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Lancet. 1989 Jan 21; 1(8630):162.This letter was written in defense of a November 19, 1988 editorial discussing the Bamako Initiative. The writer, who works for UNICEF, has been working, with WHO, on the Initiative for the past year. In addition, he taught and practiced pediatrics in Ghana for 25 years. He claims the idea of "free" health services has undermined traditional African practice and confused the debate about fairness and community responsibility. UNICEF and WHO feel that increased community involvement and contribution to costs will strengthen Primary Health Care and maternal and child health systems. Acknowledged difficulties of the program, such as equity, management, foreign currency, and drug orientation are being addressed. Research and experience in community financing for health in Africa is felt to provide a solid basis for proceeding with the Bamako Initiative.
Arlington, Virginia, Partnership for Child Health Care, 1995. , 11,  p. (Trip Report; BASICS Technical Directive: 008-GU-01-015; USAID Contract No. HRN-6006-Q-08-3032)As part of a series of activities designed to reduce morbidity and mortality from acute respiratory infections in children under the age of 5 in Guatemala, a consultant from the BASICS (Basic Support for Institutionalizing Child Survival) program visited Guatemala in 1995 to analyze, modify, and field test the protocol developed by the USAID Mission to document the degree to which drugs prescribed for pneumonia are available in the community through the private sector. This field report provides background information and describes the current situation in Guatemala in terms of availability of drugs in the public sector through the Ministry of Health, the Drogueria Nacional, municipalities, and the Pan American Health Organization. Relevant activities in the private sector are also described, including the for-profit businesses as well as services provided by UNICEF, the European Union, and nongovernmental organizations. A brief overview of one health area gives an example of the current situation. The result of this consultancy visit was the determination that the situation merited adjustment of the originally requested study and that the survey as designed would likely require modification and application within target communities. Included among the appendices is the original protocol developed for assessing community drug availability.
New York, New York, UNICEF, 1992 Jun.  p.This compendium provides statistical profiles for 136 UNICEF countries on the status of children. Statistics pertain to basic population, infant and child mortality, and gross national product data; child survival and development; nutrition; health; education; demography; and economics. Official government sources are used whenever possible. The nine major sources include the UN Statistical Office, UNICEF, the UN Population Division, the Organization for Economic Cooperation and Development, the World Health Organization, the Food and Agriculture Organization of the UN, the World Bank, Demographic and Health Surveys, and UNESCO. Statistics rely on internationally standardized estimates, and whenever standardized estimates were unavailable, UNICEF field office data were used. Some statistics may be more reliable than others. Countries are divided into four groups for under-five mortality: very high (140 deaths per 1000 live births); high (71-140/1000); middle (21-70/1000); and low (20/1000 and under). The median value is the preferred figure, but the mean is used if the range in data is not extensive. Data are footnoted by definitions, sources, explanations of signs, and individual notation where figures are different from the general definition being used. Comprehensive and representative data are used where possible. Data should not be used to delineate small differences. Countries with very high child mortality include Afghanistan, Angola, Bangladesh, Benin, Bhutan, Bolivia, Burkina Faso, Burundi, Cambodia, Cameroon, Central African Republic, Chad, Comoros, Djibouti, Equatorial Guinea, Ethiopia, Gabon, Guinea, Guinea-Bissau, India, Laos, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Nepal, Niger, Nigeria, Pakistan, Rwanda, Senegal, Sierra Leone, Somalia, Sudan, Swaziland, Tanzania, Togo, Uganda, and Yemen.
