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In: Shain RN, Pauerstein CJ, eds. Fertility control: biologic and behavioral aspects. Hagerstown, Maryland, Harper and Row, 1980. 299-312.The results of recent cross-cultural contraceptive acceptability studies conducted by WHO and by other investigators were briefly reviewed. The studies demonstrate that contraceptive acceptability is influenced by cultural and personal beliefs and attitudes. WHO multinational studies undertaken to examine the acceptability of hypothetical contraceptives revealed 1) males are willing to use contraceptives but would prefer using a form of oral contraceptive which could be self-administered, which would not reduce sexual desire, and which would be reversible; 2) females in many countries would be unreceptive to a contraceptive which produced amenorrhea; and 3) women in a number of countries indicated that the route of administration was not a major determinant of contraceptive acceptability. In conection with clinical trials, WHO conducted acceptability studies of daily pills and monthly injectables for males and of depot-medroxyprogesterone acetate or norethisterone oenanthate injectables and prostaglandin vaginal suppositories for women. WHO conducted contraceptive preferences studies in free choice situations among women in India, Korea, Philippines, and Turkey. Results indicated that preferences varied by clinics within countries and that education was highly correlated with choice. WHO also conducted discontinuation studies in Bangkok, Santiago, and Mexico City and studies of the acceptability of indigenous antifertility agents in Egypt and Malaysia. Other investigators have assessed the acceptability of specific attributes and side effects, such as the gender of the user, routes of administration, duration of effectiveness, color, reversitility and found that acceptabilty varied cross-culturally. Several investigators examined the acceptability of a number of service delivery attributes such as waiting time, privacy during clinics visits, and convenience.
Washington, D.C., PAHO, Pan American Sanitary Bureau/Regional Office of the World Health Organization, 1985. xix, 265 p. (Official Document No. 201)Efforts to meet the goal of health for all by the year 2000 have been hampered by the internal and external problems faced by many countries of the Americas. The pressures of external debt have been accompanied by a reduction in the resources allocated to social sector programs, including health programs. In addition, the conflict in Central America has constrained solutions to subregional problems. The health sector suffers from uncoordinated services, lack of trained personnel, and waste. Thus 30-40% of the population do not have access to basic health services. In 1984, the governments in the region, together with the Pan American Health Organization (PAHO), undertook projects in 5 action areas: new approaches and technology, development, intra- and intersectoral linkages, joint activities by groups of countries, mobilization of national resources and external financing, and preparation of PAHO to meet the needs of these processes. New approaches include the expansion of epidemiological capabilities and practices, the use of low-cost infant survival strategies, the improvement of rural water supplies, and the development of domestic technology. Interorganizational linkages are aimed at eliminating duplication and filling in gaps. Ministers of health and directors of social security programs are working together to rationalize the health sector and extend coverage of services. Similarly, countries have grouped to deal with common problems and offer coordinated solutions. The mobilization of national resources involves shifting resources into the health field and increasing their efficiency and effectiveness by setting priorities. External resources are recommended if they supplement national efforts and are short-term in nature. In order to enhance these strategies, PAHO has increased the managerial and operating capacity of its central and field offices. This has required consolidating programs, retraining staff, and instituting information systems to monitor activities and budgets. The report summarizes health indicators and activities by country, for all nations under PAHO.
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.
VACCINE. 1988 Oct; 6(5):393-8.In developing countries, where economic development is lacking and literacy rates are low, priority must be given to primary health care and to the establishmend of sustainable health care delivery systems. The World Health Organization's Expanded Program of Immunization was designed with the goal of immunizing all children against measles, pertussis, tetanus, poliomyelitis, tuberculosis, and diphtheria by 1990. A second function of the immunization program is to establish a health care delivery system. Today 50% of infants receive 3 doses of diptheria/pertussis/tetanus and polio vaccines, and 70% receive at least 1 dose. Measles kills 2 million children every year. The standard strain of attenuated vaccine is given at 9 months, and 1 dose protects 95% of children for life. Tetanus kills 800,000 infants every year. The vaccine must be refrigerated, and 2 doses are essential. Tuberculosis kills 2 million children under 5 every year. The attenuated BCG vaccine should be given at birth, and a single dose confers some protection. Diphtheria is most common among poor, urban children in termperate climates, and 3 doses of toxoid at monthly intervals are recommended. Poliomyelitis paralyzes 250,000 children a year. 4 doses of live attenuated Sabin vaccine are recommended. The vaccine is very sensitive to heat. Other vaccines in use or being developed include yellow fever, meningococcus, Japanese B encephalitis, rubella, hepatitis B, cholera, rotavirus, pneumonococcus, and Haemophilus influezae. 2 problems that confront the delivery of health services, including immunization, are lack of funds and lack of access to susceptible populations. Approaches to the lack of funds problem include fee for service, taxation, beter management of existing resources, reallocation of health resources, and increased funding from donor nations. Approaches to the problem of access include vaccination whenever children come into contact with a health facility for any reason, channeling by members of the community, involvement of traditional healers and birth attendants, outreach services, mass campaigns, pulse technics, and financial incentives.
