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Geneva, Switzerland, World Health Organization [WHO], 2010.  p.This report describes the status and trends with respect to the use of safe drinking-water and basic sanitation, and progress made towards the MDG drinking-water and sanitation target. As the world approaches 2015, it becomes increasingly important to identify who are being left behind and to focus on the challenges of addressing their needs. This report presents some striking disparities: the gap between progress in providing access to drinking-water versus sanitation; the divide between urban and rural populations in terms of the services provided; differences in the way different regions are performing, bearing in mind that they started from different baselines; and disparities between different socioeconomic strata in society. Each JMP report assesses the situation and trends anew and so this JMP report supersedes previous reports. The information presented in this report includes data from household surveys and censuses completed during the period 2007-2008. It also incorporates datasets from earlier surveys and censuses that have become available to JMP since the publication of the previous JMP report in 2008. In total, data from around 300 surveys and censuses covering the period 1985 - 2008, has been added to the JMP database. The updated estimates for 2008, 2000 and 1990 are given in the statistical table starting on page 38. This table for the first time shows the number of people who gained access to improved sanitation and drinking-water sources in the period 1990-2008. It is important to note that the data in this report do not yet reflect the efforts of the International Year of Sanitation 2008, which mobilized renewed support around the world to stop the practice of open defecation and to promote the use of latrines and toilets. (Excerpt)
Care of mother and baby at the health centre: a practical guide. Report of a technical working group.
Geneva, Switzerland, WHO, Division of Family Health, Maternal Health and Safe Motherhood Programme, 1994. , 55 p. (Safe Motherhood Practical Guide; WHO/FHE/MSM/94.2)This report is designed for health planners and program managers to improve access to health and to decentralize maternal and newborn health care. It covers secondary care services that traditional birth attendants (TBAs), midwives, and other nonphysician health workers in health centers can perform. Specifically, it defines the tasks and skills required to provide comprehensive care of mother and infant at the health center and in the community. It also looks at the role of the health center in training, supervision, and continuing logistic support for community based care. The first chapter examines the health center's role in maternal health and the 3 approaches to integrated care: vertical integration, integration across time, and horizontal integration. The next chapter reviews the essential elements of obstetric and neonatal care, including sexually transmitted diseases and HIV/AIDS. Topics discussed in the chapter on developing and maintaining a functional referral system include referral protocols, functional links with referral centers, obstetric first aid, maternity waiting homes, transport and communication, and reception of referred cases in referral centers. Institutional support mechanisms (chapter 4) are training; teamwork and supervision; logistics, maintenance, and essential drugs and supplies; management, communication, and interpersonal skills; and data collection and research. Topics included in the chapter on community support systems are TBA training and retraining, integrating the TBA into the health care system, IEC, and community support mechanisms for the health of mothers and newborns. The last chapter revolves around evaluation and monitoring, including estimating catchment area and coverage, monitoring quality of care for mothers and newborns, performance indicators, record keeping, and home-based maternal records.
SAFE MOTHERHOOD NEWSLETTER. 1994 Jul-Oct; (15):10.Use of the partograph during labor can prevent suffering and loss of life. The partograph records the progress of labor, especially the rate of cervical dilatation. WHO's partograph differentiates between the latent phase of labor (slow dilatation up to 2 cm) and the active phase, during which the cervix dilates by at least 1 cm/hour to full dilatation. The partograph can detect abnormal progression of labor. Then clinicians can either augment labor by administering oxytocin or, in extreme cases of prolonged or obstructed labor, perform a cesarean section. Use of the WHO partograph in 8 hospitals in Indonesia, Thailand, and Malaysia reduced postpartum infections (by 59%), the number of stillbirths, the amount of oxytocin augmentation, and unnecessary cesarean sections. Thus, the WHO partograph was able to differentiate labors requiring intervention from those not requiring intervention. WHO calls for health personnel to use its partograph and its management protocol, both in labor wards with the capabilities to manage labor complications and in health centers without these capabilities which can refer women with labor complications to a specialist facility.
Surveillance of acquired immunodeficiency syndrome in Africa: an analysis of evaluations of the World Health Organization and other clinical definitions.
