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Report of the Expanded Programme on Immunization Global Advisory Group Meeting, 20-23 October 1980, Geneva.
[Unpublished] 1980. 39 p. (EPI/GEN/80/1)This report of the Expanded Program on Immunization (EPI) Global Advisory Group Meeting, held during October 1980 in Geneva,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.
The global eradication of smallpox. Final report of the Global Commission for the Certification of Smallpox Eradication, Geneva, December 1979.
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.
Geneva, Switzerland, WHO, EPI, . 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.
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.
[Unpublished] .  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.
The World Fertility Survey: a basis for population and development planning, statement made at the World Fertility Survey Conference, London, England, 7 July 1980.
New York, N.Y., UNFPA, . 5 p. (Speech Series No. 54)The World Fertility Survey (WFS) is the largest social science research survey undertaken to date. From its inception in 1972 the WFS has received the full support of the UN and the UNFPA. This program has not only enhanced considerably our knowledge of fertility levels and fertility regulation practices in developing as well as developed countries but has also provided the UN system with internationally comparable data on human fertility on a large scale for the 1st time. The methodology developed by the WFS has made it possible to collect data on the individual and the household as well as the community. Information has become available not only on fertility levels, trends and patterns but also on fertility preferences and nuptiality as well as knowledge and use of family planning methods. Initial findings document the rather dramatic fertility decline taking place in many developing countries under various socioeconomic and cultural conditions. They also show the magnitude of existing unmet needs for family planning in the developing world which must be continuously brought to the attention of the governments of all countries. A most encouraging effect of the program, however, has been the fact that 21 industrialized countries have carried out, entirely with their own resources, fertility surveys within the WFS framework and in accordance with its recommendations, making it truly an internationally collaborative effort.
Mobilization of health manpower to meet health needs: lessons learned from the Smallpox Eradication Program.
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. 140-50.The last known naturally occurring case of smallpox was diagnosed on October 26, 1977, over 18 months ago. Since then, thousands of health workers in the recently endemic countries have searched from village to village and house to house in an attempt to detect other cases. Tens of thousands of persons who were ill with skin rashes have been screened. Thousands of specimens have been examined in World Health Organization (WHO) laboratories. None has been smallpox. 2 further cases of smallpox occurred in August of last year in Birmingham, England as a result of an accident in a laboratory. The accident dramatized the potential risk of spread as a result of laboratory infection and emphasized the need to reduce the number of laboratories retaining smallpox virus and to ensure that each provides maximum safety measures. At this time, smallpox virus is retained by only 7 laboratories and only 1 is conducting research. By the end of the year, the number of laboratories retaining smallpox virus should be reduced to 4. In October of this year, international commissions to certify smallpox eradication will be visiting the last endemic countries in the horn of Africa. On the basis of reports already documented, it is fully expected that it will be possible to certify that these countries are smallpox free and that global smallpox eradication has been achieved--the 1st disease ever to have been eradicated. It is surprising to find individuals who insist that the smallpox eradication program provides little or nothing of value to other programs. They question how the program could possibly have failed or what possible relevance it could have to primary health care provided by basic health workers. It is important to examine these beliefs in the context of the history of the program and its development and in the context of what is meant by primary health care. Global smallpox eradication was considered as anything but simple and certain when the program was adopated by the World Health Assembly in 1966. There are few, even today, who appreciate how little financial support the smallpox program was given. The single most important factor in the success of any program is to obtain the most competent, imaginative leadership possible at every level and to support and encourage those concerned. In the smallpox program, the attempt was made to identify and recruit the best possible people both for WHO and in the countries concerned. The 2nd principle of critical importance to the smallpox program was insistence that every program have a method for assessment and evaluation and that the data obtained be used in guiding the program. The 3rd key principle is that the responsibilities of village workers be clearly defined and that the worker understands what he/she is to do.
A systematic approach to planning the appropriate technology for primary child care: a necessary step toward realizing Alma-Ata.