WORLD HEALTH. 1989 Nov; 14-5.Diarrheal diseases continue to be the major causes of death for children in 4 Western Pacific Region nations: the Lao People's Democratic Republic, Papua New Guinea, the Philippines, and Viet Nam. They are also among the most frequent childhood illnesses in 18 of 35 countries and areas of the region. Many children die because physicians, health workers, and mothers do not know that oral rehydration therapy (ORT) is the single most effective treatment for diarrhea. All too often, older or hospital based physicians prescribe antidiarrheal drugs or antibiotics. ORT can successfully treat 90-95% of acute diarrheal cases. The oral rehydration salts (salt, glucose, sodium bicarbonate, and potassium chloride) are mixed with potable water so the child with diarrhea can drink it. The mixture replaces the water and salts removed from the body during diarrheal episodes. The 1st Diarrhoeal Training Unit (DTU) of the WHO Global Diarrhoeal Diseases Control programme in the region was found in Manila, the Philippines in December 1985. Its purpose continues to be the provision of hands-on training for health professionals in hospitals to convince them that ORT is effective. In 1988, 12 DTUs existed in such countries as China, the Lao People's Democratic Republic, Papua New Guinea, the Philippines, and Viet Nam. They will soon also operate out of medical, nursing, and midwifery schools. Even though 60% of the population in the Western Pacific Region has access to ORT packets, too many mothers still do no use them to treat their children with diarrhea. Further, they do not know that they should continue to feed them. In 1988 in the region, an estimated 50,000 children lived who would have died without ORT.
In: Health care of women and children in developing countries, [edited by] Helen M. Wallace, Kanti Giri. Oakland, California, Third Party Publishing, 1990. 85-95.Primary health care (PHC) taken alone is not enough to significantly reduce the death and suffering currently experienced by 3rd world nations. There are a variety of other factors such as severe poverty, lack of education, contaminated environments, social fragmentation, and political instability that prevent people from leading healthy and productive lives. The purpose of this chapter is to make some brief observations about the nature of health problems of mother and children in developing countries and use some of these problems as models for discussing broader issues, followed by an examination of some approaches to the design, management, and evaluation of PHC systems. The discussion includes social, economic, and political factors that determine health outcomes. It is clear from the available data that recurrent health problems exist for mothers and children in the 3rd world. The primary causes of ill health and death for children are malnutrition, immunizable diseases, diarrheal diseases, and acute respiratory infection. The primary cause of ill health and death for mothers are associated with pregnancy and child birth. In order to achieve health care for everyone, the World Health Organization follows 5 essential rules; universal coverage with care based on need or risk; effective, affordable, accessible, culturally acceptable care; promotive, preventive, curative, rehabilitative; community participation that promote self-reliance; and interaction with other sectors of development.
