Your search found 29 Results
Alcohol related problems and their prevention with particular reference to adolescence. Report of the Task Force meeting Geneva, 31 August - 4 September 1984.
[Unpublished] 1984. 46 p. (MNH/NAT/84.1.)Cultural, socioeconomic, and biological factors all influence alcohol use by adolescents and their experience of alcohol-related problems. Although the assessment of these problems presents methodological difficulties, strategies for prevention based on educational and legislative approaches both promise some measure of success. Further research is required to establish adequate data bases and to test the effectiveness of interventions. A number of specific research proposals were developed. These included epidemiological studies, with particular emphasis on longitudinal surveys, biomedical investigations and comparative evaluations of preventive interventions. In view of the increasing concern about alcohol-related problems in many developing countries, it was recommended that priority be given to the development of approaches applicable in such settings. It was also recommended that research projects should be facilitated which rely upon a strong multicentric approach. (author's)
WHO Programme in Maternal and Child Health and Family Planning. Report of the second meeting of the WHO Programme Advisory Committee in Maternal and Child Health, Geneva, 21-25 November 1983.
[Unpublished] 1984. 95 p. (MCH/84.5)The objectives of the 2nd meeting of the Program Advisory Committee (PAC) for the World Health Organization's (WHO's) Program in Maternal and Child Health, including Family Planning (MCH/FP) were to 1) assess the MCH/FP program's achievements since the 1st PAC meeting in June, 1982, 2) determine the level of scientific and financial resources available for the program, and 3) to examine the role of traditional birth attendants (TBAs) in the delivery of MCH/FP services. The committee reviewed the activities and targets of the program's 4 major areas (pregnancy and perinatal care, child health, growth, and development, adolescent health, and family planning and infertility), and developed a series of recommendations for each of these areas. Specific recommendations were also made for each of the major program areas in reference to the analysis and dessimination of information and to the development and use of appropriate health technologies. Upon reviewing the role of TBAs in the delivery of MCH/FP services, PAC recommended that all barriers to TBA utilization be removed and that training for TBAs should be improved and expanded. PAC's examination of financial support for MCH/FP activities revealed that for a sample of 26 countries, the average annual amount allocated to MCH activities was less than US$3/child or woman. This low level of funding must be taken into account when setting program targets. International funding agencies did indicate their willingness to increase funding levels for MCH programs. The appendices included 1) a list of participants, 2) an annotated agenda, 3) detailed information on the proposed activities of the program's headquarters for 1986-87, and 4) a description of the the function, organizational structure, and technical management of the MCH/FP program. Also included in the appendices was an overview of the current status of MCH and a series of tables providing information on infant, child, and maternal health indicators. Specifically, the tables provided information by region and by country on maternal, child, and infant mortality; causes of child deaths; maternal health care coverage; contraceptive prevalence; infant and child malnutrition; the number of low weight births; adolescent health; teenage births; breast feeding prevalence and duration; and the proportion of women and children in the population.
The role of food safety in health and development. Report of a Joint FAO-WHO Expert Committee on Food Safety.
World Health Organization Technical Report Series. 1984; (705):1-79.This document presents the recommendations of a Joint Food and Agriculture Organization (FAO)-World Health Organization (WHO) Expert Committe on Food Safety. Illness due to contaminated food is perhaps the most widespread health problem in the world and a major cause of reduced economic productivity. The safety of food is affected by food systems, sociocultural factors, food chain technology, ecologic factors, nturitional aspects, and epidemiology. It was the assumption of the Committee that, if food safety is given sufficient priority within national planning, countries can prevent and control foodborne disease, especially pathogen-induced diarrheal syndromes, and interrupt the vicious cycle of diarrhea-malnutrition-disease. Attainment of this objective requires a national commitment and the collaboration of all ministries and agencies concerned with health, agriculture, finance, planning, and commerce as well as the food industry, the biamedical and agricultural scientific community, and the consuming public. Prevention and control interventions should aim to avoid or minimize contamination, to destroy or denature the contaminant, and to prevent the further spread or multiplication of the contaminant. The Committee outlined a series of recommendations for achieving a worldwide reduction in the morbidity and mortality caused by foodborne hazards. Food safety should be considered an integral part of the primary health care delivery system. Food safety should also be regarded as an integral part of the total food system. National food control infrastructures should be strengthened, and regional, national, multinational, and international surveillance of foodborne diseases should be carried out. Each country should aim to develop at least 1 laboratory capable of identifying the etiologic agents of diarrhea and other foodborne diseases. Health workers should be trained to play a role in identifying and monitoring critical control points in food production and preparation. Health education, within the context of the cultural and social values of the community, should inform the public about food safety hazards and preventive measures. Finally, the hazard analysis critical control point approach to prevention is recommended.
