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Living well with HIV / AIDS: a manual on nutritional care and support for people living with HIV / AIDS.
Rome, Italy, FAO, 2002. vi, 97 p.The links between nutrition and infection are well known. Good nutrition is essential for achieving and preserving health while helping the body to protect itself from infections. Consumption of a well-balanced diet is essential to make up for the loss of energy and nutrients caused by infections. Good nutrition also helps to promote a sense of well-being and to strengthen the resolve of the sick to get better. The nutritional advice in this manual can help sick people, including those living with HIV/AIDS, to feel better. Few crises have affected human health and threatened national, social and economic progress in quite the way that HIV/AIDS has. The pandemic has had a devastating impact on household food security and nutrition through its effects on the availability and stability of food, and access to food and its use for good nutrition. Agricultural production and employment are severely affected and health and social services put under great strain. Families lose their ability to work and to produce. With worsening poverty, families also lose their ability to acquire food and to meet other basic needs. Time and household resources are consumed in an effort to care for sick family members, partners may become infected, families may be discriminated against and become socially marginalized, children may be orphaned and the elderly left to cope as best they can. Meeting immediate food, nutrition and other basic needs is essential if HIV/AIDS-affected households are to live with dignity and security. Providing nutritional care and support for people living with HIV/AIDS is an important part of caring at all stages of the disease. This manual provides home care agents and local service providers with practical recommendations for a healthy and well-balanced diet for people living with HIV/AIDS. It deals with common complications that people living with HIV/AIDS experience at different stages of infection and helps provide local solutions that emphasize using local food resources and home-based care and support. (excerpt)
Brunei, Indonesia, Malaysia, Philippines, Singapore Cluster Country Consultation on Migrant Workers' HIV Vulnerability Reduction: Pre-Departure, Post-Arrival and Returnee Reintegration, 15-17 April 2002, Makati City, Philippines.
Bangkok, Thailand, UNDP, South East Asia HIV and Development Programme, 2002 Sep. iv, 39 p.HIV/AIDS touches all sectors of society. It is an issue that requires appropriate responses at national, regional and global levels. Migrant workers are valuable resources that stimulate economic prosperity and contribute to the socio-economic development of Asia. Millions of migrant workers move in and out of the countries of Brunei, Indonesia, Malaysia, Philippines and Singapore (BIMPS) for economic and other reasons. Migrant workers, Non-Governmental Organizations, United Nations agencies and government officials responsible for migrant workers gathered from the BIMPS cluster countries to share their existing responses and to formulate collaborative actions for reducing migrant workers’ HIV vulnerabilities in this region and beyond. The delegates proposed a Memorandum of Understanding and drafted a set of collaborative responses. Only through the collective protection of valuable human resources will the BIMPS countries be able to mitigate the socio-economic and human impact of HIV/AIDS within each of their own countries. It is the hope of the UNDP South East Asia HIV and Development Programme that the resulting draft Memorandum of Understanding and the Joint Action Programme from the BIMPS Consultation will be considered by the Ministries of Labour, as well as the National AIDS Authorities of these countries in their future policy and programme elaborations. It is also hoped that the ASEAN Task Force on AIDS Secretariat and its dialogue partners will provide the necessary financial and technical support to materialize the proposed Joint Action Programme for the BIMPS sub-region. (excerpt)
New York, New York, United Nations Population Fund [UNFPA], 2003. 46, 6 p. (UNFPA Programme Advisory Note)This document is intended to help UNFPA country staff plan national programmes, develop strategies and projects, review progress made, and assess the soundness of their strategies. It illustrates how one can increase men’s involvement in reproductive health issues through research, advocacy, behaviour change communication and education, policy dialogues and well-tailored and innovative reproductive health services. It starts by defining partnering with men and providing a rationale for this approach from the standpoint of the International Conference on Population and Development (ICPD). A framework for selecting essential elements of such a programme is then described. Examples are provided of ways in which UNFPA has supported a partnering approach, followed by a summary of lessons learned. A matrix of sample outputs and their indicators provides options for defining and measuring results. Additional resources are also provided for information on gender, masculinities, adolescent boys, education, services, working with special populations, and research on partnering with men. (excerpt)