SCIENCE. 1991 Mar 15; 251:1312-3.AIDS scientists met in February 1991 to discuss international trials of AIDS vaccines because of the urgency in conducting such trials since the US Food and Drug Administration approved 6 vaccines for trails. Major problems discussed were how to insure access to potential AIDS vaccines to developing countries, where to conduct future tests of vaccine efficacy, and which of the leading institutions should coordinate such an effort. The most difficult issue centered around who assumes the risks and who benefits. Many researchers considered conducting AIDS vaccine trials in developing countries since they have a large population varied in age and gender at high risk of HIV infection. Assuming an HIV vaccine is effective, additional questions must be addressed: How can a developing country afford a vaccine at free market prices? If that country does get the vaccine should not other developing countries also get it? Who will pay for it and distribute it? WHO has already contacted ministries of health about AIDS trials. Other organizations, e.g., the US Centers for Disease Control and the US National Institutes of Health, also already involved in international AIDS vaccine research do not want to be kept out of the Phase III trials. Some recommended that WHO be the international umbrella, others suggested that no organization control all the research. Nevertheless the vaccine will be produced in a rich country, and if left to the free market, it will be too expensive. 1 suggestions is a 2-tiered pricing plan in which rich countries pay higher prices thereby subsidizing the price in poor countries. Another is a patent exchange where the vaccine developers donate the vaccine patent to an international organization and they in turn can get an extension on an existing patent. Another alternative includes removing AIDS vaccines from the private sector altogether.
[Unpublished] 1988 Oct 14.  p.This concept paper discusses an initiative planned for 1989-91 to redirect family planning (FP) program efforts so that vasectomy increasingly becomes of a method choice. The availability and acceptance of vasectomy is considerably less than for female sterilization. It is thought that the reason for the decline in numbers of vasectomy may be unfamiliarity with the method and lack of knowledge on the part of doctors of the best methods to use when performing vasectomies. Internationally, there has been concern about increasing the role of the male in FP. New developments such as increased vasectomy use in Africa and other unlikely countries suggest that this is an appropriate time to begin this initiative. The Chinese "no scalpel technique" has been recognized as having distinct advantages over other techniques. The WHO has produced a program and technical guide on vasectomy services for FP program managers. The objectives are 1) to introduce the Chinese method systematically through training activities; with the cooperation of the Chinese; 2) to set up demonstration projects in vasectomy services in several countries where vasectomy is not available; 3) to develop and conduct operations research projects on the best way of introducing vasectomy services; 4) to encourage clinical research on factors affecting safety, effectiveness, and satisfaction; 5) to promote dialogue on vasectomy at country and regional and international levels; and 6) to encourage donor agencies to become involved in the effort. The plan for action is to be implemented in 3 stages during a period of 3 years and is directed toward solving unanswered questions, which will be generated during an idea generation period. The approach will be multidisciplinary and will involve service and training programs, social science research, and clinical research. Other agencies must be involved. An international symposium will occur at the end of the period to relate and synthesize the experiences of the preceding 3 years. Phase I will generate ideas at, for instance, the World Fertility Rio meeting. Phase II will involve implementation, and phase III the analysis and synthesis of the experiences.
[Indications and contraindications of contraception: a new approach] Indications et contre-indications de la contraception: nouvelle approche.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1995; 73(2):269-70.In March 1994, WHO hosted a Meeting on Improving Access to Quality Care in Family Planning in Geneva, Switzerland. Participants reviewed the most recent scientific data on indications and contraindications among new acceptors of combined oral contraceptives, progestin-only pills, progestogen injectables (Depo-Provera), contraceptive implants (Norplant), and copper releasing IUDs. They proposed a new classification system to help family planning providers and new acceptors decide on a contraceptive method. It is based on an evaluation of the risks and benefits associated with the condition or current characteristics of the woman. The approach is comparable to that used to regulate traffic. The association between a condition or particular characteristics allows the placement of a given method in one of the following categories: no restriction of use (green light); advantages generally exceed the risks (orange light); the risks usually exceed the benefits and the method must not be used, except in the case where more appropriate methods are neither available nor acceptable (flashing red light); and the method must not be used at all (red light). Community-based distribution programs or health agents providing family planning services can distribute contraceptives fitting into the first two categories. Work has begun on contraceptive methods not considered at the March 1994 meeting. The recommendations from the March 1994 meeting can be ordered from the Family Health Division, WHO, 1211 Geneva 27, Switzerland.