[Main objectives of the WHO Special Program on Human Reproduction] Osnovnye napravleniia Spetsialnoi Programmy VOZ po Reproduktsii Cheloveka.
AKUSHERSTVO I GINEKOLOGIIA. 1984 Jul; (7):3-6.The WHO Special Program on Human reproduction was established in 1972 to coordinate international research on birth control, family planning, development of effective methods of contraception, and treatments for disorders of the human reproductive system. The Program's main objectives are: implementation of family planning programs at primary health care facilities, evaluation of the safety and effectiveness of existing birth control methods, development of new birth control methods, and development of new methods of sterility treatment. In order to attain these goals, the Program forth 3 major tasks for international research: 1) psychosociological aspects of family planning, 2) birth control methods, and 3) studies on sterility. Since most of the participating nations belong to the 3rd World, the Program is focused on human reproduction in developing countries. The USSR plays an important role in the WHO Special Program on Human reproduction. A WHO Paticipating Center has been established at the All-Union Center for Maternal and Child Care in Moscow. Soviet research concentrates on 3 major areas: diagnosis and treatment of female sterility, endocrinological aspects of contraception, and birth control prostaglandins.
[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.
[Unpublished] 1984. Presented at the Second Conference on Immunization Policies in Europe, Karlovy Vary, 10-12 December 1984. Issued by the World Health Organization [WHO]. Expanded Programme on Immunization [EPI]. 8 p. (EPI/GEN/84/9)This discussion of the Expanded Program on Immunization (EPI) presents some background history and discusses current program status, some linkages between the global EPI and immunization programs in Europe, and the use of vaccines. In the early 1970s, as confidence grew that the global smallpox eradication program would achieve its goals, policy advisers within and outside of the World Health Organization (WHO) looked for an initiative which could become its successor. Representatives from industrialized nations and particularly from European countries were influential in selecting childhood immunization, as such programs had been such an early and successful element of their own health systems. Thus, the EPI was born. The resolution creating the EPI was passed by the World Health Assembly in 1974. Program policies were formalized by the World Health Assembly in 1977. It was at that time that the goal of providing immunization services for all children of the world by 1990 was set and that WHO's priority attention to developing countries was specified. The European Region takes pride of place in establishing the EPI and in supporting its work in developing countries and is itself a full-fledged member of the program with respect to immunization challenges which remain within its own countries. When the EPI began, no global immunization information system existed, and it is likely that coverage in developing countries was less than 5%. It now is on the order of 30% for a 3rd dose of DPT. Given the high dropout rates persisting in many developing countries, coverage for a 1st dose of DPT may be on the order of 50%, reflecting the delivery capacity of present immunization programs. Coverage for measles and poliomyelitis in infants and for tetanus toxoid among women of childbearing age is considerably less than 30%, reflecting the perception until the last 3-4 years that measles was a problem only in Africa, that poliomyelitis was not a problem in countries with poor levels of sanitation, and that neonatal tetanus was simply not a problem. While the EPI is working at the global level to help strengthen routine disease reporting systems, particularly in developing countries, it also has had to take refuge in estimates to obtain a picture of actual morbidity and mortality. A table presents a summary of such estimates. Not all countries of the Region are yet making optimal use of existing vaccines. Countries of the Region might want to recommit themselves to the EPI goal of reducing morbidity and mortality by providing immunization services for all children by 1990.
Patterns of infertility in the developing world: preliminary observations from the WHO clinical study, Task Force on the Diagnosis and Treatment of Infertility, WHO Special Programme of Research, Development and Research Training in Human Reproduction.