EPIDEMIOLOGIC REVIEWS. 1994; 16(2):403-17.In order to improve public health efforts to combat the HIV pandemic, a system for surveillance of HIV and AIDS is needed. Definitions used for case reporting are at the heart of such a system. In many parts of Africa, however, facilities for diagnosing HIV infection and its subsequent complications are unavailable, and the definition developed by the US Centers for Diseases Control and Prevention (CDC) for use in developed countries is often impractical in Africa. The World Health Organization (WHO) in early 1985 therefore proposed using a provisional case definition of AIDS based principally upon clinical criteria. Developing a clinical definition of AIDS in Africa, however, is also complicated. The nonspecific nature of many of the signs and symptoms of HIV infection as well as the clinical redundancy between HIV and other epidemic health problems make definitive identification of any single disease problematic. Evaluation of the surveillance definition of AIDS in Africa is complicated by the lack of an accepted standard for comparison. Most studies in the field have used HIV serology as the standard, while others have employed the CDC definition for AIDS, giving the evaluations a certain relativity. This paper reviews available information on the WHO definition and other clinical definitions for AIDS in Africa in order to analyze their various field evaluations and explore the use of such definitions in the African context. Sections discuss surveillance clinical case definitions for African AIDS in adult and pediatric populations, clinical case definitions of African AIDS in adult and pediatric populations, sensitivity and specificity, the WHO clinical case definition for HIV epidemiologic survey, clinical definitions for AIDS in clinical practice, and working toward the improvement of the clinical definition of AIDS.
TUBERCLE AND LUNG DISEASE. 1994 Jun; 75(3):163-7.Poor management of tuberculosis (TB) control is responsible for resistance to antituberculosis drugs. It leads to treatment failure, relapse, transmission of resistant TB, and multi-drug resistant TB. In developing countries, where resources are already limited, an epidemic of multi-drug resistant TB would jeopardize TB control. The effect of HIV infection is likely to worsen drug resistance-related problems. Specifically, streptomycin injections pose a risk of HIV transmission. It appears that withdrawal of thiacetazone from HIV infected TB patients causes resistance to more powerful drugs. If these 2 antibiotics cannot be used to treat TB patients, the armamentarium available to control TB in high HIV prevalence countries is reduced, which could foster resistance to the fewer remaining antibiotics. Good management and supervision is needed to prevent resistance to antituberculosis drugs. Surveillance of drug resistance is also needed to monitor the current level and characteristics of the drug resistance problem and to identify effective solutions. Specifically, at the national level, a TB surveillance system can assess the TB control program's performance and assess the need to modify the current treatment policy. It can identify districts or health centers with high levels of drug resistance and determine the risk factors for resistance. WHO will assist developing countries in developing their own surveillance systems. WHO and the International Union Against Tuberculosis and Lung Disease plan on setting up a network of supranational reference laboratories to determine the quality control and standardization of susceptibility testing needed for international comparison. WHO also plans on supporting national reference laboratories in developing countries.
Laboratory diagnosis of measles infection and monitoring of measles immunization: memorandum from a WHO meeting.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1994; 72(2):207-11.Measles infection remains a major global health problem. Although it may be easily confused with other conditions, the disease is frequently diagnosed in many countries on clinical grounds alone. A World Health Organization Consultation on Laboratory Diagnosis of Measles Infection and Monitoring of Measles Immunization was held in Glasgow August 7-8, 1993, to discuss ways to improve the situation. This brief summarizes the discussions and recommendations made by the participants. It is recommended that since only limited efforts have been made in recent years to develop tools for the diagnosis and surveillance of measles virus infection, focus should be given to techniques for the rapid diagnosis of measles using inexpensive techniques and technologies currently employed in other immunological and molecular diagnostic methods, with priority given to assay systems which determine parameters associated with current and recent infection; an international network of laboratories involved in the diagnosis and surveillance of measles should be established; and to evaluate next-generation diagnostic tools and establish criteria for their use, panels of serum samples should be established from individuals with a well-defined history of vaccination and/or wild-type measles virus infection. A bank of clinical specimens from monkeys experimentally infected or vaccinated with different measles viruses should also be established. Ongoing efforts will require a sound financial base. The proposed laboratory network is described, followed by sections on the laboratory diagnosis of measles in clinical materials, the direct detection of measles virus antigens in clinical specimens, and the detection of specific nucleic acids.
