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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.
PAEDIATRIC AND PERINATAL EPIDEMIOLOGY.. 1998 Oct; 12 Suppl 2:156-64.The Data and Safety Monitoring Committee (DSMC) of the World Health Organization (WHO) Antenatal Care Randomized Controlled Trial is charged with reviewing logistics, protocol compliance, efficacy data, ethical concerns, and safety-related indications for stopping the trial. The committee is comprised of an obstetrician, an epidemiologist, and a biostatistician. The DSMC reviews monthly statistics from the 53 study sites in Argentina, Cuba, Thailand, and Saudi Arabia on maternal deaths, fetal deaths, and eclampsia as well as quarterly data on perinatal deaths. It was agreed that the DSMC should take action if an increase of more than 25% in the intervention group (a new prenatal care regimen) compared with the control group (standard prenatal care) occurred in either of the primary outcomes: low birth weight or maternal morbidity index. It was further decided that the DSMC should be independent from the steering committee, with free access to unblinded interim data on the two arms of the trial. The DSMC chose not to establish any definite stopping rules before study initiation. There was initial concern about an excess of maternal deaths in the experimental arm of the study. The first four maternal deaths occurred in the intervention group, but a review of case history details reassured the DSMC that adherence to the new prenatal care regimen was not to blame. Similarly, an initial preponderance of fetal deaths in one arm turned out, when investigated, to reflect differential timing of reporting early pregnancy events rather than real outcome differences.
Challenges for communicable disease surveillance and control in southern Iraq, April-June 2003. Letter from Basrah.
JAMA. 2003 Aug 6; 290(5):654-658.The recent war in Iraq presents significant challenges for the surveillance and control of communicable diseases. In early April 2003, the World Health Organization (WHO) sent a team of public health experts to Kuwait and a base was established in the southern Iraqi governorate of Basrah on May 3. We present the lessons learned from the communicable disease surveillance and control program implemented in the Basrah governorate in Iraq (population of 1.9 million) in April and May 2003, and we report communicable disease surveillance data through June 2003. Following the war, communicable disease control programs were disrupted, access to safe water was reduced, and public health facilities were looted. Rapid health assessments were carried out in health centers and hospitals to identify priorities for action. A Health Sector Coordination Group was organized with local and international health partners, and an early warning surveillance system for communicable disease was set up. In the first week of May 2003, physicians in hospitals in Basrah suspected cholera cases and WHO formed a cholera control committee. As of June 29, 2003, Iraqi hospital laboratories have con firmed 94 cases of cholera from 7 of the 8 districts of the Basrah governorate. To prevent the transmission of major communicable diseases, restoring basic public health and water/sanitation services is currently a top priority in Iraq. Lack of security continues to be a barrier for effective public health surveillance and response in Iraq. (author's)
Population 2005. 2003 Dec; 5(4):9.A survey conducted by the United Nations Population Fund (UNFPA), in collaboration with the International Center for Migration and Health, has tracked startling statistics regarding the health system in Iraq. According to UNFPA, the number of women who die from pregnancy and childbirth in Iraq has close to tripled since 1990. Among the causes of the reported 310 deaths per 100,000 live births in 2002 are bleeding, ectopic pregnancies and prolonged labor. In addition, stress and exposure to chemical contaminants are also partly to blame for the rise in miscarriages among Iraqi women. Access to medical facilities is becoming more difficult for women due to breakdowns in security and weakened communication and transport systems. This has caused nearly 65 per cent of Iraqi women to give birth at home, the majority without skilled help. (excerpt)
WHO Collaborating Centre for Acquired Immunodeficiency Syndrome for the Eastern Mediterranean Regional Office, Faculty of Medicine, Kuwait University, Kuwait.
Medical Principles and Practice. 2014; 23 Suppl 1:47-51.In the early 1980s, the World Health Organization (WHO) designated the Virology Unit of the Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait, a collaborating centre for AIDS for the Eastern Mediterranean Regional Office (EMRO), recognizing it to be in compliance with WHO guidelines. In this centre, research integral to the efforts of WHO to combat AIDS is conducted. In addition to annual workshops and symposia, the centre is constantly updating and renewing its facilities and capabilities in keeping with current and latest advances in virology. As an example of the activities of the centre, the HIV-1 RNA viral load in plasma samples of HIV-1 patients is determined by real-time PCR using the AmpliPrep TaqMan HIV-1 test v2.0. HIV-1 drug resistance is determined by sequencing the reverse transcriptase and protease regions on the HIV-1 pol gene, using the TRUGENE HIV-1 Genotyping Assay on the OpenGene(R) DNA Sequencing System. HIV-1 subtypes are determined by sequencing the reverse transcriptase and protease regions on the HIV-1 pol gene using the genotyping assays described above. A fundamental program of Kuwait's WHO AIDS collaboration centre is the national project on the surveillance of drug resistance in human deficiency virus in Kuwait, which illustrates how the centre and its activities in Kuwait can serve the EMRO region of WHO. (c) 2014 S. Karger AG, Basel.
Characterizing the HIV/AIDS epidemic in the Middle East and North Africa: time for strategic action.
Washington, D.C., World Bank, 2010.  p. (World Bank Report No. 54889)This study is a continuation of the previous sector review, conducted in 2004. The 2008 review had two main objectives. This review is primarily an update on the situation. In its development strategy, Benin gave considerable importance to the health of its population. This effort is part of the long-term vision of the country. Improving health status, especially for the poor, is one of eight strategic directions for that vision. Similarly, on a more operational level, this objective is reflected in the current Growth Strategy for Poverty Reduction (GPRS 2007-2009). Benin is particularly committed towards the Millennium Development Goals, including 3 on the health sector. This review was also an opportunity to further analyze the constraints in the health system, consistent with the new strategy Health Nutrition and Population World Bank, Strategy adopted in 2007. But this exercise was not intended merely to be analytical. It also aimed to enrich the political dialogue between, on one hand, the actors in health and, secondly, the World Bank and other development partners. This effort relates more specifically to some themes such as governance, private sector involvement and alignment of partners' efforts (called technical and financial partners in Benin or PTFs). From this perspective, the journal is also a contribution to Benin's efforts to advance the IHP (International Health Partnership Plus). This initiative is now the main tool for implementing the Paris Declaration. In practice, the journal has sought to contribute to the consensus between the Ministry of Health and the donor group on the diagnosis of the health system and the changes needed to strengthen it. Several guidelines have emerged stronger from this discussion, particularly in the area of governance of the health system. Beyond the reinforcement of the various components of the health system, two fundamental principles should guide the transformation of this system: 1) A principle of corporate governance: through decentralization of the health system, health facilities must have their basic needs better taken into account (hence the need for bottom-up planning) and especially as more independent financially administrative; and 2) A principle of individual governance: health workers should be strongly encouraged to improve their performance (competence, productivity and compliance of patients). Given the limited success of measures to strengthen inspections and other controls "top-down, this incentive can only come from clients, either directly (i.e., bonuses based on cost recovery), or preferably indirectly with a mechanism for payment by results funded by the state and possibly partners.