New York, New York, UNFPA, 2003. 6 p.Emergency obstetric care is the cornerstone of UNFPA's efforts to improve pregnancy outcomes. This six-panel checklist is designed to help programme planners and managers monitor elements that are critical to providing a high quality of emergency obstetric care. (author's)
The World Health Organization guidelines for air quality. Part 2: Air-quality management and the role of the guidelines. [Recomendaciones sobre calidad del aire de la Organización Mundial de la Salud. Parte 2: Manejo de la calidad de aire y papel de las recomendaciones]
EM. The Urban Environment. 2000 Aug; 23-27.In Part 1 of this article (July 2000, pp 29-34), the revised and updated guidelines for air pollutants were presented. It was emphasized that the guideline values and exposure-response relationships should be considered in the framework of air-quality management. Air-quality management is important for several reasons, which become particularly clear if one is looking at the estimated global burden of disease caused by air pollution. Recent estimates of mortality and morbidity caused by indoor and ambient air pollutions are reproduced in Figures 1 and 2. Figure 1 illustrates the daily mortality for urban ambient air exposure, urban indoor air exposure, and rural indoor air exposure as potentially caused by particulate matter in eight regions: Established Market Economies (EME); Eastern Europe (EE); China; India; SoutheastAsia/Western Pacific (SEAWP); Eastern Mediterranean (EM); Latin America (LA); and SubSaharan Africa (SSA). On a global scale, air-pollution-related mortality accounts for 4% to 8% of the total death rate of 52.2 million annually. Figure 2 estimates the number of people with respiratory diseases potentially caused, or exacerbated by, exposure to suspended particulate matter (SPM). Accordingly, between 20% and 30% of 760 million cases of respiratory diseases recorded annually may be affected by suspended particulate matter. These estimates, when viewed along with the existing information on the health effects of air pollution, lead to the conclusion that controlling sources of ambient and indoor air pollution is necessary to avoid a significant increase in the burden of disease it can cause. This issue is addressed in the World Health Organization 19996 Guidelines for Air Quality (hereafter referred to as Guidelines). In Part 2 of this article, we describe the main statements in the Guidelines with respect to ambient and indoor air management. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], Department of Vaccines and Biologicals, 2001. vi, 95 p. (WHO/V&B/01.44)Concerns have been raised over the effects of health reforms upon immunization. This document has been prepared to provide some insights into how quality immunization services can be sustained in a reformed and decentralized health system, especially if integration involves disbanding the vertical EPI programme. There is no single model that encapsulates “health reform”, which sometimes involves radical constitutional and structural changes not only to health services but also in other sectors. This document presents two case studies of countries, which have approached reforms in very different ways, and highlights the lessons learned presented in Chapter 6. For organizations supporting countries undergoing health reform, the following are prerequisites: Gain an understanding of the background leading to reform in a particular country, and of the ambitions and guiding principles behind the reforms. Identify which sectors are involved, what is the leading sector or institution, and who are the key players. Find out how far ownership extends beyond the core group, and the extent of consensus. Identify the changes in structures and functions. The organigrams developed for this document illustrate how radical the changes may be. It is likely that the old systems used for vertical programmes must be changed to fit the reformed structures and processes; appropriate solutions will be specific to a particular setting. The following general principles were identified: Use the set of essential functions in Chapter 3 to assess whether immunization seems to be adequately covered. It is important to distinguish between temporary problems arising from the transition to the new system, and structural flaws or weaknesses in the design of the new system. If necessary, propose further adjustments to ensure that essential functions can be covered. Reforms are likely to involve operational changes in the way that immunization services are to be managed. Integration of services is often perceived to provide a more cost-effective approach than the vertical programmes. Take the opportunity offered by reforms to extend the standards developed for immunization to other aspects of primary health care, thus reinforcing good management practices and building up capacity. Consider new approaches to funding arrangements for supporting immunization, especially for procurement of specialized equipment. Monitoring and reviews provide ways of assessing the execution of essential functions at national level and the management of immunization services through all levels of the system. Suggestions for indicators are given in Annex 2. Be aware of the time frame and agenda for reforms and the annual planning cycle, allow more time for reaching consensus with all key players, and be patient. (excerpt)