POPULI. 1995 Jan; 22(12):4-5.According to speakers from 45 countries, at a UN General Assembly debate (November 17-18), "a major mobilization of resources and effective monitoring of follow-up actions are needed" in order to implement the Programme of Action of the International Conference on Population and Development (ICPD). Algeria spoke for developing countries in the Group of 77 (G77) and China; commended the Programme's recognition of the key role played by population policies in development and its new approach that centered on people rather than numbers; called for concerted international mobilization to meet ICPD goals for maternal, infant, and child mortality, and access to education; and, since G77 had agreed at the Cairo Conference that developing countries should pay two-thirds of the implementation costs of the Programme, asked industrialized countries to provide the remaining third from new resources, rather than by diversion of existing development aid. It was reported that G77 is preparing a draft resolution which will address distribution of ICPD follow-up responsibilities. Germany spoke for the European Union; commended the shift of focus from demographics and population control to sustainable development, patterns of consumption, women's rights, and reproductive health; and suggested that the World Summit on Social Development and the Fourth World Conference on Women, which will be held in 1995, could carry on the Cairo agenda (a point underscored by Thailand). It was reported that several Western European countries had already pledged substantial increases in population assistance. Indonesia and South Korea addressed increasing South-South cooperation in population and development. Nigeria and the Holy See noted the emphasis on national sovereignty in regard to law, religion, and cultural values. Many called for a global conference on international migration. To ensure a common strategy for ICPD follow-up within the UN system, UN Secretary General Boutros Boutros-Ghali has asked UNFPA Executive Director Nafis Sadik to chair an inter-agency task force. All UN agencies and organizations have been asked to review how they will promote implementation of the Programme of Action.
Arlington, Virginia, Partnership for Child Health Care, 1995. , 10,  p. (BASICS Trip Report; BASICS Technical Directive: 000 HT 51 012; USAID Contract No. HRN-6006-C-00-3031-00)In March 1995, a BASICS (Basic Support for Institutionalizing Child Survival) Project technical officer participated in a World Health Organization (WHO) Global Programme on Vaccines and Immunization (GPV) meeting in Geneva, Switzerland, about introduction of vaccine vial monitors (VVMs). VVMs constitute color-coded labels that can be affixed to vials of vaccines which, when exposed to heat over time, change irreversibly. In 1994, WHO and UNICEF requested that, starting in January 1996, VVMs be affixed on all UNICEF-purchased vials of oral polio vaccine. Yet, UNICEF does not require vaccine manufacturers to include VVMs in their vaccine labels. USAID has supported much of the development and field testing of VVMs since 1987. Participants discussed status of interactions between UNICEF and vaccine manufacturers, issues and means related to introducing VVMs worldwide, and the prospect for conducting a study or studies on the initial effect of VVMs on vaccine-handling practices. They also heard an update on the pilot introduction of VVMs in some countries. BASICS could contribute to the development of a plan for global VVM introduction, since time constraints and heavy workloads face WHO/GPV leaders. UNICEF and GPV staff suggested that other VVM products from different manufacturers also be sold to avoid a monopoly. Participants considered issues of global introduction and resolution of issues with manufacturers of VVMs and vaccines to be high priority issues. WHO and UNICEF asked BASICS to draft general training materials for staff at the central, provincial, district, and periphery levels, focusing on actions that each level should take as a result of VVM use. They also asked BASICS to develop a quick-reference sheet for policy makers.
Manila, Philippines, WHO, Regional Office for the Western Pacific, 1994 Jun.  p.This document presents four configurations of tabulated socioeconomic and health data from the Regional Office for the Western Pacific of the World Health Organization. Part 1 considers each of the 35 countries in terms of the following indicators: area, population, annual population growth rate, age distribution, urban population, rate of annual natural increase of the population, crude birth rate, crude death rate, life expectancy at birth, infant mortality rate, total fertility rate, socioeconomic indicators for the year 2000, per capital gross national product (GNP) at market prices, rate of growth of per capita GNP, percentage gross domestic product derived from manufacturing industries at constant factor cost, economically active population in primary sector, daily per capita calorie supply, daily per capita protein supply, adult literacy rate, health budget/expenditure, health manpower, 10 leading causes of communicable diseases morbidity, 10 leading causes of death, cases and deaths from 18 selected diseases, proportion of infants fully immunized and pregnant women immunized against tetanus, percent of population served with safe water, percent of population with adequate sanitary facilities, percent of low birth weight infants, and maternal mortality rate. Part 2 presents these same data organized by country or area. Part 3 tabulates data on global and regional indicators used to monitor/evaluate the strategies for "health for all" by the year 2000. These indicators fall under the following headings: mortality trends, nutritional status of children, safe water and basic sanitation, maternal and child care (including family planning), immunization, treatment for common diseases, primary health care coverage, national health policies and strategies, community involvement, international support for health system development, financial resources, human resources for health, trends in education, and economic trends. Part 4 reorganizes these data according to country or area.
Planning meeting to discuss development of a health facility quality review, WHO / CDR and USAID / BASICS, Geneva, May 15-19, 1995.
