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Lancet. 2002 Mar 2; 359:775-80.The authors examine the evolution of WHO managerial policies for tuberculosis (TB) control during 1948-2001 to provide a new framework that will accelerate control expansion in the near future. In the first period (1948-63), a vertical approach to TB control was the policy adopted by WHO and the international community. However, although this approach was successful in more-developed countries, it largely failed in resource-poor settings. As a result, involvement of general health services was soon deemed essential. During 1989- 98, a new framework for effective TB control was created and a new five-element strategy was branded with the name of directly observed therapy short-course (DOTS). This period was characterized by the recognition of TB control as a public-health priority, the intensification of TB control efforts worldwide, and the return of TB to the political agenda of governments. However, although nominal adoption of DOTS increased rapidly due to massive promotion by WHO and partners, expansion to provide full access was too slow and only 23% of all infectious cases in 1999 were managed under DOTS. A truly multisectoral approach based on advocacy and social mobilization, community involvement, and engagement of private-for-profit practitioners is becoming the way forward for TB control. HIV-associated TB and multidrug-resistant TB must be tackled as priority issues. The authors conclude that, based on the lessons of the past, the future of TB control should be focused on a pragmatic approach combining a specialized, well-defined management system with a fully integrated service delivery. A multisectoral approach that builds on global and national partnerships is the key to future TB control. (author's)
Report of the European Region on Immunization Activities. (Global Advisory Group EPI, Alexandria, October 1984). WHO/Expanded Immunization Programme and the European Immunization Targets in the Framework of HFA 2000.
[Unpublished] 1984. Presented at the EPI Global Advisory Group Meeting, Alexandria, Egypt, 21-25 October 1984. 3 p. (EPI/GAG/84/WP.4)Current reported levels of morbidity and mortality from measles, poliomyelitis, diphtheria, tetanus, and tuberculosis in most countries in the European Region are at or near record low levels. However, several factors threaten successful achievement of the Expanded Program on Immunization (EPI) goal of making immunization services available to all the world's children by the year 2000, including changes in public attitudes as diseases pose less of a visible threat, declining acceptance rates for certain immunizations, variations in vaccines included in the EPI, and incomplete information on the incidence of diseases preventable by immunization and on vaccination coverage rates. To launch a more coordinated approach to the EPI goals, a 2nd Conference on Immunization Policies in Europe is scheduled to be held in Czechoslovakia. Its objectives are: 1) to review and analyze the current situation, including achievements and gaps, in immunization programs in individual countries and the European Region as a whole; 2) to determine the necessary actions to eliminate indigenous measles, poliomyelitis, neonatal tetanus, congenital rubella, and diphtheria; 3) to consider appropriate policies regarding the control by immunization of other diseases of public health importance; 4) to strengthen existing or establish additional systems for effective monitoring and surveillance; 5) to formulate actions necessary to improve national vaccine programs in order to achieve national and regional targets; 6) to reinforce the commitment of Member Countries to the goals and activities of the EPI; and 7) to define appropriate activities for the Regional Office for Europe of the World Health Organization to achieve coordinated action.
The Manager: Management Strategies for Improving Health Services. 2001; 10(4): p..This issue of The Manager offers policymakers and managers of TB programs at all levels a practical, systematic approach to strengthening drug management so that TB drugs reach and are appropriately used by patients. It introduces the drug management cycle and describes how effective drug policies and laws can support this cycle. The issue also explains how specific improvements in drug selection, procurement, distribution, and use, as well as in management support, can help to maintain an adequate flow of TB drugs. (author's)
Bulletin of the World Health Organization. 2003 Nov; 81(11):777.During the last quarter-century or so there has been a revolution in both health and information technology. For the globe as a whole we have seen tremendous strides made in life expectancy and disease control, together with an explosion of information technology and techniques. Humanity now has the potential to make all existing health knowledge available simultaneously to the entire population of the planet. By no means everyone has benefited from the overall trend of increased life expectancy, however, or from that of increased knowledge and its communicability. This gap goes beyond the notion of the “digital divide”. It is a “knowledge divide”, in which large sections of humanity are cut off not just from the information that could help them but from any learning system or community that fosters problem-solving. (excerpt)
Significance of foreign funding in developing health programmes in India - the case study of RNTCP in the overall context of North-South co-operation.
