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  1. 26

    Meeting report on Fourth Regional Workshop on HIV / STD Surveillance, Cairo, Egypt, 7-10 October 1996.

    World Health Organization [WHO]. Regional Office for the Eastern Mediterranean

    Alexandria, Egypt, WHO, Regional Office for the Eastern Mediterranean, 1997. [3], 28 p. (WHO/EM/STD/2/E/L)

    The Eastern Mediterranean Regional Office of the World Health Organization is working to develop and strengthen surveillance for HIV, AIDS, and sexually transmitted diseases (STDs). Progress in the implementation of such strategies was discussed at the Fourth Regional Workshop on HIV/STD Surveillance held in Cairo, Egypt, in October 1996. The main objectives of HIV surveillance are 1) to monitor trends in HIV infection over time and place, and 2) provide information for program planning, advocacy, and program implementation. By the end of June 1996, a cumulative total of 3979 AIDS cases had been reported by 21 Member States in the region; however, the actual number is considered to be well over 12,000 and an estimated 220,000 persons are HIV-infected. HIV surveillance has focused primarily on STD patients. Obstacles to this approach include low attendance of STD patients (especially women) at public sector clinics, the unacceptability of unlinked anonymous testing in many countries, and insufficient coordination between sentinel sites and testing laboratories. Options for improving HIV surveillance include orientation of policy-makers on the importance of using unlinked anonymous testing to reduce participation bias, involvement of private doctors and nongovernmental organizations in surveillance of high-risk groups, introduction of tests for syphilis and hepatitis B in sentinel sites before surveillance begins, proper selection of sentinel sites to ensure adequate sample size, and preparation of an operations manual for staff at surveillance sites. The AIDS case definition needs to be reviewed and revised to suit the prevailing situation in the region. For STD surveillance, reports should be obtained from both private and public health facilities, with an etiology-based rather than syndromic approach to diagnosis.
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  2. 27

    Participation in WHO EPI managers' meeting, Douala, Cameroon, October 1998.

    Nelson D; Othepa M

    Arlington, Virginia, Partnership for Child Health Care, Basic Support for Institutionalizing Child Survival [BASICS], 1998. [3], 6, [33] p. (Report; USAID Contract No. HRN-C-00-93-00031-00)

    This report pertains to a consultant visit to Douala, Cameroon, during October 1998, to fulfill World Health Organization objectives. The goals were to evaluate the implementation of recommendations made during a February conference in Chad, to examine the status of acute flaccid paralysis (AFP) surveillance in participating countries, to assess progress toward a vaccine independence initiative, and to set an agenda for 1999. The consultant participated in a workshop among representatives of Cameroon, Congo, Gabon, Equatorial Guinea, Central African Republic, Democratic Republic of Congo, and Chad. Representatives made presentations at the workshop on their current national situation on the state of preparedness for 1998 National Immunization Days (NIDs), implementation of the Chad conference recommendations on surveillance systems (SS), implementation of a sustainable integrated national SS, and reinforcement activities for routine immunization services. Plenary topics included certification criteria for eradication of polio, active surveillance of AFP, management tools for AFP surveillance, case investigation, sensitizing clinicians, reimbursing the cost of transporting samples, interagency collaboration, and vaccine independence. NIDs are planned for areas in the Congo where security risks are at the lowest, which would include coverage of about 54% of the country's population. Logistical evaluation needs to be performed before NIDs occur. A new budget needs to be drafted to meet the realities of the emerging situation. About 30 recommendations are listed for NIDs, routine EPI, and surveillance.
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  3. 28
    Peer Reviewed

    Monitoring data and safety in the WHO Antenatal Care Trial.

    Bergsjo P; Breart G; Morabia A

    PAEDIATRIC AND PERINATAL EPIDEMIOLOGY.. 1998 Oct; 12 Suppl 2:156-64.

