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Health and health services in Judaea, Samaria and Gaza 1983-1984: a report by the Ministry of Health of Israel to the Thirty-Seventh world Health Assembly, Geneva, May 1984.
Jerusalem, Israel, Ministry of Health, 1984 Mar. 195 p.Health conditions and health services in Judea, Samaria, and Gaza during the 1967-83 period are discussed. Health-related activities and changes in the social and economic environment are assessed and their impact on health is evaluated. Specific activities performed during the current year are outlined. The following are specific facets of the health care system that are the focus of many current projects in these districts; the development of a comprehensive network of primary care programs and centers for preventive and curative services has been given high priority and is continuing; renovation and expansion of hospital facilities, along with improved staffing, equipment, and supplies for basic and specialty health services increase local capabilities for increasingly sophisticated health care, and consequently there is a decreasing need to send patients requiring specialized care to supraregional referral hospitals, except for highly specialized services; inadequacies in the preexisting reporting system have necessitated a continuting process of development for the gathering and publication of general and specific statistical and demographic data; stress has been placed on provision of safe drinking water, development of sewage and solid waste collection and disposal systems, as well as food control and other environmental sanitation activities; major progress has been made in the establishment of a funding system that elicits the participation and financial support of the health care consumer through volunary health insurance, covering large proportions of the population in the few years since its inception; the continuing building room in residential housing along with the continuous development of essential community sanitation infrastructure services are important factors in improved living and health conditions for the people; and the health system's growth must continue to be accompanied by planning, evaluation, and research atall levels. Specific topics covered include: demography and vital statistics; socioeconomic conditions; morbidity and mortality; hospital services; maternal and child health; nutrition; health education; expanded program immunization; environmental health; mental health; problems of special groups; health insurance; community and voluntary agency participation; international agencies; manpower and training; and planning and evaluation. Over the past 17 years, Judea, Samaria, and Gaza have been areas of rapid population growth and atthe same time of rapid socioeconomic development. In addition there have been basic changes in the social and health environment. As measured by socioeconomic indicators, much progress has been achieved for and by the people. As measured by health status evaluation indicators, the people benefit from an incresing quantity and quality of primary care and specialty services. The expansion of the public health infrastructure, combined with growing access to and utilization of personal preventive services, has been a key contributor to this process.
[Expanded Programme on Immunization: Global Advisory Group] Programme Elargi de Vaccination: Groupe consultatif mondial.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1984 Mar 23; 59(12):85-9.In addition to the conclusions and recommendations reached at the 6th meeting of the Expanded Program on Immunization (EPI) Global Advisory Group and summarized in this report, the Group reviewed at length the status of the program in the Western Pacific Region and made a series of recommendations specifically directed to activities in the Region. Of particular significance for the operational progress of the global program are the recommendations concerning "Administration of EPI Vaccines," which were subsequently endorsed by the Precongress workshop on Immunization held before the XVIIth International Congress of Pediatrics in Manila in November 1983. These recommendations are not listed here. In his report to the World Health Assembly in 1982, the Director-General summarized the major problems which threaten the success of efforts to achieve the World Health Organization (WHO) goal of reducing morbidity and mortality by providing immunization for all children of the world by 1990. The 5-Point Action Program adopted at that time remains a relevant guide for countries and for WHO as they work to resolve those problems. The EPI is concerned about the prevention of the target diseases, not merely with the administration of vaccine. In addition to working toward increases in immunization coverage, the EPI must assure the strenghtening of surveillance systems so that the magnitude of the health problem represented by the target diseases is known at the community, district, regional, and national levels; immunization strategies are continuously adapted in order to reach groups at highest risk; and the target diseases are reduced to a minimum. The development of surveillance systems is one of the priorities in the development of effective primary health care services. Disease surveillance in its various forms should be used at all management levels for monitoring immunization programs performance and for measuring program impact. Specific recommendations regarding disease surveillance to be undertaken at global and regional levels and at the national level are listed. The results of more than 100 lameness surveys conducted in 25 developing countries confirm that paralytic poliomyelitis constitutes an important public health problem in any area in which the disease is endemic. In most programs, initial emphasis should be placed on the develpment of sentinel surveillance sites to monitor disease incidence trends. Some progress has been made in acting on the recommendations made at the meeting on the prevention of neonatal tetanus held in Lahore in 1982, but intensification of activities is required. In many developing countries, the surveillance and control of diphtheria must be improved. All aspects of progress and problems in the global program are reflected at least somewhere in the Western Pacific Region, and most of the findings and recommendations generally are valid beyond the regional boundaries.
