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Geneva, Switzerland, WHO, Family and Reproductive Health, 1996. , 29 p. (WHO/FRH/MSM/96.8)The World Health Organization (WHO) convened the Technical Working Group on Antenatal Care in Geneva for October 31-November 4, 1994. The group focused on developing recommendations on antenatal care (i.e., outlining the tasks and procedures for health workers to follow and skills of the health worker) and on examining how to optimize antenatal care in terms of clinical tasks and procedures in relationship to the timing of the visits, distance to referral centers, and frequency of attendance. Group members agreed that antenatal care significantly contributes to maternal and perinatal health and is a critical component of care for mothers and infants, together with family planning, clean and safe delivery, and essential obstetric care. Group presentations included organization of antenatal care in India, US Expert Panel on the content of antenatal care, the background and rationale for the WHO randomized clinical trial of antenatal care, development and implementation of the antenatal care protocol for the UN Relief and Works Agency for Palestine Refugees in the Near East, the potential impact of antenatal care on maternal and perinatal mortality in Malawi from the perspective of midwifery, the current draft of the Mother-Baby Package, and maternal health care. Participants divided into three subgroups to formulate recommendations: normal pregnancy, risk factors for poor maternal or fetal outcome; and medical conditions and complications of pregnancy. They considered the constraints of many countries when they identified the minimum level of care needed in terms of the number (4), length (20 minutes), and content (assessment [history, physical examination, and laboratory tests], health promotion, and care provision) of antenatal visits. They agreed that women with high-risk pregnancies or pregnancy complications will need more antenatal care visits. Participants wanted to emphasize the key role of counseling skills in the delivery of effective care. Additional recommendations were made.
Geneva, Switzerland, WHO, 1996. , 90 p. (WHO/HRH/96.4)This booklet contains the report of a 1995 Interregional Meeting on New Public Health convened by the World Health Organization (WHO) to 1) consider the new challenges to public health rising from globalization, new diseases and epidemics, entrenched public health concerns, changing societal values, and the lack of new social sector resources and 2) formulate possible responses to these challenges. After an introduction, the report opens by reprinting a paper on the new public health and WHO's ninth general program of work, which was prepared to stimulate discussion at the meeting. The next section summarizes discussions during the meeting. Consideration of the context of public health looked at 1) the new public health and key determinants of health; 2) poverty, equity, and intersectoral partnerships; and 3) the role of WHO. Consideration of the content of public health included 1) a semantic debate on the "new" public health; 2) the content of the new public health; and 3) new public health challenges and responses. A discussion of education and research focused on training venues, the core content of training, and diversity of the public health work force. For each of these topics, the report includes specific statements adopted by the meeting. Finally, the report offers four recommendations to schools of public health, four to the WHO, and five to national governments.
Geneva, Switzerland, WHO, Division of Reproductive Health, 1996. iv, 56 p. (Safe Motherhood; WHO/FRH/MSM/96.14)This progress report provides a condensed account of activities of the Maternal Health and Safe Motherhood Program (MSM) of the World Health Organization (WHO) during 1993-95. Since the Nairobi Safe Motherhood Conference of 1987, WHO with many others brought awareness to the issues of pregnancy-related death and disability and conducted research on maternal health. The 1995 Beijing Conference and the 1994 Cairo Conference firmly placed women's health on the global agenda. MSM, under the guidance of its Scientific and Technical Advisory Group, shifted its focus from advocacy to action. MSM published the "Mother-Baby Package," which identifies essential, available, and accessible interventions for safer childbirth. MSM offers a Safe Motherhood Needs Assessment tool for profiling maternal and neonatal health and services and for helping planners prioritize action and investment. The "Mother-Baby Package" also offers a cost accounting spreadsheet for resource planning. The publication of the action package stimulated implementation of safe motherhood programs in countries. The outcome of regional and national workshops was a variety of practical guides on subjects such as prenatal care, the progress of labor and delivery, management of childbirth complications, and care of the newborn. The MSM team worked within countries and in national meetings to support country efforts and to exchange ideas and information. The Safe Motherhood Newsletter offers a regular information and exchange support tool. The newsletter is available in a number of languages and offers information on practical approaches. MSM works with a range of international health personnel organizations to support health care workers. This report is organized into the following nine units: summary, introduction, technical collaboration, information and advocacy, human resources, research, technical working groups, newborn care, and conclusion.