[Unpublished] 1984 Feb. 11 p.This paper presents preliminary observations on infertility derived from a World Health Organization (WHO) clinical study conducted in 33 medical centers in 25 developed and developing countries. A major purpose of the investigation was to provide a standardized approach, including standardized diagnostic procedures and identical definitions, for the study of infertile couples. As of January 1984, 7600 couples had been enrolled in the study and over 5400 had completed the protocol. Infertility of at least 1 year's duration was required for admission to the study. The study results so far suggest certain patterns. Couples in developed countries were more likely to have primary than secondary infertility and to have been infertile for a shorter period of time than those in developing countries. However, Africa was the only area in which the majority of couples requesting medical consultation had secondary infertility. Over 70% of couples in developing countries had infertility for over 2.5 years before seeking consultation, whereas half of those in developed countries waited less than 2 years. On the other hand, similar proportions of couples (13-16%) in all regions became pregnant. Reasons for infertility were identified in both partners in 1/3 of African couples and 40% of those in the East Mediterranean region. The rate of infertility of unexplained etiology was 9-20% in developed countries, Latin America, and Asia, but 0% in Africa and 5% in the East Mediterranean. Over half of African women had infection-attributable diagnoses (including 43% bilateral tubal occlusion, 15% pelvic adhesions, and 4% acquired tubal abnormalities), a rate that was 60% higher than in other areas. Similarly, varicocele was diagnosed in 25% of African males investigated compared with 6-19% in other areas. Abnormal sperm morphology and low sperm motility were also more common among African males. Higher risks of tubal occlusion were consistently associated with number of previous pregnancies, a history of sexually transmitted infections, and a previous episode of postpartum or postabortal complications.
Geneva, WHO, 1984 Dec. ix, 152 p.88 recommendations were formulated by the International Conference on Population held in Mexico City in 1984. 4 of these dealt specifically with research requirements in the population field and are reproduced in this report in their entirety. As a result of the changing perspectives and requirements of the scientific fields in which the Special Program of Research, Development and Research Training in Human Reproduction operates and taking into account the various suggestions resulting from recent reviews of the Program, several new developments have occurred. First is the attempt to distinguish more clearly between activities related to research and development and those related to resources for research. These 2 distinct but closely connected activities will be reorganized to interact in a complementary fashion. In the research and development component, the most notable changes relate to the creation of new Task Forces on the Safety and Efficacy of Fertility Regulating Methods and on Behavioral and Social Determinants of Fertility Regulation. The Program has been actively promoting coordination with other programs which support and conduct research in human reproduction. The research and development section of this report provides a technical review of the activities and plans of the various task forces, covering the following: new and improved methods of fertility regulation (long-acting systemic methods, oral contraceptives, post-ovulatory methods, IUDs, vaccines, plants, male methods, female sterilization, and natural methods), safety and efficacy of fertility regulating methods, infertility, and service and psychosocial research. The section devoted to resources for research describes some features of the network of centers, reviews the Program's institution strengthening activities in the different regions, and also considers research training and the program of standardization and quality control of laboratory procedures. The section covering special issues in drug development focuses on relations with industry, patents, and the role of the Special Program in the drug regulatory process.
[Health costs and financing and the work of WHO] Cout et financement de la sante et activities de l'OMS.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1984; 37(4):339-50.This discussion examines the international responses to issues and problems in the cost and financing of the health sector, focusing on the work of the World Health Organization (WHO). It describes the growth of attention to these concerns beginning in the 1970s, reviews methods and applications of financial analysis in greater detail, and summarizes progress to date and the agenda for work. Emphasis is on the developing countries, for they face the most urgent problems regarding costs and financing, and more attention is directed to their needs for support in this area. By the early 1970s it was clear that progress in health development particularly in the most underprivileged countries was unsatisfactory and that changes were needed if services were to have an appreciable impact on the health problems of developing populations. A major study conducted jointly by the UN Children's Fund (UNICEF) and WHO identified several of the critical problems associated with resources. The essential financial concerns requiring attention in connection with primary health service coverage, the need for more equitable distribution of existing resources for health and the priority of resources allocation to peripheral health services were examined in detail by a WHO Study Group on Financing Health Services which met in 1977. Among the problems of health finance, those of the overall lack of funds, the maldistribution of health resources, rising health care costs, and the lack of coordination were found to be particularly important. The Study Group concluded that, despite difficulties, it was possible to collect information of sufficient reliability for planners' needs and at a modest cost, even for the private sector. To help bring this about, it recommended that research centers and universities, in collaboration with national health authorities of their country, devote considerable attention to data collection methods. The reports, studies, and papers prepared at various meetings deal in general with specific aspects of health cost and financing. A major element, and evolving product, of the meetings and studies related to developing countries was a manual on financing health services, originally based on the recommendations of the 1st Study Group meeting. This draft document served as background material for a series of further meetings and was used to guide many of the country financing studies. A number of other health financing manuals were also developed between 1979-81. In its final published form the WHO manual attempts to be relevant to all developing countries. The manual describes health policies and their financial aspects and outlines techniques for data collection. If the recommendations of the 1st Study Group are compared with the achievements recorded thus far, the following facts come to light: many countries have undertaken surveys of health sector financing and resource allocation; increased interest in this subject has been shown by other international organizations; much progress has been made in the development and refinement of methodologies for collecting and using financial data; international activities and country studies have made it possible to provide reports for country leadership; and issues of financial planning and management often appear in medium and longterm plans.
