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HEALTH POLICY AND PLANNING. 1992 Dec; 7(4):364-74.The Director of WHO's Regional Office for Africa presents a health development framework based on the primary health care (PHC) concept. the government should review national health policies, national health strategies, and national heath services to resolve basic issues. Then it should define the framework for health development by breaking down the goal into operational target-oriented subgoals for individuals, families, and communities, by creating health districts as operational units, and by organizing support for community health. Once this framework has been decided, the government should use it to restructure the national health systems. At the district level, health and development committees, helped by community health workers, and district health teams would be responsible for community health education and activities. The provincial health offices would oversee district activities, select and adapt technologies, and provide technical support to communities. A board would manage the provincial hospitals (public, private, and voluntary). These hospitals would work together to organize secondary medical care programs. A public health office wold link them with the provincial health centers. Other sectors would also be involved, e.g., departments of education and water. The national health ministry would set national policies, plans, and strategies. A suprasectoral health council would coordinate cooperation between universities and other sectors and external agencies. National capacity building would involve establishing management cycles of health development, using national specialists as health advisors, and placing health as a priority in development. To implement this framework, however, the government needs to surmount considerable structural economic, and social obstacles by at least decentralizing and integrating health and related programs at the local level, fostering a national dialogue, and promoting social mobilization.
Resolution 44/233: Prevention and control of acquired immunodeficiency syndrome (AIDS) [22 December 1989].
New York, New York, United Nations, 1990 Mar 15. 4 p. (A/RES/44/233)The UN General Assembly adopted a resolution on the prevention and control of AIDS during its 44th session in March 1990. It recognized WHO as directing and coordinating AIDS education, prevention, control, and research. It respects the human rights and dignity of people with HIV, their families, and people with whom they live. It hold that the fight against AIDS should be compatible with and not shift attention or resources from other public health priorities and development goals. It recognizes the social and economic effects of AIDS. It identifies that women and children are often at higher risk of HIV infection and may experience hardship as an indirect result of AIDS on their families and communities. It stresses the need for a supportive socioeconomic atmosphere to assure effective execution of national AIDS prevention programs and merciful care of affected persons. It calls for all sectors of society to reinforce local, national, and international efforts for HIV/AIDS prevention and control. It recognized the progress scientific research has made and emphasizes the need to offer affordable technologies and medicines as soon as possible. It appeals to the Secretary-General to work with the Director-General of WHO and other relevant organizations to deal with the likely grave consequences of the AIDS pandemic for socioeconomic development in some developing countries. It requests member nations to expand and promote national efforts to combat AIDS. It urges member nations, WHO, and other relevant organization to promote greater understanding of HIV transmission to dispel myths and to raise the public's awareness about people with HIV. It asks international, national, and research institutions to coordinate efforts to supply information to and to support policy of national AIDS committees and the global AIDS strategy. Thus the AIDS committees and WHO can appropriately develop AIDS policy and programs.
LINKS. HEALTH AND DEVELOPMENT REPORT. 1991 Fall; 8(3):11-2.The authors respond to Tony Dajer's critique of their study concerning the trend in Nicaraguan infant mortality and its possible explanations. It is pointed out that the sharp decline in Nicaragua's infant mortality in the mid-1970s is an intriguing phenomenon, since it began to occur at a time of economic slump, civil disturbance, and under a government that gave low priority to the social sector. It is contended that a number of factors (among them the Managua earthquake) prompted the government to shift its allocation of resources from hospital-based health care in the capital city to ambulatory health care throughout the country. After the revolution, the Sandinista government continued this process. Dajer's characterization of USAID-funded clinics as "notoriously ineffective" is rejected; arguing that although operating under overt political guidelines, these projects are well-advised by experts. Dajer's question as to the importance of health care within the Sandinista government is considered. It is maintained that the revolution was not fought in order to reduce infant mortality, and that health was not the primary concern of the Government of National Reconstruction. It was the international solidarity movement, not the Sandinista government, which focused so intently on infant mortality, hoping to find good news to report. The issue of health care had the added advantage of being politically noncontroversial. It is also maintained that since the mid-70s, the country's health policy has remained stable, despite the radical changes in government because the international arena helps determine national health policy.