Reproductive health programs supported by USAID: a progress report on implementing the Cairo Program of Action.
[Washington, D.C.], USAID, 1996 May. , 20 p.This report details progress made by the US Agency for International Development (USAID) in implementing the Program of Action of the 1994 International Conference on Population and Development. The report contains an introduction and an overview of the USAID program. USAID reproductive health programs have: 1) provided leadership for a supportive policy environment through multilateral, regional, and country-level initiatives; 2) developed innovative techniques for operations, biomedical, social science research and for evaluation; and 3) implemented reproductive health programs that promote access and quality in family planning and other reproductive health services, maternal health, women's nutrition, postabortion care, breast feeding, sexually transmitted disease and HIV prevention and control, integrated reproductive health programs, programs and services for youth, prevention of such harmful practices as female genital mutilation, male involvement, reproductive health for refugees and displaced people, and involvement of women in the design and management of programs. USAID programs to advance girls' and women's education and empowerment have forwarded women's legal and political rights, increased access to credit, and developed integrated programs for women. Priority challenges and directions for the future include: 1) determining the feasibility, costs, and effectiveness of reproductive health interventions; 2) improving understanding of reproductive health behavior; 3) continuing development of service delivery strategies; and 4) mobilizing resources for reproductive health.
PROGRESS IN HUMAN REPRODUCTION RESEARCH. 1996; (38):6.An assessment conducted in South Africa with the goal of formulating recommendations for a national reproductive health policy identified numerous problems with existing services, including a limited contraceptive availability through the public sector, a neglect of barrier methods despite a high incidence of sexually transmitted diseases (STDs), significant unmet need among adolescents and rural residents, and inadequate technical capabilities. Over 70% of contraceptive usage (even higher levels in underserved areas) involved injectables. Despite a high demand, female sterilization is rarely offered because of inadequate facilities, a lack of trained physicians, the risk of sterilization failure due to poor surgical technique, and the requirement for husband's consent. Of particular concern was the lack of resources for the diagnosis and treatment of STDs. The assessment team recommended that family planning services should be expanded to include a broader range of barrier methods, emergency contraception, and improved access to surgical sterilization. In addition--and in conformity with South Africa's ongoing health sector reform, the team stressed that any contraceptive introduction effort should operate within the district model. Recommended was development of a series of district-based projects in several provinces to identify changes in service delivery administration and operations necessary to expand contraceptive choice through the planned introduction of appropriate methods. However, research related to improving the use of existing methods was deemed more important at this time than the introduction of new methods. The assessment was conducted according to a three-stage model devised by the UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction.
PROGRESS IN HUMAN REPRODUCTION RESEARCH. 1996; (38):5-6.An assessment of contraceptive needs undertaken in Zambia in 1995 resulted in calls for fundamental changes in the provision of reproductive health services. The assessment team found that use of the diaphragm, IUD, foam, injectables, and implants was negligible due to constraints in the service delivery system, client and provider misinformation, and weaknesses in the management support system. Increases in the number of methods available at a given service delivery point did not, in themselves, enhance contraceptive choice. For example, many clinics in the 13 districts visited had adequate IUD supplies; however, they lacked personnel with the experience to perform pelvic examinations, detect sexually transmitted diseases, or insert the device. A review of these findings at a national workshop attended by 120 community and government representatives led to the recommendation that user-friendly service delivery guidelines be developed and field-tested and--ultimately--to production of the document, "Family Planning in Reproductive Health: Policy Framework and Guidelines." The Ministry of Health has adopted these guidelines as its future agenda for health services research. Any introduction of new contraceptive methods will be based on an assessment of both users' needs and service capabilities. For example, Norplant will be available only at a small number of urban centers capable of backing up this method with adequate program support and quality of care. The assessment was conducted according to a three-stage model devised by the UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction. Stage II research will accompany the introduction of Depo-Provera to selected Zambian districts and explore the need for emergency contraception.