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.
Studies in Family Planning. 1984 Nov-Dec; 15(6/1):253-66.This paper critically analyzes claims for the effectiveness of the Billings method of natural family planning and raises questions about the wisdom of actively promoting this method. The Billings method, developed in Australia, is based on client interpretation of changing patterns of cervical mucus secretion. Evaluation of the method's use-effectiveness has been hindered by its supporters' insistence on distinguishing between method and user failures and by the unreliability of data on sexual activities. However, the findings in 5 large studies aimed at investigating the biological basis of the Billings method provide little support for the claims that most fertile women always experience mucus symptoms, that these symptoms precede ovulation by at least 5 days, and that a peak symptom coincides with the day of ovulation. Although many women do experience a changing pattern of mucus symptoms, these changes do not mark the fertile period with sufficient reliability to form the basis for a fully effective method of fertility control. In addition, the results of 5 major field trials indicate that the Billings method has a biological failure rate even higher than the symptothermal method. Pearl pregnancy rates ranged from 22.2-37.2/100 woman-years, and high discontinuation rates in both developed and developing countries were found. Demand for the method was low even in developing countries where calendar rhythm and withdrawal are relatively popular methods of fertility control, suggesting that women of low socioeconomic status may prefer a method that does not require demanding interaction with service providers and acknowledgment of sexual activity. The Billings method is labor-intensive, requiring repeated client contact over an extended time period and high administrative costs, even when teachers are volunteers. It is concluded that although natural family planning methods may make a useful contribution where more effective methods are unavailable or unacceptable, many of the claims made for the Billings method are unsubstantiated by scientific evidence.
Who Chronicle. 1984; 38(4):155-60.The voice of the World Health Organization's (WHO) internal world is reassuring and tells of widespread political will to attain the goal of health for all, yet another voice says that if the policies adopted in WHO are slowly trickling into national health systems, the process of infiltration is much too slow and may still be far from completion by 2000. A number of developed countries are taking the challenge of health for all very seriously both within their own boundaries and in their dealings with less developed countries, but too many of them did not even take the trouble to report on the results of their monitoring of the health for all strategy. Some claimed off the record that it would have been too complicated in view of the size and complexity of their health system; others that they were not really in need of a strategy since their health service was so comprehensive. If the developed countries shy away from the responsibilities they accepted, why should more be expected of the developing countries. At Alam Alta there was enthusiastic support for action from all countries, no matter what their level of development. Most difficult to assess is the extent to which people themselves are taking the goal of health for all seriously. If the social aspects of the strategy are difficult to monitor, one would expect that the financial aspects should be clearer. This is not the case. Few countries, including the most economically developed, were able to assess the amount and flow of resources for health for all. In particular, they were unable to distinguish between the allocation of funds for the continuation of old policies and for the promotion of new ones. WHO has embarked on a new General Program of Work -- the 7th in the history of the organization. The program aims at making member nations more self-reliant than ever in the fields of health. The major task is to build up solid health infrastructures that are capable of delivering the most needed programs to the most people on the basis of equality of access for all. Unfortunately, only the sounds of the 7th program have made themselves heard, not the substance. Among the organization's successes can be included many of WHO's publications, particularly the "Health for All" series, but these publications are being used much too sparingly. New managerial arrangements have been introduced to help countries make the best use of everything WHO has to offer, yet all moves too slowly.