Management of severely ill children at first-level health facilities in sub-Saharan Africa when referral is difficult. [La prise en charge au niveau des installations sanitaires de premier niveau des enfants gravement malades, en Afrique sub-saharienne, en cas de difficulté d'orientation vers d'autres structures]
Bulletin of the World Health Organization. 2003 Jul; 81(7):522-531.Objectives: To quantify the main reasons for referral of infants and children from first-level health facilities to referral hospitals in sub- Saharan Africa and to determine what further supplies, equipment, and legal empowerment might be needed to manage such children when referral is difficult. Methods: In an observational study at first-level health facilities in Uganda, the United Republic of Tanzania, and Niger, over 3–5 months, we prospectively documented the diagnoses and severity of diseases in children using the standardized Integrated Management of Childhood Illness (IMCI) guidelines. We reviewed the facilities for supplies and equipment and examined the legal constraints of health personnel working at these facilities. Findings: We studied 7195 children aged 2–59 months, of whom 691 (9.6%) were classified under a severe IMCI classification that required urgent referral to a hospital. Overall, 226 children had general danger signs, 292 had severe pneumonia or very severe disease, 104 were severely dehydrated, 31 had severe persistent diarrhoea, 207 were severely malnourished, and 98 had severe anaemia. Considerably more ill were 415 young infants aged one week to two months: nearly three-quarters of these required referral. Legal constraints and a lack of simple equipment (suction pumps, nebulizers, and oxygen concentrators) and supplies (nasogastric tubes and 50% glucose) could prevent health workers from dealing more appropriately with sick children when referral was not possible. Conclusion: When referral is difficult or impossible, some additional supplies and equipment, as well as provision of simple guidelines, may improve management of seriously ill infants and children. (author's)
Fees-for-services, cost recovery, and equity in a district of Burkina Faso operating the Bamako Initiative. [Prestation de services, couverture des coûts et équité dans une région au Burkina-Faso exploitant l'Initiative de Bamako]
Bulletin of the World Health Organization. 2003 Jul; 81(7):532-538.Objective: To gauge the effects of operating the Bamako Initiative in Kongoussi district, Burkina Faso. Methods: Qualitative and quasi-experimental quantitative methodologies were used. Findings: Following the introduction of fees-for-services in July 1997, the number of consultations for curative care fell over a period of three years by an average of 15.4% at ‘‘case’’ health centres but increased by 30.5% at ‘‘control’’ health centres. Moreover, although the operational results for essential drugs depots were not known, expenditure increased on average 2.7 times more than income and did not keep pace with the decline in the utilization of services. Persons in charge of the management committees had difficulties in releasing funds to ensure access to care for the poor. Conclusion: The introduction of fees-for-services had an adverse effect on service utilization. The study district is in a position to bear the financial cost of taking care of the poor and the community is able to identify such people. Incentivesmust be introduced by the state and be swiftly applied so that the communities agree to a more equitable system and thereby allow access to care for those excluded from services because they are unable to pay. (author's)
Lancet. 2003 Jul 19; 362(9379):233-241.Gaps in child mortality between rich and poor countries are unacceptably wide and in some areas are becoming wider, as are the gaps between wealthy and poor children within most countries. Poor children are more likely than their better-off peers to be exposed to health risks, and they have less resistance to disease because of undernutrition and other hazards typical in poor communities. These inequities are compounded by reduced access to preventive and curative interventions. Even public subsidies for health frequently benefit rich people more than poor people. Experience and evidence about how to reach poor populations are growing, albeit largely through small-scale case studies. Successful approaches include those that improve geographic access to health interventions in poor communities, subsidised health care and health inputs, and social marketing. Targeting of health interventions to poor people and ensuring universal coverage are promising approaches for improvement of equity, but both have limitations that necessitate planning for child survival and effective delivery at national level and below. Regular monitoring of inequities and use of the resulting information for education, advocacy, and increased accountability among the general public and decision makers is urgently needed, but will not be sufficient. Equity must be a priority in the design of child survival interventions and delivery strategies, and mechanisms to ensure accountability at national and international levels must be developed. (author's)
Geneva, Switzerland, WHO, 2003.  p. (WHO/HIV/2003.21)The AMDS is a mechanism created to expand access to quality, effective treatment for HIV/AIDS by facilitating the increased supply of antiretrovirals (ARVs) and diagnostics in developing countries. The AMDS is the access and supply arm of UNAIDS/WHO 3 by 5 initiative, which aims to multiply eight-fold the number of people in poor countries receiving antiretroviral therapy by 2005. The AMDS builds on years of work by UNAIDS, WHO, UNICEF, the World Bank, and the global health community, as well as on some more recent initiatives, such as that by the Global Fund for AIDS, TB and Malaria, to address the AIDS treatment gap in developing countries. It brings together stakeholders and partners, pooling their capacities, in order to maximize impact towards meeting the 3 by 5 goal as rapidly as possible. The AMDS will be one of a trio of mechanisms, with secretariats housed at WHO, to improve access to treatment for HIV/AIDS, TB and malaria. (excerpt)
The role of the health sector in supporting adolescent health and development. Materials prepared for the technical briefing at the World Health Assembly, 22 May 2003.