    The Data and Safety Monitoring Committee (DSMC) of the World Health Organization (WHO) Antenatal Care Randomized Controlled Trial is charged with reviewing logistics, protocol compliance, efficacy data, ethical concerns, and safety-related indications for stopping the trial. The committee is comprised of an obstetrician, an epidemiologist, and a biostatistician. The DSMC reviews monthly statistics from the 53 study sites in Argentina, Cuba, Thailand, and Saudi Arabia on maternal deaths, fetal deaths, and eclampsia as well as quarterly data on perinatal deaths. It was agreed that the DSMC should take action if an increase of more than 25% in the intervention group (a new prenatal care regimen) compared with the control group (standard prenatal care) occurred in either of the primary outcomes: low birth weight or maternal morbidity index. It was further decided that the DSMC should be independent from the steering committee, with free access to unblinded interim data on the two arms of the trial. The DSMC chose not to establish any definite stopping rules before study initiation. There was initial concern about an excess of maternal deaths in the experimental arm of the study. The first four maternal deaths occurred in the intervention group, but a review of case history details reassured the DSMC that adherence to the new prenatal care regimen was not to blame. Similarly, an initial preponderance of fetal deaths in one arm turned out, when investigated, to reflect differential timing of reporting early pregnancy events rather than real outcome differences.
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  4. 29

    Global medium-term programme. Programme 13.11: Sexually transmitted diseases (venereal diseases and treponematoses).

    World Health Organization [WHO]

    [Unpublished] 1991. Presented at the 1st International Course on Planning and Managing STD Control Activities in Developing Countries, Antwerp, Belgium, September 9-21, 1991. 12 p.

    This paper outlines the World Health Organization's global medium-term program to prevent and control sexually transmitted diseases (STDs) during 1990-95, in an effort to reduce the impact of their complications and sequelae, such as infertility, congenital and perinatal infections, and genital cancers. The program has progressed considerably during the 7th General Program of Work, with the control of STDs enjoying higher priority in many countries because of the HIV/AIDS pandemic. The program will be promoted in accordance with the general principles outlined in the 8th General Program of Work, with specific emphasis upon the implementation of intervention strategies within primary health care. Priorities during the current period will include support of the application of practical and simple technologies to assess the extent and impact of STD morbidity; support of planning and implementing practical and low-cost STD control technologies at the primary health care level; better understanding of the behavioral patterns associated with STD transmission; development and application of cost-effective standard treatment regimens; transfer of simple diagnostic and therapeutic techniques to the peripheral level; refinement of technical skills for STD control workers; and support for research, including the cost-effectiveness evaluation of STD control strategies in different settings.
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  5. 30

    Progress toward poliomyelitis eradication -- African region, 1998 - April 1999.

    World Health Organization [WHO]. Regional Office for Africa. Expanded Programme on Immunization [EPI]; World Health Organization [WHO]. Department of Vaccines and Other Biologicals; United States. Centers for Disease Control and Prevention [CDC]. National Center for Infectious Diseases. Division of Viral and Rickettsial Diseases. Respiratory and Enteric Viruses Branch; United States. Centers for Disease Control and Prevention [CDC]. National Immunization Program. Vaccine-Preventable Disease Eradication Division


    This report outlines progress toward polio eradication from 1998 through April 1999 in the African region (AFRO). WHO accelerated various strategies to annihilate poliomyelitis in the region of Africa. A highlight of supplementary vaccination activities [i.e., National Immunization Days (NIDs) and acute flaccid paralysis (AFP) surveillance] was conducted in the region, and plans for program acceleration--such as intensified NIDs and mopping-up vaccinations to meet the 2000 eradication project--were developed. However, intense wild poliovirus transmission continued to occur in Angola, DR Congo, and western and central Africa. Thus, high-quality house-to-house vaccination campaigns were launched to help eliminate wild poliovirus transmission quickly in these parts of AFRO. Although civil conflict, economic decline, and the high burden of HIV-related diseases have strained public health infrastructures leading to a decline in routine vaccination coverage and low health staff morale in Africa, an intensely focused effort to eliminate the virus, if it is adequately supported, will allow WHO to achieve its goal of polio eradication by 2000.
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  6. 31

    [Advances and difficulties of Cairo] Los avances y las dificultades de El Cairo.