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1987.  p. (USAID Contract No. DPE-5927-C-00-5068-00)In 1987, consultants went to Niger to prepare the plan of operations for the national Expanded Programme on Immunization (EPI). US$ 6 million from the World Bank Health Project and around US$ 5 million from the UNICEF EPI Project were available for EPI activities. Low vaccination coverage prevailed outside Niamey. Outbreaks of diseases that EPI can prevent continued to kill children. The cold chain was not maintained, especially at the periphery. Mobile teams continued to use inadequate strategies. Record keeping did not exist. The central level did not supervise the periphery. EPI staff at departmental and division levels did not have current written guidelines. Not only did poor working communications exist between the central level and the periphery, but also between the EPI Director and the other Minister of Health divisions, between WHO and UNICEF, and between both UN agencies and EPI. The EPI Director did have a good relationship with the USAID office, however. No one took inventory of EPI resources or monitored temperatures at any point in the cold chain. Even though the World Bank Health Project intended to five EPI 50 ped-o-jets, 46% of the existing 88 ped-o-jets were in disrepair and no one knew how to repair and maintain them. Thus EPI should not routinely use ped-o-jets. The consultants recommended that USAID stay involved with EPI in Niger since the EPI Director considered it an acceptable partner. EPI staff at each level should take a detailed inventory of all material resources. Effective and regular supervision should occur at the central, regional, and peripheral levels. A health worker needs to record the temperature of the refrigerator twice a day. Technical grounds should determine the standardization and selection of all equipment. Someone should maintain an adequate supply of spare parts and technicians should undergo training in maintenance.
INDIAN JOURNAL OF PUBLIC HEALTH. 1990 Jan-Mar; 34(1):48-52.The WHO Global Diarrhoeal Disease Control (CDD) Programme has been implemented in at least 110 member countries. It encourages oral rehydration therapy (ORT) as the chief means to reduce child mortality caused by diarrhea. Despite relatively high ORT access rates ORT (20%->70% in Africa and South East Asia respectively, 1989), oral rehydration solution (ORS) use is inadequate (12.1-26.7% Africa and Eastern Mediterranean respectively, 1988) as well as ORT use (19.2-39.8% Africa and Eastern Mediterranean respectively, 1988). These poor results could be a factor of diminished knowledge and inadequate numbers of trained staff. Yet 58 countries now produce ORS and worldwide production increased from 100-350 million 1 between 1983-1987. In India, however, at least 75% of ORS brands do not meet WHO standards. Further 0.5-1 million <5 year olds succumb annually due to diarrhea (25% of all deaths among <5 year olds). In addition, about 500 million episodes of diarrhea occur each year. ORT is required in 50-100 million of these episodes and hospitalization is needed for 5 million. The Indian CDD program has reduced child mortality from diarrhea by 50% between 1981-1990. It operates under a 3 tier strategy including home management with ORS, and hospital management with ORS and/or IV fluids. This strategy faces several obstacles. For example, mothers in some villages do not know the village health guides who teach mothers how to make ORS. Besides few are motivated at the village level to teach this to mothers. According to government studies, ORT use varies in India from 36-96.3%, but according to operational research by the National Institute of Cholera and Enteric Diseases, ORT use in the best health facilitate is only 11-12%.
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1986 Jun. , 31,  p. (USAID Contract No. DPE-5927-C-00-5068-00)In the mid 1980s, the Government of The Gambia (GOTG) sought funds from the World Bank and other donors to restructure and strengthen its health system. Since the World Bank thought that recurrent cost obligations that the GOTG would find unacceptable should accompany the implementation of the National Health Project (NHP), this study was undertaken. The Italian Government agreed to fund US $9.8 million to NHP, most of the funds going to renovating and refurbishing the pediatric ward and central laboratory at Royal Victoria Hospital in Banjul. Trends in health sector expenditures showed that the devaluation of the dalasi continued to bring about shortfalls in nonsalary costs, especially in drugs and dressings. Therefore the GOTG must address the shortfalls before even considering expansion of the already inefficient health delivery system. It also needs to develop a cost recovery system for drugs which maintains a reliable source and adequate supplies of drugs in the proper amounts, effectively distributes the drugs, and manages the finances effectively. The GOTG should also develop the Ministry of Health's ability to coordinate donor support and to develop a process of budgeting, spending, and planning. The study team also recommended consolidating staff rather than expand staff in light of financial constraints. A flotation policy and exchange rates less favorable to the dalasi may grant the GOTG more access to exchange within the banking system.