Mortality and health policy: highlights of the issues in the context of the World Population Plan of Action.
In: Mortality and health policy. Proceedings of the Expert Group on Mortality and Health Policy, Rome, 30 May to 3 June 1983, [compiled by] United Nations. Department of International Economic and Social Affairs. New York, New York, United Nations, 1984. 37-79. (International Conference on Population, 1984.; ST/ESA/SER.A/91)This paper reviews the major issues that have emerged in the analysis of mortality and health policy since the 1974 World Population Conference. The 1st part summarizes current mortality conditions in the major world regions and evaluates progress toward achieving the goals of the World Population Plan of Action. It is noted that the current mortality situation is characterized by continued wide disparities between the more developed and less developed regions, especially during the 1st year of life. The 2nd part focuses on the synergistic relationship between health and development, including social, economic, and health inequalities. It is asserted that mortality rates in developing countries are a function of the balance governments select between development strategies favoring capital accumulation and concentrated investments on the 1 hand and strategies oriented toward meeting basic needs and reducing inequalities in income and wealth. Data from developed countries suggest that economic development does not necessarily lead to steady gains in life expectancy. Some variations in mortality may reflect changes in family relationships, especially women's status, that are induced by social and economic development, however. The 3rd part of this paper analyzes the effect of health policies on mortality, including curative and preventive programs and primary health care. The lack of community participation is cited as a key factor in the weak performance of primary health care in many developing countries. In addition, there is strong evidence that the concepts and technologies of modern medicine must be adapted to existing systems of disease prevention and care to gain acceptability. The 4th section, on the implementation of health policies, discusses health care management, planning, and financing. It is noted that successful implementation of health policies is often hindered by scarcity, inadequate allocation, and inefficient utilization of health resources. Finally, more effective means to cope with rising costs of health care are needed.
In: The Graduate Education of Foreign Physicians in Public Health and Preventive Medicine. The Role of United States Teaching Institutions, edited by Wendy W. Steele and Sally F. Oesterling. Philadelphia, Pennsylvania, Educational Commission for Foreign Medical Graduates, . 26-28.The School of Public Health at Loma Linda University in California was founded in 1967, and as of December 1983 had graduated a total of 1764 students, 187 of whom were physicians. 28 countries and 45 foreign schools were represented in this enrollment. The experience at Loma Linda University is different from many others in that there has been little government sponsorship of foreign medical graduates. Of 89 foreign medical graduates, only 17 were sponsored by the US Agency for International Development or the WHO, and all 17 returned to their home countries where they are making significant contributions in Tanzania, Kenya, Thailand and Indonesia. In 1970, the Loma Linda University School of Public Health developed an evening program in which most of the course work was taught in Los Angeles 1 evening per week over a 2-year period. 10 health officers and a few others completed that program. Their success stimulated extending the program. In 1973 an experimental program teaching a general Master of Public Health (MPH) course to Canadians was initiated. In 1980, Loma Linda University also launched an extended program in the Central American-Caribbean area. In the context of a general program in public health and preventive medicine leading to a Master of Public Health Degree, the curriculum in international health seeks to prepare health workers who will be: trainers of trainers; cross-cultural communicators; managers and supervisors of primary health care services; and practitioners of the integrated approach to community development. Graduates are prepared to deal with sociocultural, environmental and economic barriers. Students not having a professional background in health are required to add an area of concentration to degree requirements. Areas of concentration include: tropical agriculture, environmental health, health administration, health promotion, maternal and child health, nutrition and quantitative methods/health planning. The goal of the International Health Department is to help people help themselves to better health. Loma Linda University has also been involved with schools in Asia, Africa, Latin America and recently in the Philippines. The preventive medicine residency program at Loma Linda is for the 2nd and 3rd years only at the present.
