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Strengthening of management of maternal and child health and family planning programmes. Report of an intercountry workshop, New Delhi, 27-31 August 1990.
[Unpublished] 1991 Feb 14. , 20 p. (SEA/MCH/FP/99; Project No. ICP MCH 011)>20 participants from UNFPA/UNICEF/USAID and 23 participants from 10 countries from the WHO Southeast Asia Region attended the Workshop on Strengthening of Management of Maternal and Child Health (MCH) and Family Planning (FP) Programmes in New Delhi, India in August 1990. The workshop consisted of presentations and discussions of country reports, technical papers, dynamic work groups, and plenary consensus. The WHO/SEARO technical officer for family health presented a thorough overview on strengthening MCH/FP services in a primary health care setting. Issues addressed included regional status on population growth, urban migration and development. MCH status, management of MCH/FP services, strategic planning, and management information. In Bangladesh, the government integrated MCH services with FP services, but other child programs including immunization, control of diarrheal disease program, nutrition, acute respiratory infection remained with the health division. Obstacles of the MCH/FP program in the Maldives were shortage of trained human resources, preference of health providers to work in urban areas, inadequate logistics, and insufficient supervision in peripheral health centers. A nomadic way of life among the rural peoples posed special problems for the delivery of MCH services in Mongolia where large family size was encouraged. Other country reports included Bhutan, India, Myanmar, Nepal, and Sri Lanka. A case study of the model mother program in Thailand and the local area monitoring technique in Indonesia were shared with participants. District team work groups identified key MCH/FP management problems including organization, planning, and management; finance and resource allocation; intersectoral action; community participation; and human resource development. The workshop revealed the national health leaders with hopes for WHO technical assistance were developing a rapid evaluation methodology.
IN POINT OF FACT 1991 Jun; (76):1-3.This paper describes the serious effect of diarrheal and acute respiratory (ARI) disease upon children under 5 years old, and international efforts undertaken by the World Health Organization (WHO) to reduce such mortality. Combined, these diseases account for more then 1/2 of all deaths in this age group, and constitute the most serious threat to their health. WHO estimates for 1990 that diarrheal illnesses caused 3.2 million childhood deaths and that ARI caused 4.3 million. While some child deaths are due to measles and pertussis, the majority is caused by pneumonia and the consequences of diarrheal illnesses. These deaths could be readily averted through the timely, effective treatment of trained health workers with essential drugs. Immunization as well as improved nutrition, particularly through the practice of exclusive breast feeding of the child's 1st 4-6 months of life, are addition weapons potentially employed against child mortality. WHO programs for diarrhea and ARI control focus upon simplified treatment guidelines, training, communication messages, drug supplies, and evaluation methodology. Despite obstacles such as the marketing of useless and/or potentially dangerous anti-diarrheal drugs and cough and cold remedies, and inappropriate breastmilk substitutes and unnecessary foods, widespread progress in program development and implementation has been made over the past decade. Increased amounts of oral rehydration therapy and solutions are available and used, while many health workers have benefited from training programs.