Geneva, Switzerland, WHO, 1994. viii, 143 p.This World Health Organization publication provides an analysis of the importance of providing a mix of contraceptive methods to the achievement of family planning (FP) program goals. The first chapter defines contraceptive method mix as a component of reproductive health care for women. Chapter 2 looks at the impact of method mix on contraceptive prevalence. Chapter 3 provides detailed information on all of the currently available methods. The fourth chapter considers the factors that play a role in the successful matching of methods to clients. Chapter 5 describes the program factors that influence method mix. The sixth chapter deals with information, education, and communication (IEC) to promote method mix and includes a discussion of the importance of IEC to client choice as well as guidelines covering the role of providers, administrators, and policymakers in IEC. Chapter 7 provides guidelines for the training and supervision of contraceptive providers including supporting and coordinating training and supervision activities, determining training needs, and the relationship among training, supervision, and quality of care. The eighth chapter covers such issues as the introduction of new methods as research and development and introduction procedures. Chapter 9 discusses the essential role of evaluation in determining whether method mix and client choice objectives are being met. Guidelines are proposed for defining the scope of the evaluation, formulating the questions to be addressed, identifying the measurable indicators of achievement, determining acceptable levels of achievement, choosing a methodology and collecting data, and analyzing information and recommending changes. The concluding chapter provides the following steps program managers, administrators, and policymakers can take in insuring provision of an appropriate method mix and, thereby, improving contraceptive prevalence rates and accelerating fertility decline: 1) assessing client needs; 2) reviewing and changing existing policy; 3) considering costs; 4) paying attention to logistics; 5) developing IEC, training, and supervisory capabilities; 6) including indicators of client choice in monitoring and evaluation; and 7) evaluating method mix based on client choice and satisfaction and on overall contraceptive use.
New York, New York, UNFPA, . 74 p.The introduction to the 1995 Annual Report of the UN Population Fund (UNFPA) notes that, during the year, the UNFPA operated in 150 countries and represented the largest single source of population assistance. At the request of developing countries, the UNFPA helps to improve reproductive health care, to promote sustainable development, and to provide data on population. The $3.5 billion dispersed since the UNFPA's inception in 1969 has come solely from voluntary contributions from 167 nations. In 1995, 85 nations contributed $313 million. Another aim of the fund is to promote the goals of the Program of Action of the 1994 International Conference on Population and Development (ICPD), which seek to expand the availability of education, reduce infant and child mortality, and increase access to reproductive health care, including family planning. This annual report highlights the ways in which the fund exercised its mandate during 1995. Graphs detail UNFPA assistance by major function, by geographical region, by country/intercountry category, and by executing agency. Activities in the core program areas are summarized, as are the ICPD follow-up efforts. Regional reviews are provided for Africa South of the Sahara, the Arab States and Europe, Asia and the Pacific, and Latin America and the Caribbean. In addition, interregional and nongovernmental organization programs are described. The report ends with a consideration of the increased future resource requirements needed from donor countries to implement the ICPD Program of Action. Appendices include such 1995 data as an income and expenditures report, a record of government pledges and payments, project allocations, executive board decisions, and resolutions.
In: Missing links: gender equity in science and technology for development, [compiled by] United Nations. Commission on Science and Technology for Development. Gender Working Group. Ottawa, Canada, International Development Research Centre [IDRC], 1995. 129-57.This document (the sixth chapter in a UN Gender Working Group book on the overlay of science and technology [S&T], sustainable human development, and gender issues) considers health issues from women's viewpoint to highlight the fact that S&T has failed to guaranteed improved health for women. This failure is exemplified by the use of amniocentesis for sex selection that leads to abortion of female fetuses. The chapter explains why gender and health deserve consideration in the S&T debate by looking at women as victims of health care systems, the fact that women's contributions have been undervalued, and the failure of health research and statistics to treat gender as a scientific variable. The issues specific to national-level technology transfer are grouped for preliminary review into 1) women's access to health S&T, 2) the impact of S&T on gender equality, and 3) women's roles in the development of health S&T. After outlining the need for a national S&T policy across sectors, the chapter reviews global activities of such groups as the UN, women's nongovernmental organizations, and the World Health Organization to meet this challenge. Next, recommendations are offered for 1) strategic actions that focus on youth, build on previous successes, and emphasize IEC (information, education, and communication) and 2) research and development. It is concluded that women's right to health is a fundamental human right that, when achieved, will benefit entire societies.