    GIRE. 1998 Mar; (16):2-4.

    The 184 governments represented at the 1994 International Conference on Population and Development in Cairo achieved consensus on a Program of Action with goals for the next 20 years. The Conference recognized that population policies could not be separated from the decisions of men and women regarding their human rights to sexuality and reproduction and that healthy economic and social development must consider the balance between population and environmental resources. Women in particular must be given information, sex education, and contraceptive methods to allow them to implement their reproductive choices. The participation of thousands of independently organized women in sessions preparing for the Cairo conference and in the conference itself facilitated the change of emphasis away from imposition of family planning goals and toward a more humanist demography centering on women. An accord at the Cairo conference called for the donor countries to contribute one-third of the resources needed to carry out the Program of Action. A regular flow of funds was observed in 1994 and 1995, but external aid began to decline in 1996. Every effort must be made to ensure that the goals of the Program of Action are met.
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  7. 32

    Indicators for monitoring poverty reduction.

    Carvalho S; White H

    Washington, D.C., World Bank, 1994. xii, 54 p. (World Bank Discussion Papers No. 254.)

    This paper discusses the indicators that are relevant in monitoring the Bank's lending performance for poverty reduction. It focuses on indicators that measure performance in achieving project goals rather than on the physical or financial indicators such as hiring of consultants or procurement rates that are usually part of the project reporting and management process. It is organized in four parts. Part I presents the purpose of the paper, background, audience, motivation of the paper, and the scope and organization of the paper. Part II provides the conceptual framework for assessing the performance of poverty reduction operations. It outlines relevant definitions, discusses the evolution of thinking on the role and scope of monitoring systems, develops a typology of indicators, and reviews key issues in interpreting these indicators. Part III reviews performance indicators in the Bank's 178 IDA targeted poverty projects and 32 IDA poverty-oriented SAL/SECALs that were approved during fiscal 1988-93, and discusses the main findings of the review. Final statements are presented in part IV.
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  8. 33

    Comments on "Evaluating the Effectiveness of Poverty Alleviation Programs," by Squire.

    Davis G

    In: Evaluation and development: proceedings of the 1994 World Bank conference, edited by Robert Picciotto and Ray C. Rist. Washington, D.C., World Bank, 1995. 54-6. (World Bank Operations Evaluation Study)

    This article focuses on the nature of the questions that need to be asked in the evaluation of poverty programs, and on the role of participation in answering them. To answer some of the questions pertinent to the evaluation of poverty reduction projects requires knowing the reasons behind why people are poor. Poverty is caused by political, economic, or social factors, and each of these factors is important. Development takes place within a set of interrelationships that are mutually reinforcing and continually changing, and economic development cannot occur without corresponding changes in the political, institutional, and cultural norms of the countries involved. Hence, poverty programs cannot be evaluated unless the full spectrum of issues that contribute to the success of such programs are understood, and unless specific interventions are evaluated in their wider social and political context. Furthermore, participation, which is the involvement of beneficiaries and stakeholders in development efforts, should begin at the initial stage of the project. Participation at this stage improves the quality of information available for decision-making and strengthens stakeholders' commitment to monitoring and evaluation, while it enhances the sustainability of interventions by leaving behind the capacity, or social learning, needed to address such issues.
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  9. 34
    Peer Reviewed

    Adverse events monitoring as a routine component of vaccine clinical trials: evidence from the WHO Vaccine Trial Registry.

    Mayans MV; Robertson SE; Duclos P

    Bulletin of the World Health Organization. 2000; 78(9):1167.