PROGRESS IN HUMAN REPRODUCTION RESEARCH. 1996; (38):4-5.An assessment conducted in municipalities in four of Brazil's nine states in 1993 revealed high rates of unwanted fertility. As many as 58% of pregnant women reported that their current pregnancy was either unwanted or mistimed. Despite Ministry of Health approval for the provision of oral contraceptives, IUDs, condoms, spermicides, diaphragms, and natural family planning methods, public-sector programs generally offered a limited range of contraceptive options and frequently were out of supplies. Also observed by the assessment team was a strong medical (as opposed to primary health care) orientation among contraceptive providers and a lack of training of physicians and nurses in family planning. On the basis of this assessment, the team recommended that efforts be directed toward strengthening the provision of methods that are often unavailable (e.g., IUDs, barrier methods, and lactational amenorrhea) rather than expanding contraceptive options. Research currently underway in Sao Paulo state seeks to identify the operational and management changes necessary to broaden contraceptive choice and improve the quality of reproductive health services. A data collection and information retrieval system has been set up to record health post activities, and a family planning training and referral system has been established. The Brazil assessment was conducted according to a three-stage model devised by the UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction.
PROGRESS IN HUMAN REPRODUCTION RESEARCH. 1996; (38):2-4.The UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction has developed a three-stage model for the introduction of new contraceptive methods that emphasizes both users' needs for additional contraceptive choices and the ability of the family planning service to provide these methods with suitable quality of care. The three stages of this approach, which has been field-tested in Africa, Asia, and Latin America, are: 1) assessment, 2) research to guide decision making about contraceptive introduction, and 3) use of research for policy and planning as the method is made more widely available. Assessment in the first stage is based on determining whether there is a need for a new contraceptive method, for improved use of existing methods, or for withdrawing methods whose safety and efficacy have not been established or have been replaced by improved formulations. Research in the second stage addresses the ability of the program to provide the method within the context of the current method mix and user attitudes toward both the method and the service delivery system. In the third stage, research activities are focused on ensuring that previous research findings are applied systematically to upgrade the quality of care, ensure contraceptive availability, and promote program sustainability. Advantages of this model over previous approaches include its orientation to the entire mix of methods provided and its recognition that methods must be matched with management capabilities to ensure they are provided appropriately. Also unique is its insistence that users as well as administrators should participate in the research and decision-making processes and that decisions should be driven by country needs rather than by donor priorities.
PROGRESS IN HUMAN REPRODUCTION RESEARCH. 1996; (38):1.Before new contraceptive options are introduced to a family planning program, administrators must ensure that the methods are needed and that the service delivery system can provide them with appropriate quality of care. The UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction has devised a three-stage research approach to the introduction of fertility regulation methods. This model allows for consideration of factors such as the total mix of methods available, sociocultural factors that influence contraceptive acceptance and use, provider skills and capabilities, and the managerial and logistic systems required for service delivery. Moreover, it calls for the participation of all those affected by method introduction, including policymakers, program managers, women's groups, and young people. Finally. the introduction of a contraceptive method is conceptualized as an opportunity to improve the quality of care associated with the provision of all available methods.
QA Brief. 1996 Summer; 5(1):19-21.In November 1995, a World Bank mission went to Jordan to conduct a study of the health sector. The study recommended three strategies to reform the health sector: decentralization of Ministry of Health (MOH) management; improvement of clinical practices, quality of care, and consumer satisfaction; and adoption of treatment protocols and standards. The MOH chose quality assurance (QA) methods and quality management (QM) techniques to accomplish these reforms. The Monitoring and QA Directorate oversees QA applications within MOH. It also institutes and develops the capacity of local QA units in the 12 governorates. The QA units implement and monitor day-to-day QA activities. The QM approach encompasses quality principles: establish objectives; use a systematic approach; teach lessons learned and applicable research; use QA training to teach quality care, quality improvement, and patient satisfaction; educate health personnel about QM approaches; use assessment tools and interviews; measure the needs and expectations of local health providers and patients; ensure feedback on QA improvement projects; ensure valid and reliable data; monitor quality improvement efforts; standardize systemic data collection and outcomes; and establish and disseminate QA standards and performance improvement efforts. The Jordan QA Project has helped with the successful institutionalization of a QA system at both the central and local levels. The bylaws of the QA councils and committees require team participation in the decision-making process. Over the last two years, the M&QA Project has adopted 21 standards for nursing, maternal and child health care centers, pharmacies, and medications. The Balqa pilot project has developed 44 such protocols. Quality improvement (COUGH) studies have examined hyper-allergy, analysis of patient flow rate, redistribution of nurses, vaccine waste, and anemic pregnant women. There are a considerable number of on-going clinical and non-clinical COUGH studies. Four epidemiological studies are examining maternal mortality, causes of death, morbidity, and perinatal mortality.