[Unpublished] 2000 May.  p.Many countries and institutions face problems in the purchase of HIV tests. These problems are due to the variation in suppliers, prices and quality of these tests in different countries. In response, the WHO offers reimbursable procurement services as for other laboratory reagents and equipment. WHO invited suppliers to participate in a tender for bulk purchase. The first step was a pre-qualification through a quality assessment of suppliers, test kits and their assistance to ‘tropical conditions’. These pre-qualified suppliers have then participated in a tender for this type of bulk purchasing. Reimbursement procurement procedures are then discussed for interested clients/purchasers. This paper lists the specifications of HIV test kits for bulk-purchase.
AIDS Policy and Law. 2002 Jan 18; 17(1):4.This news article discusses details of the WHO report entitled, "Macroeconomics and Health: Investing in Health for Economic Development". The report asserts that partnership between poorer and richer countries could provide improved access to essential health services and generate economic benefits.
Geneva, Switzerland, World Health Organization, Maternal and Child Health and Family Planning, Division of Family Health, 1990. iv, 59 p. (WHO/MCH/90.11)In February, 1987, the Safe Motherhood Conference was held in Nairobi, Kenya. It was sponsored by WHO, the World Bank, the UN Fund for Population Activities (UNFPA) and joined by UNDP. The Safe Motherhood Initiative was then started. This is a worldwide attempt to reduce maternal morbidity and mortality. The goal is to reduce maternal deaths by at least 1/2 by the year 2000. Partners in the safe motherhood initiative are governments, agencies, nongovernmental organizations (NGOs) and other groups and individuals who want to take part in efforts which will reduce the number of women dying and suffering from childbearing and pregnancy. A combination of health and nonhealth schemes is being used to add to the quality and safety of women's lives. Focus is on the need for more and better maternal health services, the extension of family planning facilities, and instruments that will improve the nutritional, social, and health status of females. Activities of the Safe Motherhood Initiative are reflected in many of the World Health Assembly Resolutions. There has also been a series of WHO Regional Committee resolutions. The major approach to achieve the reduction of maternal mortality and morbidity is actions in 4 areas. The 1st area is addressing social inequities; the 2nd, ensuring family planning access; the 3rd, developing community-based maternity care; and the 4th, providing support and backup at the 1st referral level for women who need obstetric care. Epidemiologic studies have been done, as have operation research studies. Evaluations of the home-based maternal record were completed in 12 countries by the end of 1988. Information analysis and dissemination and advocacy activities are described, as are technical cooperation activities with countries. Also described are human resources development activities and other closely linked program activities. Coordination and cooperation are described in chapter 4. A description of program management and resources is given in chapter 5.
The role of health centres in the development of urban health systems: report of a WHO Study Group on Primary Health Care in Urban Areas.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1992; (827):i-iv, 1-38.The WHO Study Group on Primary Health Care (PHC) in Urban Areas has written a report after examining the development of reference health centers in urban areas in various parts of the world. It considers such centers to be a potentially important way to improve urban health services. Reference health centers, with real roots in the community and good links to first level and referral level care, can address the problems of access to health care and intersectoral collaboration. Each center should be based on a general model, but its exact operation depends on local conditions and on a comprehensive situation analysis that considers social and financial factors and the level of organizational development. Each reference center should determine what needs to be done locally with local and national resources. Outside donors should only provide assistance for operational costs and a last resort. To plan services adequately, decision makers must define geographical catchment areas and travel times. These definitions must see to it that services integrate with each other vertically (with services at health post and hospital levels), and horizontally (with government, and nongovernmental, and community projects). A solid epidemiological understanding of major local health problems is essential for expanding PHC through reference health centers. This knowledge comes from an assessment of demographic, morbidity, mortality, and social data an evaluation of coverage of underserved and marginal groups. Reference health centers would be in an ideal position to gather and analyze these data. Innovative ways to obtain the resources for urban PHC are collection of user fees and close supportive links with universities and nongovernmental organizations. The Study Group looks at how reference health centers in Cali, Colombia; Manila, the Philippines; and Newark, New Jersey in the US, developed.