Arlington, Virginia, Partnership for Child Health Care, 1995. , 9,  p. (BASICS Trip Report; BASICS Technical Directive: 000 HT 55 012; USAID Contract No. HRN-6006-C-00-3031-00)In May 1995, representatives of the World Health Organization Division of Diarrheal and Acute Respiratory Disease Control and of the US Agency for International Development's Basic Support for Institutionalizing Child Survival Project (BASICS) met in Geneva to discuss the first phase of the process of developing a methodology for collecting information on the quality of facility services in areas where integrated case management is being used. This monitoring and evaluation instrument is called Health Facility Quality Review: Case Management of Childhood Illness. The discussions revolved around the focus of activities, series of quality review activities, personnel, facilities, health workers observed and interviewed, indicators, pre-assessment for program planning, the process, materials, sampling, guidelines for developing forms, country adaptation, and format. A BASICS staff member has developed a pre-assessment tool for program planning scheduled to be used in Eritrea in June 1995. Content categories of the Health Facility Quality Review forms should include case observation, case examination, caretaker interview, health worker interview, review of records, review of facility space and furnishings, review of availability of facility equipment and supplies, review of drug supplies, review of vaccines available, review of other supplies, drug management, staffing, supervision, clinic organization, and interventions. BASICS will budget and make plans for the field test of the quality review during June-July 1995. It will oversee the pretest of forms probably in October 1995.
Arlington, Virginia, Partnership for Child Health Care, 1995.  p. (BASICS Trip Report; BASICS Technical Directive: 000 HT 51 012; USAID Contract No. HRN-6006-C-00-3031-00)A specialist of vaccine vial monitors (VVMs) assisted in developing the agenda for and participated in a meeting in Geneva designed to develop plans for introducing VVMs on oral polio vaccine (OPV). Representatives of the World Health Organization (WHO) Global Programme on Vaccines and Immunization (GPV), the US Agency for International Development (USAID), UNICEF, and Basic Support for Institutionalizing Child Support Project (BASICS)/ Program for Appropriate Technology in Health (PATH) participated in the discussions. The meeting served to update all agencies involved with OPV delivery about VVMs and to identify what actions are needed as well as the parties responsible for the global introduction of vaccines with VVMs. In the summer of 1995, Tanzania will be hosting a pilot project of introducing VVMs with OPVs. Other potential pilot sites include Swaziland and Vietnam. Discussion of pilot activities focused on their purpose, resources available for establishing and monitoring them, and the appropriate number of pilot countries. There were also discussions of a framework for global introduction of VVMs, potential costs associated with VVMs, the effect on vaccine forecasting, and training materials. There were sessions on the organization of the GPV, vaccine supply and quality, the view from Sudan and Indonesia, and human and financial resources. Meeting participants agreed on follow-up actions: continue to work with international OPV supplies, begin to approach national OPV producers to lay the groundwork for use beginning in 1996, limit pilot activities to 4-5 countries (1-2 countries only receiving a packet of information and no technical assistance), develop a package of introduction materials, and develop a briefing sheet on VVMs.
Experts and NGOs discuss the implementation of the Dakar / Ngor Declaration and the Cairo Programme of Action in Abidjan.
AFRICAN POPULATION NEWSLETTER. 1995 Jan-Jun; (67):1.An Experts and Nongovernmental Organizations (NGOs) Workshop on the implementation of the Dakar/Ngor Declaration (DND) and the Cairo Programme of Action (ICPD-PA) was organized in Abidjan, Ivory Coast, June 6-9, 1995 by the Joint ECA/OAU/ADB Secretariat with the financial support of the governments of France and the Netherlands, the United Nations Population Fund (UNFPA), the International Planned Parenthood Federation (IPPF), and the African Development Bank. Goals of the Workshop included the following: 1) to evolve a methodology for monitoring and evaluating the implementation of the DND and the ICPD-PA; 2) to define the role of the NGOs in the conceptualization, implementation, and monitoring of policies and programs derived from the DND and the ICPD-PA; 3) to create a network of major NGOs working in the area of population and development in the ECA region; and 4) to define IEC strategies to publicize the recommendations in the DND and the ICPD-PA. 26 experts, and representatives of 28 NGOs, several international and research institutions, UNFPA, and IPPF attended the Workshop. Sessions focused on the following themes: 1) Implementation of the Kilimanjaro Programme of Action at the regional level; 2) National experiences in the implementation of the DND and the ICPD-PA; 3) Framework of monitoring and evaluating the implementation of DND and the ICPD-PA; 4) African Population Commission and the implementation of DND and the ICPD-PA; 5) ADB experience in the field of population programs and projects; and 6) the role of NGOs in the implementation of the DND and the ICPD-PA. The recommendations of the Workshop, which will affect ECA member states, will be disseminated in the second half of 1995.