The Manager: Management Strategies for Improving Health Services. 2001; 10(4): p..This issue of The Manager offers policymakers and managers of TB programs at all levels a practical, systematic approach to strengthening drug management so that TB drugs reach and are appropriately used by patients. It introduces the drug management cycle and describes how effective drug policies and laws can support this cycle. The issue also explains how specific improvements in drug selection, procurement, distribution, and use, as well as in management support, can help to maintain an adequate flow of TB drugs. (author's)
Management of suspected cases of HIV disease in developing countries: the need for clinical guidelines for primary healthcare workers [letter]
Tropical Doctor. 2001 Oct; 31(4):250-251.There is, therefore, an urgent need for guidelines that can be used by primary care staff in developing countries. This may involve putting greater emphasis on symptoms such as weight loss, fever, diarrhoea, cough and skin diseases. A syndromic approach allows primary care level staff to correctly manage patients in the absence of specialist medical laboratory support. There is a crucial need for research and development to provide such guidelines. (excerpt)
Canadian HIV-AIDS Policy and Law Newsletter. 1999 Fall-Winter; 5(1):30-31.1999 was the third anniversary of the drafting the International Guidelines on HIV/AIDS and Human Rights. This article reviews the history of the Guidelines, notes some obstacles to their implementation, and concludes with suggestions for governments and development agencies. (author's)
London, England, International Planned Parenthood Federation [IPPF], 2001 Jul. 61 p.This document offers a framework for achieving an effective advocacy campaign in the field of SRH by family planning associations, the International Planned Parenthood Federation, and other nongovernmental organizations.
Geneva, Switzerland, UNAIDS, 1999 Sep. 9 p. (UNAIDS Best Practice Collection. Key Material; UNAIDS/99.47/E)These guidelines provide standards--from a public health perspective--which prison authorities should strive to achieve in their efforts to prevent HIV transmission in prisons and to provide care to those affected by HIV/AIDS. It is expected that the guidelines presented in this paper will be adapted by prison authorities to meet their local needs. (excerpt)
Guidelines for drinking-water quality. 2nd ed. Volume 2. Health criteria and other supporting information.
Geneva, Switzerland, WHO, 1996. xvi, 973 p.The first edition (1984-85) of guidelines for drinking water quality was intended for use as a basis for the development of national standards to ensure the elimination--or significant reduction--of constituents of water known to be hazardous to health. This revised edition includes many drinking water contaminants not included in the earlier book and revises some of the recommended guideline values in light of new scientific information. This volume explains how guideline values for drinking water contaminants are to be used; defines the criteria used to select the chemical, physical, microbiological, and radiological contaminants included; and evaluates the effects of these substances on human health. The guidelines presented were developed by over 200 experts from 40 countries. It is emphasized that guideline values should be considered in the context of environmental, social, economic, and cultural conditions rather than as absolutes. Moreover, guideline values are recommended only when control techniques are available to remove or reduce contaminant concentrations to desired levels. Source protection is almost invariably the best method of ensuring safe drinking water.
Education for the prevention of AIDS. No. 1. Selection of extracts from teachers' guides. Revised ed. Education pour la prevention du SIDA. Selection d'extraits de guides pedagogiques a l'usage des enseignants. Educacion para la prevencion del SIDA. Seleccion de paginas de guias pedagogicas para el uso de personal docente.
[Paris, France], UNESCO, 1992 Oct. , 146 p.UNESCO's AIDS School Education Resource Center (ASERC), in collaboration with the World Health Organization (WHO), has compiled eight teachers' guides from Australia, Canada, Cameroon, Spain, the Pacific islands, Uganda, and the US (Hispanic curriculum). The teachers' ability to consider the myths, taboos, attitudes, habits, and knowledge of their students determines the effectiveness of AIDS preventive education. There are different approaches to effectively teach secondary school students. Essentially all the guides have a section on knowledge and information about HIV/AIDS (e.g., ways to prevent HIV transmission and clinical symptoms) and a section on appropriate attitudes and behavior towards HIV/AIDS (e.g., adopting preventive behavior). This last section contains participatory activities on decision making and on how students should behave towards and deal with persons with AIDS. Various teaching aids proposed by the guides include transparencies, fact sheets for teachers, pupils' guides, videocassettes, films, ideas for making puppets, and a glossary. Annex 1 has a pre-test that teachers can use to assess student knowledge, attitudes, and behavior towards AIDS. Annex 2 lists bibliographical references to other guides available at ASERC.