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. 128-39.Focusing on the essential technologies for the clinical aspect of primary health care (PHC), this discussion argues that it is possible to define them. If PHC is ever to achieve an acceptable standard, these technologies must be available in the languages of all the world's health workers in a systematic form. This objective is both concrete and practicable. A great need exists for appropriate knowledge, and there is an even greater "application gap" in which technologies of proven value are not even known to the people who might use them. There are 2 essential preliminary steps, both of which are largely attainable: to organize the technologies systematically in at least 1 language and to keep the system currently under review so that it is always up to date; and to keep a careful watch on what is available in the languages of the world's health workers and to try to fill as many as possible of the gaps, either by encouraging original writing or by translation. With minor exceptions, the essential technologies for PHC are universally applicable. About 90% of the technologies for primary care are applicable everywhere. PHC is so complex that 2 initial simplifications are required: the level of the worker to be addressed; and to isolate appropriate technology, which is mostly applicable worldwide, from matters of culture and administration, which are highly specific locally. The ultimate objective is for an appropriate technology to be adopted and applied to heal the sick. Technologies can be promoted in at least 6 ways: the appropriate technology must be carefully and completely described step by step; the description of the appropriate technology must be accompanied by sufficient theory to make the necessary action seem reasonable to the workers; the necessary equipment must appear in a government medical store's list and in the UN International Children's Emergency Fund (UNICEF) list; the technology must be accompanied by the necessary evaluation procedures; a group of technologies must be accompanied by its appropriate management targets; and the appropriate technologies must be accompanied by the necessary teaching aids. There are important links between technologies; they mutually support each other. Not only does 1 technology support another, but the various different ways of promoting the same technology support one another. Currently, the emphasis is rightly on providing everyone with access to at least some health care, but the need to measure and increase the quality of that care is already being felt. It is a formidable task to plan these detailed systems of technologies for primary care. The World Health Organization (WHO) could do it by mobilizing the necessary talent globally. Also, WHO, assisted by the bilateral agencies, has the power to define the essential technologies for PHC, to systematize them anonymously, and to encourage its member states to make sure they are available in the languages of all the world's health workers.
Conventional health care systems and meeting the essential needs of underserved population groups in developing countries.
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.
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.
In: Wood C, Rue Y, ed. Health policies in developing countries. London, England, The Royal Society of Medicine, 1980. 11-7. (Royal Society of Medicine. International Congress and Symposium Series; No. 24)In developing countries systems of "bare-foot doctor" health care are being used. The goal is to provide a health service that is within the reach of each individual and family in the community, is acceptable to participants, that entails their full participation at a cost suitable to the individual and the nation. As opposed to hospital oriented Western medicine, there is usually a health officer from the local community, trained and provided with a dispensary, who returns to the home community. 2 projects in progress which were having negative results, 1 in Zaire and 1 in Senegal, were evaluated. The principles which redirected the programs are discussed. Problems such as mobile centers versus fixed sites for health centers, single aim projects and self-administration of the centers are explored. The acceptance of responsibility by the local public by using funding and resources of its own was judged to run the least risk of failing in the long term. In Senegal a new law on administrative reform was passed which allowed district health committees dealing with about 100,000 people to be set up. With a system of self-financing, more than 500,000 people were treated in 3 years. The fees were modest and 65% of the income from fees was used to keep drug supplies up to date. 3 dangers were identified and overcome: risk of embezzlement by district treasurers, overconsumption of drugs, and stocking excessively expensive products. The basic conditions necessary to provide an efficient network of health services in a rural environment (Zaire) and an urban environment (Senegal) are joint financing of activities through contractual financial participation, local administration, improved medical personnel, standardized medical procedure, and continuous supervision in collaboration with non-professional health workers.
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.
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.
In: White KL, Bullock PJ, ed. The health of populations: a report of two Rockefeller Foundation conferences, March and May 1979. New York, Rockefeller Foundation, Sept. 1980. 116-23.The quality of the health service delivery systems developed in many newly emerging nations over the past few decades has been limited. Authoritarian regimes are prominent among countries registering greater degrees of success, while health has typically received low priority in free enterprise countries. Given the variety, no 1 approach by international agencies will be suitable for all situations, but some guidelines can be suggested. Agencies should work through the ministries of health, which will be the main avenues for providing health care for the foreseeable future. Funding agencies could contribute to local costs during and after actual program initiation, to allow time for local institutions to assume the maintenance and recurring costs. The present emphasis on primary health care should be balanced by adjustments in the secondary and tertiary sector; curative and preventive services are both needed. Selected vertical programs, especially immunization programs, have a place in the overall provision of health care, but should not be stressed to the detriment of general improvement in the health of the population. Systems are needed in which appropriately trained doctors and auxiliaries can complement each other. If low level personnel are used to provide health care, they should be adequately supported and supervised. Care should be exercised in diverting scarce resources to support for traditional medicine. Key areas for future research in health care include the role and functioning of middle management, logistical support, and intersectoral schemes.