    This article assesses whether and how investigators are monitoring adverse events following immunization (AEFI) in vaccine trials, using evidence from the WHO Vaccine Trial Registry. It is noted that the Registry includes all vaccine trials sponsored since 1987 by the WHO Expanded Programme on Immunization, Global Programme for Vaccines and Immunization, and Department of Vaccines and Biologicals. For each trial, records include internal documents, reports of visits to trial sites, and publications. Based on the records from 68 trials, completed or in progress, analysis indicates that only few investigators included detailed AEFI monitoring in their study reports and publications. However, an increasing trend to include AEFI monitoring in vaccine clinical trials was noted. Since many vaccine trials are conducted by independent investigators, and AEFI monitoring methods and results deserve to be included in any publication, along with vaccine efficacy methods and results, it should be the responsibility of the study investigators, rather than of the vaccine manufacturer and the national control authority, as suggested. Several practical points for monitoring AEFIs in vaccine clinical trials are cited.
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  10. 35

    Monitoring human rights.

    Abram MB

    In: All of us. Births and a better life: population, development and environment in a globalized world. Selections from the pages of the Earth Times, edited by Jack Freeman and Pranay Gupte. New York, New York, Earth Times Books, 1999. 124-6.

    For populations to enjoy any of the economic fruits of development, access to political and civil rights must be observed. However, the main international body charged with protecting political and civil rights has in itself been misguided. Political gamesmanship, structural problems, and misguided priorities continue to plague the UN Commission on Human Rights. The Commission's mandate to discuss "civil liberties, the status of women, freedom of information, the protection of minorities, the prevention of discrimination on the basis of race, sex, language, or religion" has not been adequately upheld at the Commission sessions held in Geneva, Switzerland. Each country has its own agenda, which destroys the main goal of the Commission. In order for the Commission to be the preeminent human right forum, countries must cease their political posturing, strengthen conditions for state membership in the Commission, and address the world's most pressing human rights concerns.
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  11. 36
    Peer Reviewed

    Monitoring emergency obstetric services in Malawi.

    Reproductive Health Matters. 2001 Nov; 9(18):191.

    In 1997 UN International Children's Fund, WHO, and UN Population Fund developed guidelines for monitoring obstetric services, offering relevant process indicators which used proxy measures for maternal mortality, because counting deaths had been highly inaccurate. The Malawi Safe Motherhood Project covers half the country's population of 5 million and was the first large project to adopt the use of the recommended indicators within routine monitoring procedures, albeit with significant adaptation. Development of the monitoring process required: a needs assessment, including identification of sources of data and definition of terms, such as for obstetric conditions; development of tools for data collection: and actual operations research. The research considered patient flow in obstetric clinics; recording of complications; and identification of maternal deaths, referral systems and the origin of patients, in order to determine the catchment populations for each service point. Subsequently, when the new monitoring system was deemed to be feasible and effective, training programs were conducted by trainers from each district, and information was disseminated. The intention is that the Safe Motherhood information system training modules will eventually be incorporated into all basic and in-services training for maternity staff. Introduction of the indicators in Malawi was characterized by wide consultation, systematic clarification of all definitions, rigorous testing and use of already established systems. All of these steps were required to gain support and motivate staff involved in data collection and analysis. (full text)
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  12. 37

    Information, education and communication: lessons from the past; perspectives for the future.

    Clift E

    Geneva, Switzerland, World Health Organization [WHO], Department of Reproductive Health and Research, 2001. [5], 34 p. (Occasional Paper No. 6; WHO/RHR/01.22)

    This paper was commissioned by the Department of Reproductive Health and Research at the WHO to examine lessons learned from more than 2 decades of experience in applying information, education and communication (IEC) interventions in support of public health. It defines IEC, then offers lessons learned in planning, monitoring, and evaluating a strategy. It also discusses peer education, gender issues, youth, life skills, religious institutions, and building partnerships with other organizations.
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  13. 38

    Government of Sierra Leone. National report on population and development. International Conference on Population and Development 1994.

