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The Bulgarian experience, statement made at the Special Convocation, Sofia State University, Sofia, Bugaria, 7 October, 1983.
New York, N.Y., UNFPA, . 5 p.Although world fertility has entered a perceptible period of decline heralding a deceleration in the rate of population growth, even with the current rate, which is about 1.7%/year, the world is still adding close to 78 million people to its population each year. This figure is estimated to rise to 89 million by the year 2000. A major concern confronting most developing countries at present is the integration of population factors into the development process. In this context, Bulgaria's progress in the twin fields of population and development provides an outstanding example of what can be achieved. Demographic development in the country since 1950 has been impressive. Although the bulk of transition in fertility and growth rate of population had occurred by 1950, the consistent improvement in health services has achieved at an early date what was sought by the World Population Plan of Action in its 2 quantified targets: lower infant mortality rates and longer life expectancy. A major reason for this success is the official policy in regard to the full integration of women into the development process. Internally, Bulgaria pursues a pronatalist policy. Within the context of Bulgaria's national goals of development objectives and human resource potential, this policy is understandable. Bulgaria's population program includes activities to reduce infant and child mortality, improve maternal health, augment reproductive health and increase marital fertility. The United Nations Fund for Population Activities, because of its respect for the sovereign rights of countries to determine their own population policies, has provided assistance for the implementation of this national program.
The Global Drug Facility: a unique, holistic and pioneering approach to drug procurement and management.
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.In January 2006, the Stop TB Partnership launched the Global Plan to Stop TB 2006-2015, which describes the actions and resources needed to reduce tuberculosis (TB) incidence, prevalence and deaths. A fundamental aim of the Global Plan is to expand equitable access to affordable high-quality anti-tuberculous drugs and diagnostics. A principal tool developed by the Stop TB Partnership to achieve this is the Global Drug Facility (GDF). This paper demonstrates the GDF's unique, holistic and pioneering approach to drug procurement and management by analysing its key achievements. One of these has been to provide 9 million patient-treatments to 78 countries in its first 6 years of operation. The GDF recognized that the incentives provided by free or affordable anti-tuberculosis drugs are not sufficient to induce governments to improve their programmes' standards and coverage, nor does the provision of free or affordable drugs guarantee that there is broad access to, and use of, drug treatment in cases where procurement systems are weak, regulatory hurdles exist or there are unreliable distribution and storage systems. Thus, the paper also illustrates how the GDF has contributed towards making sustained improvements in the capacity of countries worldwide to properly manage their anti-TB drugs. This paper also assesses some of the limitations, shortcomings and risks associated with the model. The paper concludes by examining the GDF's key plans and strategies for the future, and the challenges associated with implementation. (author's)
ENTRE NOUS. 1999 Spring; (42):8.The alarming increase of STDs, particularly syphilis (from 378 cases in 1990 to 2520 cases in 1997), has been identified as a high priority area in Bulgaria, where Doctors Without Borders has been working since 1997. In July 1998, DWB Switzerland set up a pilot project that supported the implementation of an innovative treatment procedure and encouraged the Bulgarian Minister of Health to adopt a new ordinance on syphilis treatment. The treatment procedure is recommended by WHO and is based on delayed-release penicillin; it is less expensive and requires no hospitalization, which makes it more acceptable to patients. An assessment conducted in January 1999 to evaluate the evolution of the project showed that of the total 274 patients treated, approximately half of them were in the primary stage, which indicates a high incidence of primo-infections. An increase in the cost of treatment was noted due to the different treatment procedures used. Lack of understanding of the criteria on the part of the physician and resistance to adopting a new treatment procedure were among the problems encountered. Thus, an appeal to annul the old ordinance of 1978 regarding syphilis treatment, which requires hospitalization, was made in order to ensure the rapid implementation of the new procedures. Furthermore, DWB is planning to implement a program that will give emphasis to the training of Bulgarian professionals to respect the patients and their rights to confidentiality, reinforce therapeutic services and health education, distribution of condoms, and access to HIV testing and counseling.
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.
