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Report of the European Region on Immunization Activities. (Global Advisory Group EPI, Alexandria, October 1984). WHO/Expanded Immunization Programme and the European Immunization Targets in the Framework of HFA 2000.
[Unpublished] 1984. Presented at the EPI Global Advisory Group Meeting, Alexandria, Egypt, 21-25 October 1984. 3 p. (EPI/GAG/84/WP.4)Current reported levels of morbidity and mortality from measles, poliomyelitis, diphtheria, tetanus, and tuberculosis in most countries in the European Region are at or near record low levels. However, several factors threaten successful achievement of the Expanded Program on Immunization (EPI) goal of making immunization services available to all the world's children by the year 2000, including changes in public attitudes as diseases pose less of a visible threat, declining acceptance rates for certain immunizations, variations in vaccines included in the EPI, and incomplete information on the incidence of diseases preventable by immunization and on vaccination coverage rates. To launch a more coordinated approach to the EPI goals, a 2nd Conference on Immunization Policies in Europe is scheduled to be held in Czechoslovakia. Its objectives are: 1) to review and analyze the current situation, including achievements and gaps, in immunization programs in individual countries and the European Region as a whole; 2) to determine the necessary actions to eliminate indigenous measles, poliomyelitis, neonatal tetanus, congenital rubella, and diphtheria; 3) to consider appropriate policies regarding the control by immunization of other diseases of public health importance; 4) to strengthen existing or establish additional systems for effective monitoring and surveillance; 5) to formulate actions necessary to improve national vaccine programs in order to achieve national and regional targets; 6) to reinforce the commitment of Member Countries to the goals and activities of the EPI; and 7) to define appropriate activities for the Regional Office for Europe of the World Health Organization to achieve coordinated action.
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.
BULLETIN OF THE PAN AMERICAN HEALTH ORGANIZATION. 1984; 18(2):188-92.Outbreaks of yellow fever in recent years in the Americas have prompted concern about the possible urbanization of jungle fever. Vaccination, using the 17D strain of yellow fever virus, provides an effective, practical method of large scale protection against the disease. Because yellow fever can reappear in certain areas after a 2-year dormancy period, some countries maintain routine vaccination programs in areas where jungle yellow fever is endemic. The size of the endemic area (approximately half of South America), transportation and communication difficulties, and the inability to ensure a reliable cold chain are problems facing these programs. In addition, the problem of reaching dispersed and isolated populations has been addressed by the use of mobile teams, radio monitoring, and educational methods. During yellow fever outbreaks, many countries institute massive vaccination campaigns, targeted at temporary workers and migrants. Because epidemics in South America may involve extensive areas, these campaigns may not effectively address the problem. The ped-o-jet injector method, used in Brazil and Colombia, should be used in outbreak situations, as it is effective for large-scale vaccination. Vaccine by needle, suggested for maintenance programs, should be administered to those above 1 year of age. An efficient monitoring method to avoid revaccination, and to assess immunity, should be developed. The 17D strain produces seroconversion in 95% of recipients, and most is prepared in Brazil and Colombia. But, problems with storage methods, instability in seed lots, and difficulties in large-scale production were identified in 1981 by the Pan American Health Organization and WHO. The group recommended modernization of current production techniques and further research to develop a vaccine that could be produced in cell cultures. Brazil and Colombia have acted on these recommendations, modernizing vaccine production and researching thermostabilizing media for yellow fever vaccine.
INFECTION CONTROL. 1984 Nov; 5(11):538-41.In 1978 the Ministry of Health and Social Welfare (MHSW) of Liberia launched the Expanded Program on Immunization (EPI) with the 5-year objective of establishing an 80% reduction in child mortality and morbidity from measles, polio, diphtheria, neonatal tetanus, pertussis, and tuberculosis. The program at first adopted a strategy of using 15 mobile units in 11 operational zones to deliver vaccinations throughout the country. However, by 1980, despite support from the Baptist World Alliance, the UN International Children's Emergency Fund (UNICEF), and the World Health Organization (WHO), it became evident that the mobile strategy was neither economically feasible nor practical. Therefore, with support from the US Agency for International Development (USAID), the EPI shifted to a strategy of integrating immunization activities into the existing network of state health facilities. After 5 years, in 1982, the Program was evaluated by a team from the MHSW, WHO, USAID, and the Centers for Disease Control. The evaluating team felt that the EPI's strategy was good, but its goals were not being achieved due to deficiencies in funding, clinic supervision, and rural community outreach, as well as shortages of kerosene and spare parts needs to keep the essential refrigerators in operating condition. Measles remains endemic; in the capital, Monrovia, only 9% of the children have been vaccinated against it. Immunization coverage is particularly low in the capital the countries. Other reasons for low vaccination coverage in Liberia are lack of community awareness of existing facilities and the importance of vaccination and lack of coordination at the community level to use the existing facilities efficiently. International assistance is still needed, especially to develop heat-stable vaccines, so that maintenance of refrigerators will not be necessary.