    Sierra Leone. National Population Commission

    Freetown, Sierra Leone, National Population Commission, 1994. [4], 15, [4] p.

    The government of Sierra Leone is very concerned about the poor health status of the country as expressed by the indicators of a high maternal mortality rate (700/100,000), a total fertility rate of 6.2 (in 1985), a crude birth rate of 47/1000 (in 1985), an infant mortality rate of 143/1000 (in 1990), and a life expectancy at birth of only 45.7 years. A civil war has exacerbated the already massive rural-urban migration in the country. Despite severe financial constraints, the government has contributed to the UN Population Fund and continues to appeal to the donor community for technical and financial help to support the economy in general and population programs in particular. Sierra Leone has participated in preparations for and fully supports the 1994 International Conference on Population and Development. This document describes Sierra Leone's past, present, and future population and development linkages. The demographic context is presented in terms of size and growth rate; age and sex composition; fertility; mortality; and population distribution, migration, and urbanization. The population policy planning and program framework is set out through discussions of the national perception of population issues, the national population policy, population in development planning, and a profile of the national population program [including maternal-child health and family planning (FP) services; information, education, and communication; data collection, analysis, and research; primary health care, population and the environment; youth and adolescents and development; women and development; and population distribution and migration]. The operational aspects of the program are described with emphasis on political and national support, FP service delivery and coverage, monitoring and evaluation, and funding. The action plan for the future includes priority concerns; an outline of the policy framework; the design of population program activities; program coordination, monitoring, and evaluation; and resource mobilization. The government's commitment is reiterated in a summary and in 13 recommendations of action to strengthen the population program, address environmental issues, improve the status of women, improve rural living conditions, and improve data collection.
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  14. 39

    Strengthening nutrition through primary health care: the experience of JNSP in Myanmar.

    World Health Organization [WHO]. Regional Office for South-East Asia [SEARO]

    New Delhi, India, WHO, SEARO, 1991 Dec. [3], 35 p. (Regional Health Paper, SEARO, No. 20)

    The Joint WHO/UNICEF Nutrition Support Programme (JNSP) began operations in Myanmar in 1984 and expanded nationwide in three phases. A detailed situation analysis of nutrition conditions and nutrition programs in primary health care (PHC) were conducted prior to JNSP activities. They served as the rationale for the decision to implement JNSP activities nationally. These activities are almost entirely administered through the Ministry of Health. JNSP redesigned nutrition training for village workers, their supervisors, and district health personnel. It has strengthened nutrition units at the central and regional levels. All JNSP-technical activities revolve around nutrition monitoring and counseling. JNSP participated in the establishment and operations of a food and nutrition surveillance system. It facilitated implementation of the nutrition and nutrition-related aspects of the People's Health Plan. The JNSP was evaluated in 1989. During the JNSP period, mortality among children less than 3 years old fell. 3-year-old children grew at a faster rate than prior to JNSP. Improvements were also noted in young child feeding practices, health seeking behavior of mothers, counseling by voluntary workers, and health staff performance. The evaluators concluded that JNSP directly benefitted the health and nutrition of children less than 3 years old. External costs of JNSP added up to US$5.63 million. The government put in another US$5.43 million. The communities contributed US$2.9 million. JNSP covers 30% of the total population. Per capita annual costs were US$1.67. These low per capita costs suggest that JNSP is sustainable and replicable. JNSP's further expansion depends on expansion of the health delivery system. All levels regularly provide support and supervision. Planned evaluation and feedback is the norm.
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  15. 40

    Vector control for malaria and other mosquito-borne diseases. Report of a WHO study group.