[Geneva, Switzerland], WHO, 1994. , 17 p. (WHO/CDD/94.49)The clinical diagnosis of bloody diarrhea refers to any diarrheal episode in which the loose or watery stools contain visible red blood. This does not include episodes in which blood is present in streaks on the surface of formed stool, is detected only by microscopic examination or biochemical tests, or in which stools are black due to the presence of digested blood. The health practitioner may diagnose the presence of bloody diarrhea in a child by either asking the mother whether the child's stool contains red blood or by looking at the stool, but the former approach is usually more efficient than waiting for the child to pass a stool and as equally sensitive and precise. All infants and children with bloody diarrhea should be treated promptly with an antimicrobial effective against Shigella. Such antimicrobials include ampicillin, TMP-SMX (cotrimoxazole), nalidixic acid, pivvmecillinam, newer quinolones, and ceftriaxone. Dehydration when detected in children with bloody diarrhea should be treated at the health facility. Children with bloody diarrhea and signs of dehydration are at increased risk of complications and should be re-evaluated two days after treatment. The caretakers of all children should be encouraged to offer increased amounts of suitable fluids at home. Moreover, the continued provision of nutritious food is important for all children with dysentery, even though they may have to be coaxed to eat. Appetite usually improves after 1-2 days of effective antibiotic therapy. Frequent small meals with familiar foods are usually better tolerated than a few large meals. Furthermore, mothers should be advised to breastfeed as often and as long as their children want, while children convalescing from dysentery should be given an extra meal each day for at least two weeks. Severely malnourished children with bloody diarrhea are at very high risk of complications and should be referred immediately to hospital after starting treatment for shigellosis.
Geneva, Switzerland, WHO, Action Programme on Essential Drugs, 1993. ii, 87 p. (WHO/DAP/93.1; DAP Research Series No. 7)The WHO Action Program on Essential Drugs has developed and field tested a core set of drug use indicators capable of describing drug use patterns and prescribing behaviors in a country, region, or individual health facility. These indicators can be used to measure the impact of interventions designed to change prescribing practices, detect performance problems, and compare the performance of providers and institutions. Three categories have been developed: 1) prescribing indicators--average number of drugs per encounter, percentage of drugs prescribed by generic name, percentage of encounters with antibiotic prescribed, percentage of encounters with injection prescribed, and percentage of drugs prescribed from essential drugs list or formulary; 2) patient care indicators--average consultation time, average dispensing time, percentage of drugs actually dispensed, percentage of drugs adequately labelled, and patients' knowledge of correct dosage; and 3) facility indicators--availability of copy of essential drugs list or formulary and availability of key drugs. All data required to measure the core indicators can be derived from medical records or direct observation. Field testing in developing countries such as Nigeria and Tanzania found these measures both feasible to obtain and informative as first-level indicators. Also presented are descriptions of key issues related to study design and sampling, field methods, analysis, and follow up.
Geneva, Switzerland, WHO, . 28 p. (WHO/CDD/SER/87.11)This manual provides an overview of the nature of acute diarrhea and its treatment, especially through the use of oral rehydration therapy (ORT), for pharmacists in developing countries. The composition of oral rehydration sales (ORS) is covered as is how to treat dehydration with ORS solution and how to prevent dehydration. The booklet also stresses that antimicrobial and antidiarrheal agents are not recommended for the routine treatment of acute diarrhea. The information presented in the main text is then reviewed in a series of questions and answers, and the World Health Organization's Diarrhoeal Disease Control Programme is described. Finally, a series of guidelines suggest that pharmacists: 1) persuade mothers to use ORT when necessary, 2) supply ORS packets and ensure that mothers know how to prepare and use the solution, 3) prepare ORS solutions in the pharmacy on a daily basis if packets are not available, 4) explain to mothers how household food solutions or sugar/salt solutions can be used to prevent dehydration, 5) persuade mothers not to purchase expensive and ineffective medication, 6) ensure that all cases of severe diarrhea and dehydration are taken to an appropriate health facility, 7) give advice on ways to prevent diarrhea, 8) participate fully in the diarrheal diseases control program of their country, and 9) advocate the teaching of ORT in pharmacy schools and continuing education programs.
Global biodiversity strategy. Guidelines for action to save, study, and use Earth's biotic wealth sustainably and equitably.