[Unpublished] 1984. 13 p. (EPI/CCIS/84.3)This document summarizes the work performed during 1983 and the 1st half of 1984 to improve the vaccine cold chain for the Expanded Program on Immunization (EPI). It provides a broad outline of the work being carried out by the World Health Organization (WHO) and summarizes major equipment developments. The state of the cold chain is described under 3 headings: cold chain management, training, and equipment. In recent years, the EPI has focused much effort on strengthening the weakest spots in the cold chain. The section of the report devoted to cold chain management describes progress in the development of management aids, such as indicators to monitor the cold chain, and an equipment maintenance and spare parts project. Additionally, it summarizes the current situation with the cold chain support services and projects in the countries and draws attention to the results of recent cold chain studies. There are 5 types of chemical indicators in use in the cold chain, and in 1983 a document was issued giving an update on the current status of field trials and feedback on routine use. These indicators are outlined. Cold chain training has been provided on a continuing basis to health workers and technicians. Over the past 5 years several audiovisual aids for cold chain training have been prepared: 3 films, 7 posters, 2 slide sets, and 3 stickers. 3 courses of cold chain training are being used at this time: a revised version of "Manage the Cold Chain" from the mid-level managers course; logistics and cold chain course for primary health care; and refrigerator repair technicians course. Development of equipment for the cold chain has fallen into 3 main areas: finding and testing existing equipment, modifying existing equipment so that it will work better in tropical conditions, and developing new equipment for the cold chain that cannot be found on the open market.
EPI in the Americas. Report to the Global Advisory Group Meeting, Alexandria, Egypt, 22-26 October 1984.
[Unpublished] 1984. 15 p.This discussion of the Expanded Program on Immunization (EPI) in the Americas covers training, the cold chain, the Pan American Health Organization's (PAHO) Revolving Fund for the purchase of vaccines and related supplies, evaluation, subregional meetings and setting of 1985 targets, progress to date and 1984-85 activities, and information dissemination. All countries in the Region of the Americas are committed to the implementation of the EPI as an essential strategy to achieve health for all by 2000. During 1983, over 2000 health workers were trained in program formulation, implementation, and evaluation through workshops held in Argentina, Brazil, Cuba, El Salvador, and Uruguay. From the time EPI training activities were launched in early 1979 through 3rd quarter 1984, it is estimated that at least 15,000 health workers have attended these workshops. Over 12,000 EPI modules have been distributed in the Region, either directly by the EPI or through the PAHO Textbooks Program. The Regional Focal Point for the EPI cold chain in Cali, Colombia, continues to provide testing services for the identification of suitable equipment for the storage and transport of vaccines. The evaluation of solar refrigeration equipment is being emphasized increasingly. PAHO's Revolving Fund for the purchase of vaccines and related supplies received strong support from the UN International Children's Emergency Fund (UNICEF), which contributed US $500,000, and the government of the US, which contributed $1,686,000 to the fund's capitalization. These contributions raise the capitalization level to US $4,531,112. Most countries are gearing their activities toward the increase of immunization coverage, particularly to the high-risk groups of children under 1 year of age and pregnant women. To evaluate these programs, PAHO has developed and tested a comprehensive multidisciplinary methodology for this purpose. Since November 1980, 18 countries have conducted comprehensive EPI evaluations. 6 countries also have had followup evaluations to assess the extent to which the recommendations from the 1st evaluation were implemented. At each subregional meeting, participants met in small discussion groups to review each other's work plans and discuss appropriate targets for the next 2 years. Immunization coverage has improved considerably in the Americas over the last several years. Figure 2 plots the incidence rates of polio, tetanus, diphtheria, whooping cough, and measles from 1970-83 in the 20 countries which make up the Latin American subregion. If all countries meet their 1985 targets, immunization coverages for DPT and polio will range from 60-100%, with most countries attaining coverages of over 80%. For measles, 1985 targets range from 50-95%, and from 70-99% for BCG. The main vehicle for dissemination of information is the "EPI Newsletter," which publishes information on program development and epidemiology of the EPI diseases.