London, England, Macmillan, 1988. x, 165 p.Evaluations of progress made toward greater primary health care (PHC) among nations since the Alma Ata Conference of 1978 indicate that problems exist in managing PHC and reorienting existing services to PHC. The overwhelming majority of plans set forth through country policy have not been set into motion. Contributors from a host of disciplines and interests were called upon to explore manners in which countries may reorient their health services to the ideal of PHC and Health for All by the Year 2000. Prescription for change is avoided, yet a number of successful country examples are described in the text. Principles with potential application for other country setting are then explored. PHC and change is first explored, followed by a discussion of the theory and practice of organizational change. Subsequent chapters address PHC as it relates to ministries of health, district management, hospitals, medical education, nursing, intersectoral collaboration, and NGOs and international organizations. Challenges for the future close the text. Health professionals must help enable individuals, families, and communities to take the major responsibility for their health; a concept central to PHC. Continual dialogue, popular consultation, and organizational adaptation and change are required along with a bottom-up approach for setting targets and identifying needs. The authors understand that intersectoral collaboration along with administrative flexibility and adaptation are needed if goals are to be met. Finally, the health sector should get its house in order before working out the details of PHC policy.
INTERNATIONAL NURSING REVIEW. 1991 Mar-Apr; 38(2):31.A brief report summarizes issues and concepts discussed by participants from Malawi, Tanzania, and Zambia at the 2nd ICN/WHO intercountry conference in Lusaka, Zambia. Broadly discussing nursing care of people with HIV/AIDS and their families, counseling and case/family support should be considered major components of local initiatives in Africa. While local constraints must be recognized in diagnosing, counseling, caring for, and supporting cases and families, programs may also build upon community strengths. Present official health services are often unable to accommodate the needs of all patients with HIV/AIDS. Participants therefore examined innovative, new home-based approaches to care and case/family support. Examples of community-based support programs tailored to meet local needs are mentioned. The role of counseling in both case/family support and for behavioral change is also voiced. A multidisciplinary approach carried out by open, flexible, and understanding personnel is required. Nurses must provide clinical care to cases while also working to facilitate behavioral change.
New York, New York, UNFPA, . ix, 66 p.This paper discusses Sri Lanka's population policy with special focus upon UNFPA's role in establishing and implementing a successful multi-sectoral family planning program for the country. Progress made in the past years must continue, while ongoing efforts are made to attain the goal of 2.1 TFR by year 2000. A suitable program must be better coordinated with a view to cutting waste and duplication, guarantee an adequate supply of appropriate contraceptive supplies, streamline research operation, more fully implement its educational programs, and recognize women's centrality in population programs, and recognize women's centrality in population programs. UNFPA assistance should be offered to effect such programmatic change and development, with service delivery needs addressed 1st. The Government of Sri Lanka lacks adequate resources to supply calls for an integrated approach focused upon creating a National Coordinating Council; developing a more sophisticated and targeted approach to information, education, and communication; providing contraceptive supplies, software for service delivery, and client counseling; training providers; and improving coordination with other multilateral programs for child care and human resource development. The present population and development situation, the national population program, proposed sectoral strategies for implementation, the role of technical assistance, and general recommendations for external assistance are discussed in detail.
