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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[Unpublished] 1984.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.
Report of the third meeting of the Scientific Working Group on Bacterial Enteric Infections: Microbiology, Epidemiology, Immunology, and Vaccine Development.
[Unpublished] 1984. 17 p. (WHO/CDD/BEI/84.5)The scientific topic discussed in detail by the Scientific Working Group (SWG) was recent research advances in the field of cholera. The SWG reviewed new knowlenge in areas such as epidemiology and ecology, phage-typing, pathogenesis, immunization, and related pathogens, and made recommendations for future research. The Diarrhoeal Disease Control Pragramme was continuing to emphasize the implementation of oral rehydration therapy as a means of reducing diarrheal mortality, and research aimed at an improved case-management strategy. The Steering Committee granted support to a number of projects aimed at clarifying the epidemiology of diarrhea and the pathogenesis of bacterial agents of acute diarrhea. Support was provided by the Steering Committee to projects aimed at, or closely related to the development of new vaccines against typhoid fever, cholera, and Shigella dysentery.
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.
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.
[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.
Geneva, Switzerland, WHO, EPI, 1984. 54 p. (Logistics and Cold Chain for Primary Health Care 22; EPI/LOG/84/22)This handbook provides information on the following: how the cooling equipment in a vaccine cold store works; how to prevent it from breaking down; what to do if the cooling equipment is not working properly; and what spare parts and tools are needed. The handbook also outlines instructions on the following: routine tasks which must be carried out on the cold store and cooling equipment on a daily, weekly, and monthly basis; how to prevent trouble with the cold store and cooling equipment; what to do if the storage temperature is too high; what to do if the compressor runs for too long; what to do if the compressor "short cycles;" what to do if the compressor is not running; what to do if the "cooling load" is too high; what to do if the condenser is not working properly; what to do if the evaporator is not working properly; what to do if the system is losing refrigerant; what to do if the filter-drier must be changed; what to do if the expansion valve requires attention; what to do if the thermostat is faulty; how to replace a faulty thermostat; what to do if the electrical supply fails; what to do if the safety cutouts are faulty; what to do if the supply voltage is too low; what to do if a fuse fails; what to do if the compressor driving belts require attention; what to do if the electrical conneections require attention; what to do if there is a blockage in the cooling system; what to do if the compressor is faulty; what to do if the storage temperature is too low; what to do if the condensing unit runs noisily; what to do if the cold storage door is not closing properly; what to do if the cold store floor is wet; and what to do if air is getting into the store through joints in the walls and roof. Spare parts and tools required for maintenance and repair work are listed.
Geneva, Switzerland, WHO, EPI, 1984 Jul. 15 p. (Logistics and Cold Chain for Primary Health Care 21; EPI/LOG/84/21)This booklet should be used with the "User's Handbook for Vaccine Cold stores." It contains 13 cold store task sheets that cover the following tasks: find the main parts; know what the main parts are for; every day maintenance tasks; every week maintenance tasks; check the evaporator; every month maintenance tasks; how to prevent trouble; the storage temperature is too high; the storage temperature is too low and cannot be made higher; there is water on the floor of the cold store; and spare parts and tools.
Geneva, Switzerland, WHO, EPI, 1984. 24 p. (Logistics and Cold Chain for Primary Health Care 12; EPI/LOG/84/12)This booklet is a guide for those who already have played the cold chain game, a game for teaching logistics for primary health care, and who want to organize their own game. The cold chain game was developed originally by the Expanded Program on Immunization (EPI) as a method of teaching people how to distribute vaccine effectively. In this booklet, the game has been adapted to teach how to distribute chloroquine tablets as well as vaccines. The cold chain game is designed for 5-10 people or 11-20 people depending on how it is organized. 2 or 3 supervisors are needed, one to direct the game and the others to assist the participants. The game's purpose is learning. The players learn by discovering the problems of trying to manage a cold chain and solving thse problems by themselves. The players take on the roles of cold chain workers, storekeepers, supervisors and learn the complex nature of these tasks. This booklet describes what the game is designed to teach, how to set up the game, how to run the game, and how to devise one's own cold chain game.