Geneva, Switzerland, World Health Organization [WHO], 2003. 15 p.I am very pleased to be here, and to be part of the discussion on Young Peoples Health at the World Health Assembly, for two reasons: because of the work we have been doing in adolescent health over the past years together with the Member States of the European Region of WHO, the work in cooperation with other UN agencies, especially UNICEF, UNFPA, and UNAIDS on adolescent health and development. Secondly, because Youth is a priority area of work of German Development Cooperation, and of the German Agency for Technical Cooperation, where I am working presently. Indeed, we have devoted this years GTZ´s open house day on development cooperation to youth I would also like to take this opportunity to remember the work of the late Dr. Herbert Friedman, former Chief of Adolescent Health in WHO, whose vision of the importance of working for and with young people has inspired many of the national plans and initiatives which we will hear about today. In many countries of the world, young people form the majority of populations, and yet their needs are being insufficiently met through existing health and social services. The health of young people was long denied the public, and public health attention it deserves. Adolescence is a driving force of personal, but also social development, as young people gradually discover, and question and challenge the adult world they are growing into. (excerpt)
Reaching communities for child health and nutrition: a proposed implementation framework for HH/C IMCI.
Arlington, Virginia, Partnership for Child Health Care, Basic Support for Institutionalizing Child Survival [BASICS], 2001.  p. (USAID Contract No. HRN-C-00-99-00007-00; USAID Contract No. FAO-A-00-98-00030-00)The Household and Community component of IMCI (Integrated Management of Childhood Illness) was officially launched as an essential component of the IMCI strategy at the First IMCI Global Review and Coordination Meeting in September 1997. Participants recognized that improving the quality of care at health facilities would not by itself be effective in realizing significant reductions in childhood mortality and morbidity because numerous caretakers do not seek care at facilities. Since that first meeting, several efforts were undertaken to strengthen interagency collaboration for promoting and implementing community approaches to child health and nutrition. (excerpt)
Accelerating Access Initiative. Widening access to care and support for people living with HIV / AIDS. Progress report, June 2002.