FRONT LINES. 1991 Nov; 16.Indonesia's success in reaching World Health Organization (WHO) universal immunization coverage standards is described as the result of a strong national program with timely, targeted donor support. USAID/Indonesia's Expanded Program for Immunization (EPI) and other USAID bilateral cooperation helped the government of Indonesia in its goal to immunize children against diphtheria, pertussis, tetanus, polio, tuberculosis, and measles by age 1. The initial project was to identify target areas and deliver vaccines against the diseases, strengthen the national immunization organization and infrastructure, and develop the Ministry of Health's capacity to conduct studies and development activities. This EPI project spanned the period 1979-90, and set the stage for continued expansion of Indonesia's immunization program to comply with the full international schedule and range of immunizations of 3 DPT, 3 polio, 1 BCG, and 1 measles inoculation. The number of immunization sites has increased from 55 to include over 5,000 health centers in all provinces, with additional services provided by visiting vaccinators and nurses in most of the 215,000 community-supported integrated health posts. While other contributory factors were at play, program success is at least partially responsible for the 1990 infant mortality rate of 58/1,000 live births compared to 72/1,000 in 1985. Strong national leadership, dedicated health workers and volunteers, and cooperation and funding from UNICEF, the World Bank, Rotary International, and WHO also played crucially positive roles in improving immunization practice in Indonesia.
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA. 1991 Jun; 5(2):221-34.Public and private domestic expenditures for health in a total 148 developing countries for 1983, were estimated to be $100 billion. 1986 external donor health expenditures totalled $4 billion, a small percentage of overall health expenditure for developing countries. U.S. direct donor assistance for development was 0.5% of the federal budget for 1988, with approximately 10% of all U.S. development assistance allocated for health, nutrition, and population planning. As such, the U.S. accounts for 13% of total health contributions from external donors to developing countries. Approximate at best, private and volunteer organizations are estimated to contribute 20% of all such health assistance. Developing countries are therefore required to efficiently use their own resources in the provision of national health services. Technical assistance and donor experience also counting as external assistance, the overall supply of health financing is far greater than developing country demand in the form of well-articulated, officially approved proposals. Reasons for this imbalance include health ministry unfamiliarity with potential donor sources, passive approaches to external financing, unfamiliarity with proposal preparation, increasing competition from other sectors of developing nations, limited numbers of trained personnel, and lack of an international system of support to mobilize financing. The paper discusses 6 years of Pan American Health Organization interventions for resource mobilization in Latin America and the Caribbean, and suggests World Health Organization regional extension backed by U.S. encouragement and support.
Geneva, Switzerland, WHO, 1988. vi, 80 p.This publication focuses on the action needed to improve child health in growing urban centers in the 3rd world and outlines the staggering problems that stand in the way. It also gives an overview of community and governmental efforts to make improvements. Lastly, summary conclusions are drawn and recommendations given. The unprecedented population growth that has taken place in urban areas has created serious housing and health problems. Many people are living in illegally constructed housing with little or no provision for piped water, sanitation, collection and disposal of household waste, or health care. Chapter 1 discusses the health problems and poor living conditions that are common in urban centers. Studies of low-income settlements have identified 3 major types of pathology: infectious and gastrointestinal diseases, chronic degenerative diseases, and pathogenic conditions. It is estimated that up to 44% of all deaths in children under 4 years of age is a result of diarrhoeal disease. Respiratory infections and nutritional deficiencies are the other 2 major causes of morbidity and mortality in young children. Malnutrition poses one of the most serious threats to clinical health. It is estimated that 145 million children under 5 have insufficient diets. In urban low income communities up to 50% of children may show signs of malnutrition, 10% of this group in severe form. Malnutrition is a complex problem that involves not only a shortage of food, but also inadequate preparation and storage of food and lack of knowledge about nutrition. Many urban centers within developing countries share these relevant difficulties in regard to child health, but it is important not to make sweeping generalizations. As the book points out, urbanization has taken a multitude of forms, and the health problems of these urban centers need a variety of approaches. This publication sees a growing gap between child health needs and the responses of government. The last century has seen tremendous growth in urban population, as well as tremendous growth in the associate urban problems. Local and national response has been slight at best. Further, approaches have primarily been "sectoral " instead of the "multi-sectoral" approach that this book recommends. A "multi-sectoral" approach addresses a combination of urban problems all at once. It is further recommended that those in need of help to be targeted and prioritized. Also, a systematic coordination of individuals, households, neighborhood groups, local government, national government, and aid agencies is strongly urged. Local governments are deemed particularly crucial in the fight for child health.