Idrc Reports. 1984 Oct; 13(3):18-9.Every 6 seconds someone contracts a sexually transmitted disease (STD), according to Dr. Richard Morisset, chairperson of the International Conjoint STD Meeting held in June 1984 in Canada. Under the patronage of the World Health Organization (WHO), this meeting brought together 1000 specialists from more than 50 countries. Several workshops dealt with STDs in the 3rd world. The workshops revealed an urgent need for drug therapies and assistance for women and children in developing countries because these groups are most affected. A resolution to this effect had been adopted during the annual meeting of the general assembly of the International Union Against Veneral Diseases and Treponematoses (VDTI). WHO was asked to take aggressive action in this area of health. The VDTI resolution also mentioned the fatal cases of acquired immunodeficiency syndrome (AIDS), the connection between cancer and venereal diseases, and the increases in the rates of mortality, infertility, and neonatal infections resulting from chlamydia, a bacterial infection. The need to form a common front in order to review and improve diagnostic methods and various treatments was also emphasized. Dr. King Holmes, an STD researcher at the University of Washington, claimed that "even though a reduction in the number of cases of STDs is possible in the long run, the immediate future is rather bleak." Efforts of the medical world should focus primarily on chlamydis, according to Holmes. This disease is similar to gonnorrhea but is now believed to be much more widespread. Currently, it is estimated that more than 500 million people throughout the world are afflicted. The resulting infections are said to be responsible for a significant proportion of cases of pelvin inflammatory disease and of ectopic pregnancies. US show that when the disease goes undiagnosed in pregnant women, their newborns risk contracting conjunctivitis (50% chance) and penumonia (20% chance). The longterm effects of chlamydia on newborns are unknown. Women and children suffer the most serious complications for STDs. Half of all infertility in women is caused by such diseases. Cervical cancer is the result of an STD. Dr. Willard Cates from the Centers for Disease Control in Atlanta appealed to governments, WHO, and other international organizations to concentrate their efforts on pregnant women, if prevention and treatment programs for the entire population were not feasible at present. Research in progress in the US and France has identified the virus that causes AIDS, but neither group of researchers believe that the production of vaccine is imminent. 1 conclusion of the Canada conference was that without a profound change in attitude, scientists will be unable to stamp out the epidemic of STDs.
[Unpublished] 1984. v, 25 p.This meeting was sponsored by the World Health Organization (WHO) with Dr. Wayne S. Stinson participating at WHOs request. The objectives of the informal consultation were: 1) to strengthen national capabilities for undertaking the costing of preimary health care and for the utilization of results for development and management; 2) to exchange experiences on the costing of PHC in different countries; 3) to discuss methodologies used for data collection at the PHC center; and 4) to make recommendations for future work. This consultation is one in a series of costing and financing meetings held by WHO since 1970. The most recent meeting prior to 1983 was an interregional workshop on the cost and financing of primary health care, held in Geneva in December 1980. Papers distributed at that meeting (which have not yet been published) suggest a need for greater understanding of costing principles and technical refinement of methodologies. Judging by the papers presented at the Nazareth workshop, costing efforts have greatly improved since 1980. Representatives from the following countries participated in the Nazareth workshop: Argentina, Botswana, Columbia, Thiopia, Gambia, Kenya, Lesotho, Malawi, Sierra Leone, Sri Lanka, Swaziland, Tanzania, Thailand, Uganda, and Zambia. Some of these reported costing studies. This report consists of a narrative description of the meeting itself followed by a commentary on some of the issues raised. There is then a discussion of Arssi Province and Ethiopia as a whole based on a 1-day field trip. Finally recommendations are given regarding the United States Agency for International Development's (AID's) further PHC costing efforts.
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.
Doctors--barefoot and otherwise. The World Health Organization, the United States, and global primary medical care.
Jama. 1984 Dec 14; 252(22):3146-8.The international effort to provide primary health care (PHC) services for all by the year 2000 requires the development of appropriate manpower resources in the developing countries. Given the limited health budgets of developing countries, research on manpower development is necessary to ensure that funds for manpower development are used in the most efficient manner. In recognition of this need, the World Health Organization (WHO) and the International Organization for Medical Sciences convened a workshop, entitled "Health for All - A Challenge to Health Manpower Development Research" in Ibadan, Nigeria in 1982. The participants at the workshop agreed that manpower development strategies must be developed in the context of PHC, and that the current manpower development strategies in most developing countries do not provide the type of manpower required in PHC systems. Specifically, the workshop recommended that health manpower development strategies must 1) take into account the fact that health improvement is dependent not just on health services but on improvements in sanitation, water, housing, and nutrition; 2) recognize that PHC systems require an extensive cadre of health workers, paramedics, and auxiliary personnel, and that PHC systems are not highly physician dependent; and 3) recognize that medical schools must train physicians capable of serving the needs of the entire population rather than just the needs of the elite few. Participants also recognized that the development of effective strategies may be hindered by various professional, technical, financial, and bureaucratic factors. Given the pressing needs and scarce resources of developing countries, manpower development research must be highly policy oriented. The recommendations of the workshop were endorsed by WHO's Advisory Committee on Medical Research in 1983 and then distributed to WHO's 6 regional offices. The regional offices are currently discussing the recommendations with individual countries in an effort to determine how each country can implement the recommendations. The success of the effort to train appropriate manpower will require the assistance of developed countries and especially the US. The US can assist by providing training in US institutions for individuals from developing countries. Training programs, however, must be reoriented in such a way as to equip students to work in PHC settings. Medical personnel from the US can provide technical assistance in the developing countries, but efforts must made to ensure that this assistance is directed toward the development of PHC prsonnel and services.