JOURNAL OF COMMUNICABLE DISEASES. 1994 Dec; 26(4):231-2.The World Health Organization (WHO) criteria for HIV clinical disease were tested among individuals with high-risk behavior in northern India. A questionnaire, based upon history and physical examination alone, standardized by the WHO to include both major and minor signs necessary for the clinical diagnosis of AIDS in adults was applied to 165 consecutive patients attending the STD clinic of Dr. R.M.L. Hospital, New Delhi. All patients were screened for the presence of STDs by the dermatologist in charge of the clinic, with patients fulfilling two major and at least two minor WHO criteria eventually classified as having clinical AIDS based upon the WHO case definition. Each of those patients was subjected to serological confirmation of the clinical suspicion using ELISA and Western blot commercial tests. Of the 165 patients screened, a definite diagnosis of STD was possible in 85. These patients were 20-45 years old (mean age, 30.59 years). All were male and chancroid was the most common STD in the cohort. Of the 85, only one satisfied the WHO clinical criteria for AIDS. Serological investigations, ELISA, and Western blot confirmed the subject's HIV-seropositive status. These results indicate that in northern India, clinical HIV disease remains rare even among individuals with high-risk behavior. The low prevalence of clinical HIV disease in that part of the country makes it difficult to assess the specificity and sensitivity of the WHO clinical criteria for AIDS.
In: The progress of nations 1995, compiled by UNICEF. New York, New York, UNICEF, 1995. 29.The main activity of the UN International Committee on the Rights of the Child is the examination of each nation's progress in protecting children. The Committee assumes that by ratifying the Convention a government has made a deliberate commitment, and it seeks to help governments live up to their commitments. The Committee meets with government officials and nongovernmental organizations, researches the health, nutrition, and educational status indicators, studies the internal disparities, and monitors national legislation, juvenile justice systems, and institutional arrangements. Many countries still use child labor, have child prostitution, fail to protect children during armed conflicts, and allow discrimination against girls. These conditions can not be tolerated on the basis of culture and tradition; they are violations of the internationally accepted Convention. The rights of the child include civil and political rights and the right to adequate nutrition, primary health care, and a basic education to "the maximum extent of available resources." Juvenile criminals must be separated from adults or be in violation of article 37. Article 2 stipulates the same minimum marriage age for boys and girls. A lower age for girls is discriminatory. The Committee recommends training courses, comparative study of another country's system, or reviews of national establishments, institutions, plans, legal systems, and policies. Working with governments may be slow and bureaucratic, but it effects internal change. Governments cooperate once they understand that the Committee is not interested in criticizing but in helping. The Committee must review policies from 174 countries, and the task is behind schedule. Staffing is inadequate with only 10 elected members working for three months each year. More support is needed for researching and publicizing issues. The Committee prepares reports on each nation's performance against a universal standard. These reports are useful tools in increasing public pressure, monitoring progress, and protesting violations. The first reports have been received and after a five year interval, progress will be assessed. The second reports are coming due soon. Universal implementation of the Convention is still a work in progress and in need of public support.
Arlington, Virginia, Population Technical Assistance Project [POPTECH], 1994 Dec. xix, 84,  p. (POPTECH Report No. 94-011-015; USAID Contract No. CCP-3024-Q-00-3012)The Tanzania Family Planning Services Support Project (FPSS) aims to improve the health and welfare of women and children by providing women and couples the opportunity to choose freely the number and spacing of children. FPSS was implemented in 1991. The three interrelated project outputs are expanded delivery of quality family planning services, enhanced Tanzanian institutional capacity, and development of an institutional base. USAID/Tanzania requested a midterm evaluation, which was conducted in December 1994. It supports FPSS by directly providing funds to the government and cooperating agencies who provide technical assistance to the National Family Planning Program and the private sector. Other significant donors to the family planning sector include UNFPA, IPPF, Overseas Development Assistance, and German Association for Technical Cooperation. During 1991-94 modern contraceptive prevalence increased from 7% to 16%. New acceptors increased 40-50%. Monthly resupply clients increased 23%. In mid-1994, 79% of women and 90% of men were familiar with at least one modern contraceptive method. The proportion of facilities providing injectables, IUDs, and vaginal foam increased more than two-fold. Almost all the facilities provided oral contraceptives and condoms. The number of first attendances for family planning services increased 46%. FPSS supported a wide variety of training (e.g., 6 types of training courses), but the needs for more training were stifled by lack of trainers and of supervisors, weak distribution of training documents, failure to institutionalize family planning into the medical and nursing schools, and lack of equipment and supplies. There were solid improvements in contraceptive logistics and availability, strengthening of the family planning unit within the Ministry of Health, and flexibility by USAID/Tanzania's management in addressing changing country needs. Based on the findings, the team developed 12 major recommendations (e.g., development of a national strategy to achieve a sustainable family planning program).