AMERICAN JOURNAL OF PUBLIC HEALTH. 1990 Oct; 80(10):1188-92.Health trends since 1950 in both developed and developing countries are classified and discussed in terms of causative factors: socioeconomic development, cross-national influences and growth of national health systems. Despite the vast differences in scale of health statistics between developed and developing countries, economic hardships and high military expenditures, all nations have demonstrated significant declines in life expectancy and infant mortality rates. Social and economic factors that influenced changes included independence from colonial rule in Africa and Asia and emergence from feudalism in China, industrialization, rising gross domestic product per capita and urbanization. An example of economic development is doubling to tripling of commercial energy consumption per capita. Social advancement is evidenced by higher literacy rates, school enrollments and education of women. Cross-national influences that improved overall health include international trade, spread of technology, and the universal acceptance of the idea that health is a human right. National health systems in developing countries are receiving increasing shares of the GNP. Total health expenditure by government is highly correlated with life expectancy. The view of the World Bank and the International Monetary Fund that health care should be privatized is a step backward with anti-egalitarian consequences. The UN Economic Commission for Africa attacked the IMF and the World Bank for promoting private sector funding of health care stating that this leads to lower standards of living and poorer health among the disadvantaged. Suggested health strategies for the future should involve effective action in the public sector: adequate financial support of national health systems; political commitment to health as the basis of national security; citizen involvement in policy and planning; curtailing of smoking, alcohol, drugs and violence; elimination of environmental and toxic hazards; and maximum international collaboration.
[Unpublished] 1989. Presented at the 5th International Conference on AIDS, Montreal, Canada, June 4-10, 1989. 19 p.The charts and figures that comprise this document summarize the accomplishments of the World Health Organization's (WHO) Global Program on Acquired Immunodeficiency Syndrome (AIDS). As of May 1989, National AIDS Programs had been established in 188 countries/areas (46 in Africa, 42 in the Americas, 11 in Southeast Asia, 23 in the Eastern Mediterranean, 31 in Europe, and 35 in the Western Pacific). Program development involves a request, an initial technical visit, formulation of a short-term program, medium-term program formulation and resource mobilization, and program implementation and monitoring. National AIDS policies are formulated and publicized, a National Advisory Committee is created, a management structure is put in place, the relationships between the AIDS Program and other elements of the health care system are clearly defined, and financing is concretized. A review of the financial contributions to 29 National AIDS Programs in 1988-89 indicates the following funding sources: multibilateral (37%), bilateral (43%), WHO (18%), and national (2%). 126 of the National AIDS Programs currently in place are multisectoral and nongovernmental organizations are involved in 91 programs. Condom use in being promoted in 118 programs, while sentinel surveillance is in place in 46 programs. Preliminary program evaluations suggest a need for greater attention to management issues (e.g., structure, staffing, coordination with other sectors) and selected areas such as IEC monitoring, quality control in laboratories, patient care, sexually transmitted diseases, targeting, condom promotion, and perinatal transmission.
In: AIDS and associated cancers in Africa, edited by G. Giraldo, E. Beth-Giraldo, N. Clumeck, Md-R. Gharbi, S.K. Kyalwazi, G. de The. Basel, Switzerland, Karger, 1988. 292-302.The global strategy of AIDS prevention, managed by the WHO Special Programme on AIDS (SPA) was created in 1987, and is intended to be as intense as the smallpox eradication campaign. Its objectives are to prevent HIV transmission, to care for HIV-infected persons and reduce morbidity and mortality, and to unify national AIDS programs. AIDS can be prevented because it in only transmitted by 3 routes, sexual, blood and perinatal. AIDS-infected persons must be provided with medical, psychological and social support, without discrimination. The key elements of a national AIDS program are political openness, creation of a national AIDS committee, initial epidemiologic and resource assessment, and development of a medium-term AIDS plan. The plan should include epidemiological surveillance, laboratory capability, education programs for health workers, prevention of sexual transmission, prevention of blood transmission, prevention of intravenous drug abuse, strict single-use of medical and traditional skin-piercing instruments, and prevention of infection of women of childbearing age altogether. HIV-infected women should receive acceptable contraceptive methods. Evaluation of national programs is vital not only to maximize limited resources, but to discover how HIV prevention can best be achieved.