    World Health Organization [WHO]. Study Group on Vector Control for Malaria and other Mosquito-Borne Diseases


    In 1993, the World Health Organization (WHO) Study Group on Vector Control for Malaria and other Mosquito-Borne Diseases convened in Geneva to develop well-defined guidelines for implementing the vector control component of the Global Malaria Control Strategy. Goals and objectives of the control strategy, vector control, and the study group as well as those concerning use of the insecticide DDT are addressed in the meeting's published report. A review of the global status and trends in malaria and other mosquito-borne diseases follows. Malaria status and experiences, priorities, and trends in vector control in the various WHO regions are examined. One section reviews objectives of vector control, considerations in planning and implementation, selectivity and sustainability, information systems management, stratification of malarious areas by eco-epidemiological criteria, and priority geographical areas and risk groups. Indoor residual spraying, personal protection measures, larviciding and biological control, and environmental management are also discussed. The next section examines the role of vector control in malaria epidemics and drug-resistant malaria. Another section examines indicators of operational and entomological impact and of impact on disease and integrated use of control methods under the context of monitoring and evaluation of vector control efforts. Entomological parameters and techniques discussed include detection and monitoring of insecticide resistance, bioassays, adult density, resting indices, mosquito age and survival rates, human-vector contact, mosquito infection rates, entomological inoculation rate, and measurement of malaria transmission as well as choice of parameters and design for evaluating interventions. Other topics include the role of entomological services in malaria control, managerial aspects of malaria vector control and entomological services, comprehensive vector-borne disease control, capacity building, role of communities and other sectors in vector control, cost-effectiveness in vector control, research in vector control, and policy issues related to vector control.
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  16. 41

    Prevention of STD / HIV / AIDS among women in prostitution: changing trends.

    Voluntary Health Services. AIDS Prevention and Control Project

    Chennai, India, Voluntary Health Services, AIDS Prevention and Control Project, [2000]. 43 p.

    In Tamil Nadu, India, there are no research studies undertaken to establish the prevalence of HIV among women in prostitution. However, the clinical data from various sources reveal that a significant proportion of them are infected with HIV. The situational assessment conducted by the nongovernmental organization (NGO) partners facilitated by AIDS and Prevention and Control (APAC) revealed various factors, which made women more prone to the infection. It was mainly due to the inconsistent usage of condoms; various myths and misconceptions; lower empowerment; lower social status and educational level. To this effect, the APAC project adopted the implementation of holistic, participatory gender specific and culture sensitive prevention programs among women in prostitution. It provides relevant information to risk population groups, promotion of quality condoms, enhancement of sexually transmitted disease and counseling services, and explorative research for increasing the effectiveness of the project. It is noted that APAC supports six NGOs in six towns in Tamil Nadu to implement the targeted intervention among women in prostitution.
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  17. 42

    U.N. publicly chastises China for inaction on H.I.V. epidemic.

    Rosenthal E

    New York Times on the Web. 2002 Jun 28; [2] p..

    The United Nations today issued a stinging public criticism of China's lackluster efforts to face its rapidly accelerating epidemic of H.I.V. infection and AIDS, saying the country is "on the verge of a catastrophe." In a new report, "H.I.V./AIDS: China's Titanic Peril," the Joint United Nations Program on H.I.V./AIDS criticized Chinese officials on many fronts, from the lack of adequate education programs to the absence of treatment for people infected with H.I.V. "We are now witnessing the unfolding of an H.I.V./AIDS epidemic of proportions beyond belief, an epidemic that calls for an urgent and proper but as yet unanswered quintessential response," the report said, noting that the lack of action meant China could have the largest number of people infected with H.I.V. in the world within a few years. While much of the report circulated as an internal document among United Nations agencies late last year, its very public release today at a large news conference in Beijing signaled a new willingness by the United Nations to press China into action. (excerpt)
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  18. 43

    Fertility, contraception and population policies.