In: International Health Conference (1980 : Washington, D.C.). International health: measuring progress: proceedings, 1980 International Health Conference, June 11-13, 1980. Washington, D.C., National Council for International Health, 1980. 39-41.In the year 2000, the World Health Organization (WHO) and its member countries will be judged regarding their success in realizing the goal of "Health for All by the Year 2000." This assessment will require 4 types of data: baseline data on health status and priority causes of morbidity and mortality; identification of priority areas for intervention; establishment of quantitative time limited objectives; and establishment of implementation of monitoring systems to measure progress toward objectives. As discussions on monitoring are often confused by different definitions and interpretations, it is important to differentiate measures of service delivery (process indicators) from those that measure impact of services on health (outcome indicators). The Alma-Ata document identifies primary health care (PHC) as the operational strategy to realize Health for All. It envisions action in all of the following areas: education concerning prevailing health problems and methods of prevention of them; promotion of food supply and proper nutrition; adequate supply of safe water and basic sanitation; maternal and child health care including family planning and immunizations; prevention and control of endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs. Monitoring is an active selective measurement of key indicators to measure progress toward specific objectives. WHO has identified certain basic principles for selecting indicators and these are listed. Monitoring is required at all levels, and the most important is probably the local level. Some of the key aspects of local monitoring are reviewed. Unless there is a commitment to effective monitoring, the current talk on "Health for All" will be nothin more than rhetoric.
In: International Health Conference (1980 : Washington, D.C.). International health: measuring progress: proceedings, 1980 International Health Conference, June 11-13, 1980. Washington, D.C., National Council for International Health, 1980. 12-5.The World Bank made a formal decision in 1979 to lend for specific health activities. The bank is not a granting agency and lends money on favorable terms. It can only deal with governments and cannot deal directly with nongovernmental organizations of private institutions, although it may act as advocate with governments for such groups. The objective of the Bank in international health is to provide basic health services to the poorest populations, rural and semi-urban. It will support the concept of primary health care, i.e., simple methods of diagnosis and treatment managed within the limited resources which developing countries can devote to health. Primary health care cannot be prepackaged for export; it must be developed on site. It depends, to a large extent, on the development of human resources. One of the most important challenges is to raise the priorities attached to health by the government, their economic planning departments, and key decision makers in donor agencies. Also important to the Bank and other donor agencies is the relative cost-effectiveness of various approaches and health interventions. Community mobilization is a key issue in view of the limited resources that developing countries are likely to devote to health through the public sector. Also, there is evidence that some of the most successful primary health care projects have been executed by nongovernmental agencies. Another important question is the interface between government-operated services and the community. Community movements may be feared by governments in some of these countries and in others success leads to takeover. Issues for evaluation need to be chosen on the past of their importance to policy questions or program decisions in the developing nations themselves. The time schedule for evaluation should coincide with the time schedule of the decision makers in those settings.
Population Review. 1980 Jan-Dec; 24(1-2):5-8.The medical system perfectd in India--"Knowledge of the Span of Life"--in many ways foreshadowed the World Health Organization's (WHOs) own definition of health as a "state of complete physical, mental and social wellbeing." The goal of "health for all by the year 2000" envisages strengthening of public health programs of developing countries, where most diseases are concomitants of economic backwardness. Yet, it should not be assumed that developed countries are without health problems. They are experiencing the tensions, mental and physical, to which residents of densely populated cities succumb. Once it is recognized that better health is not simply an offshoot of overall economic development, and that major improvements in health are possible in the absence of industrialization, it follows that the patterns of public health and health administration of advanced countries are not necessarily appropriate for developing nations. What must be stressed is the need for a health revolution in developing countries, to wipe out diseases and to make available specialized treatment as well as to provide basic health care and to take preventive measures. Education from the earliest stages needs to include certain elementary information about health, sanitation, cleanliness, the avoidance of contagious diseases, and the preservation of the environment which is closely linked to these. There is a need at this time for a global campaign for eradication of leprosy, prevention of blindness, and greater research to produce an ideal contraceptive. Family planning programs are awaiting a big breakthrough. Without a safe, preferably oral, drug which women and men can take, no amount of government commitment and political determination will bring success.