Tropical Medicine and International Health. 2002 Nov; 7(11):970-976.Public–private partnerships have become central to efforts to combat infectious diseases. The characteristics of specific partnerships, their governance structures, and their ability to effectively address the issues for which they are developed are being clarified as experience is gained. In an attempt to promote access to and rational use of second-line anti-tuberculosis (TB) drugs for the treatment of multidrug-resistant TB, a unique partnership known as the Green Light Committee (GLC) was established by the World Health Organization. This partnership relies on five categories of actors to achieve its goal: academic institutions, civil society organizations, bilateral donors, governments of resource-limited countries, and a specialized United Nations agency. While the for-profit private sector is involved in terms of supplying concessionally priced drugs it is excluded from decision-making. The effectiveness of the partnership emerges from its review process, flexibility to modify its modus operandi to overcome obstacles, independence from the commercial sector, and its ability to link access, rational use, technical assistance, and policy development. The GLC mechanism may be useful in the development of other partnerships needed in the rational allocation of resources and tools for combating additional infectious diseases. (author’s)
In: Making childbirth safer through promoting evidence-based care, [compiled by] Global Health Council. Washington, D.C., Global Health Council, 2002 May. 12-14. (Technical Report)The WHO Reproductive Health (RH) Library project was initiated in 1997 with the objective of providing access to the most up-to-date and reliable information about the effectiveness of RH care interventions. The underlying theme was to make Cochrane systematic reviews available to health workers in under-resourced settings with additional contents to make the information easy to understand and apply. (excerpt)
AIDS Asia. 2002 Mar-Apr; 4(2):10.In a decisive move to strengthen action against AIDS in developing countries, the World Health Organization (WHO) has announced treatment guidelines for HIV/AIDS in poor settings. Parallel to that, WHO has endorsed the inclusion of AIDS medicines in its Essential Medicines List. The 41 drug formulations on the list, include II antiretroviral drugs (ARVs) and five drugs for the opportunistic infections, funguses and cancers that attack AIDS patients. Twenty six come from the major international pharmaceutical manufacturers but ten are from Cipla and three small European generic manufacturers. (excerpt)
WHO must continue its work on access to medicines in developing countries. Il faut que l'OMS poursuive son travail en vue de l'accès aux médicaments dans les pays en développement.
Lancet. 2003 Jan 4; 361(9351):3.The driving force behind all of WHO’s actions should be public health, with no compromises accepted that would ultimately prevent those needs from being effectively and swiftly met. In the face of rising infectious diseases such as AIDS, TB, and malaria, and the increasing marginalisation of health problems that do not affect the developed world, the importance of an international, independent organisation that is brave, aggressive, and vocal in its defence of global public health has never been more important. (excerpt)
Lancet. 2003 May 31; 361(9372):1873.US Health and Human Services Secretary Tommy Thompson earlier outraged developing countries and activists by submitting a resolution stressing the need to “promote innovation in the field of public health by encouraging respect for strong intellectual property rights”. (excerpt)
Prediction of community prevalence of human onchocerciasis in the Amazonian onchocerciasis focus: Bayesian approach. [Prévisions portant sur la prévalence communautaire de l'onchocercose humaine au niveau du foyer amazonien de l'onchocercose : approche bayésienne]
Bulletin of the World Health Organization. 2003 Jul; 81(7):482-490.Objective: To develop a Bayesian hierarchical model for human onchocerciasis with which to explore the factors that influence prevalence of microfilariae in the Amazonian focus of onchocerciasis and predict the probability of any community being at least mesoendemic (>20% prevalence of microfilariae), and thus in need of priority ivermectin treatment. Methods: Models were developed with data from 732 individuals aged515 years who lived in 29 Yanomami communities along four rivers of the south Venezuelan Orinoco basin. The models’ abilities to predict prevalences of microfilariae in communities were compared. The deviance information criterion, Bayesian P-values, and residual values were used to select the best model with an approximate cross-validation procedure. Findings: A three-level model that acknowledged clustering of infection within communities performed best, with host age and sex included at the individual level, a river-dependent altitude effect at the community level, and additional clustering of communities along rivers. This model correctly classified 25/29 (86%) villages with respect to their need for priority ivermectin treatment. Conclusion: Bayesian methods are a flexible and useful approach for public health research and control planning. Our model acknowledges the clustering of infection within communities, allows investigation of links between individual- or community-specific characteristics and infection, incorporates additional uncertainty due to missing covariate data, and informs policy decisions by predicting the probability that a new community is at least mesoendemic. (author's)
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)
Bulletin of the World Health Organization. 2003 Jul; 81(7):539-545.Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions’ work. Equity and human rights perspectives can contribute concretely to health institutions’ efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector. (author's)