Expanded Programme of Immunization Eastern Mediterranean Region. A report for the EPI Global Advisory Group Meeting, Alexandria, 21-25 October 1984.
[Unpublished] 1984. 10,  p. (EPI/GAG/84/WP.7.a)The strategy adopted by the Members States of the Eastern Mediterranean Region (EMR) to achieve the objective of the promotion of the Expanded Program of Immunization (EPI) through primary health care (PHC) concentrates on strengthening synergistic integration of EPI with other services. Activities have been planned and implemented or are being implemented at the Regional Office and at the country level. 21 countries of the Region now have either a full-time or part-time manager or an EPI focal point. This is a considerable development, for in 1982 there were EPI managers in 9 countries. Except for 3 countries, all national EPI managers/focal points have received senior level training in EPI. At delivery points, vaccination is performed to a large extent by multipurpose health workers, but full-time vaccinators are available in about 6 countries. All field workers have received training at their respective regional levels. Limited financial resources continue to be 1 of the primary constraints of the program in the Region. Plans to resolve this problem include: counteracting wastage factors; close collaboration with the UN International Children's Emergency Fund (UNICEF) and other international agencies at the country level to standardize approaches and avoid overlap; tapping regional and international voluntary agencies to increase their contributions; and increased use of associate experts, UN volunteers, and national technical staff. The overall information system is to some extent weak and suffers from irregularity and a lack of continuity. Regular reports are received from 9 countries which have World Health Organization staff. Repeated requests from other countries yield incomplete and at times contradicting data. Research efforts are directed towards operational areas, and research in strategies, integration, community, and surveillance areas is being encouraged.
[New cold chain monitor to be introduced on 1 January 1985] Introduction d'une nouvelle fiche de controle de la chaine du froid le 1er Janvier 1985.
[Unpublished] 1984.  p. (EPI/CCIS/84.6)As of January 1, 1985, a new and simpler vaccine cold chain monitor will be distributed with vaccines supplied by the UN International Children's Emergency Fund (UNICEF) and the World Health Organization (WHO). This new monitor (available in Arabic, English, French, and Portuguese) has the same function as the previous monitor, but it has 3 new features. These are: temperatures above 10 degrees Centigrade are monitored by a strip indicator that has only 3 windows, marked A, B, and C, and temperatures above 34 degrees Centigrade are monitored by a disk indicator; a simplified interpretation guide has been added to the bottom of the card; and the back of the card has some instructions on the use of the indicator. As previously, the new cold chain monitor will be activated by the vaccine manufacturer and sent with the vaccine to the central store. The storekeeper should complete the top part of the card. The monitor then is sent with the vaccine down the cold chain. The top part of the card should be completed at each level of the cold chain -- when the vaccine arrives in the store and again when the vaccine is dispatched. In the cold chain, the vaccine cold chain monitor has 2 functions: to monitor any temperatures above 10 degrees Centigrade so that the cold chain can be improved; and to give the person responsible for caring for the vaccine some guidance on whether to use the vaccine or not.
[Unpublished] 1984. 24 p. (EPI/CCIS/84.4)Since 1979, vaccine hand carriers, cold boxes, and vaccine packaging have been submitted by the World Health Organization (WHO) for laboratory testing at the Consumers Association Laboratories, Harpenden Rise, UK, and UNIVALLE, Cali, Colombia. The tests results have been summarized in this document in order to inform users and buyers of the equipment available as to its performance capacities and to serve as a guide to the selection of equipment most suited to specific conditions. Detailed tables list all equipment which has been tested. The equipment is divided into categories on the basis of vaccine storage capacity, and the following major features are listed: external dimensions (in centimeters); vaccine in storage capacity (in litres); number of icepacks necessary (as used during the tests); cold life at an ambient temperature of +43 degrees Centigrade; weight fully loaded (in kilograms); and durability (under rough handling conditions). Equipment has been subjected to 2 main types of routine test: performance or temperatur rise test; and durability or drop test. In the course of testing, a number of interesting observations were made, including: using more icepacks than specified will lengthen the cold life of a container without harming the vaccine but also will increase weight load and decrease the vaccine storage capacity; icepacks are more quickly frozen in "icepack freezers" as opposed to chest type domestic freezers; some boxes had problems with lid fastenings, which came undone on impact; and 5 factors should be taken into consideration in the purchase of any box, that is, vaccine storage capacity, cold life, weight fully loaded, durability, and price.