Geneva, Switzerland, World Health Organization [WHO], 2002.  p.The World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) estimate that in 2001 about 3 million people died from AIDS, with the vast majority of these deaths occurring in developing countries. While the availability of antiretroviral (ARV) therapy has significantly reduced AIDS morbidity and mortality in the industrialized world, in developing countries, where 95% of HIVpositive people live, the overwhelming majority of HIV-positive people do not have access to these life-sustaining medications. WHO conservatively estimates that in 2002, around 6 million people in developing countries are in need of ARV therapy. Yet only about 230,000 people living with HIV in those countries have such access today. Half of these live in one country, Brazil. Access to medicines is dependent on their rational selection and use, the availability of financial resources, the strength of the health infrastructure and their affordability. As the high cost of medicines is a major factor limiting access to ARVs in developing countries, in May 2000 five UN organizations (the United Nations Population Fund [UNFPA], United Nations Children’s Fund [UNICEF], World Health Organization [WHO], World Bank and UNAIDS Secretariat) entered into a partnership offered by five pharmaceutical companies (Boehringer Ingelheim GmbH; Bristol-Myers Squibb; GlaxoSmithKline; Merck & Co., Inc.; and F. Hoffmann-La Roche Ltd. – later joined by Abbott Laboratories) to address the lack of affordability of HIV medicines and to work together to increase access to HIV/AIDS care and treatment in developing countries. (excerpt)
Journal of the Association of Nurses in AIDS Care. 2005 May-Jun; 16(3):41-51.Children in Southern Africa are living under extreme, difficult circumstances because of the spread of HIV/AIDS. Protecting and enhancing the rights of children can be regarded as an investment in the future. The principles identified in the World Fit for Children document from the United Nations International Children’s Emergency Fund, within the context of HIV/AIDS, were used as a theoretical framework for a study conducted in one of the provinces of South Africa. A survey was conducted as a collaborative research project to map out critical trends regarding the fulfillment of children’s rights, patterns, and structures of services available and the identification of capacity gaps. Right holders and duty bearers were interviewed, area surveys were conducted, and field observations were performed to determine data. Recommendations were made to raise the awareness of children’s rights and to mobilize the community into action. To realize children’s rights, emphasis must be placed on physical survival, development, and protection. Duty bearers should recognize and accept their responsibilities to establish, facilitate, manage, and/or control plans of action to address the devastating consequences of HIV/AIDS. Children should be empowered with knowledge, skills, and awareness to engage in and claim their rights. (author's)
UN Chronicle. 1989 Sep; 26(3): p..Promoting a better and healthier life for children, after ensuring their survival, will increasingly occupy the agenda of the United Nations Children's Fund (UNICEF) in the 1990s. The pursuit of primary health care systems, safe motherhood activities, birth spacing, better water supply and sanitation, and basic education, particularly for women and girls, will be UNICEF priorities through the end of the century. At its 1989 session the UNICEF Executive Board asked the Fund to formulate a global strategy through the last decade of the century to promote the well-being of children. (excerpt)
Quality maternal and newborn care to ensure a healthy start for every newborn in the World Health Organization Western Pacific Region.
BJOG: An International Journal of Obstetrics and Gynaecology. 2014 Sep; 121 Suppl 4:154-9.In the World Health Organization Western Pacific Region, the high rates of births attended by skilled health personnel (SHP) do not equal access to quality maternal or newborn care. 'A healthy start for every newborn' for 23 million annual births in the region means that SHP and newborn care providers give quality intrapartum, postpartum and newborn care. WHO and the UNICEF Regional Action Plan for Healthy Newborn Infants provide a platform for countries to scale-up Early Essential Newborn Care (EENC). The plan emphasises the creation of an enabling environment for the practice of EENC; thereby, preventing 50,000 newborn deaths annually. (c) 2014 Royal College of Obstetricians and Gynaecologists.
New York, New York, UNICEF, Program Division, Health Section, Knowledge Management and Implementation Research Unit, 2014 Jul.  p. (Maternal, Newborn and Child Health Working Paper)In addition to a comprehensive literature review, the study used a cross-sectional survey with close- and open-ended questions administered to UNICEF Country Offices and public sector key informants to investigate and map CHW characteristics and activities throughout the region. Responses were received from 20 of the 21 UNICEF Country Offices in the UNICEF East and Southern Africa region in May-June 20013. Data on 37 cadres from across the 20 countries made up of nearly 266,000 CHWs form the basis of this report. This report catalogues the types and characteristics of CHWs, their relationship to the broader health system, the health services they provide and geographic coverage of their work.
[New York, New York], UNICEF, 2017 May. 20 p.As part of a series highlighting the challenges faced by children in current crisis situations, this UNICEF Child Alert examines the impact of the reforms, economic growth and national reconciliation process in Myanmar. It also looks at the investments in children’s health, education and protection that Myanmar is making, and shows how children in remote, conflict-affected parts of the country have yet to benefit from them.