[Effectiveness of the expanded programme on immunization] Efficacite du programme elargi de vaccination
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1986; 39(2):161-70.The Expanded Program on Immunization (EPI) aims at the reduction of morbidity and mortality from vaccine-preventable diseases through the provision of immunization to women and children. Program effectiveness is measured by immunization coverage and by incidence of the target diseases. Information on these 2 indicators is provided by national programs to WHO Regional Offices and forwarded to EPI, Geneva. Although considerable progress has been made in delivering vaccines to the children of the world, the potential impact of immunization remains unfulfilled. In the developing world (excluding China) less than 40% of infants receive a 3rd dose of DPT or polio vaccines, and coverage with measles vaccine remains at only 1/2 of that level. Over 3 million children still die each year from measles, neonatal tetanus and pertussis, while over a 1/4 of a million children are crippled by poliomyelitis. In the European Region the coverage goal of the EPI has been largely achieved. In the American Region dramatic progress has been made since the beginning of EPI. The South-East Asia Region has made steady progress since the start of the EPI. The Western Pacific Region is the most heterogenous within WHO, with countries ranging in size from the smallest to the largest in the world. Levels of socioeconomic development and immunization coverage also differ widely. Nevertheless, satisfactory progress is observed in the majority of countries. In the African Region, the problems of drought, famine and civil unrest are extensive. Despite these problems, progress has been satisfactory and exemplary in a few countries. In the Eastern Mediterranean Region, progress in increasing immunization coverage has been remarkably good. It will be difficult, however, to improve immunization services for the remainder of the decade in a number of countries currently ravaged by drought, famine and civil unrest.
In: Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C., edited by Richard Cash. Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 4-5. (International Conference on Oral Rehydration Therapy, 1983, proceedings)The Honorable Margaret Heckler, secretary of Health and Human Services, presents the goal of the conference--discussion of the remarkable potential of oral rehydration therapy and its importance to the health of infants and children throughout the world. The conference celebrates the scientific advances of recent years that give new hope for millions of children every year. Over 500 million episodes of diarrhea afflict infants in developing countries each year; each year, some 5 million children lose their lives to these diseases. In Europe, and in North America as well, diarrhea is the 6th most common cause of death among small children. At the turn of the century, mortality due to cholera was 60%. A scientist in Calcutta and 1 in Manila developed methods of intravenous therapy that reduced mortality dramatically to 20%. Treatment of the disease remained relatively unchanged until the middle of the century when work in Egypt and Asia resulted in a therapy method that reduced mortality for cholera to less than 1%. The crucial discovery of an effective cholera agent occurred in India in 1959. In 1962, scientists in Manila established the vital role of oral glucose in the absorption of sodium and water. The large-scale use of oral rehydration therapy was demonstrated in Dhaka and Calcutta in the 1960s, when 100s of cholera cases were managed under field conditions during a rural epidemic. A massive epidemic during a refugee crisis in 1971 was well-coped with by the Johns Hopkins group in Calcutta by treating 3700 patients over an 8-week period. This was one of the 1st large-scale uses of prepackaged materials for oral hydration, costing only US$750. In Dhaka and Calcutta in the early 1970s the critical discovery that noncholera diarrheal diseases could be treated with the oral rehydration therapy developed for cholera was made. The discovery of the role of glucose in accelerating the absorption of salt and water was underscored in the British journal "Lancet" as being potentially the most important medical advance of this century. A strong coalition of interest exists between governments and scientists of many nations as well as the international organizations to promote oral rehydration therapy. WHO, UNICEF, USAID and other agencies are playing an extremely important part in discovering how oral rehydration therapy can best be incorporated into broader health services, and how to prevent diarrheal diseases from occurring.
From Bangkok to Mexico: towards a framework for turning knowledge into action to improve health systems [editorial]
Bulletin of the World Health Organization. 2004 Oct; 82(10):720-721.As a follow-up to the International Conference on Health Research for Development that took place in Bangkok, Thailand, in 2000, WHO convened a Ministerial Summit on Health Research to be held in Mexico City in November 2004, to review progress to date and reflect on emerging opportunities in the global field of health research. In 1990, the Commission on Health Research for Development recommended that all countries should undertake essential national health research; it stipulated that international partnerships are the foundations for progress and that financing for these efforts should be mobilized from both international and national sources. In 1996, WHO'S Ad Hoc Committee on Health Research Relating to Future Intervention Options outlined a five-step priority-setting approach to decide how health research funds should be allocated. It identified "best buys" for the development of products and procedures in several key areas, including childhood infections, malnutrition, microbial threats, noncommunicable diseases and health systems. Overall, progress has been slow and there is much more to be done to deal with major health challenges. (excerpt)