Development: Seeds of Change. 1984; 2:66-7.UN International Children's Emergency Fund (UNICEF) experience over the last 20 years suggests that successful development for poor people is not possible without substantial grassroots involvement. This is the experience both in the developing and in industrialized countries. In the 1960s it became increasingly clear to UNICEF that if programs were to succeed with the small and landless farmers and the urban slum dwellers, there was no possibility of finding enough money to meet needs of these people through governmental channels. It was equally clear that in most places the existing patterns of development andeconomic growth would not reach these people until the year 2000 or thereabots. It was this that led UNICEF to adopt its basic services approach in the late 1960s and early 1970s, which implied that the cost of the most needed basic health services, education, and water had to be reduced to manageable limits. At this stage UNICEF began to articulate the imperative of using paraprofessionals, the need for much greater use of technology that was appropriate to rural and slum areas, and the importance of involving the people in this effort. Looking at those low income countries which have managed to achieve longer life expectancy and higher literacy rates, they are all societies which have practiced much more people's participation in economic and social activities than most other countries. These 3 very different societies -- China, South Korea, and Sri Lanka -- all have had a rather unique degree of people's participation in the development process. Grassroots participation in development is a very important element in developing and in industrial countries. 1 example concerns the whole question of proper nutrition practices, the promotion of breastfeeding, and the problem of the infant formula code. It was the people's groups which picked up the research results in the 1960s, which showed that breastfeeding was a better and more nutritious way of feeding children. The 2nd example pertains to the US government recommendation of significant cuts in UNDP and UNICEF, and the refusal of Congress to give in to those cuts. In regard to the developing countries, over the last year it has increasingly become the consensus of international experts that a childrens' health revolutioon is possible. The conclusion was based upon the fact that there were 2 new sets of developments coming together that created this new opportunity: some new technological advances in the development of rural rehydration therapy; and the capacity to communicate with poor people. With the whole emphasis on the basic human needs of the last 10 years, and on primary health care in the last 5 years, literally millions of health auxiliaries and community workers have been trained, a group of people who, if a country can mobilize them, can provide a new form of access.
In: Research Consortium for the Infant Feeding Study. The determinants of Infant feeding practices: preliminary results of a four-country study. New York, N.Y., Population Council, 1984 Apr 45-56. (International Programs Working Paper No. 19)The World Health Assembly, governing body of the World Health Organization (WHO), adopted a Code of Marketing of Breast Milk Substitutes in May, 1981. The question of what impact legislative, reggulatory, and voluntary actions by government and industry have had on the commercial marketing of infant food in Colombia, Indonesia, Kenya, and Thailand is addressed. The research was conducted between 1981 and 1983. This study of marketing activities was intended to analyze the direct effects of marketing activities and the interaction of marketing with other factors found to influence infant feeding practices. Research objectives were organized around 3 basic questions. 1) What are the characteristics of current marketing practices and strategies of infant food companies? 2) What factors account for the current marketing environment for infant foods? 3) What is the intensity of promotional activity at this time? Data was collected through interviews and a cross-sectional survey of mothers and infants. There have been 5 important trends in the way the marketing of infant foods has changed since 1981. They are: 1) an increased amount of price competition; 2) increased product availability; 3) discontinuance of consumer-oriented mass media advertising; 4) extensive promotion of commercial infant foods to health care workers, and through them to consumers; and 5) continued distribution of infant formula samples to mothers, directly or indirectly, many of whom live in a high-risk environment.