In: O'Connor RW, ed. Managing health systems in developing areas: experiences from Afghanistan. Lexington, Massachusetts, D.C. Heath, 1980. 117-20.Most donor/contractor relations within the health care field in Afghanistan have been excellent. Primary interaction and responsibility was with USAID (U. S. Agency for International Development). The nature of the project, however, required cooperation with other donors, e.g., UNICEF, UNFPA, and the World Bank. The USAID team gave the project staff a great deal of freedom of management. When more than 1 donor happened to be involved with a particular rural health project, none tried to take over control of the project. Locally knowledgeable personnel should be used for program development instead of USAID relying on outside contractors with minimal knowledge of the country.
World Health. 1980 Feb-Mar; 36.The point was made recently in an article in "World Health" in December 1980 that hospitals continue to risk becoming breeding grounds for disease unless people take the right precautions. Florence Nightingale, writing 120 years ago, noted her horror upon seeing the cholera and dysentery infested hospitals of the British army during the Crimean war of 1853-1856. She suggested that hospitals may have actually increased, rather than diminished, the rate of mortality. She identified 5 essential points for securing "the health of houses": pure air; pure water; efficient drainage; cleanliness; and light. If by pure air and light she meant good environment, her message was the same as the message of the World Health Organization (WHO) today. Nightingale also stressed the need for a sensible diet. By primary health care is meant the need for health care to reach all the millions of people who are still without access to doctors or hospitals or drugs.
World Health. 1980 Feb-Mar; 3, 5.The World Health Assembly, in launching the movement for health for all by the year 2000, has identified health for all as the attainment by all the people of the world of a level of health that will allow them to lead socially and economically productive lives. The definition implies that the level of health of all individuals should be such that they are capable of working productively and of actively participation in the social life of the community in which they live. To bring this about will necessitate reforms in the health sector as well as reforms of a political, social and economic nature. A more equitable distribution of resources for health can be the 1st of several of such reforms in all sectors. The health infrastructure needs to be reorganized in order to play a leading role in forging together the different health programs into a single unified system. The International Conference of Primary Health Care held in Almata of the Union of Soviet Socialist Republics in 1978 issued a Declaration. This Declaration stated that primary health care is the key to realizing health for all by the year 2000. Also identified were 8 essential elements of primary health care. These include the following: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; and maternal and child health care, including family planning and immunization against the major infectious diseases.
[Unpublished] 1980. 26 p.During the meeting of the Technical Advisory Group, the following objectives and strategies of the WHO diarrhoeal Diseases Control Programme were endorsed: 1) reduction of diarrheal diseases mortality by means of widespread implementation of oral rehydration therapy, along with guidance on appropriate feeding practices and the strengthening or establishment of adequate epidemiological surveillance mechanisms to evaluate mortality changes, and 2) promotion of maternal and child care and environmental health practices to reduce diarrheal morbidity. By 1983, the Programme hopes to make oral rehydration salts (ORS) accessible to 25% of children under 5 years of age in developing countries. About 70 developing countries were reported to be either planning to develop or were formulating plans of operation for national CDD (Diarrheal Diseases Control) as a primary health care activity. Proposed Programme activities in the areas of country program planning and evaluation, management and technical training, logistic support and information dissemination were endorsed by the Group. The research component of the Programme was also reviewed, and priority areas were recommended for operational and basic research designed to improve strategies for program delivery and develop new tools for prevention and treatment. The Group also strongly endorsed the formation and convening of global and regional Scientific Working Groups or analogous bodies to coordinate and execute the research programme. The current budgetary status of the Programme was also discussed.