Health Administrator. 2003; 15(1-2):52-60.External assistance on disease containment and health policy has been a global phenomenon ever since the advent of modern medicine. The technically and resource advanced countries have been contributing to health programs of the resource constrained nations particularly with an objective of disease containment and eradication. India has its own history of receiving external assistance for its health programs since 1950s. Eradication of Small Pox, control of Malaria in 1970s, Family Planning Program, Universal Immunization Program (UIP), Pulse Polio and more recently campaigns against Human Immune-deficiency Virus (HIV) and Tuberculosis Programme had been supported by bilateral or multilateral aids. External assistance in India is small in terms of its proportion to the Gross Domestic Product (GDP). In health, it has never been more than 1-3 % of the total public health spending in any given year. Yet external assistance has had a profound impact on health, as technical support obtained from such assistance has made a significant contribution to hastening India’s demographic and epidemiological transition. The present paper reviews the issue of foreign funding in health programmes and specifically highlights its impact of TB Programme development in India. (excerpt)
Seminars in Pediatric Infectious Diseases. 2004 Jul; 15(3):150-154.Although accurate data are scarce for children, tuberculosis (TB) represents one of the most common infectious causes of morbidity and mortality worldwide. TB case rates have declined among children in the United States in the last decade, but they remain high among children from low-income countries and racial or ethnic minorities. Establishing the definitive diagnosis of TB in a child remains difficult and frequently relies on a constellation of history, clinical findings, and bacteriology. Recently, updated national and international treatment recommendations have been published. Contact investigation and treatment using directly observed therapy are important components of the optimal case detection and management of TB in children. (author's)
Emerging Infectious Diseases. 2006 Sep; 12(9):1389-1397.Evidence of successful management of multidrugresistant tuberculosis (MDRTB) is mainly generated from referral hospitals in high-income countries. We evaluate the management of MDRTB in 5 resource-limited countries: Estonia, Latvia, Peru, the Philippines, and the Russian Federation. All projects were approved by the Green Light Committee for access to quality-assured second-line drugs provided at reduced price for MDRTB management. Of 1,047 MDRTB patients evaluated, 119 (11%) were new, and 928 (89%) had received treatment previously. More than 50% of previously treated patients had received both first- and second-line drugs, and 65% of all patients had infections that were resistant to both first- and second-line drugs. Treatment was successful in 70% of all patients, but success rate was higher among new (77%) than among previously treated patients (69%). In resource-limited settings, treatment of MDRTB provided through, or in collaboration with, national TB programs can yield results similar to those from wealthier settings. (author's)
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2005 Oct 27. 19 p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-068; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)Many national TB programs continue to encounter problems in providing quality TB medicines to patients when they need them. While lack of financial resources may be one constraint for procuring all TB medicines needed, national programs experience a host of other problems in pharmaceutical management. Strong pharmaceutical management is one of the key pillars to effective tuberculosis (TB) control; without appropriate selection, effective procurement, distribution, stock management and rational use of TB medicines and related supplies, individuals will not be cured of the disease and countries will not reach global targets. Management Sciences for Health's Rational Pharmaceutical Management Plus (RPM Plus) program funded by USAID in collaboration with Stop TB Partnership's Global TB Drug Facility (GDF) housed at World Health Organization (WHO) Geneva conducted a workshop at the 36th International UNION World Congress on Tuberculosis and Lung Health on October 19th 2005 at Paris, France. This is the fourth year MSH and GDF have collaborated in such an event at the UNION congress due to popular demand by national TB programmes and their partners. (excerpt)
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2005 Oct. 13 p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-075; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)USAID, through its SO5 TB global objective, promotes TB pharmaceutical management activities through the RPM Plus program. The global activities support the DOTS scheme, a WHO initiative, documented to break the transmission of TB when implemented correctly by national TB programs (NTP). One of the five primary elements of the DOTS scheme is an uninterrupted supply of TB drugs. RPM Plus provides technical assistance to the following WHO/Stop TB organizations: The Global TB Drug Facility (GDF): established in 2001 to provide free grants of TB medicines to countries unable to satisfy their medicine needs and to serve as a source of good quality TB drugs for those countries having their own funds; The Green Light Committee (GLC): technical support group for the DOTS Plus program. Initiated by the WHO and its partners to promote the correct treatment of multi-drug resistant (MDR) TB. The GLC makes medicines available to countries at affordable prices. As part of the global support RPM Plus also provides training in Pharmaceutical Management for TB at various World Health Organization consultant-training courses promoted by the Stop TB Department. (excerpt)
WHO training course for TB consultants: RPM Plus drug management sessions in Sondalo, Italy, September 28 - October 1, 2006: trip report.
Arlington, Virginia, Management Sciences for Health, Center for Pharmaceutical Management, Rational Pharmaceutical Management Plus, 2006 Oct 18. 26 p. (USAID Cooperative Agreement No. HRN-A-00-00-00016-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ACI-323)WHO, Stop-TB Partners, and NGOs that support country programs for DOTS implementation and expansion require capable consultants in assessing the capacity of countries to manage TB pharmaceuticals in their programs, developing interventions, and providing direct technical assistance to improve availability and accessibility of quality TB medicines. Beginning in 2001, RPM Plus, in addition to its own formal courses on pharmaceutical management for tuberculosis, has contributed modules and facilitated sessions on specific aspects of pharmaceutical management to the WHO Courses for TB Consultants in Sondalo. The WHO TB Course for TB Consultants was developed and initiated in 2001 by the WHO Collaborating Centre for Tuberculosis and Lung Diseases, the S. Maugeri Foundation, the Morelli Hospital, and TB CTA. The main goal of the course is to increase the pool of international level TB consultants. As of December 2005, over 150 international TB consultants have participated in the training, a majority ofwhom have already been employed in consultancy activities by the WHO and international donors. In 2006 fiscal year RPM Plus received funds from USAID to continue supporting the Sondalo Course, which allowed RPM Plus to facilitate sessions on pharmaceutical management for TB at four courses in May, June, July, and October of 2006. RPM Plus Senior Program Associate, Edgar Barillas, traveled to Sondalo from September 28 to October 1 to facilitate the TB pharmaceutical management session at the WHO course for TB Consultants in Sondalo, Italy. (excerpt)
European Journal of Public Health. 2007 Oct; 17(5):409.In public health teaching, tuberculosis (TB) has been a traditional example of how disease occurrence is determined by the triad agent, environment, host. And it has since long been standard textbook knowledge that there are strong socioeconomic determinants behind all three components: The agent is more prevalent and is spread more easily in conditions of crowding and poor hygienic conditions, and under these conditions several host factors are also more prevalent, such as malnutrition and alcoholism. In recent years another dimension has been added to the socioeconomic patterning of TB: An already very solid mass of research has highlighted the social and economic aspects of care and follow-up of patients with TB. A recent example of this research is the paper by Wang et al. in this issue of the journal, on differences in both patient's delay and doctor's delay in the diagnosis of TB, when comparing residents and non-residents (rural immigrants) in Shanghai. (excerpt)