[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.
WHO CHRONICLE. 1984; 38(38):34-5.Early in November 1983, WHO, UNICEF, and other agencies dispatched yellow fever vaccine, cold chain equipment, and motorcycles, fuel, and camping materials for mobile vaccination teams to help the governments of Ghana and Upper Volta (Burkina Faso) fight an outbreak of yellow fever. By December 1, 1983, the outbreak had claimed over 450 lives in the 2 countries combined. The 1st report of yellow fever cases in Ghana was received in mid-October. Retrospective inquires suggest that the outbreak actually began in July 1983. In Upper Volta, the first clinically suspect cases were reported to the authorities on October 4, 1983. Retrospective inquires suggest that the earliest cases occurred on September 18, 1983. In Upper Volta, a high level national committee was formed to coordinate activities against yellow fever. Immunization was carried out in the affected localities and, on a large scale in Ouagadougou. Health controls were established at the borders with Niger, Togo, and Ghana. Vaccination was carried out in Ghana and Togo. Ground spraying against domestic mosquitos in Ouagadougou began on November 11. In all, over 1 million people were immunized over a 3-week period with vaccine supplied by WHO, UNICEF, and other agencies. By early December a WHO team was in West Africa visiting the countries at risk from the epidemic evaluating the epidemiological situation and the measures already taken, proposing additional measures if necessary, reviewing yellow fever surveillance, and evaluating entomological activities.
In: Medical education in the field of primary maternal child health care [edited by] M.M. Fayad, M.I. Abdalla, Ibrahim I. Ibrahim, Mohamed A. Bayad. [Cairo, Egypt, Cairo University, Faculty of Medicine, Dept. of Obstetrics and Gynecology, 1984]. 421-34.This paper begins by stating that the mortality from neonatal tetanus has been peculiarly underestimated until recently, and discusses why this has been the case. The availability of a methodology for retrospective surveys and undertaking of such surveys in recent years has thrown much light on the subject. The results of these surveys from 15 countries are presented in tabular form. It is apparent that at present between 500,000 and 1 million newborn infants a year succumb to tetanus. The prospects for control, using the combined approach of improved maternity care and maternal immunization, are discussed, and an appropriate schedule of immunization suggested. The prospects for control are good wherever there is realization of the magnitude of the problem plus reasonable access to even quite basic primary health care. Some activities of WHO in this field are briefly described. (author's)
Report on the evaluation of UNFPA assistance to the maternal and child health programme of Malawi: project MLW/78/P03 (February 1984).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Sep. xi, 36,  p.The 3 initial objectives of the Maternal and Child Health Program of Malawi were health and nutrition education, training of traditional midwives, and immunization against measles and polio. The Evaluation Mission found that the strong points of the project are: the Government's commitment to improve the status of maternal and child health by its expansion of services and its recent acceptance of child spacing as part of its program in maternal child health; the high level of dedication of the personnel in the Ministry of Health; the attention given to strengthening the Health Education section; and the establishment of a good management information framework upon which planning, supervision and monitoring can be further developed. Factors which seem to have hindered the project have been the lack of trained staff at the supervisory and service delivery level caused in large part by the lack of accomodation at the various national training institutions; the failure to appoint international staff to key positions within the project; and the lack of adequate transportation for project personnel. As child spacing will soon be included in project activities, the present organization of the Central Medical Stores to procure and distribute contraceptives and other needed supplies will adversely affect project performance. In total, the evaluation Mission made 19 recommendations addressed mainly to the Government and a number to the World Health Organiation and the United Nations Fund for Population Activities for project management decisions.