Geneva, Switzerland, WHO, EPI, 1984 Oct. 12 p. (Logistics and Cold Chain for Primary Health Care 3; EPI/LOG/84/3)This booklet considers 4 important aspects of good distribution of supplies: decide a delivery interval; decide a delivery method; choose the transport; and make a timetable. In a system that works well, supplies never run out, there is never too much of any supply, the expiration date is never passed, the cost of the distribution is as low as possible; and in the case of vaccines, they are kept cold all the time. The design of a good delivery depends on: what storage facilities exist; what transport exists; how many people can be trained in the different skills needed; what volume and weight of supplies need to be delivered; and many other factors that only can be decided locally. It is necessary to estimate the volume and the weight of the supplies required in order to make a decision about the distribution means. There are 2 ways of distributing supplies: collection and delivery. In many places, both methods are used. There are 3 types of transport that may be chosen: public, project vehicle, and hired vehicle. The type of transport is not limited to motor vehicles. Boats, trains, carts, bicycles, and walking may be used. In certain cases, it may be justified to use domestic air service. However the distribution system is planned, it is important to make a timetable so that it will operate regularly and properly. The module includes diagrams and exercises.
Geneva, Switzerland, WHO, 1984. 37 p. (Immunization in Practice. A Guide for Health Workers who Give Vaccines. Module 1.; EPI/PHW/84/1)This module, a guide for health workers who give vaccines, explains what those who give vaccinations need to know about vaccines and when to give them. As health workers cannot learn all that they need from a book or from lectures, a "Trainer's Guide" includes suggestions for practical exercises as well as answers and comments for the questions and exercises in this module and the 6 other modules in the series. This module covers the following: the properties of the 6 Expanded Program Immunization (EPI) vaccines; how to look after vaccines in a health center; the immunization schedule; contraindications to immunization; and doses, courses, and side effects of the 6 vaccines. The EPI aims to immunize all children against 6 important infectious diseases that are very serious and can kill or cripple many children: poliomyelitis; measles; diphtheria; pertussis; tetanus; and tuberculosis. The module includes some practical exercises.
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.
[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.
in Touch. in Touch 1984 Mar-Apr; 8(66):8-9, 13.Each year the World Health Organization (WHO) promotes a slogan to highlight a problem in need of attention. This year's slogan is "Children's Health-Tomorrow's Wealth." To get a healthy citizen, the nation must take care of its infants and children over a very long period. at the outset the mother must be healthy and not suffering from any chronic disease. She must not have intestinal parasites which adversely affect her nutrition. After birth up to 3 years the baby grows rapidly, requiring effective breastfeeding, supplementary feeding, prevention of disease, treatment, sunlight, fresh air, environmental sanitation, and so forth. From the 3rd to the 10th year the growth is slow. The 3rd growth spurt is from the 10th to 15th year. After this age the growth slows down. Any disease may affect the natural growth of the baby. The health of children can be assured if environmental sanitation, safe drinking water, medical care, education, housing, and so forth can be ensured for the mother, her family, her children. Bangladesh differs from other countries in many aspects. In Bangladesh the major problems are poor environmental sanitation, intestinal parasite disease, diarrheal diseases, scarcity of safe drinking water, poor preventive care, and a lack of health education. Depending on the country's gross national product with appropriate WHO assistance, it is possible to improve the condition. The government cannot take on the responsibility alone. It must share the responsibility with the people. Prevention of diseases by vaccianation is a simple and relatively cheap technique, but it requires good organization to ensure that enough children are protected and that the vaccine used is effective. The full responsibility for dealing with mother and child health does not rest with the families alone. The efforts of families must be aided by the provision of adequate health care that is available on all levels.