    United Nations. Department of Economic and Social Affairs. Population Division

    New York, New York, United Nations, 2003. iv, 37 p. (ESA/P/WP.182)

    Governments’ views and policies with regard to the use of contraceptives have changed considerably during the second half of the 20th century. At the same time, many developing countries have experienced a transition from high to low fertility with a speed and magnitude that far exceeds the earlier fertility transition in European countries. Government policies on access to contraceptives have played an important role in the shift in reproductive behaviour. Low fertility now prevails in some developing countries, as well as in most developed countries. The use of contraception is currently widespread throughout the world. The highest prevalence rates at present are found in more developed countries and in China. This chapter begins with a global overview of the current situation with regard to Governments’ views and policies on contraception. It then briefly summarizes the five phases in the evolution of population policies, from the founding of the United Nations to the beginning of the 21st century. It examines the various policy recommendations concerning contraception adopted at the three United Nations international population conferences, and it discusses the role of regional population conferences in shaping the policies of developed and developing countries. As part of its work programme, the Population Division of the United Nations Secretariat is responsible for the global monitoring of the implementation of the Programme of Action of the 1994 International Conference on Population and Development (ICPD). To this end, the Population Division maintains a Population Policy Data Bank, which includes information from many sources. Among these sources are official Government responses to the United Nations Population Inquiries; Government and inter-governmental publications, documents and other sources; and non-governmental publications and related materials. (excerpt)
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  19. 44
    Peer Reviewed

    IUHPE partnership in European networks and projects.

    Health Promotion International. 2003 Jun; 18(2):171-172.

    The International Union for Health Promotion and Education (IUHPE) is currently involved as a partner in a number of European projects. These networks and projects also involve many IUHPE individual and institutional members. Although all three of the following projects are European-focused, their added value is not limited by borders. All of the collaborations noted below are of great interest to health promotion professionals across the globe. (excerpt)
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  20. 45

    Education for All: Is the the world on track?


    Paris, France, UNESCO, 2002. 310 p.

    The Report is presented in six parts. Chapter 1 reaffirms why Education for All is of such overriding importance. Chapter 2 updates our understanding of progress towards, and prospects for, achieving the six EFA goals. Chapter 3 examines the international response to the call for EFA National Action Plans, the engagement of civil society in planning, and whether the distinctive challenges of HIV/AIDS, and conflict and emergency are being confronted. Chapter 4 assesses the costs of achieving the EFA goals and the availability of the resources to secure them. Chapter 5 explores whether the international commitments made in Dakar, and subsequently, are being met and, if so, by what means. Finally, Chapter 6 putts some of these threads together as a basis for looking forward and identifying opportunities for sustaining the momentum generated by the World Education Forum. (excerpt)
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  21. 46

    Early Warning Rapid Response System: HIV vulnerability caused by mobility related to development.

    Guest P; du Guerny J; Hsu LN

    [Bangkok, Thailand], United Nations Development Programme [UNDP], South East Asia HIV and Development Project, 2000 Jul. [4], 19 p.

    One of the greatest challenges for workers in HIV prevention is the establishment of programmes that result in primary prevention of the spread of HIV. Such programmes must target the temporal and spatial factors that create environments that are fertile for transmission, rather than simply reacting post facto to local trends in HIV prevalence and incidence. Recently, the role of development in affecting the vulnerability leading to possible HIV infection in communities has become increasingly clear. Development efforts can sometimes de-stabilize a community by moving people in or out of it, or by affecting people’s economic or cultural environment. For example, the construction of a dam can at once force people to leave their homes near the construction and find work elsewhere, and recruit new people into the area to work on the dam. Such social and cultural flux changes the way people behave and the populations with whom they are in contact. To be effective, HIV preventive efforts must be closely synchronized with exactly those development factors that acutely increase a population’s vulnerability. The proposed Early Warning Rapid Response System (EWRRS) has been conceived to establish this synchronization. By linking information about development activities with information about effective prevention for the populations affected, an EWRRS would have a critical role in HIV prevention. Knowing which development activities can trigger population movements, which populations are moving, where they will be, and what languages they speak can foster public- and private-sectoral coordination of immediate actions to educate and support these populations to reduce their vulnerability. Such knowledge can also lead to retooling development activities in order to achieve both the development objectives and HIV prevention. In May of 2000, representatives from the Greater Mekong Sub-region and international HIV specialists met in Bangkok for a Think Tank Consultation on the EWRRS. The work of that meeting is summarized here. While the EWRRS is an unconventional idea, the efficacy of which may be difficult to show at this point in its conception, its potential to promote well-informed and coordinated actions to significantly reduce HIV spread is compelling. (excerpt)
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  22. 47
    Peer Reviewed

    Reducing child mortality: Can public health deliver?