Washington, D.C., WRI, 1992. vi, 244 p.Humanity depends on all other forms of life on Earth and its nonliving components including the atmosphere, ocean, bodies of freshwater, rocks, and soils. If humanity is to persist and to develop so that everyone enjoys the most basic of human rights, it must protect the structure, functions, and diversity of the world's natural systems. The World Resources Institute, the World Conservation Union, and the UN Environment Programme have joined together to prepare this strategy for global biodiversity. The first 2 chapters cover the nature and value of biodiversity and losses of biodiversity and their causes. The 3rd chapter presents the strategy for biodiversity conservation which includes the goal of such conservation and its contents and catalysts and 5 actions needed to establish biodiversity conservation. Establishment of a national policy framework for biodiversity conservation is the topic of the 4th chapter. It discusses 3 objectives with various actions to accomplish each objective. Integration of biodiversity conservation into international economic policy is 1 of the 3 objectives of the 5th chapter--creating an international policy environment that supports national biodiversity conservation. Correct imbalances in the control of land and resources is a clear objective in creating conditions and incentives for local biodiversity conservation--the topic of the 6th chapter. The next 3 chapters are devoted to managing biodiversity throughout the human environment; strengthening protected areas; and conserving species, populations, and genetic diversity. The last chapter provides specific actions to improve human capacity to conserve biodiversity including promotion of basic and applied research and assist institutions to disseminate biodiversity information.
Bangkok, Thailand, ESCAP, 1984. 323 p. (ESCAP Programme on Health and Development Technical Paper No. 66/PHD 19; ST/ESCAP/286)This training manual describes the organization of the courses, the course syllabus, the 1983 course on planning, development and health, the follow-up evaluation of the training courses of 1976-82 and the specialized activities in planning for health and development at ESCAP. Planning for health is viewed as an integral part of overall development planning with the conscious incorporation of clear goals, to help ensure that development programs have a positive impact on the health of the region's poor. ESCAP's training program aims to amplify, in concrete terms, the close relationship between health and development and to build the capability to take an integrated and multisectoral approach to inproving health and accelerating development. The design and implementation of a training program oriented to strengthen capacities in planning, development and health is a function of these 3 terms. The basic frame has remained farily similar to the 1976 course. Training aims at behavior change--to strengthen capacity for action, rather than to accumulate knowledge and information for information's sake. Training objectives must be appraised in terms of relevance, adequacy, effectiveness, efficacy and impact before actual implementation beings. The course is conceived as a unified, multi-sectoral approach to assess the health situation and propose intervention measures aimed at the elimination of the social causes of ill-health and disease of a country. The focus is in the relationships between health and development through systems analysis and relevant planning tools. The aim of the courses is to produce a cadre of planners for health with an innovative and intersectoral outlook, consistent with the dynamic approaches in health, development and planning and with abilities to convince the higher planning structures, rally political support and enlist coummunity involvement with focus on Health for All by the Year 2000. Tables and charts facilitate understanding of concepts involved in this training.
London, England, Oxfam, May 1981. 439 p.This handbook was developed to provide field directors of Oxfam overseas projects with guidelines for managing and assessing the numerous aspects of their projects. Oxfam's philosophy, objectives, strategies, and resources are described, and a directory of Oxfam field offices and other agencies world wide is provided. Guidelines and strategies in the areas of agriculture, health, social development, humanitarian programs, and disaster relief are covered in individual sections, with a bibliography for each.
Chicago, Illinois, Planned Parenthood Association of Chicago, 1966. 16 p.Add to my documents.