BOLD. 1992 Nov; 3(1):9-10.This is the keynote address of H.E.Dr. Vincent Tabone, President of Malta, at the International Conference on Aging, which was held in San Diego in September 1992. He states that the conference celebrates the tenth anniversary of the Vienna International Plan of Action, and provides an opportunity to evaluate progress and plan future direction. Dr. Tabone, as Minister of Foreign Affairs, first introduced the question of aging at the UN General Assembly over twenty years ago; the United Nations Secretariat established its first program in the field of aging in 1970. At the World Assembly on Aging in 1982, all members adopted the International Plan of Action, which defined guidelines for policies and programs in support of the aging populations. As a direct result of this, and in support of the needs of developing countries, the UN signed an agreement with the government of Malta that established the International Institute on Aging as an autonomous body under the auspices of the UN; it is the major expression of the Vienna Plan of Action. Concern for aging populations has developed enough maturity and momentum to oversee its own progress. Although current events may relegate the social and economic implications of the aged to the sphere of rhetoric, they demand thinking in terms of generations and transcend all political boundaries. This conference will evaluate progress toward deflecting a situation where the elderly constitute an increasing proportion of the population, without adequate and appropriate provision for their livelihood, and could have direct bearing on encouraging and ensuring the continuity of the family's vital and traditional role in preserving the dignity, status, and well-being of its aging members. A nation which begrudges its dues to the elderly, the successful products of society and triumphs of life, denies its past. This conference is a reaffirmation of commitment to the United Nations Principles for Older Persons, an omen of the review of the Global Targets on Aging for the year 2001 by the General Assembly at its forty-seventh session in October, and a stepping stone in the path toward integrating the elderly more fully into the mainstream of society. The year 1992 is a year for solidarity between the generations.
Progress towards health for all: third monitoring report. Progres vers la sante pour tous: troisieme rapport de suivi.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1995; 48(3-4):174-249.In 1977, the World Health Assembly designated the year 2000 as the time by which it should be possible for all citizens of the world to obtain a level of health that would permit them to be socially and economically productive. This document, which assesses implementation of health-for-all strategies during 1991-93, is the third report to monitor progress toward this goal. The report opens with an introduction describing the monitoring process and the data upon which the assessment was based. The second section of the report describes population and socioeconomic trends and considers such issues as patterns in population growth, longterm trends in births and deaths, social change, age structure, migration, urbanization, refugees and displaced persons, and trends in education. The third section discusses trends in the provision of a healthy environment and promotion of healthy life styles. Section 4 summarizes health status data on life expectancy, mortality rates, causes of death, morbidity trends, disability trends, and the nutritional status of children. Implementation of primary health care (PHC)is covered in the next section, which looks at health education and promotion, food supply and proper nutrition, safe water and basic sanitation, maternal and child care, control of locally endemic diseases, immunization, treatment of common diseases, and PHC coverage. The sixth section assesses the development of health systems based on PHC and looks at national health policies, strategies, and legislation; organization and management of health systems based on PHC, intersectoral collaboration, community involvement, health systems research, technology for PHC delivery, international support for health system development, sustainable development initiatives, and emergency preparedness and relief. Section 7 is devoted to health resources in the areas of financial activities, human resources, the physical infrastructure, and logistics and supplies. The concluding section of the report summarizes the status of 1) the major determinants of health, 2) the implementation of PHC and the development of health systems, and 3) the distribution of health resources. The next in-depth analysis of progress toward health-for-all is scheduled to begin in 1997.