    Bryce J; el Arifeen S; Pariyo G; Lanata CF; Gwatkin D

    Lancet. 2003 Jul 12; 362(9378):159-164.

    This is the third paper in the series on child survival. The second paper in the series, published last week, concluded that in the 42 countries with 90% of child deaths worldwide in 2000, 63% of these deaths could have been prevented through full implementation of a few known and effective interventions. Levels of coverage with these interventions are still unacceptably low in most low-income and middle-income countries. Worse still, coverage for some interventions, such as immunisations and attended delivery, are stagnant or even falling in several of the poorest countries. This paper highlights the importance of separating biological or behavioural interventions from the delivery systems required to put them in place, and the need to tailor delivery strategies to the stage of health-system development. We review recent initiatives in child health and discuss essential aspects of delivery systems, including: need for data at the subnational level to support health planning; regular monitoring of provision and use of health services, and of intervention coverage; and the need to achieve high and equitable coverage with selected interventions. Community-based initiatives can extend the delivery of interventions in areas where health services are hard to access, but strengthening national health systems should be the long-term aim. The millennium development goal for child survival can be achieved, but only if strategies for delivery interventions are greatly improved and scaled-up. (author's)
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  23. 48
    Peer Reviewed

    Poverty, equity, human rights and health. [Pauvreté, équité, droits de l'Homme et santé]

    Braveman P; Gruskin S

    Bulletin of the World Health Organization. 2003 Jul; 81(7):539-545.

    Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions’ work. Equity and human rights perspectives can contribute concretely to health institutions’ efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector. (author's)
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  24. 49

    HIV / AIDS and STI prevention and care in Rwandan refugee camps in the United Republic of Tanzania.

    African Medical and Research Foundation [AMREF]; London School of Hygiene and Tropical Medicine

    Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2003 Mar. 28 p. (UNAIDS Best Practice Collection. Key Material; UNAIDS/03.16E)

    Until recently, relatively little attention had been paid to HIV/AIDS care and prevention in the context of a humanitarian response. Traditional priorities in emergencies included the provision of food, water, sanitation, shelter and basic health services. Because of the long incubation period of HIV, the disease was not considered an immediate threat to life and was therefore not thought of as a ‘relief issue’. Factors (such as poverty, social instability and powerlessness), typically associated with conflicts and the forced displacement of people, were already known to exacerbate HIV transmission. Until the catastrophic Rwandan refugee crisis of 1994, however, there was little appreciation of how very significant these factors were. Before that date, no major specific interventions for HIV infection or for other sexually transmitted infections (STIs) had been designed for refugees. This monograph documents the first large-scale AIDS and STI intervention programme to be implemented during a refugee crisis. It describes the operational aspects of the intervention, the observed impact and the effect this experience had on policies and practices in other refugee situations, among both international and nongovernmental organizations. It provides insights into the elements and approaches for STI services that will be useful for reproductive health programme managers from government and international organizations as well as nongovernmental organizations involved in relief operations. It will also be useful for district or regional health managers in identifying needed support systems for STI service delivery. (excerpt)
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  25. 50

    Military networks for surveillance of communicable diseases.

    D'Amelio R; Heymann D

    Civil-Military Alliance Newsletter. 1997 Jul; 3(3):6-7.

    This article reviews the complementary initiatives between the Civil-Military Alliance to Combat HIV & AIDS and the Division of Emerging and other Communicable Diseases Surveillance and Control of the World Health Organization in Geneva. (excerpt)
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