WORLD HEALTH. 1988 Jan-Feb; 10-11.In 1979 WHO invited its member states to participate in a global strategy for health and to monitor and evaluate its effectiveness using a minimum of 12 indicators. Members' 1982 implementation reports and 1985 evaluation reports form the basis for evaluating each measure. Indicators 1-6 have strong political and economic components in both developed and developing countries and are not complete. Indicator 7, for which rates of reply are satisfactory, asks whether at least 5 elements of primary health care are available to the whole population. The 8th gauge seeks information on the nutritional status of children, considering birth weight (a possible indicator of risk) and weight for age (a monitor of growth). Infant mortality rate and life expectancy at birth, indicators 9 and 10, are difficult to estimate in developing countries, and health services are not always kept informed of current estimates. Indicator 11 asks whether the literacy rate exceeds 70%; it can provide information on level of development and should emphasize literacy for women, for whom health information is critical. The last global measure yields information about the gross national product, which is not always the most recent, despite the trend of countries to publish their gross domestic product. Failure to make use of the best national sources, such as this, is one of several problems encountered by WHO's member states in collecting accurate data. Other problems include lack of universally acceptable definitions, different national accounting systems, disinterest of health authorities in economic matters, lack of staff, lack of financial resources in developing countries, and inadequately structured health system management. Each country must choose the most appropriate methods for collection of data. If an indicator cannot be calculated, the country is encouraged to seek and devise a substitute. WHO must produce more precise and reliable indicators. It must respond to requests for ways of improving or strengthening national systems.
[Unpublished] 1988 May 21. 18 p. (NCIH 15th Annual International Health Conference; Papers)This address covers the 3 phases of National Primary Health Care (PHC) Implementation in Nigeria from 1975 to the present. The concept for the implementation of the 1st phase was to build and equip health centers, then train and post health workers to the facilities. No attempt was made to involve the community, use appropriate health technology, or set up management systems (such as referrals, supplies, monitoring, and evaluation of the delivery system). In short, at the end of the planned period, nowhere in the Federation were services, as described in the Alma Atta Declaration, being delivered. Between 1980 and 1985, because of the failure of the Basic Health Services Scheme, the Federal Ministry of Health abandoned any attempt to set up a PHC system and began the implementation of vertical systems of health care. Within the Ministry, groups attached themselves to particular agencies, leading to severe fragmentation of the Ministry. The Ministry as a whole had ceased to pursue the goals of PHC and adopted new objectives agreeable to each donor agency. Since 1985, the present Nigerian administration has aimed at establishing local government by local government, with the nation's PHC system incorporating the existing vertical programs. The considerable resources available through many AID agencies, international organizations, and governments need to be harnessed to achieve Nigeria's goals. Nigeria must therefore be clear as regards what these are and how to achieve them, bearing in mind that most of these agencies and organizations have their mandates and objectives limiting the activities in which they may engage.
In: Management information systems and microcomputers in primary health care, edited by Ronald G. Wilson, Barbara E. Echols, John H. Bryant, and Alexandre Abrantes. Geneva, Switzerland, Aga Khan Foundation, 1988. 17-20.A wide array of issues must be addressed if the development and use of management information system (MIS) and microcomputers are to improve management of primary health care (PHC) programs and increase the equity and cost-effectiveness of PHC. These issues include: specification of the purpose and objectives of MIS at community and district levels; distinquishing types of information required; the understanding of organizational issues that must be resolved as a result of introducing MIS; the practical definition of the most useful indicators of program effectiveness and efficiency; the specification and monitoring of data collection, compilation, and analysis requirements and procedures; procedures for generating and using processed MIS data and management information; the PHC program's capacity to absorb technological innovations; and personnel requirements. The need for improved data systems must be recognized. Data quality and systematic flow of information must be ensured from the field level upwards, and minimum information requirements need to be defined. The success of any MIS is heavily dependent on feedback of the data collected. Unless staff at all levels of a PHC program understand the importance of the data they are collecting, the value and use of the information system will be negligible. Examples of the Egyptian government's National Health Information System and the role of the World Bank are used to show how MIS and microcomputer can be introduced and used in PHC.