Lancet. 1984 Aug 11; 2(8398):340-1.The implementation of primary health care seems seriously hampered because it is not properly handled by many of the international agencies. Initial concern is the haste with which primary health care projects are being established and executed. These projects are expected to improve the health status of the target group within 2-3 years. Almost everywhere health officials are trying to expand primary health care schemes as rapidly as possible and to provide a maximum of the population with village health workers, yet little attention is directed to the structure needed to support the village workers nor to the problems related to their training motivation and financial reward. There is also the tendency to ignore the complex interrelations between the socioeconomic, cultural, and political factors and health improvement in general. A better way of attaining permanent improvement in health is to build slowly, using the local results and positive experiences in primary health care to reinforce the awareness and political organizations of the poor so that they will have more power to demand a shift in money allocation in their favor from their governments. In most countries this is not likely to happen even after the year 2000, and the World Health Organization (WHO) should stop advertising "Health for All by the Year 2000" and call for slow and careful expansion of the primary health care policy. There are some negative aspects to the amount of money available for primary health care. Donors keen to help with primary health care may not see that it needs the assistance of all medical departments to operate effectively. Despite considerable financial investment in primary health care over the past few years, few countries have been able to change their health budgets from hospital-based services to primary health care. The priorities in the ministries of health still seem heavily biased toward the existing curative and urban-based health services. Through primary health care, predominantly Western values are introduced into the countries to be served by the projects. 1 such case is the emphasis on efficiency in establishing and running primary health care projects. The preoccupation with data collection in primary health care is another example of Western influence as is the tendency to plan, in as much detail as possible, the objectives to be met at each stage of a project. A less ambitious approach to a community health care proposal by the government of Giunea-Bissau with less defined objectives would have been preferable, but it is questionable whether the Western donor would have accepted such a "vague proposal.
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.
Who Chronicle. 1984; 38(2):60-4.The International Drinking Water Supply and Sanitation Decade, 1981-90, which has a diversity of objectives, takes a different form in each country. What makes this decade different from previous actions for water and sanitation is the way in which the programs, projects, and services are to be conceived, planned, implemented, managed, operated, and maintained. The urban population to be covered by water and sanitation services, in the developing nations that have prepared plans for the Decade, is roughly between 280-290 million people. In rural areas, some 750 million people are to be provided with drinking water and around 300 million with sanitation facilities. The initial goal of 100% of the population to be provided with water and sanitation by 1990 is proving difficult to realize. Only a small proportion of developing nations have even planned for 100% coverage by 1990. The initial optimism arising from the declaration of the Decade and the expectations of increased aid has given way to realism in the face of the global recession and the scarcity of development capital. The Southeast Asia Region of the World Health Organization (WHO) covers 11 member countries with a combined population of over 1000 million people. Among the countries in Southeast Asia that have prepared Decade plans, the following populations are to be covered by 1990: urban water supply, 126 million; urban sanitation, 156 million; rural water supply, 585 million; and rural sanitation, 212 million. Such a challenge calls for a stock taking of the real issues in order to identify what action can be taken. The lack of up-to-date and comprehensive databases is a serious problem. The information system for the Decade should be and integral part of it, be timed to keep pace with it, and be developed from the lowest level. The annual investment needed during the Decade is estimated at over 4 times that prior to the Decade. The accepted strategy is to meet the minimum needs of the largest number of people as quickly as possible. Evan without financial constraints, the Decade would not reach its goals unless critical manpower and institutional problems were addressed forthwith. Efforts are needed to train engineers, other specialists, and staff in the subprofessional and artisan categories. Good management requires intersectoral coordination. A decentralized "bottom-up" approach is mandatory at the planning stage, with strong financial, administrative, and technical support for implementation. Technology must be relevant, cost effective, feasible, necessary, sufficient, and energy conserving. Communities benefiting from the Decade should be encouraged to participate in the decision making process to the maximum extent possible. Country specific studies should be conducted to document the hardships of women and activities should be designed to alleviate their burdens. The provision of sanitation lags far behind that of drinking water, and low cost technology options for excreta disposal must be adopted. The responsibility for operation and maintenance should be delegated to the lowest level and to the community, with technical support from higher levels.