In: Report of the Third Meeting of Directors of WHO Collaborating Centres for Traditional Medicine, Beijing, People's Republic of China, 23-26 October 1995, sponsored by the World Health Organization [WHO] and China. State Administration of Traditional Chinese Medicine. Geneva, Switzerland, WHO, 1996. 25-30. (WHO/TRM/96.1)Within the World Health Organization's (WHO's) Western Pacific Region, traditional medicine takes the form of simple family remedies and a system of traditional medicine that has been developed and documented over thousands of years. Traditional medicine is an integral part of the community, and its practitioners are well-patronized and valued. Traditional medicine is accessible and affordable in developing countries. Even in developed countries in the region, traditional medicine is available as an alternative to modern medicine, and medicinal plants are studied as potential sources for pharmaceuticals. While the field of traditional medicine is vast, the WHO has chosen to concentrate on herbal medicine and acupuncture because these aspects have the most to contribute to national health services. In this region, traditional medicine is an integral part of the national health care systems in China, Japan, the Republic of Korea, and Viet Nam, and the WHO regional office will promote the formulation of relevant national policies in these and the other countries it serves. Efforts to promote the safe and effective use of traditional medicine for primary health care include the development of training materials and courses in Viet Nam, selection of medicinal plants in Laos and the Philippines, and promotion of health among the elderly using traditional means in Viet Nam. Efforts in the areas of research, information exchange, and quality control have contributed to improved delivery of traditional health care services. Despite these achievements, the potential impact of the services of traditional practitioners is far from being met. Training of both traditional and modern practitioners requires strengthening, increased information exchange, assured government involvement, and financial support.
In: Report of the Third Meeting of Directors of WHO Collaborating Centres for Traditional Medicine, Beijing, People's Republic of China, 23-26 October 1995, sponsored by the World Health Organization [WHO] and China. State Administration of Traditional Chinese Medicine. Geneva, Switzerland, WHO, 1996. 17-22. (WHO/TRM/96.1)Within the World Health Organization's (WHO) African Region, there is a great deal of interest in incorporating traditional health practitioners in national health systems. This interest is in line with the objective of the WHO Regional Office (to promote rational utilization of traditional medicine within national health care systems). Specific objectives are to help develop policy clarifying the role of traditional medicine in this context, to identify through research and to license appropriate traditional techniques, and to provide complementary training to practitioners of traditional and modern health care systems. The Region's goals are to have such training programs implemented in 25 of the 46 member states by December 1995. By this date, inventories and licensing studies should be instigated in an additional 5 states, and formal structures should be established in yet another 5. Education, information, and advocacy will be forwarded through a series of workshops. The current status of the practice of traditional medicine in the region has been assessed through a survey questionnaire. The Regional Office has contributed to international efforts in this field and is in the process of creating a regional data bank. Constraints include the absence of a focal point for traditional medicine in the various countries, the skepticism of certain decision makers, the lack of objectives and materials for retraining of practitioners in the two systems, and inadequate funding. A biennial regional workshop would foster important South-South cooperation in achieving programmatic goals. In addition to meetings of Directors of the WHO Collaborating Centres, WHO traditional medicine advisors should meet annually to evaluate the program and share experiences.
WORLD HEALTH. 1996 Mar-Apr; 49(2):4-5.In 1977, the year in which the World Health Organization (WHO) Traditional Medicine Program was established, the World Health Assembly urged governments to give their traditional systems of medicine the greater attention which they need and merit. Appropriate regulations should be developed and applied as suited to national health system needs. Traditional medicine plays a major role in primary health care in many developing countries, and its use has increased in recent years. WHO understands that while many elements of traditional medicine are beneficial, others are not. The organization therefore does not blindly endorse all forms of traditional medicine, but works to ensure that traditional medicine is examined critically and objectively, and that safe and effective forms of traditional medicine are developed and made available to the public. WHO supports research and training in traditional medicine in member states. National policy, herbal medicine, acupuncture, and training and research are discussed.