New York, New York, UNFPA, 1984 May. xii, 156 p. (Report No. 67)A Needs Assessment and Program Development Mission visited the People's Republic of China from March 7 to April 16, 1983 to: review and analyze the country's population situation within the context of national population goals as well as population related development objectives, strategies, and programs; make recommendations on the future orientation and scope of national objectives and programs for strengthening or establishing new objectives, strategies, and programs; and make recommendations on program areas in need of external assistance within the framework of the recommended national population program and for geographical areas. This report summarizes the needs and recommendations in regard to: population policies and policy-related research; demographic research and training; basic population data collection and analysis; maternal and child health and family planning services; management training support for family planning services; logistics of contraceptive supply; management information system; family planning communication and education; family planning program research and evaluation; contraceptive production; research in human reproduction and contraceptives; population education and dissemination of population information; and special groups and multisectoral activities. The report also presents information on the national setting (geographical and cultural features, government and administration, the economy, and the evolution of socioeconomic development planning) and demographic features (population size, characteristics, and distribution, nationwide and demographic characteristics in geographical core areas). Based on its assessment of needs, the Mission identified mjaor priorities for assistance in the population field. Because of China's size and vast needs, external assistance for population programs would be diluted if provided to all provincial and lower administrative levels. Thus, the Mission suggests that a substantial portion of available resources be concentrated in 3 provinces as core areas: Sichuan, the most populous province (100,220,000 people by the end of 1982); Guandong, the province with the highest birthrate (25/1000); and Jiangsu, the most densely populated province (608 persons/square kilometer. In all the government has identified 11 provinces needing special attention in the next few years: Anhui, Hebei, Henan, Hubei, Hunan, Jilin, Shaanxi and Shandong, in addition to Guangdong, Jiangsu, and Sichuan.
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.
In: Infant and child survival technologies, annual technical update No. 1 by Technologies for Primary Health Care Projects [PRITECH]. Arlington, Virginia, Management Sciences for Health, PRITECH Project, 1984 Sep. 34-5.During the past few years, 1 of the more exciting developments in vaccine production is the great improvement in the thermal stability of vaccines. Such improvements in vaccine stability, in combination with a carefully monitored distribution system (cold chain), have the potential for greatly increasing the coverage of an immunization program. The Expanded Programme on Immunization of the World Health Organization (WHO/EPI) has played a major role in aiding the development, adaptation, and field testing of equipment designed to meet the conditions encountered in the distribution of vaccines through the cold chain. An important innovation is the development of solar powered refrigerators for vaccine storage and ice making. In addition, WHO/EPI has attempted to identify the best methods for packing vaccine carriers and cold boxes. Since the rate of decline of vaccine potency is affected both by temperature and by age, it is important to know what temperature each vial of vaccine has been exposed to. Temperature monitoring devices that have been devised are discussed. Vaccination equipment (i.e., needles, syringes, and methods for sterilizing them) is essential to an immunization program. Alternatives to the syringe or needle for vaccine administration include the jel-injector and aerosol administration. Less expensive, more durable syringes are also being developed.
[The significance of "Health for All" and the primary health care approach] La signification de la sante pour tous et l'approche des soins de sante primaires.
Famille, Sante, Developpement. 1984; (1):33-40.Health for All was the primary theme of the 30th World Health Assembly held in 1977; the idea was reaffirmed at the Alma Ata International Conference on Primary Health Care in 1978 and currently serves as the goal of the World Health Organization and those individual states, including Rwanda, which form its membership. The Health for All campaign is directed toward the maintenance of primary health care within an established national health care system. It encourages planned action in the health care system and promotes coordination and integration of health care with other sectors. The social objective of Health for All is based on the implementation of primary health care. This was defined at Alma Ata: "primary health care is essential health care based on practical techniques, scientifically valuable and socially acceptable, and rendered universally acceptable to all individuals and families..." The essence of primary health care is fundamental care necessary to promote and protect the physical, mental, and social health of man. The philosophy of primary needs is constituted by the ensamble of biological and physical conditions, wherein satisfaction is necessary for the survival of the individual. A global view of primary health care in Rwanda involves renewed emphasis on health education, the promotion of healthful and nutritious foods, the provision of sufficient and noncontaminated water, and the prevention and treatment of local epidemics. Health for All from now to the year 2000 is an operational objective with a recognized strategy and political framework determined by the states themselves.
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.