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  1. 1
    069275

    Priorities for maternal and child health for the 1990s.

    Belsey M

    [Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference, Washington, D.C., August 5-7, 1991. 8 p.

    The maternal and child health/family planning (MCH/FP) program at WHO specifies the priorities for MCH/FP in the 1990s. Results of the Demographic and Health Surveys (DHS) in many, but not all, developing countries have shown overall improvement in fertility and maternal and child health, especially in the family planning and child survival movements. Maternal mortality did not change, however. Moreover, maternal mortality in some countries exceeded natural maternal mortality. These elevations sparked a 3rd movement in the late 1980s, safe motherhood. These results confirm that the public health community cannot become complacent. Indeed it must strengthen the infrastructure, management, and performance of the health system to maintain gains. This involves identifying a novel strategy to priority setting and program development which are adapted to the changing needs and circumstances of each country, and even within each country. In fact, firm program strategies and policies need to concentrate on maternal health and morbidity, newborn care, breast feeding, perinatal infections, and HIV/AIDS. Based on DHS data and on evaluations of MCH/FP programs, WHO lists crucial principles for successful programs. The 1st principle includes equity in access and use of social resources which includes disaggregating data according to geographic and population subgroups to find appropriate strategies to close the widening gap within and between countries. The next principle is community and health care provider participation and ownership. Indeed successful MCH/FP programs are those where the community identifies problems and needs and evaluates the program. The 3rd principle encompasses quality data collection to assess quality of care and program effectiveness. WHO has proposed 5 priorities for organization and management of MCH/FP programs. 1 priority which WHO suspects will generate the most debate is integration of family planning, child survival, and safe motherhood programs.
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  2. 2
    068776

    Drug supply by ration kits: report of an evaluation.

    ESSENTIAL DRUGS MONITOR. 1991; (11):12-4.

    In the late 1980s, the WHO Action Programme on Essential Drugs conducted an evaluation of the drug ration kit system in developing countries. The most successful effect on the kit system was the much improved availability of essential drugs in rural health facilities. External donors tended to pay for and supply the essential kits, however, which contributed to better availability. In those cases, where external funding did not exist, lack of funds were a major problem. Indeed the evaluation determined that the sustainability of the kit system is dependent on funding. The kit system diminished the practice of drugs being diverted to other levels of health care and wastage by expiry. Most kit programs included training for health workers in diagnosing and treating a limited list of common diseases which led to rational prescribing. An ample supply of essential drugs lent itself to quality health care and revealed ruthlessly any weaknesses in the health system, such as lack of training. It took about 2 years to iron out the problems of estimating requirements and achieving a stable kit content. Accumulation of surpluses sometimes occurred early in the kit program. The drugs that accumulated are usually stable and inexpensive drugs (oral rehydration salts and iron tablets), however. The biggest problems of matching need and supply arose from suppliers, e.g., long delivery times. The evaluation showed that a kit system can operate if health workers can adequately identify essential drugs, funding can be secured, and management if well trained and dedicated. In conclusion, the kit system addresses the logistic problem and lends itself to rational prescribing.
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