In: The Graduate Education of Foreign Physicians in Public Health and Preventive Medicine. The Role of United States Teaching Institutions, edited by Wendy W. Steele and Sally F. Oesterling. Philadelphia, Pennsylvania, Educational Commission for Foreign Medical Graduates, . 15-8.At a time when there is a growing interdependency among nations with regard to trade, resources and security, there is an increasing provincialism in the US. In such a climate it is difficult to generate support for international programs. Involvement on the part of medical schools has waned almost to the point of nonparticipation in international medical affairs, largely because of constraints on training and residency programs. Academic health centers have not been supported as a matter of policy. Leadership in international health in other parts of the world, diminished involvement in international health, current priorities and programs and a future prospectus are discussed. The WHO seems an unlikely source for necessary leadership in helping define future directions for education or new strategies in preventive medicine and public health in the developing world. Institutions in Europe have deteriorated and participation and leadership from them are unlikely. Few people today are interested in clinical tropical medicine. Another reason for waning academic activity in international health relates to the paucity of interest on the part of foundations. An important initiative was the development about 5 or 6 years ago of the WHO Tropical Disease Research Program. It now has a budget of about US $25 million and has attracted additional money from the US and from other countries. A gamut of prospects has resulted including a maria vaccine, a leprosy vaccine, a new drug for malaria. In the developing countries, there is a much larger base of basic competence than existed only 10 or 20 years ago, but these health workers need support if health goals are to be attained. Schools of public health should be as much professional schools as schools of medicine, and the practice of public health should be engaged in. The US Centers for Disease Control (CDC), in its global Epidemic Intelligence Service (EIS) program in Thailand and in Indonesia has pioneered admirable new approaches in practical training. Provision must be made for sufficient faculty to permit both professional practice and education in any school that offers public health education. The US has a vital and unique role to play in public health and preventive medicine.
Assignment Children. 1984; (65/68):43-8.The General Assembly Resolution 35/36 called for accelerated progress towards social, child-oriented goals as part of the International Development Strategy for the 3rd UN Development Decade. The reduction of mortality rates is seen as a major objective; life expectancy in all countries should reach 60 years as a minimum and infant mortality rates should reach 50/1000 live births, as a maximum, by the year 2000. The Resulution also called for full and effective participation by the entire population at all stages of the development process. Women, in particular, should play an active role in that process. All countries should respect and snsure the right of parents to determine the number and spacing of their children and make universally available advice on and means of achieving the desired family size. A comprehensive and adequate system of primary health care, as an integral part of a more general health system and as part of a general improvement in nutrition and living standards, is the strategy through which an acceptable level of health for all by the year 2000 can be achieved. The response of UNICEF should be an intensification of its concern with seeking more resources for children's services by promoting and protecting breastfeeding and improving maternal nutrition. In 1981 the Executive Board of UNICEF decided upon these objectives and stated that basic services strategy was the principal approach to be followed. The 1982 Executive Board meeting called for a new attack on child and maternal nutrition and for the inclusion of low-cost interventions in infant and child feeding, diarrheal disease control, and child immunization. The elements of UNICEF's Childrens Revolutioon are Oral Rehydration Therapy, universal child immunization, the promotion of breastfeeding, growth charts, birth spacing and food supplements. The 1683 Executive Board meeting supported the initiatives aimed at effecting a child health revolution. In 1984, the Executive Board meeting agreed that achieving the full potential f the child survival and development revolution would require strengthened program delivery and more effective program implementation at the national scale, aiming at universal coverage of target population groups.