Who Chronicle. 1984; 38(2):76-81.An early objective of the World Health Organization's (WHO) traditional medicine program was to promote a realistic approach to the subject. The realism with which countries around the world, both developed and developing, examine their own traditional practices suggests that progress is being made towards this goal. The current challenge is to pursue action along 3 lines: evaluation, integration, and training. In traditional medicine it is necessary to separate myth from reality so that valid practicies and remedies can be distinguished from those that are patently ineffective and/or unsafe. Thus, WHO will continue to promote the development, teaching, and application of analytical methods that can be used to evaluate the safety and efficacy of various elements of traditional medicine. Action need not await the results of formal evaluation. Efforts can be initiated now to synthesize traditional and modern medicine. Several countries have attempted such a synthesis. For example, medical curricula in China include elements of Chinese medicine such as acupuncture, moxibustion, manipulation and massage, relaxation, and herbal medicine. A critical training need is to incorporate in the curricula of conventional health workers certain traditional practices and remedies that have been evaluated and proven safe and effective. Traditional practitioners also require training. They need to be provided with additional skills. It is essential to make practitioners of traditional medicine allies rather than competitors. The training of traditional birth attendants in aseptic delviery techniques and simple antenatal and postpartum care provides a good example of the possibilities that exist for collaboration between the traditional and modern health care sectors. In the past 2 years WHO has carried out numerous activities in the field of traditional medicine. For example, among the activities coordinated by WHO headquarters was the continuing search for indigenous plants for fertility regulation in men and women. In 1983, WHO collaboration centers for traditional medicine continued to strengthen national efforts in research and development. A prerequisite for the success of primary health care is the availability and use of suitable drugs. It is reasonable for decision makers to identify locally available plants or plant extracts that could usefully be added to the national list of durgs or that could even replace some pharmaceutical preparations that need to be purchased and imported. NAPRALERT (for national products alert) is a computerized database derived primarily from scientific information gathered from the world literature on the chemistry, pharmacology, and ethnopharmacology of natural plant products. It can provide both a general profile on a designated plant and a profile on the biological effects of a chemical constituent thereof. A valuable feature of the NAPRALERT database is its ability to generate information on plants from a given geographical area.
BMJ. British Medical Journal. 1984 May 26; 288(6430):1611-2.In response to an article on disease among children in the Third World, the author of this letter outlines the efforts of the World Health Organization (WHO) to both alleviate disease in delveloping countries and promote an approach to health suited to current realities in these countries. WHO has become increasingly aware that the diseases affecting the Third World can be eradicated only through a broad, integrated approach that places health in the wider context of social and economic development. WHO has adopted a primary health care strategy to tackle the control of tropical diseases and the reduction of mortality and morbidity among Third World children. Central to this approach is the use of appropriate health technology and the participation of families and communities in the health services. A primary health care orientation further addresses theproblem of how Third World countries can best allocate scarce health resources. In its specific action programs such as control of diarrheal diseases and immunization, WHO aims to help countries and communities to improve their own health. It is the application of existing knowledge thatis needed in the Third World, not new knowledge or technology.
World Smoking and Health. 1984 Spring; 9(1):4-6.An Expert Committee met in World Health Organization Headquarters in Geneva in November 1982 to discuss Smoking Control Strategies in Developing Countries. They reviewed the harmful health effects of different types of tobacco which characterized developing countries and the adverse effects of tobacco use on their economics due to smoking related diseases and higher smokers' work absenteeism. It advised on the objectives of smoking control programs, including data collection; education and information; legislation; smoking cessation; the role of medical, political, social, and religious leaders; the role of WHO, UN agencies, and nongovernmental organizations; research on smoking behavior; and evaluation of program efficacy. In addition, the Committee provided guidance on how to counteract tobacco industry arguments. More than a million people worldwide die prematurely each year because of cigarette smoking. In developed countries smoking is generally understood to cause lung cancer, coronary heart disease, chronic bronchitis, and other respiratory disorders. Major campaigns have been launched to reduce the rate of smoking. The public in most developing countries are unaware of the dangers, and no educational, legislative, or other measures are being taken to combat the smoking epidemic. The Committee called for firm steps to be taken to prevent this unnecessary modern epidemic. The incidence of tobacco related diseases is increasing in developing countries. Many of the developing countries have cigarettes on sale with high yields of tar and nicotine. Tobacco cultivation has spread to about 120 countries, becoming a substantial source of employment and creating new vested interests. Overall, the costs outweigh the "benefits." Tobacco taxes may be Politically comfortable," that is, easy to administer and generally acceptable to smokers, but these taxes do not contribute to national wealth but merely redistribute wealth. They cannot offset the economic losses caused by tobacco production and use: health service expenditures on smoking related diseases, disablement and work absenteeism, domestic and forest fires, use of scarce fule to cure tobacco, and reduced food production. Action against smoking can be inexpensive yet effective. Health warnings can be placed on cigarette packets, and legislation can be enacted to put an end to the double standards in marketing practices, whereby cigarettes of the same brand carrying health warnings in developed countries are marketed without these warnings in developing countries. Recommendations issued to governments and public health authorities in developing countries are listed.