In: Operations research: helping family planning programs work better. Proceedings of an International Conference and Workshop on Using Operations Research to Help Family Planning Programs Work Better, held in Columbia, Maryland, June 11-14, 1990, edited by Myrna Seidman, Marjorie C. Horn. New York, New York, Wiley-Liss, 1991. 395-410. (Progress in Clinical and Biological Research Vol. 371)Systems analysis was adopted by the AID Office of Health, Primary Health Care Operations Research (OR) Project (PRICOR) for evaluating the process of delivery of child survival services. Actual performance is compared with an accepted standard. The rationale for examining the process of service delivery is provided along with an outline of the process evaluation methodology and an overall framework for examining the different systems. Illustrative examples of findings are given. Applications of this approach for routine management evaluation are discussed with particular reference to small, rapid, cheap and relatively simple OR studies. Outcome analysis screens for unsatisfactory performance, and process analysis specifies certain activities which require management action or improvements in a supervisor's performance. The PRICOR project objective was the development of practical methodologies for gathering information on service delivery and quality of care. The first task was the detailed identification of concrete activities necessary in providing effective services, which were drawn from the public health literature and a panel of outside experts. This thesaurus was used to examine staff performance in 12 countries: Thailand, Zaire, Haiti, Costa Rica, Colombia, Indonesia, Philippines, Peru, Niger, Pakistan, Senegal, and Togo. Although not a statistically representative sample, it was the first large scale, systematic effort. The following areas were evaluated by observation or review: service delivery, clinical and support facilities, home visits, records, informant interviews, role- playing, training courses, supervisory contacts, and population-based surveys. 6000 interviews and observations were addressed to immunizations, maternal health, child spacing, and growth monitoring and promotion. The systems analysis focused on 7 major systems (quality of care, outreach, primary supervision, secondary and higher levels of supervision, training, logistics, and management of information which were subdivided into approximately 40 issues areas which broke down into approximately 200 distinct and observable staff activities. The findings were that there are extensive and serious deficiencies in quality of care, that program mechanisms are poorly developed to detect and correct deficiencies, and that it is feasible to examine the process of service delivery and determine practical solutions.
Rapid anthropologic assessment: applications to the measurement of maternal and child mortality, morbidity and health care.
[Unpublished] 1991. Presented at the International Union for the Scientific Study of Population [IUSSP] Committee on Population and Health and Cairo University Institute of Statistical Studies and Research, Center for Applied Demography Seminar on Measurement of Maternal and Child Mortality, Morbidity and Health Care: Interdisciplinary Approaches, Cairo, Egypt, November 4-7, 1991. 14 p.University Nations University (UNU) leaders requested rapid anthropological assessment procedures (RAP) guidelines in the early 1980s to examine health-seeking behavior in 16 developing countries. They were not content with the expense, time, and poor accuracy of standard survey techniques to study health care. UNU project researchers studies 42 communities in these countries. They used triangulation to assess the validity of their data and found the data to be accurate. RAP involves applied medical anthropologists and other social scientists with appropriate training to pass about 6 weeks in a community where a supposed effective primary health care (PHC) programs operates to learn the household and community perspective on PHC services. 6 weeks constitute a long time for health planners and policymakers, but for anthropologists this time period tends to be too. Yet the required time hinges on the amount and complexity of data needed. It is important that the anthropologists and/or other social scientists already know the language and the culture because they interview biomedical and indigenous health providers. RAP depends on limited objectives and on existing data and prior research. Research designers should modify the limited objectives or data collection guidelines to fit each culture and each project. RAP data collection techniques include formal and informal interviews, conversations, observation, participant observation, focus groups, and data collection from secondary sources. Indeed researchers should be able to adapt these various techniques during the project. Obstacles which RAP research designers must consider are: some anthropologists do not feel at ease with RAP; not all cultures are comfortable with an outsider coming into their community asking questions, thus highlighting the importance of using an anthropologist already known and trusted in the community; and the topic may not be appropriate for discussion in a community.
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY. 1991 Sep; 20(3):589-94.Epidemiology is considered under 4 aspects: its contribution to world health; its future role in solving health problems; application of advances in epidemiology; and its social and ethical implications. Epidemiology now encompasses all ill health as affected by development, not just infectious diseases. The WHO uses epidemiologic tools to understand the incidence, prevalence, natural history, causes, effects, and control of disease, as exemplified by the eradication of smallpox and the AIDS prevention program. Now WHO is applying epidemiologic methods of monitoring and evaluation to set goals for health for all by 2000. The major contributions that epidemiologists can make are to warn decision makers about the many world problems before it is too late. This should be done with human rights and social justice in mind, rather than by commercial marketing of health products. Future health care systems must continue to increase efficiency and efficacy of interventions, compatible with political and social reality, and respectful of human rights, freedom, and integrity. WHO is preparing a plan of action to strengthen epidemiologic capabilities of the countries with the greatest need in the next 5 years, to be extended to other needy countries in the future.