Assignment Children. 1984; (65/68):13-20.The central idea behind UNICEF's rubric of the Child Survival and Development Revolution (CSDR) is to enable parents to protect their children from preventable death an disablement. The CSDR strategy takes the demand approach, which opens the possibilities for parents to see what they should and could do to "grow" their children better. The concept of demand implies supply and therefore goes 1 step further than the concept of needs, spoken of for years in the development literature. Demand is often latent demand. The "demand" for good health and survival of a child is covered over by a widespread perception o fFate, the only explanation available to most people to help them bear their suffering. It is possible to change the climate of fatefulness through the media and the influential members of the community and to communicate the mssage that Fate is not Destiny, thus introducing the possibility of acting to change that Fate. What is therefore needed is to communicate the information and knowledge needed to bring about that change, thereby converting latent demand into articulate and effective demand to which supply is the response. 3 fronts are identified to carry out such a CSDR program: 1) training effective communicators of the CSDR message; 2) producing adequate program communication materials of sensitive and direct relevance to particular communities and 3) responding to the demand raised by hving supplies at hand. To make good on the promise of the CSDR, society needs to be mobilized, the political will stimulated and the professional will, active. Social mrketing is a new idea which is being adopted by UNICEF. It is an integral element of its program of social communication as are also public information and program communication. All 3 elements are integral to UNICEF's main programs of child development and survival.
Geneva, Switzerland, World Federation of Public Health Associations [WFPHA], 1984 Aug. vii, 78 p. (Information for Action)This bibliograph contains 4 parts. Part 1 is anannotated bibiography covering the following topics: an overview of health care in developing countries; planning and management of primary health care (PHC): manpower training and utilization; community participation and health education; delivery of health services, including nutrition, maternal and child health, family planning, medical and dental care; disease control, water and sanitation, and pharmaceutical; and auxiliary services, Part 2 is a reference directory covering periodicals directories, handbooks and catalogs, in PHC, as well as computerized information services, educational aids and training programs, (including audiovisual and other teaching aids), and procurement of supplies and pharmaceuticals. Also given are lists of international and private donor agencies, including development cooperation agencies, and directories of foundations and proposal writing. Parts 3 and 4 are the August 1984 updates of the original May 1982 edition of the bibliography.
Who Chronicle. 1984; 38(3):109-15.The theme of the 1984 World Health Day--children's health, tomorrow's wealth--provides an occasion to convey to a worldwide audience the message that children are a priceless resource, and that any nation which neglects them does so at its peril. World Health Day 1984 spotlights the basic truth that the healthy minds and bodies of the world's children must be safeguard, not only as a key factor in attaining health for all by 2000, but also as a major part of each nation's health in the 21st century. An investment in child health is a direct entry point to improved social development, productivity, and quality of life. Care of child health starts before conception, through postponement of the 1st pregnancy until the mother herself has reached full physical maturity, and through spacing of births. It continues from conception on, through suitable care during pregnancy, childbirth, and childhood. In the developing countries the child must be protected by all available means, particularly from the killer diseases. What happens in the immediate family and community around the mother and child, and even far away in the world, can have a direct impact on the health and security of both of them. The mother and child need to be placed in an environment that will ensure their health by protecting the overall setting in which they live. This means providing clean water, disposing of waste, and helping to improve shelter. Nothing can diminish the importance of good food, enough food, and proper nutrition for children and their mothers. Beyond the immediate physical needs are the equally important needs for love and understanding which stimulate the healthy development of the child. The emergence of new health problems of mothers and children in developing and developed countries should be kept in mind. Better health services must be made available to all who need them. The World Health Organization (WHO) provided resource material on World Health Day issues for dissemination throughout the world. Extracts from 4 articles on this year's theme are reproduced. The articles report on the success of the Rural Health Center in Ballabhgarh (India) in reducing maternal and infant mortality, the value of breastfeeding as 1 of the simplest and safest ways of ensuring adequate spacing of births, Tunisia's integration of a program of immunization into the routine activities of the health care system, and the needs of the healthy child.