QA Brief. 1996 Summer; 5(1):19-21.In November 1995, a World Bank mission went to Jordan to conduct a study of the health sector. The study recommended three strategies to reform the health sector: decentralization of Ministry of Health (MOH) management; improvement of clinical practices, quality of care, and consumer satisfaction; and adoption of treatment protocols and standards. The MOH chose quality assurance (QA) methods and quality management (QM) techniques to accomplish these reforms. The Monitoring and QA Directorate oversees QA applications within MOH. It also institutes and develops the capacity of local QA units in the 12 governorates. The QA units implement and monitor day-to-day QA activities. The QM approach encompasses quality principles: establish objectives; use a systematic approach; teach lessons learned and applicable research; use QA training to teach quality care, quality improvement, and patient satisfaction; educate health personnel about QM approaches; use assessment tools and interviews; measure the needs and expectations of local health providers and patients; ensure feedback on QA improvement projects; ensure valid and reliable data; monitor quality improvement efforts; standardize systemic data collection and outcomes; and establish and disseminate QA standards and performance improvement efforts. The Jordan QA Project has helped with the successful institutionalization of a QA system at both the central and local levels. The bylaws of the QA councils and committees require team participation in the decision-making process. Over the last two years, the M&QA Project has adopted 21 standards for nursing, maternal and child health care centers, pharmacies, and medications. The Balqa pilot project has developed 44 such protocols. Quality improvement (COUGH) studies have examined hyper-allergy, analysis of patient flow rate, redistribution of nurses, vaccine waste, and anemic pregnant women. There are a considerable number of on-going clinical and non-clinical COUGH studies. Four epidemiological studies are examining maternal mortality, causes of death, morbidity, and perinatal mortality.
HIV / AIDS workshop: community-based prevention and control strategies, Volume II. Khon Kaen, Thailand, November 15-26, 1993. Report.
Woking, England, Plan International, 1993. , 61 p.This report contains the proceedings of the portion of a 1993 HIV/AIDS workshop held in Thailand dealing with community-based prevention and control strategies. The report opens by identifying PLAN international's identity, vision, and mission. The next section reviews PLAN's policy on children directly or indirectly affected by HIV/AIDS. Section 3 brings perspectives from Burkina Faso, India, Kenya, Thailand, and Zimbabwe to the problem of home care, and section 4 applies perspectives from Indonesia, Kenya, the Philippines, Senegal, and Zimbabwe to the evaluation of health education interventions. Section 5 presents a commentary on planning, monitoring, and evaluating PLAN's AIDS programming, and section 6 summarizes a group discussion on possible future actions that PLAN should take. The seventh section of the report contains profiles of the HIV/AIDS situation in Burkina Faso, India, Indonesia, Kenya, the Philippines, Senegal, Thailand, and Zimbabwe. The report ends with a description of the collaboration between the Family AIDS Caring Trust and PLAN International in Zimbabwe.
Washington, D.C., Futures Group, Gender in Economic and Social Systems Project [GENESYS], 1994 Oct. , 48 p. (GENESYS Special Study No. 17; USAID Contract No. PDC-0100-Z-00-9044-00)In order to reveal essential lessons learned about the process undertaken by major bilateral and multilateral donor agencies to institutionalize gender awareness in their organizational structure and programs and to define the scope of the remaining work in this area, this paper compares strategies of major agencies and assesses the degree to which these strategies have allowed the agencies to meet stated objectives. The first main section of the paper provides background information on the following issues: 1) the importance of recognizing women's dual productive and reproductive roles and of the concept of mainstreaming in the development of policies and plans of action; 2) the key structures and processes that enhance capacity for institutionalizing gender, including a commitment to raising awareness, the presence of a Women in Development (WID) office and/or staff, and WID training and research; 3) the process of incorporating gender issues into country programs and project cycles; 4) involving women in all stages of development programming; and 5) strategies for the future. The second section of the paper analyzes the institutionalization of gender issues into the development process funded by the bilateral donors (Australia, Canada, Denmark, Japan, Norway, Sweden, the UK and the US). Each analysis includes a look at the content and scope of the country's policy and plan of action, at organizational commitment to raising awareness, at efforts to build a knowledge base, at how gender issues are incorporated into programs and project cycles, and at efforts to bring women into the process. The same framework is applied to the consideration of multilateral donors (the African Development Bank, the Asian Development Bank, the Inter-American Development Bank, the World Bank, and the UN Development Programme) contained in the final section of the paper.
MEMORIAS DO INSTITUTO OSWALDO CRUZ. 1996 May-Jun; 91(3):335-8.The World Health Organization (WHO) Global Program on AIDS (GPA) organized the WHO Network for HIV-1 Isolation and Characterization to monitor HIV-1 variability. Brazil is one of the HIV vaccine trial sites selected by WHO-GPA. HIV-1 subtypes B, F, and C have thus far been found in the country. A study involving 235 Brazilian isolates found subtype B to prevail in 88.5% of cases, subtype F in 8.9%, and subtype C in 1.7%. 2 samples (0.9%) were variants resulting from a recombination between subtypes B and F. Further studies have found that Brazilian HIV-1 strains have genetic and antigenic differences compared to North American/European prototype strains, potentially affecting the success of immunoprophylactic programs based upon HIV-1 vaccine candidates currently proposed for testing in Brazil. A Brazilian Network for HIV-1 Isolation and Characterization (BNHIC) was thus established in March 1993, as part of the National Program of HIV/AIDS Vaccine Development and Evaluation. The BNHIC was organized upon a 3-tier basis including primary site, central reference laboratory, and secondary laboratories. The authors discuss efforts made to achieve network goals in Brazil.