Social Science and Medicine. 1987; 25(6):615-20.It is expected that community involvement in health policy be not only cost-effective but also the best way of providing comprehensive solutions to public health problems. Over 50 years of experience in India show that public enthusiasm does tend to wane after a short period of time, but efforts continue to be made. Governmental and other organizations and UN agencies have been active in promoting the concept of community involvement. The best that can be expected is that people will come forward voluntarily to participate in public health programs formulated by governments and other agencies. Generally, however, public cooperation has to be sought and participation motivated. There is little support for coercive measures. Community participation is often hampered by a wide range of factors including: difficult terrain; inegalitarian social structure; the tendency to depend on others to look after one's needs; and the absence of an understanding of healthful conditions and practices. Also, bureaucrats and medical professionals often consider community involvement an interference. Nevertheless individuals and organizations are everywhere engaged in experiments in such involvement, and certain Indian projects have provided valuable insights which may be of use in other developing countries.
Health aspects of population dynamics: report by the Director-General to the 21st World Health Assembly.
[Unpublished] 1968 Apr 24. 8 p. (A21/P and B/9)Add to my documents.
International Journal of Health Services. 1985; 15(2):275-99.Until the mid 1960s, Latin American health system reflected the skewed distribution of wealth in the region: most health resources were found in curative care medicine and were concentrated in the capital cities, where they primarily served the needs of the elite. For many countries, however, the 1964 Pan American Health Organization's (PAHO) efforts to introduce health planning, intended as a 1st step in rationalizing the health sector, marked a fundamental turning point in the structural development of their delivery systems. Guatemala, however, was and remains an exception. Its technocrats have proven unable to plan effectively; no single entity is responsible for health sector planning, and the 5-year plans have come to consist of disjointed mini-plans, each reflecting the aims, desires and goals of a particular vested interest group or institution. The Guatemalan oligarchy has proven unwilling to appropriate the resources necessary to effect change. The reforms that have been made have been the products of bilateral and multilateral agencies such as the InterAmerican Development Bank, USAID, UNICEF, Kreditanstaldt and PAHO, which have conceptualized, promoted, designed, built and underwritten them. Those changes have not altered the fundamental structure of the system, but instead have been tacked onto it, and exemplify what may be termed additive reform. The government of Guatemala's own commitment to these outside agency funded projects is reflected in the recurrent shortfall of current or operating funds, and in the rapid depreciation of facilities. Evidence suggests that without the continued sponsorship, support, and guidance of the bilateral and multilateral agencies, even these additive reforms will not last.
[Unpublished] 1984 Aug. Background note presented to the International Conference on Population held in Mexico City, August 6-13, 1984. 4 p.The United Kingdom's birth rate has been below replacement level since 1973. Average family size is becoming smaller; the most popular size is 2 children. Women are postponing births to a later date, and age at marriage has risen. Problems of providing support and services for the growing number of very elderly are being studied by the government. Size of population is of less concern than well-being to the government. They provide assistance with family planning through the National Health Service, but believe that decisions about fertility and childbearing are each couple's to make. Population figures are taken into account in making economic and social policy, but there is no attempt to influence overall size and components of change except in the area of immigration where they lose more people by emigration than they gain from immigration.
Statement by the Head of Delegation of the Republic of Korea at the International Conference on Population (ICP).
[Unpublished] 1984 Aug. Presented at the International Conference on Population, Mexico City, August 6-13, 1984. 3 p.In a 5-year plan, the Korean government has integrated family planning programs, including maternal and child health, medical insurance, and social welfare programs, into its primary health ervices in order to reach its hard-core low-income residents in both urban and rural areas. The Korea Women's Development Institute was established in 1982 to enchance the status of women, and the Labor Standard Law has been revised to try to overcome deep-rooted son-preference among Korean parenst. Migration out of rural areas is creating rural manpower problems, and stepped-up rural community development programs are planned. Population predictions by the mid-21st century stand at 61 million, too great for a country with such limited natural resources to support. Korea recommends an exchange of information on population and development between all countries, the setting aside of 1% of each country's annual budget for national population programs, and convening the world population conference every 5 instead of every 10 years so that more progress can be made in solving the problem.