[A possible objective from now to the year 2000: reduce infant mortality in the third world by half] Un objectif possible d'ici 1' an 2000: reduire de moitie la mortalite infantile dans les pays du tiers-monde
Hygiene Mentale. 1984 Jun; 3(2):41-9.Every day 40,000 children die throughout the world, most of them in developing countries. There is a close relationship between infant mortality, life expectancy at birth, the adult literacy rate and national income per capita. Why such huge differences between the infant mortality rate of 7/1000 (live births) in Sweden and 208 in Upper Volta? The 4 scourges which afflict developing countries: hunger (malnutrition), disease, ignorance and poverty are responsible for this state of affairs. The author suggests that coordinated action by governments and International Agencies should be taken to halve the infant mortality rate by the year 2000. He notes that in the past 3 mistakes were made which should not be repeated. The 1st was to improve the living conditions of the population. The green revolution in India provides a striking example of an important progress which benefited only the wealthier farmers. A 2nd mistake was to believe that only a medical approach reduces the infant mortality rate. A 3rd error was to overlook the importance of health education and not to seek the active participation of the people concerned. The author recalls that the International Union for Health Education carried out a sanitary and social program from 1975 to 1978 in Africa, south of the Sahara. To this effect, the IUHE had to find out what the people really wanted, whether they could be motivated to increase the welfare of the villagers by measures adapted to existing possibilities, and to study how the people could recruit health workers among the villagers and train them to create village health committees. 4 weapons used together should reduce the infant mortality rate by 1/2 in the developing world before the end of the century. They are: the promotion of breast feeding, the extended coverage of vaccinations, the early detection of malnutrition and the treatment at hoem of diarrheic diseases thanks to oral rehydration. (author's modified) (summaries in ENG, SPA)
Who Chronicle. 1984; 38(2):47-59.The 73rd session of the World Health Organization's (WHO) Executive Board met in January 1984 to review progress in implementing strategies for health for all by the year 2000, based on information emanating from the countries themselves. This monitoring function was assigned to the Board by the World Health Assembly in 1981 and calls for the Board to evaluate progress towards health for all at regular intervals and to report back to the Health Assembly. The 1st country reports together with comments of the regional committees and relevant information provided by theSecretariat were examined in November 1983 by the Board's Program Committee. Emphasis at this stage was placed on reviewing the relevance of national health policies to the attainment of health for all and the progress being made in implementing national strategies. Actual evaluation of the strategies will begin in 1985. As many of the country reports submitted were not as complete or as accurate as they could have been, the overall progress report submitted were not as complete or as accurate as they could have been, the overall progress report suffered from a lack of detailed and precise informattion on many important aspects that were crucial to national health for all strategies. Dr. Brandt, presenting the Program Committee's views, told the board that the report did indicate that a high level of political sensitization had occurred and that the political will to attain the goal of health for all existed in a large majorithy of the countries that had reported. The report indicated that to a large extent the Secretariat had met its responsibilities. It was the Member States that had to shoulder the responsibility and reaffirm their commitment by action. The Program Committee's progress report points to the existence of specific technical needs, particularly in national capability to carry out health policies. Among the areas requiring strengthening are information analysis and management, financial analysis, assessment of status of public information, competence in planning and management, effective involvement of relevant sectors in health, and measurement of intersectoral action for health. The Board urged Member States to give highest priority to the continuing monitoring and evaluation of their health for all strategies and to assume full responsibility for this process. In regard to the action program on essential drugs and vaccines, priority in the last 2 years has gone to training and manpower development, the dissemination of experience and information, cooperation in the procurement and production of essential drugs, technical cooperation among developing countries, and contracts with nongovernmental organizations and the pharmaceutical industry. During the far ranging discussion that ensued in the Executive Board, members addressed themselves in considerable detail to numerous aspects of the action program. The Board approved a new and carefully phased procedure for the review of substances to be recommended for international drug control.
New York, New York, UNICEF, . 42 p.In the last 12 months, world-wide support has been gathering behind the idea of a revolution which could save the lives of up to 7 million children each year, protect the health and growth of many millions more, and help to slow down world population growth. This document summarizes case studies which illustrate the techniques which make this revolution possible. These techniques are: oral rehydration therapy (ORT); growth monitoring; expanded immunization using newly improved vaccines to prevent the 6 main immunizable diseases which kill an esitmated 5 million children a year and disable 5 million more (measles, whooping cough, neonatal tetanus, polio, diphtheria and tuberculosis); and the promotion of scientific knowledge about the advantages of breastfeeding and about how and when an infant should be given supplementary foods. Results are summarized from Guatemala, Papua New Guinea, Brazil, Egypt, Indonesia, Barbados, the Philippines, Nicaragua and Honduras, Malawi, China, Nepal, Bangladesh, Colombia, and Ethiopia. The impact of economic recession and female education on childrens' health is discussed, and basic statistics for developed and underdeveloped countries are given.