Contraception. 2002 Jul; 66(1):1-5.The use of consensus recommendations and clinical guidelines is now widespread in industrialized countries and is becoming more common in developing countries. As guidance documents have become more influential, their methodological rigor has come under closer scrutiny. Using two independently developed scales, the authors assessed the methodological quality of an important set of guidelines developed by the WHO. The consensus recommendation document called Improving Access to Quality Care in Family Planning: Medical Eligibility Criteria for Contraceptive Use has become the basis for national guidelines in dozens of countries. The authors compared the quality of the WHO guidelines to that of over 300 previously assessed published guidelines. In most categories of quality, the WHO exceeded the mean scores for other published guidelines. The authors discuss these comparisons, as well as the strengths and weaknesses of the WHO guidelines. (author's)
Geneva, Switzerland, World Health Organization [WHO], 1998. 87 p. (WHO/TB/98.250)Tuberculosis (TB) is common in many prisons worldwide and treatment is often ill-informed and inadequate. In this perspective, the WHO and the International Committee of the Red Cross (ICRC) have joined forces to produce guidelines for the control of TB in prisons. This document presents the results of the collaborative effort of WHO and ICRC. The guidelines, based on recent experience, outline the many obstacles to effective diagnosis and treatment and it gives useful guidance as to how to overcome these obstacles. Outlined into three parts, these guidelines are primarily for prison authorities, policy- makers and decision-makers in relevant ministries, nongovernmental organizations (NGOs) and donor agencies, and National TB Program staff. Part I provides background information on TB and prisons, of particular relevance to prison authorities and decision-makers in relevant ministries. Part II provides guidelines for the control of TB in prisons, of particular relevance to prison health staff. Finally, Part III gives guidance to national prison authorities and NGOs on how to establish a prison TB control program.
[Unpublished] 1990 Jan 26. vii, 169 p.In 1988, research teams from 17 countries from all regions of Africa met in Ethiopia to assess how to develop a broad, adaptable knowledge, attitudes, beliefs, and practices (KAP) survey and interview schedule for AIDS research. Subsequently, researchers from North and South America and Europe have been involved in adapting the African KAP surveys to their regions. This document presents the research documents resulting from that work. Organized into four parts, this WHO draft document has been prepared to permit researchers to follow a standardized approach to this type of research and to generate information that will be comparable between countries. Part one covers the introduction. Part two deals with the study design, including the conceptual framework, objectives, training, ethical issues, and information dissemination. The interviewers' manual is described in part three. This section includes information on locating subjects in the community, conducting interviews, fieldwork, training interviewers, and detailed notes on the individual questionnaire. Finally, part four presents models of each of the tabulation plans.
Rights of women: a guide to the most important United Nations treaties on women's human rights. 2nd ed.
New York, New York, International Women's Tribune Centre, 1998. , 148 p.This Rights of Women manual presents a guide to the most important UN treaties on women's human rights to encourage and inform the continuing struggle for women's human rights around the world. Organized into five sections, this book focuses on those human rights that are guaranteed by human rights conventions, and how these conventions might be better realized. Section one provides an explanation of human rights conventions, how they work and why they are important to women. Section two outlines the many human rights to which women are entitled. It also draws particular attention to some specific human rights that are of special importance to women, including education, employment, equality in marriage, refugee rights, and protection from sexual exploitation, trafficking and torture. Section three, on the other hand, highlights some areas that women's human rights groups are fighting to have recognized as women's human rights. A focus on action around women's human rights issues is being presented in section four. Finally, chapter five describes the resources kit which includes convention ratification charts, lists of UN human rights conventions, the Convention of the Elimination of All Forms of Discrimination Against Women, an illustrated outline and summary of the Beijing Platform for Action, and information on International Women's Tribune Centre and Women, Ink. with a list and order form for Women, Ink. books.
[Programming for safe motherhood. Instructions for maternal and neonatal survival. Development and implementation of a plan of action] Programmer pour une maternite sans risque. Directives pour la survie de la mere et du nouveau-ne. Elaboration et mise en oeuvre d'un plan d'action.
New York New York, UNICEF, Health Section, Programme Division, 1999 Oct. 134 p.Based upon respect for human rights, safe motherhood programs help build the intersectoral actions needed to improve maternal health and effect behavioral changes favoring safe motherhood among women, adolescents, men, health personnel, and political leaders. Men, as well as their spouses, partners, neighbors, and leaders, need to actively support women in their choices and actions aimed to improve women's health and well-being. Each chapter of this publication is an independent guide outlining interventions, considering cost-effectiveness, which address the direct and indirect causes of maternal mortality and including malnutrition, the lack of education, violence, and the mistreatment of women. Community participation in conceiving, developing, and implementing programs; improving communication and transportation systems; training midwives; delivering care in welcoming settings; and improving healthcare facilities are concrete, decisive measures. Such measures comprise a spring- board for new action made possible by growing knowledge and experience, and aim to overcome those maternal health challenges faced in poor countries and low income communities. This guide was conceived to help UNICEF personnel working at the country level to implement elements of the safe motherhood initiative.