Alternative approaches to meeting basic health needs in developing countries: a joint UNICEF/WHO study.
Geneva, World Health Organization, 1975. 116 p.Based on the failure of conventional health services and approaches to make any appreciable impact on the health problems of developing populations, this study examined successful or promising systems of delivery of primary health care to identify the key factors in their success and the effect of some of these factors in the development of primary health care within various political, economic, and administrative frameworks. In the selection of new approaches for detailed study, emphasis was placed on actual programs that are potentially applicable in different sociopolitical settings and on programs explicitly recognizing the influence of other social and economic sectors such as agriculture and education on health. Information was gathered from a wide range of sources; including members, meeting reports, and publications of international organizations and agencies, gathered country representatives, and field staff. The 1st section, world poverty and health, focuses on the underprivileged, the glaring contrasts in health, and the obstacles to be overcome--problems of broad choices and approaches, resources, general structure of health services, and technical weasknesses. The main purpose of the case studies described in the 2nd part was to single out, describe, and discuss their most interesting characteristics. The cases comprised 2 major categories: programs adopted nationally in China, Cuba, Tanzania, and, to a certain extent, Venezuela, and schemes covering limited areas in Bangladesh, India, Niger, and Yugoslavia. Successful national programs are characterized by a strong political will that has transformed a practicable methodology into a national endeavor. In all countries where this has happened, health has been given a high priority in the government's general development program. Enterprise and leadership are also found in the 2nd group of more limited schemes. Valuable lessons, both technical and operational, can be derived from this type of effort. In all cases, the leading role of a dedicated individual can be clearly identified. There is also evidence that community leaders and organizations have given considerable support to these projects. External aid has played a part and apparently been well used. Every effort should be made to determine the driving forces behind promising progams and help harness them to national plans.
A national approach to health service management information services. The work of the English Steering Group on Health Services Information.
[Unpublished] 1984. 23 p. (WHO/HS/NAT.COM/84-387)In February 1980 the Secretary of State for Social Security appointed the joint National Health Service/Department of Health and Social Security Group on Health Services Information to conduct the 1st comprehensive review of national health services (NHS) management information services since the inception of the NHS. The 1st report presents the Group's conclusions and recommendations about the information required by management regarding clinical facilities and departments in hospitals and the patients using them. In due course this report will be followed by reports on information about community services, paramedical services, personnel, finance, patient transport services, dental service, and other areas of interest. The Steering Group's approach to its task has been based on the requirement to collect data because they are essential for operational purposes. The Group also aims to establish a series of minimum data sets, covering the major areas of management activity in the NHS, to provide the information needed by a district health authority and its officers to manage health services, and to actively influence the allocation of services. The Group began with a review of existing data systems. Working groups were established to investigate hospital facilities used by consultant medical staff, laboratory and scientific services, paramedical services, community health services, health service personnel, health service management accounting, and patient transport services. The smooth implementation of recommendations requires training of the staff responsible for data collection. In formulating proposals, focus has been on the information required by a district health authority and its officers. It is believed possible to identify a minimum set of data which should be used in all districts and that the data should be collected largely as a byproduct of operational procedures. The approach to information for management postulates that the needs of the district tier of the NHS are paramount. In developing the district minimum data set, the working groups paid particular attention to the following characteristics of data: relevance; timeliness; and ability to be collated with data from other sources. Statistical information about the clinical services in a district is drawn from activity data, health services personnel data, and financial data. The major areas of clinical work can be categorized as services provided on hospital premises, off hospital premises, and in or for the community. This report is a synthesis of the recommendations of the 2 working groups which have reviewed the data required about the activity of: the services provided on hospital premises (except radiotherapy); the services provided in consultant outpatient clinics; the services provided in day care facilities; and the services related to a registrable birth. Recommendations are summarized.