Impact of the 1994 expanded World Health Organization AIDS case definition on AIDS surveillance in university hospitals and tuberculosis centers in Cote d'Ivoire.
AIDS. 1997 Dec; 11(15):1867-72.To assess the impact of the 1994 expanded World Health Organization (WHO) AIDS case definition upon AIDS surveillance in Cote d'Ivoire, passive AIDS case surveillance was conducted from March 1994 through December 1996 at the 3 university hospitals in Abidjan, while active AIDS case surveillance was conducted at the 8 large tuberculosis (TB) centers throughout Cote d'Ivoire. Standardized questionnaires were administered and blood samples for HIV testing were collected from patients evaluated. 3658 of the 8648 hospital patients met the clinical and/or expanded case definition: 744 HIV-seropositive individuals met only the expanded definition, 44 HIV-seropositive individuals met only the clinical definition, 2334 HIV-seropositive individuals met both definitions, and 536 HIV-seronegative persons met only the clinical definition. Of 18,661 TB center patients, 9664 met the clinical and/or expanded case definition: 5685 HIV-seropositive individuals met only the expanded definition, none of the HIV-seropositive individuals met only the clinical definition, 2625 HIV-seropositive individuals met both definitions, and 1354 HIV-seronegative persons met only the clinical definition. The use of the 1994 expanded definition for surveillance purposes should be encouraged in areas of the developing world where HIV serologic testing is available.
PEOPLE. 1998 Feb; 7(1):8.With nearly 60% of the world's couples using modern contraception, reproductive health is now recognized as a human right. This is reflected in a 1997 UN report on reproductive rights and health that highlights the links among reproductive choice, gender equality, and sustainable development. The components of reproductive rights, including voluntary choice in marriage, in sexual relations, and in childbearing as well as the right to enjoy the highest attainable standards of sexual and reproductive health were agreed upon during the 1994 International Conference on Population and Development and the 1995 Fourth World Conference on Women. The UN report traces these understandings to the UN Charter, the Universal Declaration on Human Rights, and various international human rights treaties. Because these treaties obligate governments to protect individuals against violations of their reproductive rights and to ensure universal access to safe and affordable services, the UN system for monitoring treaty compliance offers an important way to support efforts to protect and promote reproductive rights.
INTERNATIONAL DIGEST OF HEALTH LEGISLATION. 1998; 49(1):265-82.The significance of human rights for the advancement of women's health and self-determination has gained recognition and momentum through recent UN conferences, with the program of action adopted by member states at the 1994 International Conference on Population and Development recognizing the importance of human rights in protecting and promoting reproductive health. The author discusses the application of human rights to protect and promote women's health. She surveys some of the decisions of regional and international courts which advance women's health, and describes monitoring mechanisms to hold governments and their agents accountable for violating women's rights to health protection and promotion. The author also suggests actions the World Health Organization could take with regard to women's health and human rights over the next 50 years.
International Family Planning Perspectives. 1999 Jan; 25 Suppl:S50-2, S55.When the 1994 International Conference on Population and Development adopted a reproductive health approach, it became necessary to develop and adopt new indicators of progress. While former program experience has been used to further this task, less attention has been paid to the underlying conceptual framework or to reconciliation of the goals of 1) developing a universal set of indicators and 2) responding to local conditions. The concept of reproductive health was developed through coalition-building but is nevertheless a cultural construct. Thus, challenges to the development of indicators include 1) defining reproductive health and its scope, 2) translating concepts into languages that have no equivalents, 3) incorporating a gender perspective in settings where even women may seek other goals before seeking empowerment, 4) setting appropriate priorities, and 5) resolving discrepancies between women's perceptions and expressions of needs and biomedical assessments of their health. It is useful, therefore, to consider reproductive health indicators as existing on an continuum with quantifiable measures on one end and new indicators on the other to measure socioeconomic conditions, changes in awareness, satisfaction or well-being, and empowerment. These latter measurements must be flexible enough to respond to specific cultural contexts. The very interdisciplinary nature of the current conceptualization of reproductive health will demand development of multidisciplinary interventions.