in the International Conference on Primary Health Care held during September 1978. A number of countries have begun to train primary health workers who have completed elementary or intermediate general education, followed by a few months of health training. Further and more effective use of traditional health workers is being explored in several countries. In some countries primary care is delivered by health professionals. WHO is collaborating with countries in the planning, formulation, implementation, and evaluation of PHC programs.
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  23. 23

    A global perspective of health, vintage 1979.

    Gangarosa EJ

    In: American University of Beirut. Faculty of Health Sciences. Human resources for primary health care in the Middle East. Beirut, Lebanon, American University of Beirut, 1980. 1-4.

    Discussion focuses on the global state of health as an introduction and background for deliberations. There are several dramatic indications of the worsening state of global ill health, particularly in developing countries. During the past 2 decades a cholera pandemic has spread extensively in Asia and Africa. During this same time, in large areas of South Asia and Central America, bacillary dysentery has spread extensively. It too had been virtually absent from the world scene for the preceding 50 years. Like cholera, this pandemic took its greatest toll from the most deprived populations. The largest outbreaks of typhoid fever ever recorded in the literature have occurred in the current decade. Malaria has reemerged as a major public health problem in the poorest parts of Asia, Africa, and Central and South America. Diseases such as measles, diphtheria, tetanus, and polio, for which vaccines have been long available, persist as major public health problems. These diseases, especially the epidemic and pandemic diseases, may be considered public health indicators. Their resurgence in recent years after decades of quiescence is symptomatic of a state of global ill health. It is significant that developing areas have been rather exclusively affected. In recent times, seemingly, the world has been divided into epidemic prone areas and areas essentially free of the major infectious diseases. This health disparity is underscored by some startling statistics on infant mortality. The industrialized nations currently enjoy the lowest infant mortality ever, but the rate is higher than ever in most of the developing areas of Africa, Asia, and Latin America. 3 major demographic changes that have primarily affected the poor and a major economic upheaval are largely if not totally responsible for the worsening state of global ill health: the population explosion, urbanization, and migration. The fundamental problem is usually the quality of life and the common denominator is the search for a better way of life. This conference devoted to human resources for technology transfer in primary health care deals with a new direction in health care under the able leadership of the World Health Organization (WHO) and other UN agencies which have the potential to change the situation. WHO's slogan is adequate health care for all by the year 2000. The start is with a new working premise, i.e., that health is quality of life, not just freedom from physical and mental burdens.
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  24. 24

    Sixth report on the world health situation. Pt. 1. Global analysis.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1980. 290 p.

    This Sixth Report on the World Health Situation tries to bring out the main ideas on health and health care issues and how to deal with them that arose during the 1973-1977 period. The primary sources of information used in the preparation of the report were the following: information routinely passed on by Member Governments to the World Health Organization (WHO); country reviews specially submitted by Member Governments for the Sixth Report; information routinely collected by other organizations of the United Nations system; and information for the reference period collected by WHO on an "ad hoc" basis to meet specific policy and program requirements. A background chapter focuses on general considerations, population, food and nutrition, education, social changes, economic trends, employment, poverty, health-related behavioral factors, evaluation of development progress and data needs, and policy issues. Subsequent chapters examine health status differentials, health action, research, and the outlook for the future in terms of demographic prospects, social and economic aspects, health status trends, health manpower supply and demand, and world health policies. Most significant during the 1973-1977 period was the explicit recognition of the view that health development is a reflection of conscious political, social, and economic policy and planning rather than merely an outcome (or by-product) of technology. The goal of "health for all by the year 2000" expresses the political commitment of health services and the agencies responsible for them to a "new Health order." Primary health care is the most important vehicle for achieving this new health order. The most important social trends during the report period are reflected in the still low and in some areas worsening nutritional level of the majority of the population. The overall picture with regard to mortality continues to be mixed, with a few notable cases of marked decline and many of continuing unspectacular decline. The data on morbidity are even less reliable than those on mortality, but it appears that there has been a significant increase or resurgence of certain communicable diseases. There is evidence of decreasing dependence on physicians in some parts of the world and a related strengthening of various paramedical and auxiliary groupings. Some of the important new health programs are to be found in the area of family health. The overall role and importance of primary health care are emphasized in many parts of the report. There are some specific indications of ways in which primary health care activities are being integrated with the more traditional activities of the health sector.
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  25. 25

    Sixth report on the world health situation. Pt. 2. Review by country and area.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1980. 412 p.

    This report on the world health situation comes in 2 volumes, and this, the 2nd volume, reviews the health situation by country and area, with the additions and amendments submitted by the governments, and an addendum for later submissions. Information is presented for countries in the African Region, the Region of the Americas; the Southeast Asia Region, the European Region, the Eastern Mediterranean Region, and the Western Pacific Region. The information provided includes the following areas: the primary health problems, health policy; health legislation; health planning and programming; the organization of health services; biomedical and health services research; education and training of health manpower; health establishments; estimates of the main categories of health manpower; the production and sale of pharmaceuticals; health expenditures; appraisal of health services; demographic and health data; major public health problems; training establishments; actions taken; preventive medicine; and public health.
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